1
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Affiliation(s)
- Christopher R McHenry
- Department of Surgery MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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2
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Widiarti W, Saputra PBT, Mustofa A, Meitavany EN, Oktaviono YH, Alkaff FF. The roles of thyroidectomy in patients with amiodarone-induced thyrotoxicosis: A systematic review. Curr Probl Cardiol 2024; 49:102395. [PMID: 38232922 DOI: 10.1016/j.cpcardiol.2024.102395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 01/19/2024]
Abstract
The principal management of Amiodarone-induced-thyrotoxicosis (AIT) is balancing cardiac-thyroid conditions. However, the role of thyroidectomy is still contentious. This systematic review aims to provide insights into the roles of thyroidectomy in the management of AIT. This systematic review encompasses 303 AIT patients who underwent thyroidectomy from 14 studies. The indication of thyroidectomy can be due to cardiac factors, thyrotoxicosis conditions, and patient-physician considerations. Thyroidectomy is more effective in improving thyroid hormone status, cardiac function, and mortality compared to optimal medical therapy, especially in those with left ventricular ejection fraction < 40 %. Thyroidectomy is effective in improving cardiac function and mortality due to shorter duration for achieving euthyroid. Thyroidectomy and medical therapy have comparable side effects. However, the identification of high-risk patients may reduce thyroidectomy complications. Thus, thyroidectomy should not be viewed as the last resource and should be performed immediately when indicated.
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Affiliation(s)
| | - Pandit Bagus Tri Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia
| | - Ali Mustofa
- Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Estya Nadya Meitavany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia.
| | - Firas Farisi Alkaff
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, Netherlands; Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
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3
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Reineke R, Gembruch U, Geipel A. Fetal thyrotoxicosis after total thyroidectomy due to Graves' disease. Arch Gynecol Obstet 2023; 308:1885-1886. [PMID: 37097313 PMCID: PMC10579105 DOI: 10.1007/s00404-023-06994-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/01/2023] [Indexed: 04/26/2023]
Affiliation(s)
- R Reineke
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
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4
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Frey S, Caillard C, Mahot P, Pattier S, Volteau C, Knipping G, Lande G, Drui D, Mirallié E. Mortality After Total Thyroidectomy for Amiodarone-Induced Thyrotoxicosis According to Left Ventricular Ejection Fraction. Otolaryngol Head Neck Surg 2023; 169:1542-1549. [PMID: 37317630 DOI: 10.1002/ohn.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/28/2023] [Accepted: 05/13/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To report cardiac outcomes after total thyroidectomy for amiodarone-induced thyrotoxicosis according to the baseline left ventricular ejection fraction in a tertiary referral center. STUDY DESIGN Retrospective, monocentric. SETTING The tertiary health care system. METHODS Patients who underwent total thyroidectomy for amiodarone-induced thyrotoxicosis between 2010 and 2020 with age >18 and available preoperative left ventricular ejection fraction were included in this study. Patients were dichotomized into: group 1 with left ventricular ejection fraction ≥40% (mildly reduced/normal ejection fraction), and group 2 with left ventricular ejection fraction <40% (reduced ejection fraction). RESULTS There were 34 patients in group 1 and 17 to group 2. The latter were younger (median 58.4 [Q1-Q3 48.0-64.9] vs. 69.8 years in group 1 [59.8-78.3], p = .0035) and they presented more cardiomyopathy (58.8 vs. 26.5%, p = .030). Overall, the median time until surgery referral was 3.1 [1.9-7.1] months and 47.1% underwent surgery after restoration of euthyroidism. Surgical complications accounted for 7.8%. In group 2, the median left ventricular ejection fraction was significantly improved after surgery (22.5 [20.0-25.0] vs. 29.0% [25.3-45.5], p = .0078). Five-year cardiac mortality was significantly higher in group 2 (p < .0001): 47.0% died of cardiac causes versus 2.9% in group 1. A baseline left ventricular ejection fraction <40% and a longer time until surgery referral were significantly associated with cardiac mortality (multivariable Cox regression analysis, p = .015 and .020, respectively). CONCLUSION These results reinforce the idea that surgery, if chosen, should be performed quickly in patients with left ventricular ejection fraction <40%.
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Affiliation(s)
- Samuel Frey
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Nantes, France
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Cécile Caillard
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - Pascale Mahot
- Nantes Université, CHU Nantes, Service d'Endocrinologie, Diabétologie et Nutrition, l'institut du thorax, Nantes, France
| | - Sabine Pattier
- Nantes Université, CHU Nantes, Service de cardiologie, Hôpital Nord Laennec, Nantes, France
| | - Christelle Volteau
- Nantes Université, CHU Nantes, DRCI, Département Promotion, Nantes, Cedex, France
| | - Garance Knipping
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - Gilles Lande
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
- Nantes Université, CHU Nantes, Service de cardiologie, Hôpital Nord Laennec, Nantes, France
| | - Delphine Drui
- Nantes Université, CHU Nantes, Service d'Endocrinologie, Diabétologie et Nutrition, l'institut du thorax, Nantes, France
| | - Eric Mirallié
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Nantes, France
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5
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Kothari S, Townsend W, Chaudhry Z, Kalin S, Freeman K. Psychosis secondary to thyrotoxicosis that persisted post-thyroidectomy: a case report. BMC Psychiatry 2023; 23:750. [PMID: 37833705 PMCID: PMC10576329 DOI: 10.1186/s12888-023-05227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND This case report is of a patient with psychosis secondary to thyrotoxicosis that persisted and reemerged after definitive treatment of thyroidectomy, which is a unique occurrence in the literature. CASE PRESENTATION This patient is a male between 30 and 35 years of age with a history of Graves Disease and no past psychiatric history who was admitted to the hospital due to psychosis secondary to thyrotoxicosis. The thyrotoxicosis was treated with surgical removal, but the psychotic symptoms persisted after surgery and normalization of standard thyroid functional measures. The symptoms were of sufficient significance for inpatient psychiatric hospitalization, a rare occurrence. Ultimately after an extended stay in the psychiatric unit, the patient's symptoms stabilized with a second-generation antipsychotic, and the patient was discharged from the psychiatric unit. CONCLUSION This case is evidence that the link between psychosis and hyperthyroidism is still poorly understood due to the patient's psychotic symptoms persisting after the definitive treatment of thyroidectomy and the fact that it required anti-psychotic medications for normalization.
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Affiliation(s)
- Shiva Kothari
- University of Mississippi Medical Center Jackson, MS 39216, Jackson, USA.
| | - William Townsend
- University of Mississippi Medical Center Jackson, MS 39216, Jackson, USA
| | - Zuhaib Chaudhry
- University of Mississippi Medical Center Jackson, MS 39216, Jackson, USA
| | - Seth Kalin
- University of Mississippi Medical Center Jackson, MS 39216, Jackson, USA
| | - Kevin Freeman
- University of Mississippi Medical Center Jackson, MS 39216, Jackson, USA
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Zheng B, Wang N, Wu T, Yin T, Tan L, Xu W, Ren J. Effects of thermal ablation on thyroid function in patients with thyrotoxicosis. Chin Med J (Engl) 2023; 136:2257-2259. [PMID: 37341648 PMCID: PMC10508366 DOI: 10.1097/cm9.0000000000002685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Indexed: 06/22/2023] Open
Affiliation(s)
- Bowen Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, Guangzhou, Guangdong 510630, China
| | - Nana Wang
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, Guangzhou, Guangdong 510630, China
| | - Tao Wu
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, Guangzhou, Guangdong 510630, China
| | - Tinghui Yin
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, Guangzhou, Guangdong 510630, China
| | - Lei Tan
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, Guangzhou, Guangdong 510630, China
| | - Wen Xu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, Guangzhou, Guangdong 510630, China
| | - Jie Ren
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, Guangzhou, Guangdong 510630, China
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7
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Sneyers Closa M, Pérez Requena A, Sánchez García S, Sistac Ballarín J. Anaesthetic management of thyroid storm in a patient with Friederich's ataxia. A case report. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:362-365. [PMID: 37276964 DOI: 10.1016/j.redare.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/02/2022] [Indexed: 06/07/2023]
Abstract
A 26-year-old patient with Friederich's ataxia with hypertrophic obstructive cardiomyopathy undergoing total thyroidectomy due to persistent amiodarone-induced thyrotoxicosis (despite high doses of antithyroid drugs and corticosteroids), presented an intraoperative episode suggestive of thyroid storm. Thyroid storm is an endocrine emergency that is associated with high morbidity and mortality. Early diagnosis and treatment, which is of vital importance to improve survival, includes symptomatic treatment, treatment of cardiovascular, neurological, and/or hepatic manifestations and thyrotoxicosis, measures to suppress or avoid triggering stimuli, and definitive treatment.
