Perioperative Management and Outcomes of Hyperthyroid Patients Unable to Tolerate Antithyroid Drugs. World J Surg 2020 Nov;44(11):3770-3777
Date
06/24/2020Pubmed ID
32572525DOI
10.1007/s00268-020-05654-4Scopus ID
2-s2.0-85086709261 (requires institutional sign-in at Scopus site) 6 CitationsAbstract
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.
Author List
Hsieh LB, Yen TWF, Dream S, Patel D, Evans DB, Wang TSAuthors
Sophie Y. Dream MD Associate Professor in the Surgery department at Medical College of WisconsinDouglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAntithyroid Agents
Female
Graves Disease
Humans
Hyperthyroidism
Male
Middle Aged
Perioperative Care
Postoperative Complications
Prospective Studies
Thyroidectomy
Treatment Outcome
