Haemodynamic instability during thyroid surgery: a baroreflex-mediated neurogenic phenomenon?

Hemodynamic Instability during Thyroidectomy in Graves' Disease

BACKGROUND

The aim of this study was to investigate the changes in vital signs and hemodynamic status that occur in patients during the intraoperative course of thyroidectomy in Graves' Disease (GD).

METHODS

A total of 71 patients were included in the study. Patients were directed to surgery when they had large goiters with compressive symptoms or suspicious nodules, were pregnant or lactating, were unresponsive or intolerant to antithyroid drugs (ATDs), or expressed a preference to have surgery. All patients scheduled for operations underwent surgery while in the euthyroid state.

RESULTS

Hemodynamic instability was observed in 18 patients during thyroidectomy. Disease duration, sample weight, and thyroid-stimulating hormone receptor antibodies (TRAb) levels were found to be effective on hemodynamic instability. Logistic regression analysis revealed an 11-fold increase in the instability risk in patients with a period of disease shorter than 21 months (P = 0.037). A TRAb value >11.5 increased the risk by 235fold (p < 0.001).

CONCLUSION

High levels of TRAb values and new onset of disease with shorter periods of ATDs use may be risk factors for hemodynamic instability during thyroidectomy. Patients with larger thyroid glands are at greater risk for instability during surgery. Those risks should be taken into account during surgery, and the surgical and anesthetic management of the patient should be made more carefully in concordance with the anesthesia team.

Acute baroreflex-mediated hemodynamic instability during thyroid surgery: A case report

During thyroid surgery, intraoperative hemodynamic instability can be attributed to episodic surges of thyroid hormones. Thyroid storms are emergency situations characterized by persistent hypertension, tachycardia, hyperthermia, and end-organ damage. However, baroreflex-mediated neurogenic phenomena due to surgical procedures near the carotid sinus are a likely cause of acute hemodynamic changes during thyroid surgery. We describe a case of sudden hemodynamic instability occurring after thyroid manipulation during thyroidectomy in a 61-year-old man who presented with a 6-cm-sized thyroid mass in a euthyroid state.