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Affiliation(s)
- M Sneyers Closa
- Servicio Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitari Arnau de Vilanova, Lleida, Spain.
| | - A Pérez Requena
- Servicio Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - S Sánchez García
- Servicio Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J Sistac Ballarín
- Servicio Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitari Arnau de Vilanova, Lleida, Spain
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Bakkar S, Cappellani D, Forfori F, Di Salvo C, Catarsi S, Ambrosini CE, Miccoli P, Bogazzi F, Materazzi G, Papini P. Early surgery: a favorable prognosticator in amiodarone-induced thyrotoxicosis-a single-center experience with 53 cases. Updates Surg 2022; 74:1413-1418. [PMID: 35612729 DOI: 10.1007/s13304-022-01297-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/09/2022] [Indexed: 11/27/2022]
Abstract
Fewer than 100 cases of amiodarone-induced thyrotoxicosis (AIT) managed surgically have been reported worldwide. This study aims to assess the outcome of thyroidectomy under general anesthesia in a relatively large case series. A retrospective analysis of the clinical records of 53 patients who underwent thyroidectomy for AIT between 1995 and 2019 was conducted. There were 48 (90%) males and 5 females with an average age of 63.7 years. Type 1 and 2 AIT were present in 35 (66%) and 18 (34%) of patients, respectively. The mean preoperative ejection fraction (EF) was 45 ± 13%. Salvage surgery was performed in 6 (11%) patients due to decompensating heart failure and/or malignant arrhythmias. 35 (66%) patients underwent urgent surgery due to a predicted late response to medical therapy and/or the need to discontinue it. Elective surgery was performed in the remainder. A considerable improvement in mean EF occurred 12 months post-surgery (44% vs. 49%; p < 0.001). The overall survival rate following thyroidectomy was 96% at 12 months, and 83% at 5 years. No survival differences were observed based on systolic function. Cardiac-specific mortality was 11%, and these patients demonstrated a considerably shorter survival post-surgery compared to those who died of a non-cardiac cause (27 ± 18 vs. 77.5 ± 54 months; p < 0.05). Total thyroidectomy can be safely performed under general anesthesia despite severe cardiac disease. It considerably improves cardiac function and confers a survival advantage. Therefore, it should be considered early in the treatment plan of select cases.
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Affiliation(s)
- Sohail Bakkar
- Department of Surgery, Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan.
| | - Daniele Cappellani
- Department of Clinical and Experimental Medicine, University of Pisa, 56124, Pisa, Italy
| | - Francesco Forfori
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, 56124, Pisa, Italy
| | - Claudio Di Salvo
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, 56124, Pisa, Italy
| | - Sonia Catarsi
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, 56124, Pisa, Italy
| | - Carlo Enrico Ambrosini
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, 56124, Pisa, Italy
| | - Paolo Miccoli
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, 56124, Pisa, Italy
| | - Fausto Bogazzi
- Department of Clinical and Experimental Medicine, University of Pisa, 56124, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, 56124, Pisa, Italy
| | - Piermarco Papini
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, 56124, Pisa, Italy
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Abstract
We see an increasing number of patients with amiodarone-induced thyrotoxicosis. This condition can be treated pharmacologically, but treatment over several months may give rise to adverse reactions. In most cases we recommend that amiodarone therapy be continued despite newly detected thyrotoxicosis. Particularly in cases of heart failure, one should not wait too long before considering thyroidectomy. Treatment of amiodarone-induced thyrotoxicosis must be delivered with close collaboration between endocrinologist and cardiologist.
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Okazaki-Hada M, Maruoka A, Yamamoto M, Ito M, Hirokawa M, Nishikawa M, Akamizu T, Miyauchi A, Toyoda N. Poorly Differentiated Thyroid Carcinoma Coexisting with Graves' Disease Involving T3 Thyrotoxicosis due to Increased D1 and D2 Activities. Thyroid 2021; 31:1592-1596. [PMID: 34278816 DOI: 10.1089/thy.2021.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Poorly differentiated thyroid carcinoma is rare and patients are typically euthyroid. We report a novel rare case of poorly differentiated thyroid carcinoma with triiodothyronine (T3) thyrotoxicosis. Patient's Findings: A 77-year-old man presented to Kuma Hospital due to a neck tumor. A thyroid ultrasonography revealed a 220-mL mass in the right lobe. Laboratory data showed low serum thyrotropin (TSH), low free thyroxine (fT4), and high free T3 (fT3) levels. Anti-TSH receptor antibodies and thyroid-stimulating antibodies were positive. 131I scintigraphy showed diffuse uptake only in the left thyroid lobe. The patient underwent a total thyroidectomy and histological examination identified as poorly differentiated thyroid carcinoma. He was diagnosed with poorly differentiated thyroid carcinoma coexisting with Graves' disease. The tumor showed elevated type 1 iodothyronine deiodinases (D1) and type 2 iodothyronine deiodinases (D2) activities compared with that of the left thyroid lobe. Summary and Conclusions: Increased D1 and D2 activities in poorly differentiated carcinoma resulted in T3 toxicosis with a high serum fT3/fT4 ratio.
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Affiliation(s)
| | - Azusa Maruoka
- Internal Medicine II, Kansai Medical University, Hirakata City, Japan
| | | | - Mitsuru Ito
- Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | | | | | - Takashi Akamizu
- Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Akira Miyauchi
- Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Nagaoki Toyoda
- Internal Medicine II, Kansai Medical University, Hirakata City, Japan
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Cappellani D, Papini P, Di Certo AM, Morganti R, Urbani C, Manetti L, Tanda ML, Cosentino G, Marconcini G, Materazzi G, Martino E, Bartalena L, Bogazzi F. Duration of Exposure to Thyrotoxicosis Increases Mortality of Compromised AIT Patients: the Role of Early Thyroidectomy. J Clin Endocrinol Metab 2020; 105:5873248. [PMID: 32678873 DOI: 10.1210/clinem/dgaa464] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/13/2020] [Indexed: 01/21/2023]
Abstract
CONTEXT Patients with amiodarone-induced thyrotoxicosis (AIT) and severely reduced left ventricular ejection fraction (LVEF) have a high mortality rate that may be reduced by total thyroidectomy. Whether in this subset of patients thyroidectomy should be performed early during thyrotoxicosis or later after restoration of euthyroidism has not yet been settled. OBJECTIVES Mortality rates, including peritreatment mortality and 5-year cardiovascular mortality, and predictors of death, evaluated by Cox regression analysis. METHODS Retrospective cohort study of 64 consecutive patients with AIT selected for total thyroidectomy from 1997 to 2019. Four groups of patients were identified according to serum thyroid hormone concentrations and LVEF: Group 1 (thyrotoxic, LVEF <40%), Group 2 (thyrotoxic, LVEF ≥40%), Group 3 (euthyroid, LVEF < 40%), Group 4 (euthyroid, LVEF ≥40%). RESULTS Among patients with low LVEF (Groups 1 and 3), mortality was higher in patients undergoing thyroidectomy after restoration of euthyroidism (Group 3) than in those submitted to surgery when still thyrotoxic (Group 1): peritreatment mortality rates were 40% versus 0%, respectively (P = .048), whereas 5-year cardiovascular mortality rates were 53.3% versus 12.3%, respectively (P = .081). Exposure to thyrotoxicosis was longer in Group 3 than in Group 1 (112 days, interquartile range [IQR] 82.5-140, vs 76 days, IQR 24.8-88.5, P = .021). Survival did not differ in patients with LVEF ≥40% submitted to thyroidectomy irrespective of being thyrotoxic (Group 2) or euthyroid (Group 4): in this setting, peritreatment mortality rates were 6.3% versus 4% (P = .741) and 5-year cardiovascular mortality rates were 12.5% and 20% (P = .685), respectively. Age (hazard ratio [HR] 1.104, P = .029) and duration of exposure to thyrotoxicosis (HR 1.004, P = .039), but not presurgical serum thyroid hormone concentrations (P = .577 for free thyroxine, P = .217 for free triiodothyronine), were independent predictors of death. CONCLUSIONS A prolonged exposure to thyrotoxicosis resulted in increased mortality in patients with reduced LVEF, which may be reduced by early thyroidectomy.
