Perioperative Management and Outcomes of Hyperthyroid Patients Unable to Tolerate Antithyroid Drugs
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ORIGINAL SCIENTIFIC REPORT
Perioperative Management and Outcomes of Hyperthyroid Patients Unable to Tolerate Antithyroid Drugs Lily B. Hsieh1 • Tina W. F. Yen1 • Sophie Dream1 • Dhaval Patel1 • Douglas B. Evans1 Tracy S. Wang1
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Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Prior to thyroidectomy for hyperthyroidism, it is recommended that patients are managed with antithyroid drugs (ATDs) and rendered euthyroid to decrease the risk of thyroid storm. However, not all patients tolerate ATD and the risk of thyroid storm during thyroidectomy in these patients is unclear. Therefore, the aim of this study was to compare the management and outcomes of hyperthyroid patients that were on ATDs prior to surgery to those who were not. Study design A prospectively maintained, single-institution database was queried for all hyperthyroid patients who were initially treated with ATDs and underwent thyroidectomy from January 1, 2012, to June 18, 2018. Patients were divided into two groups: (1) those on ATDs at surgery (ATD group) and (2) those who could not tolerate and stopped ATDs prior to surgery (no-ATD group). Demographic and clinical data were collected. Primary outcomes were readmissions/emergency department visits and postoperative complications within 30 days of thyroidectomy. Results Of the 248 patients, 231 were in the ATD group and 17 (7%) were in the no-ATD group. There were no mortalities or thyroid storm events in either group. There was no difference in Clavien–Dindo Grade 2 or 3 complications between the two groups. There were no ED visits or 30-day readmissions in the no-ATD group compared to 17 (7%) events in the ATD group (p = 1.0). Conclusion While it is preferable to render patients euthyroid prior to thyroidectomy for hyperthyroidism, results of this study suggest that when patients cannot tolerate ATDs, it is possible to perform thyroidectomy without increased risk of thyroid storm or intra- and postoperative complications.
Abbreviations ATD Antithyroid drug ED Emergency Department MMI Methimazole PTH Parathyroid hormone PTU Propylthiouracil TSH Thyrotropin, thyroid-stimulating hormone & Tracy S. Wang [email protected] 1
Section of Endocrine Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
Introduction Hyperthyroidism is an endocrine disorder that affects 1.2% of the US population [1]. The most common causes of hyperthyroidism are Graves’ disease, toxic multinodular goiter, and toxic adenoma [2]. Excess thyroid hormone adversely affects the cardiovascular, musculoskeletal, and neuropsychiatric systems [3, 4]. In untreated or undertreated thyrotoxicosis, patients can present with palpitations, arrhythmias such as atrial fibrillation, bone loss (osteopenia/osteoporosis), unintentional weight loss, tremors, and rarely, thyroid storm-associated multisystem organ failure [2]. Overall, patients with hyperthyroidism
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World J Surg
have been found to have an increased risk for all-cause mortality and acute cardiovascular
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