The results of therapeutic plasma exchange in patients with severe hyperthyroidism: a retrospective multicenter study.

Hyperthyroidism characterized by elevated serum levels of circulating thyroid hormones. The aim of hyperthyroidism treatment is to achieve a euthyroid state as soon as possible and to maintain euthyroid status. However, drug withdrawal and utilization of alternative therapies are needed in cases in which leucopenia or impairment in liver functions is observed during medical therapy. In the present study, we aimed to present our cases which underwent therapeutic plasma exchange (TPE) due to severe hyperthyroidism. The results of 22 patients who underwent therapeutic plasma exchange due to hyperthyroidism in Apheresis Units of Erciyes University and Gaziantep University, between 2006 and 2012, were retrospectively reviewed. These cases had severe thyrotoxic values despite anti-thyroid drug use. After TPE, we observed a significant decrease in free thyroxin (FT4) (p<0.001) and free triiodotyhronin (FT3) (p<0.004) levels. There was statistically significant increase in the mean values of TSH levels after TPE (p<0.001). Clinical improvement was achieved in hyperthyroidism by TPE in 20 cases (91%). Both FT3 and FT4 levels remained above the normal limits in two of 22 patients. TPE should be considered as an effective and safe therapeutic option to achieve euthyroid state before surgery or radioactive iodine treatment. TPE is a useful option in cases with severe hyperthyroidism unresponsive to anti-thyroid agents and in those with clinical manifestations of cardiac failure and in patients with severe adverse events during anti-thyroid therapy.

Effect of serum selenium levels on radiotherapy-related toxicity in patients undergoing radiotherapy for head and neck cancer.

AIM: To investigate whether there is a difference in selenium levels before and after radiotherapy (RT) and to study the effects of serum selenium levels on RT-related toxicity in patients undergoing RT for head and neck cancer. PATIENTS AND METHODS: A population of 47 consecutive patients was enrolled in the study. RT was given by conventional fractionation. RT-related acute toxicity was evaluated once a week. Blood samples were obtained before and after RT to evaluate selenium levels. RESULTS: There was no significant difference between the levels of selenium before and after RT (58.09 ± 1.36 µg/l and 56.34 ± 1.11 µg/l, p-value=0.747, respectively). Grade III-IV mucositis, dysphagia, radiodermatitis, and nausea were seen in 6 (12.7%), 32 (68.2%), 24 (51.1%), and 3 (6.4%) patients, respectively. It was found that there was no statistically significant difference in the levels of selenium before and after RT, and no observed differences in regard to RT-related toxicities. CONCLUSION: The serum selenium levels do not affect RT-related toxicities.