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Affiliation(s)
- Daniele Cappellani
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Piermarco Papini
- Unit of Endocrine Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Agostino Maria Di Certo
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Claudio Urbani
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Manetti
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Laura Tanda
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Giada Cosentino
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Marconcini
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Unit of Endocrine Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Enio Martino
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luigi Bartalena
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Fausto Bogazzi
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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12
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Donckier JE, Bertrand C. Letter to the Editor: " Comparison Between Total Thyroidectomy and Medical Therapy for Amiodarone-Induced Thyrotoxicosis ". J Clin Endocrinol Metab 2020; 105:5843474. [PMID: 32445572 DOI: 10.1210/clinem/dgaa298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Julian E Donckier
- Department of Endocrinology, University Hospital - Godinne, Université catholique de Louvain, CHU UCL Namur (Site Godinne), Yvoir, Belgium
| | - Claude Bertrand
- Unit of Digestive, Endocrine and General Surgery, Department of Surgery, University Hospital - Godinne, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
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13
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Cappellani D, Bogazzi F. Response to the Letter to the Editor: "Comparison Between Total Thyroidectomy and Medical Therapy for Amiodarone-Induced Thyrotoxicosis". J Clin Endocrinol Metab 2020; 105:5843475. [PMID: 32445571 DOI: 10.1210/clinem/dgaa300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/18/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Daniele Cappellani
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Pisa, Italy
| | - Fausto Bogazzi
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Pisa, Italy
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14
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Cappellani D, Papini P, Pingitore A, Tomisti L, Mantuano M, Di Certo AM, Manetti L, Marconcini G, Scattina I, Urbani C, Morganti R, Marcocci C, Materazzi G, Iervasi G, Martino E, Bartalena L, Bogazzi F. Comparison Between Total Thyroidectomy and Medical Therapy for Amiodarone-Induced Thyrotoxicosis. J Clin Endocrinol Metab 2020; 105:5572853. [PMID: 31545358 DOI: 10.1210/clinem/dgz041] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/20/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT It is not known whether total thyroidectomy is more favorable than medical therapy for patients with amiodarone-induced thyrotoxicosis (AIT). OBJECTIVE To compare total thyroidectomy with medical therapy on survival and cardiac function in AIT patients. METHODS Observational longitudinal cohort study involving 207 AIT patients that had received total thyroidectomy (surgery group, n = 51) or medical therapy (medical therapy group, n = 156) over a 20-year period. AIT types and left ventricular ejection fraction (LVEF) classes were determined at diagnosis of AIT. Cardiac and thyroid function were reevaluated during the study period. Survival was estimated using the Kaplan-Meier method. RESULTS Overall mortality and cardiac-specific mortality at 10 and 5 years, respectively, were lower in the surgery group than in the medical therapy group (P = 0.04 and P = 0.01, respectively). The lower mortality rate of the surgery group was due to patients with moderate to severely compromised LVEF (P = 0.005 vs medical therapy group). In contrast, mortality of patients with normal or mildly reduced LVEF did not differ between the 2 groups (P = 0.281 and P = 0.135, respectively). Death of patients with moderate to severe LV systolic dysfunction in the medical therapy group occurred after 82 days (interquartile range, 56-99), a period longer than that necessary to restore euthyroidism in the surgery group (26 days; interquartile range, 15-95; P = 0.038). Risk factors for mortality were age (hazard ratio [HR] = 1.036) and LVEF (HR = 0.964), whereas total thyroidectomy was shown to be a protective factor (HR = 0.210). LVEF increased in both groups after restoration of euthyroidism, above all in the most compromised patients in the surgery group. CONCLUSIONS Total thyroidectomy could be considered the therapeutic choice for AIT patients with severe systolic dysfunction, whereas it is not superior to medical therapy in those with normal or mildly reduced LVEF.
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Affiliation(s)
- Daniele Cappellani
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Piermarco Papini
- Unit of Endocrine Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Alessandro Pingitore
- Clinical Physiology Institute, Consiglio Nazionale delle Ricerche (CNR), Pisa, Italy
| | - Luca Tomisti
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michele Mantuano
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Agostino M Di Certo
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Manetti
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Marconcini
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ilaria Scattina
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Urbani
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Claudio Marcocci
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Unit of Endocrine Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Giorgio Iervasi
- Clinical Physiology Institute, Consiglio Nazionale delle Ricerche (CNR), Pisa, Italy
| | - Enio Martino
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luigi Bartalena
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Fausto Bogazzi
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Conaglen HM, Tamatea JAU, Conaglen JV, Elston MS. Treatment choice, satisfaction and quality of life in patients with Graves' disease. Clin Endocrinol (Oxf) 2018; 88:977-984. [PMID: 29633307 DOI: 10.1111/cen.13611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/14/2018] [Accepted: 03/31/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Thyrotoxicosis, most often caused by Graves' disease (GD), when treated inadequately may result in premature mortality. There is little consensus as to which of the 3 treatment options available - antithyroid drugs (ATD), radioactive iodine (RAI) and surgery, is better. AIMS (i) To assess factors involved in treatment choice and treatment satisfaction in patients treated for Graves' disease; (ii) To assess quality of life (QoL) following treatment of Graves' disease. METHOD Participants were selected from a prospective study cohort assessing thyrotoxicosis incidence and severity. Of the 172 eligible patients with Graves' disease, 123 treated patients participated (64% had received ATD only, 11% RAI and 25% total thyroidectomy, the latter 2 usually after a period of ATD), along with 18 untreated patients with newly diagnosed Graves' disease (overall participation rate, 73%). Consented patients completed a questionnaire detailing factors involved in treatment choice, QoL and satisfaction with treatment. RESULTS Participants reported that the most important factors in choosing a treatment were the following: the effects on activities of daily living, concern about use of radioiodine, possibility of depression or anxiety, and doctor's recommendations. Satisfaction levels were high across all 3 treatment types. QoL 1-year following treatment was higher than in untreated patients, and comparable with other international studies. CONCLUSIONS Patient satisfaction with therapy and QoL does not differ by treatment type. Therefore, clinical and social factors, in combination with patient choice and resource availability, should determine which treatment modality patients with Graves' disease should receive.
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Affiliation(s)
- Helen M Conaglen
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Waikato Clinical Campus, Hamilton, New Zealand
| | - Jade A U Tamatea
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Waikato Clinical Campus, Hamilton, New Zealand
- Department of Endocrinology, Waikato Hospital, Hamilton, New Zealand
| | - John V Conaglen
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Waikato Clinical Campus, Hamilton, New Zealand
- Department of Endocrinology, Waikato Hospital, Hamilton, New Zealand
| | - Marianne S Elston
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Waikato Clinical Campus, Hamilton, New Zealand
- Department of Endocrinology, Waikato Hospital, Hamilton, New Zealand
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Inoue K, Saito J, Kondo T, Miki K, Sugisawa C, Tsurutani Y, Hasegawa N, Kowase S, Kakuta Y, Omura M, Nishikawa T. Amiodarone-induced Thyrotoxicosis with Cardiopulmonary Arrest. Intern Med 2018; 57:59-63. [PMID: 29033440 PMCID: PMC5799058 DOI: 10.2169/internalmedicine.9177-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a case of amiodarone-induced thyrotoxicosis (AIT) with cardiopulmonary arrest (CPA) in a 49-year-old woman. The patient had been treated with amiodarone for non-sustained ventricular tachycardia. Two weeks prior to her admission, she developed thyrotoxicosis and prednisolone (PSL, 30 mg daily) was administered with the continuation of amiodarone. However, she was admitted to our hospital for CPA. We performed total thyroidectomy to control her thyrotoxicosis and the pathological findings were consistent with type 2 AIT. She gradually improved and was discharged on day 84. This case demonstrates the importance of considering immediate total thyroidectomy for patients with uncontrollable AIT.
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Affiliation(s)
- Kosuke Inoue
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Jun Saito
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Tetsuo Kondo
- Department of Human Pathology, University of Yamanashi Interdisciplinary Graduate School of Medicine and Engineering, Japan
| | - Kaoru Miki
- Departments of Endocrinology and Diabetes, JCHO Tokyo Yamate Medical Center, Japan
| | - Chiho Sugisawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Yuya Tsurutani
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | | | - Shinya Kowase
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Japan
| | - Yukio Kakuta
- Department of Pathology, Yokohama Rosai Hospital, Japan
| | - Masao Omura
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Tetsuo Nishikawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan
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Seymour M, Morton A. Unilateral facial swelling in a thyrotoxic patient. BMJ 2017; 356:j534. [PMID: 28183855 DOI: 10.1136/bmj.j534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Matthew Seymour
- Mater Misericordiae Health Services Brisbane Ltd, Queensland Diabetes and Endocrine Centre, South Brisbane, Queensland, Australia
| | - Adam Morton
- Mater Misericordiae Health Services Brisbane Ltd, Queensland Diabetes and Endocrine Centre, South Brisbane, Queensland, Australia
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Diaconescu MR, Glod M, Costea I. Clinical Features and Surgical Treatment of Thyroid Pathology in Patients Over 65 Years. Chirurgia (Bucur) 2016; 111:120-125. [PMID: 27172524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The significant increase in the average lifespan of the general population lead to a proportional enhacement in the prevalence of benign and malignant thyroid conditions and equally the number of surgeries for this pathology. PATIENTS AND METHOD In a personal series of 464 thyroid disorders undergoing surgery over a two decades period we registered 51 patients (10.9%) aged over 65 years of which 11 (2.4%) having over 75 years. Demographic, clinical and diagnostic characteristics of these cases were analysed together with indications, management practice and outcome. Retrospective statistical analysis reaearching risk factor and confidence interval has not identified factors predicting higher risk of complication in this age group. RESULTS There have been recorded 33 females and 18 males (R1=1,8/1) with clinically, laboratory and histologically confirmed diagnosis of 24 (multi)nodular goiters (47.0%), 18 thyrotoxicosis (35.2%) and also 9 (17.6%) thyroid carcinomas. Thirty-four total or near total thyroidectomies and 17 conservative exeresis were performed. There were not postoperative deaths but we recorded three cases of prolonged hypocalcemia, and two cases each of recurrent laryngeal nerve paresis and recurrences. In all benign cases we obtained a stable in time cure while in carcinomas survivals of 3-5 years were obtained in only 4 papillary tumors. CONCLUSIONS Despite some difficulties in diagnostic and additional risks related to comorbidity benign and malignant pathology installed in patients over 65 years, may benefit of all types of conservative or radical thyroidectomies in terms of strict monitoring individualized in each case.
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Kvachenyuk AN, Suk LL. [THYROID SURGERY WITH ELECTRIC WELDING OF BIOLOGICAL TISSUE: COURSE OF THE EARLY POSTOPERATIVE PERIOD]. Klin Khir 2016:33-35. [PMID: 30256581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The experience of performing surgery on the thyroid gland (TG) in 205 patients was generalised, including the use of electric welding of biological tissue technologies (EST) — at 95. We used the apparatus for electric welding and high frequency surgical coagulator EK300—M1 and EKVZ—300 "Patonmed" as well as the original adaptive bipolar coagulation instruments. Operations carried out under endotracheal anesthesia "open" process, completed their stratified overlay nodal joints and vacuum—suction drainage. To assess the effectiveness of EST in thyroid surgery were analyzed during the early postoperative period. The positive impact of technology EST not only on surgical tactics, but also course of the early postoperative period. Recommended use of EST as a standard for surgical interventions on the thyroid.
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Diaconescu MR, Costea I, Glod M, Diaconescu S. Cardiothyreosis: Pathogenic Conjectures, Clinical Aspects and Surgical Approach. Chirurgia (Bucur) 2015; 110:333-338. [PMID: 26305196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The presence of striking cardiovascular manifestations were noted in the first descriptions of hyperthyroidism owing to Parry (1825) and Basedow (1840) in his famous Merseburg triad. Hyperthyroidism may either cause cardiac complications in individuals with a normal myocardium (genuine form of disorder) or complicate preexisting cardiac troubles. MATERIAL AND METHOD An homogenous series of 49 cardiothyreosis, 11 males and 38 females, aged 12 - 78 (mean 45) years selected between 138 thyrotoxic patients operated on in a period of two decades is herein presented. There were registered 15 Basedow diseases, 16 toxic adenomas and 18 multinodular toxic goiters. Among these were found isolated or dominating when combined together, 21 cases with rhythm troubles (4 with extrasistolic arrhythmia and one with fibrilloflutter, 10 cases with cardiac failure and 9 cases with coronary cardiac disease. To these 7 hypertensive patients and two with mitral valvulopathy were added. In hyperthyroidism clinical diagnosis was confirmed on imaging exams and hormonal determinations while cardiovascular disturbances was ascertained by interrogatory, clinical signs, EKG and echocardiography. All our cases were operated on performing 33 total or near total thyroidectomies and 16 lobectomies without morbidity recording however 5 postoperative tachyarrhythmias but finally most of them with good clinical results (87,7% cured or significantly ameliorated). DISCUSSIONS AND CONCLUSIONS Pathogenic diagnosis of such so-called "cor thyreotoxicosis" is not always easy on account of cardiovascular syndrome which frequently overshowed the thyroid subclinical pictures or emergencies of new described entities as amidarone induced thyrotoxicosis. The single administration of a whole calculated dose of I 131 with subsequent treatment with thyrostatics and B-blockers till remission of toxicosis is achieved can be chosen opposing to thyroidectomy after short medicamentous preparation which is effective in large thyromegalies and toxic adenomas.
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Ohrling H, Törring O, Yin L, Iliadou AN, Tullgren O, Abraham-Nordling M, Wallin G, Hall P, Lönn S. Decreased birth weight, length, and head circumference in children born by women years after treatment for hyperthyroidism. J Clin Endocrinol Metab 2014; 99:3217-23. [PMID: 24878049 DOI: 10.1210/jc.2014-1168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Whether hyperthyroidism influences the birth characteristics of children born several years after treatment is unknown. OBJECTIVE The objective of the study was to compare birth characteristics in singleton newborns delivered by women previously treated for Graves' disease (GD), toxic nodular goiter (TNG), or nontoxic goiter (NTG). DESIGN This was a nested case-control design within a national cohort registry study from 1950 through 2006. SETTING The study was conducted at a university and a hospital center in collaboration. PATIENTS The birth characteristics of newborns (n = 3421) delivered in a cohort of 43 633 women treated for GD or toxic nodular goiter by radioiodine or surgery (exposed group) at least 1 year prior to pregnancy were compared with newborns (n = 2914) of 45 655 mothers, previously operated for NTG (unexposed group). MAIN OUTCOME The primary outcome was birth weight, length, and head circumference. The secondary outcome was malformations, gestational age, and type of hyperthyroidism. RESULTS The birth weight of exposed children was 3431 ± 607 g (mean ± SD) compared with the unexposed, 3520 ± 641 g (P < .001). The cumulative odds ratio (OR) for lower birth weight was 1.29 [95% confidence interval (CI) 1.16-1.43]. The average birth length for the exposed children was 50.0 ± 2.7 cm compared with the unexposed of 50.4 cm ± 2.6 cm (P < .01) [cumulative OR 1.25 (95% CI 1.13-1.37)]. The head circumference was 34.5 ± 1.9 cm among exposed and 34.7 ± 1.8 cm, respectively (P < .001), with an OR of 1.24 (95% CI 1.13-1.35). No differences in birth characteristics were observed between children born after maternal GD or toxic nodular goiter. CONCLUSIONS Previous GD or TNG may influence the birth characteristics several years after radioiodine or surgical treatment.
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Affiliation(s)
- Hans Ohrling
- Division of Endocrinology (H.O., O.Tö.), Department of Internal Medicine, Södersjukhuset, 11883, Stockholm, Sweden; Institution of Clinical Research and Education (O.Tö.), Department of Medical Epidemiology and Biostatistics (L.Y., A.N.I., P.H., S.L.), and Institution of Molecular Medicine and Surgery (M.A.-N., G.W.), Karolinska Institutet, 17177, Stockholm, Sweden; Department of Oncology (O.Tu.), Karolinska University Hospital, 171 76 Solna, Sweden; and Department of Research and Development (S.L.), Region Halland, 301 80 Halmstad, Sweden
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Goktas U, Isik Y, Kati I, Aytekin OC, Bartin S. Bilateral superficial and deep cervical plexus block for thyroidectomy in pregnancy. Int J Obstet Anesth 2013; 22:171. [PMID: 23465360 DOI: 10.1016/j.ijoa.2012.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 11/23/2012] [Accepted: 12/04/2012] [Indexed: 11/30/2022]
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Faggiano A, Ramundo V, Assanti AP, Fonderico F, Macchia PE, Misso C, Marciello F, Marotta V, Del Prete M, Papini E, Lombardi G, Colao A, Spiezia S. Thyroid nodules treated with percutaneous radiofrequency thermal ablation: a comparative study. J Clin Endocrinol Metab 2012; 97:4439-45. [PMID: 23019349 DOI: 10.1210/jc.2012-2251] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Percutaneous radiofrequency thermal ablation (RTA) was reported as an effective tool for the management of thyroid nodules (TNs). The aim of this study was to investigate the effects of RTA and to establish whether they were treatment-related by comparison with a matched, untreated control group. PATIENTS AND METHODS The study population included 40 patients with compressive TNs: 22 had nontoxic TNs, and 18 had toxic TNs and were treated with methimazole. In all patients, a fine-needle aspiration cytology was performed to exclude a thyroid malignancy. STUDY DESIGN Twenty patients were treated with RTA (group A), and 20 others did not receive any treatment (group B). At baseline, age, gender, and TN features did not differ significantly between groups. All patients were clinically, biochemically, and morphologically evaluated at baseline and after 1, 3, 6, and 12 months. RESULTS TN volume significantly decreased in group A (1.8 ± 0.3 ml at 12 months vs. 13.3 ± 1.8 ml at baseline; P < 0.0001) and remained stable in group B [11.7 ± 1.5 ml at 12 months vs. 11.2 ± 1.5 ml at baseline; P = not significant (NS)]. At 3-, 6-, and 12-month evaluations, TN volume was significantly lower in group A than in group B (P < 0.005). At the end of the follow-up, pressure symptoms were improved in all patients in group A but persisted unchanged in group B. In group A, hyperthyroidism completely recovered in 40% and improved in 40% of patients with toxic TNs, whereas it persisted in all patients with toxic TNs in group B. RTA was safe and well tolerated in all patients. CONCLUSIONS RTA induced a marked TN volume shrinkage resulting in parallel improvement of pressure symptoms. In most patients with toxic TNs, hyperthyroidism significantly improved as well. RTA may represent a valid therapeutic approach in patients with TNs not receiving conventional treatments.
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Affiliation(s)
- A Faggiano
- Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
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Tomisti L, Materazzi G, Bartalena L, Rossi G, Marchello A, Moretti M, De Napoli L, Mariotti R, Miccoli P, Martino E, Bogazzi F. Total thyroidectomy in patients with amiodarone-induced thyrotoxicosis and severe left ventricular systolic dysfunction. J Clin Endocrinol Metab 2012; 97:3515-21. [PMID: 22865896 DOI: 10.1210/jc.2012-1797] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Patients with amiodarone-induced thyrotoxicosis (AIT) and left ventricular (LV) systolic dysfunction have a high mortality rate. Usually, medical therapy is the first choice for AIT patients, whereas the role of the thyroidectomy is unsettled. OBJECTIVE The objective of the study was to evaluate the effect of a total thyroidectomy on cardiac function and survival of AIT patients with severe LV systolic dysfunction. DESIGN This was a retrospective cohort study. SETTINGS The study was conducted at a tertiary university center. PATIENTS All AIT patients (n=24; nine patients with type 1 AIT, 15 patients with type 2 AIT) referred to the Department of Endocrinology and submitted to a total thyroidectomy at the Department of Surgery, both at the University of Pisa, during the years 1997-2010. INTERVENTION The intervention was a total thyroidectomy. MAIN OUTCOME MEASURE LV ejection fraction (EF) after the thyroidectomy and survival in December 2011 were measured. RESULTS All enrolled patients had previously undergone to medical treatment for AIT, as appropriate, without achieving euthyroidism. Patients with moderate to severe LV systolic dysfunction (EF<40%, group 1, n=9) or with mild systolic dysfunction (40%≤EF≤50%, group 2, n=5) were compared with patients with normal systolic function (EF>50%, group 3, n=10). Two months after thyroidectomy, under levothyroxine replacement therapy, LVEF improved in patients with LV systolic dysfunction, particularly in those of group 1, in whom it increased from 28.2±7.2 to 38.3±6% (P=0.007). On the contrary, LVEF did not significantly change in group 3 (from 57.1±3.0 to 59.8±6.6%, P=0.242). The mean follow-up was 67±42 months. No death occurred during and 2 months after surgery. One death occurred in one patient of group 1, 30 months after the thyroidectomy, due to acute myocardial infarction. No patient had relevant complications of thyroidectomy. CONCLUSIONS Total thyroidectomy, by rapidly restoring euthyroidism, may improve cardiac function and reduce the risk of mortality in AIT patients with severe LV dysfunction.
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Affiliation(s)
- Luca Tomisti
- Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124 Pisa, Italy
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Affiliation(s)
- Ozgur Mete
- Department of Pathology, University Health Network, Toronto, ON, Canada.
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lonescu L, Stefănescu C, Dănilă R, Trifescu I, Savin M, Dragomir C, Ferariu D, Vulpoi C. Myasthenia gravis associated with thymoma and toxic multinodular goiter. A case report. Rev Med Chir Soc Med Nat Iasi 2012; 116:540-544. [PMID: 23077950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Adequate antithyroid drug treatment or surgery usually generates remission of myasthenia gravis (MG) in patients with thymus hyperplasia associated with Graves' hyperthyroidism. The case of a 46-year-old woman diagnosed with MG based on the clinical picture, anticholinesterase drug test and positive electromyography (EMG) is presented. The cervico-thoracic computer tomography revealed a compressive nodular goiter and normal antero-superior mediastinum and led to the diagnosis of MG secondary to the hyperthyroidism. An uneventful total thyroidectomy was performed, but postoperatively the MG symptoms worsened. TC99m tetrofosmin scintigraphy revealed an area of hyperfixation in the antero-inferior mediastinum, suggestive for thymoma, as confirmed by a repeated thoracic CT scan. Following a longitudinal sternotomy, a well incapsulated tumor of approximately 6/5 cm located in the antero-inferior mediastinum was found and an extensive thymomectomy was performed. The postoperative course was uneventful and the patient was discharged 9 days later with complete remission of myasthenia. The pathology report of the specimen revealed a mixt thymoma or AB thymoma after Muller-Hermelink and WHO classification, with invasive capsular foci corresponding to Masaoka II stadium. In conclusion, scintigraphy proved to be useful in the diagnosis and decision making of a thymoma.
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Affiliation(s)
- Lidia lonescu
- University of Medicine and Pharmacy "Grigore T. Popa"-- lasi, Romania
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Larina AA, Shapoval'iants OS, Mazurina NV, Troshina EA. [Diagnostics and treatment of polyglandular syndrome of adults]. Klin Med (Mosk) 2012; 90:64-66. [PMID: 23101263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Autoimmune polyendocrine syndromes (APS) are rare endocrinopathies characterized by the coexistence of at least two glandular autoimmune diseases. APS comprise a wide spectrum of autoimmune disorders and are divided into a very rare juvenile (APS type 1) and a more common adult type with (APS 2) or without adrenal failure (APS 3). The first clinical manifestations of APS 1 usually occur in childhood whereas APS 2 mostly occurs during the third and fourth decades of life. The third type has been described in adults that, contrary to types 1 and 2, does not involve the adrenal cortex. No clinical differences between types 2 and 3 have been described except the absence of adrenal failure. Type 4 APS is a rare syndrome characterized by the combination of autoimmune conditions not falling into the above categories. It consists of adrenal failure with one or more minor autoimmune disorders barring major components of type 1 and 2 APS. Usually, autoimmune polyendocrine syndrome of adults manifests itself as one of the major autoimmune diseases (such as adrenal failure, Grave's disease, or type 1 diabetes) and minor autoimmune disorders (vitiligo, alopecia) preceding the development of autoimmune deficiency of major endocrine glands. This article describes a patient with type 3 APS, who developed type 1 diabetes. Grave's disease and vitiligo. The development of the syndrome started from vitiligo in the chidhood. Moreover, the patient suffered primary sterility and presented with progressive diabetic nephropathy of autoimmune origin. It is concluded that patients with a single autoimmune component of polyendocrine syndrome should be screened to exclude other autoimmune endocrine disorders.
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Hinchliffe WT, Main J. Severe hypercalcaemia following cessation of hormone replacement therapy. QJM 2011; 104:1091-2. [PMID: 21131287 DOI: 10.1093/qjmed/hcq232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- W T Hinchliffe
- Department of Renal Medicine, James Cook University Hospital, Marton Road, Middlesbrough, Cleveland, TS4 3BW, UK
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Kahara T, Shimizu A, Uchiyama A, Terahata S, Tajiri J, Nishihara E, Miyauchi A, Abo H, Sumiya H, Ishikura K, Usuda R, Noto H. Toxic multinodular goiter with low radioactive iodine uptake. Intern Med 2011; 50:1709-14. [PMID: 21841330 DOI: 10.2169/internalmedicine.50.5256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 74-year-old woman was referred to our hospital for goiter and persistent thyrotoxicosis. She had no signs of ophthalmopathy. She was not taking thyroid hormone. Thyroid CT revealed multiple nodules. The thyroid gland was not detected on (99m)Tc scintigraphy, (123)I uptake rate was 4.5% at 24 hours without hot nodules, and aberrant goiter was negative. After partial thyroidectomy, she was treated with levothyroxine. TRAb was undetectable during the disease course, and focal destructive change or chronic lymphocytic thyroiditis on the pathological specimens was not evident. We report a rare case of toxic multinodular goiter with low radioactive iodine uptake.
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Affiliation(s)
- Toshio Kahara
- Department of Internal Medicine, Toyama Prefectural Central Hospital, Japan.
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Romanchishen AF, Kuz'michev AS, Klimshin SB. [Cardiometric data as indications to surgical treatment of elderly and senile patients suffering from thyrotoxicosis]. Vestn Khir Im I I Grek 2011; 170:55-57. [PMID: 22191259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
On the basis of studying clinical symptoms of thyrotoxicosis in elderly patients and an analysis of results of investigation of the heart the authors marked out additional indications to surgical treatment of this category of patients. Results of surgical treatment of elderly and senile patients suffering from thyrotoxicosis are also described.
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31
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Iwańczuk W. [Myocardial infarction and shock associated with thyrotoxicosis]. Anestezjol Intens Ter 2010; 42:142-146. [PMID: 21413419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND A thyroid storm--a sudden, life-threatening exacerbation of thyrotoxicosis--can lead to multiple organ failure due to hyperactivity of the sympathetic nervous system. Symptoms may include fever, tachycardia, cardiovascular collapse, myocardial infarction, hepatic failure, cerebral infarction, delirium, coma, and rhabdomyolysis. Various therapies have been proposed for the management of thyrotoxicosis. They include: reduction of sympathetic outflow (beta-blockers); decreased production and release of thyroid hormone (thiamazole, propylthiouracyl, or iodine solution); and peripheral conversion of T4 to T3 (beta-blockers and steroids). CASE REPORT We present a case report of an atypical thyroid storm accompanied by multiple organ failure including coma, myocardial infarction, shock, respiratory failure and liver dysfunction. A 51-year-old female was admitted to the emergency department because of multiple organ failure. On admission the patient was unconscious, hypotensive, acidotic and hyperkalemic. Her core temperature was 37.6 degrees C, and she had an LVEF of 30%. Thyroid function tests showed thyrotoxicosis: the fT3 concentration was 17.3 pmol L(-1) (ref. range 2.3-6.3), fT4 50.4 pmol L(-1) (ref. range 10.3-24.4), and TSH 0.009 microU mL(-1) (ref. range 0.4-4.0). SGOT and SGPT concentrations were also increased. The electrocardiogram showed an elevated ST in leads II, III, aVF, and V2 to V5. Troponin I concentration was 5.1 ng mL(-1) (ref. range < 0.05). An emergency coronary angiogram revealed normal perfusion. Treatment was started with vigorous inotropic support(dopamine, dobutamine and norepinephrine, followed by intraaortic balloon counterpulsation. She also received thiamazole, beta-blockers, iodine solution, glucocorticoids and diuretics. On the 8th day, a subtotal thyroidectomy was performed. The patient was weaned from mechanical ventilation after 14 days and recovered without any neurological deficit. CONCLUSION The described case showed that a thyroid storm can present as multiple organ failure, requiring intraaortic balloon counterpulsation for the management of catecholamine-resistant shock.
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Affiliation(s)
- Waldemar Iwańczuk
- Oddział Anestezjologii i Intensywnej Terapii, Wojewódzki Szpital Zespolony w Kaliszu Wydział Ratownictwa Medycznego PWSZ w Kaliszu.
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Calò PG, Tuveri M, Pisano G, Tatti A, Medas F, Donati M, Nicolosi A. [Recurrent goitre: our experience]. Chir Ital 2009; 61:545-549. [PMID: 20380256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Recurrence after conservative thyroid surgery ranges from 7 to 40%. Risk factors for recurrence are female sex, multiple nodules in the resected lobe and lack of postoperative LT4 therapy. Indications for reoperation are suspected malignancy, recurrent thyrotoxicosis and recurrent uninodular or multinodulare goitre. From 2002 to 2008, 2149 total thyroidectomies were performed. Ninety-two patients had a completion thyroidectomy. The indication was recurrent multinodular goitre in 81, recurrent thyrotoxicosis in 3, and suspected malignancy in 8. Bilateral completion thyroidectomy was performed in 63 cases, lobectomy in 27 cases, removal of a mediastinal recurrence in 1 case and removal of a pyramidal remnant in 1 case. Histological examination revealed papillary cancer in 18 patients and follicular cancer in 1. Mean operative time was 140 minutes (range: 60-260). All patients were submitted to a minimum follow-up of 6 months. Temporary hypoparathyroidism occurred in 36 patients (39.1%) and definitive hypoparathyroidism in 7 patients (7.6%). Transient recurrent laryngeal nerve palsy occurred in 3 cases (3.2%) and permanent nerve palsy in 1 (1.1%). In 3 cases (3.2%) surgical revision of haemostasis was necessary for postoperative haemorrhage. Total thyroidectomy is the treatment of choice in multinodular goitre. In the cases in which reoperation is necessary, the intervention must be performed by an experienced surgeon.
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Affiliation(s)
- Pietro Giorgio Calò
- Dipartimento di Chirurgia e Scienze Odontostomatologiche, Università degli Studi di Cagliari
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Abstract
BACKGROUND Struma ovarii is a highly specialized form of mature ovarian teratoma consisting of thyroid tissue and exhibiting all the histological features of the thyroid gland. Malignant transformation of thyroid tissue in struma ovarii and metastasis are extremely uncommon. In rare cases, benign thyroid tissue may spread to the peritoneal cavity, and pathologic examination of the peritoneal implants shows multiple nodules of varying sizes of mature thyroid tissue similar to struma ovarii. This condition is termed "peritoneal strumosis." SUMMARY We report a 49-year-old woman with struma ovarii complicated by peritoneal strumosis with thyrotoxicosis. After surgical resection of the struma ovarii and peritoneal strumosis the patient became euthyroid. CONCLUSION To the best of our knowledge this is the first report of a patient with peritoneal strumosis complicated by thyrotoxicosis. The relative contribution to circulating thyroid hormones by the patient's struma ovarii as compared to the peritoneal strumosis is not known.
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Affiliation(s)
- Dohee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dankook University, College of Medicine, Cheonan, Republic of Korea
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Romanchishen AF, Kuz'michev AS, Klimshin SB. [Specific clinical course of thyrotoxicosis and results of surgical treatment of elderly patients]. Vestn Khir Im I I Grek 2009; 168:48-51. [PMID: 19663280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Age is one of the most significant risk factors of the development of diseases of the thyroid gland. Hyperthyroidism is much more difficult for diagnosing in elderly patients since its symptoms might be rubbed off and somewhat atypical. Rather often the cardial symptoms in elderly and senile patients are brought to the forefront when there are no other external manifestations of the disease. One of the most difficult questions in decision on the strategy of treatment of toxic goiter in elderly people having thyrotoxicosis is the question of indications to surgery. The article describes clinical symptoms and exact indications to surgical treatment in elderly people with thyrotoxicosis and assesses long-term results.
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Shpak LV, Volkova IA. [Heart rate variability in patients with thyrotoxicosis before and after thyroid resection]. TERAPEVT ARKH 2009; 81:58-62. [PMID: 19459426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM To evaluate parameters of variation pulsometry, heart rate variability (HRV) before and after surgical treatment of patients with thyrotoxicosis. MATERIAL AND METHODS Enzyme immunoassay measured blood levels of TTH and free thyroxin (T4f), HRV was traced for 5 min with variation pulsometry, frequency and time course analysis in 124 patients (37 males, 87 females, age 20-74, mean age 50.4 +/- 1.7 years) with manifest (n = 73) and complicated (n = 51) thyrotoxicosis in diffuse (n = 36) or multinodular (n = 88) toxic goiter before and 7 days after thyroid resection. RESULTS Aggravation of thyroxinemia with progression of thyrotoxicosis was accompanied with sympathicotonia change for vagotonia showing depletion of adaptive mechanisms in a complicated form of the disease. The weaker was sympathicotony in manifest thyrotoxicosis and the stronger was parasympathetic tension in complicated thyrotoxicosis, the higher were SDNN, RMSSD, TF, HF and LF/HF. Early after surgery (thyroid resection) thyrotoxicosis relieved with attenuation of thyroxinemia, vegetative regulation rearranged for adaptation up to achievement of vagosympathetic balance. This was more frequent in a manifest (56.1%) than in a complicated form of the disease (41.1%). CONCLUSION HRV provides an objective assessment of the effects of surgical treatment on the status of the autonomic nervous system.
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Piga M, Serra A, Boi F, Tanda ML, Martino E, Mariotti S. Amiodarone-induced thyrotoxicosis. A review. MINERVA ENDOCRINOL 2008; 33:213-228. [PMID: 18846027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Amiodarone (AM), a potent class III anti-arrhythmic drug, is an iodine-rich compound with a structural resemblance to thyroid hormones triiodothyronine (T3) and thyroxine (T4). At the commonly employed doses, AM causes iodine overload up to 50-100 times the optimal daily intake, which may be responsible of a spectrum of effects on thyroid function often counterbalancing its heart benefits. Although most patients on chronic AM treatment remain euthyroid, a consistent proportion may develop thyrotoxicosis (AM-induced thyrotoxicosis, AIT) or hypothyroidism. AIT is more prevalent in iodine-deficient areas and is currently subdivided in two different clinico-pathological forms (AIT I and AIT II). AIT I develops in subjects with underlying thyroid disease, and is caused by an exacerbation by iodine load of thyroid autonomous function; AIT II occurs in patients with no underlying thyroid disease and is probably consequent to a drug-induced destructive thyroiditis. Mixed or indeterminate forms of AIT encompassing several features of both AIT I and AIT II may be also observed. The differential diagnosis between AIT I and AIT II (which is important for the choice of the appropriate therapy) is currently made on radioiodine uptake (RAIU), which may be high, normal or low but detectable in AIT I, while is consistently very low or undetectable in AIT II and on colour-flow Doppler sonography (CFDS) showing normal or increased vascularity in AIT I and absent vascularity in AIT II. Quite recently, studies carried out in our Units at the University of Cagliari (Italy) showed that sestaMIBI thyroid scintigraphy may represent the best single test to differentiate AIT I (showing increased MIBI retention) from AIT II (displaying no significant uptake). Treatment of AIT is dependent from its etiology. AIT usually responds to combined thionamides and potassium perchlorate (KClO4) therapy, AIT II generally responds to glucocorticoids, while indeterminate forms may require both therapeutic approaches. In patients with AIT I definitive treatment of hyperthyroidism by administration of (131)I, initially not feasible for the low RAIU and/or the risk of thyrotoxicosis exacerbation, is advised after normalization of iodine overload. To control severe AIT additional treatment with lithium carbonate, the use of short course of iopanoic acid and plasmapheresis have been also proposed. In cases resistant to medical treatment and/or in patients with severe cardiac diseases who cannot interrupt AM or require quick AM reintroduction, total thyroidectomy (possibly carried out by minimally invasive video-assisted technique) may be proposed after rapid correction of thyrotoxicosis with combination of thionamides, KClO4, corticosteroids and a short course of iopanoic acid.
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Affiliation(s)
- M Piga
- Department of Nuclear Medicine and Endocrinology, University Policlinic, University of Cagliari, Cagliari, Italy.
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England RJA, Kamath MB, Jabreel A, Dunne G, Atkin SL. How we do it: surgery should be considered equally with I131 and thionamide treatment as first-line therapy for thyrotoxicosis. Clin Otolaryngol 2008; 31:160-2. [PMID: 16620341 DOI: 10.1111/j.1749-4486.2006.01150.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Radioiodine and thionamide treatment are the most frequently used treatment modalities for thyrotoxicosis in Europe and North America with surgery being reserved for selected cases. * In our clinic patients were offered all three modalities via simultaneous interview with an endocrinologist and a surgeon, with international risk benefit data for radioiodine and thionamide therapy, and local risk benefit data for total thyroidectomy provided. * When given the choice, at least 15% of patients opted for total thyroidectomy over the other modalities. * In our series of 100 consecutive surgical patients there was a 4% malignancy rate. * Total thyroidectomy should be offered equally, with radioiodine and thionamide treatment, as a first line treatment modality in the management of thyrotoxicosis.
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Affiliation(s)
- R J A England
- Departments of Otolaryngology Head and Neck Surgery and Endocrinology, Hull Royal Infirmary, UK.
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38
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Ibatullin RA, Romanchishen AF, Lebedinisnkiĭ KM. [Safety of surgical interventions on the thyroid gland and anesthesia against the background of thyrotoxicosis]. Vestn Khir Im I I Grek 2008; 167:61-66. [PMID: 18942440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Results of surgical treatment of 192 patients aged from 19 through 72 years were analyzed, they had euthyroid goiter, compensated and subcompensated forms of toxic goiter. A comparative assessment is given of sodium thiopental, propophol and sibazon for induction of general anesthesia according to their effects on the indices of central hemodynamics, thyroid status and subjective patient's comfort, as well as propranolol, thalinolol and esmolol as medicines for intraoperative correction of hemodynamic manifestations of thyrotoxicosis. The influence of surgical manipulations was assessed on main hemodynamic indices and the level of thyroid glands hormones. Attention is called to the main tasks of anesthesiologists responsible for anesthesiological maintenance of operation under conditions of compensated and subcompensated thyrotoxicosis.
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Del Rio P, Berti M, Sommaruga L, Arcuri MF, Cataldo S, Sianesi M. Pain after minimally invasive videoassisted and after minimally invasive open thyroidectomy--results of a prospective outcome study. Langenbecks Arch Surg 2007; 393:271-3. [PMID: 17909847 DOI: 10.1007/s00423-007-0229-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 09/10/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Substantial modifications in surgical treatment of thyroid disease have changed the postoperative management of thyroidectomized patients. The reduction of postoperative pain permit a short-stay surgery. MATERIALS AND METHODS We have analyzed the patients treated in our Unit from July 2006 to December 2006, with minimally invasive cervicotomy and mini-invasive video-assisted thyroidectomy. We have registered the postoperative pain applying an evaluation protocol numeric scale. The results were analyzed by t test. RESULTS One hundred thirteen patients were divided in two groups: group A, minimally invasive cervicotomy (15 male and 46 female patients); group B, mini-invasive video-assisted thyroidectomy (9 male and 43 female patients). Upon returning to the ward, the pain scale group A vs B was 2.77 +/- 1.16 vs 2.5 +/- 0.762 (p = 0.22) .At 24 h after surgery, the pain scale in group A was 1.82 +/- 1.258 vs 1.031 +/- 0.8608 (p < 0.005). CONCLUSIONS Both methods are safe, but mini-invasive video-assisted thyroidectomy gives not only a better cosmetic result but a reduction of postoperative pain especially at 24 h.
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Affiliation(s)
- P Del Rio
- Department of Surgical Science, General Surgery and Organ Transplantation, University of Parma, Parma, Italy.
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Dionigi G, Dionigi R, Bartalena L, Tanda ML, Piantanida E, Castano P, Annoni M, Boni L, Rovera F, Bacuzzi A, Vanoli P, Sessa F. [Current indications for thyroidectomy]. MINERVA CHIR 2007; 62:359-372. [PMID: 17947947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Thyroid surgery, one of the most common interventions in endocrine surgery, is practiced by many specialists who perform this procedure exclusively. It accounts for the bulk of work even in reference centers that treat rare endocrine tumors (e.g. adrenal and gastrointestinal tract cancer). Better results are obtained by experienced and skilled operators. Surgeons who correctly perform thyroid surgery can achieve excellent outcomes even in other areas of endocrine surgery. So it is surprising that not more is being done to teach the procedure, which has always been considered something of an art, perhaps because surgical treatment of rare endocrine tumors is more stimulating to teach than routine surgical procedures. Nonetheless, teaching correct surgical technique is essential for reducing and avoiding postoperative complications caused by inadequate experience and knowledge. Numerous studies have reported that the incidence of complications is high and that the rate is growing: 5% involve permanent injury to the recurrent laryngeal nerve after intervention for a benign tumor, despite repeated reports that the incidence could be reduced to near zero or at least to 1%. Alarmingly high is the 20% incidence of persistent hypoparathyroidism after total thyroidectomy. Here, too, accurate technique could reduce this rate to 1%. An important point is that permanent laryngeal nerve injury and persistent hypoparathyroidism are both sources of considerable discomfort for patients. One of the chief objectives of modern endocrine surgery is, therefore, to reduce the complications rate to acceptable levels by establishing adequate, uniform teaching protocols and universal guidelines that would help improve the practice of surgery.
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Affiliation(s)
- G Dionigi
- Centro di Ricerche in Endocrinochirurgia, Dipartimento di Scienze Chirurgiche , Università degli Studi dell'Insubria, Varese.
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Finucane FM, O'Connell J, Kinsley BT. Propylthiouracil induced C-ANCA positive agranulocytosis complicating Graves' thyrotoxicosis in pregnancy. Ir J Med Sci 2007; 177:69-71. [PMID: 17611791 DOI: 10.1007/s11845-007-0055-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Accepted: 05/21/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Thionamide induced agranulocytosis is associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA) in some patients. This poses a particular challenge when it occurs during pregnancy. AIMS To report a case of a 31-year-old woman with Graves' disease who presented at 11 weeks gestation with propylthiouracil induced agranulocytosis. METHODS After cessation of propylthiouracil the patient developed recurrent thyrotoxicosis, and underwent an elective subtotal thyroidectomy at 23 weeks gestation. RESULTS The patient required postoperative thyroxine replacement therapy. Subsequent pregnancy was uneventful and she delivered a healthy baby boy at 41 weeks gestation. As part of our routine work up for agranulocytosis we measured C-ANCA levels, which were significantly elevated. CONCLUSION This case highlights the association of propylthiouracil induced ANCA positivity and agranulocytosis. Second trimester subtotal thyroidectomy was safe and effective in treating this pregnant patient's thyrotoxicosis.
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Affiliation(s)
- F M Finucane
- Department of Endocrinology and Diabetes Mellitus, Mater Misericordiae Hospital, Eccles' Street, Dublin 7, Ireland
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Lefevre JH, Tresallet C, Leenhardt L, Jublanc C, Chigot JP, Menegaux F. Reoperative surgery for thyroid disease. Langenbecks Arch Surg 2007; 392:685-91. [PMID: 17593385 DOI: 10.1007/s00423-007-0201-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Accepted: 05/08/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Reoperative surgery for thyroid disease is rare. However, it is sometimes indicated for nodular recurrence after partial surgery for initially benign thyroid disease or for a completion total thyroidectomy when a final diagnosis of well-differentiated thyroid cancer (WDTC) is confirmed on a permanent section of a partially removed thyroid gland. This surgery can expose the patient to postoperative complications such as recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism. The aims of our study were to describe the population subjected to reoperative thyroid surgery and to evaluate postoperative morbidity to find the risk factor. PATIENTS AND METHODS The present study is a retrospective analysis of our experience with completion thyroidectomy: 685 consecutive patients underwent this procedure in a 14-year period, for a recurrent uninodular (85 patients) or multinodular (333 patients) goiter, recurrent thyrotoxicosis (42 patients), or a completion thyroidectomy for WDTC after partial resection of the thyroid gland (225 patients). The operative technique was standardized with identification of the RLN and parathyroid glands before removal of the thyroid gland. L-thyroxin treatment was started the day after surgery. Postoperative rates of suffocating hematoma, wound infection, RLN palsy, hypoparathyroidism, and persistence or recurrence of hyperthyroidism were studied and compared to the same parameters in patients who underwent primary bilateral thyroid gland resection during the same period. RESULTS The transient morbidity rate was 8%, with 5% hypoparathyroidism, 1.2% RLN palsy, 0.9% suffocating hematoma, and 0.2% wound infection. These results were higher than those from cases of primary thyroid resection for bilateral disease. Within the secondary surgery group, postoperative complications depended on the mean weight of the resected thyroid gland, hyperthyroidism, and the bilaterality of thyroid exploration during the previous surgery. The permanent morbidity rate was 3.8%, including 1.5% RLN palsy and 2.5% hypoparathyroidism. Permanent complication rates were higher than those for primary thyroid resection. Incidental carcinoma was found in 92 patients (13%): 10% (42 of 418) in patients with recurrent euthyroid nodular disease, 7% (3 of 42) in patients with recurrent hyperthyroidism, and 21% (47 of 225) in patients who underwent a completion thyroidectomy for cancer. CONCLUSION Because reoperative thyroid surgery can lead to potential complications, especially permanent RLN palsy or hypoparathyroidism, it should be reserved for patients who need it. The importance of respecting specific technical rules should be emphasized.
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Affiliation(s)
- Jérémie H Lefevre
- Service de Chirurgie Générale, Hôpital de la Pitié, 47-83 Boulevard de l'hôpital, 75651, Paris Cedex 13, France.
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Diaconescu MR, Glod M, Costea I, Palade M, Grigorovici M. [Reoperations of the thyroid gland]. Chirurgia (Bucur) 2007; 102:297-302. [PMID: 17687858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Reoperative thyroid surgery may be necessary in recurrent simple goiters, thyrotoxicosis and especially cancers of the thyroid gland. The present series reviewed 33 cases representing 7.3 % from our experience consisting of 440 thyroid operations. Five patients had undergone two prior operation. Details of original procedures were available only for 26 patients, the first operations being carried "extra muros" in 20 cases. There were 25 women and 8 men with mean patient age 44.5 (range 22-75) years, which had undergone one prior operations. The interval between the primary operation and the second one varies between 5 days and 44 years. Eleven cases had benign lesions: eight with uni or bilateral nodular goiters and three thyrotoxicosis (two with Basedow-Graves'disease and one with toxic adenoma) for which nodulectomy, subtotal lobectomies or thyroidectomies were performed. In twenty one cases the surgical indication was done for persistent or recurrent thyroid carcinomas (16 papillary, two follicular and one case each of medullary, anaplastic and malignant lymphoma). Among these 6 patients underwent completion total thyroidectomies associated in 9 another patients with radical or modified neck dissection and in the 6 remaining cases conservative procedures (lobectomies, tumoral excision) of the gland or nodes were done. Complications, includes two recurrent laryngeal nerve palsy, two spontaneously healed esophageal fistulas and one case each of permanent hypothyroidism and hypoparathyroidism. Reoperative thyroid surgery constitute a valuable surgical procedure for persistence or recurrence of benign and especially malignant thyroid lesions but is associated with significant increased risk of functional and anatomic complications rate than those of the initial surgery.
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Affiliation(s)
- M R Diaconescu
- Clinica a IV-a Chirurgie, Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi.
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Barczyński M, Cichoń S, Konturek A. Which criterion of intraoperative iPTH assay is the most accurate in prediction of true serum calcium levels after thyroid surgery? Langenbecks Arch Surg 2007; 392:693-8. [PMID: 17370085 DOI: 10.1007/s00423-007-0165-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2006] [Accepted: 02/01/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Intraoperative quick intact parathyroid hormone (iPTH) assay (IOPTH) has become a valuable adjunct in parathyroid surgery reliably predicting cure from hyperparathyroid state. Similarly to parathyroid surgery, the accuracy of the assay in predicting postoperative calcemia after thyroid surgery is related to blood sample timing and the criteria applied with no guidelines widely accepted, so far. This study compares different IOPTH criteria in predicting hypoparathyroidism-related hypocalcemia after thyroid surgery. MATERIALS AND METHODS The study included 200 consecutive patients undergoing total thyroidectomy. Three blood samples for IOPTH were taken in each patient: preoperatively--baseline (BL), at the end of surgery--skin closure (SC), and at 4 h postoperatively (4H). Serum calcium was routinely monitored at 4, 12, 24, 48, and 72 h postoperatively. The incidence and severity of hypocalcemia and related symptoms were matched to IOPTH results. The following criteria were tested: A, greater than 50% drop from BL at SC; B, greater than 70% drop from BL at SC; C, greater than 50% drop from BL at 4H; D, greater than 70% drop from BL at 4H; E, serum iPTH less than 15 pg/ml at SC; F, serum iPTH less than 10 pg/ml at SC; G, serum iPTH less than 15 pg/ml at 4H; H, serum iPTH less than 10 pg/ml at 4H. The accuracy of the tested criteria was calculated in predicting serum calcium level less than 2.0 mmol/l at any point after thyroidectomy. RESULTS Tested criteria had the following value in predicting serum calcium level less than 2.0 mmol/l after thyroidectomy (sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy, respectively): A (60, 89, 38, 95, and 86%), B (80, 93, 57, 98, and 92%), C (70, 90, 44, 96, and 88%), D (85, 95, 65, 98, and 94%), E (80, 91, 50, 98, and 90%), F (90, 95, 69, 99, and 95%), G (90, 95, 70, 99, and 95%), H (95, 99, 90, 99, and 98%). CONCLUSIONS The criterion of iPTH serum level less than 10 pg/ml at 4 h postoperatively has the highest accuracy in predicting serum calcium level below 2.0 mmol/l after total thyroidectomy when compared with the other criteria.
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Affiliation(s)
- Marcin Barczyński
- Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University College of Medicine, 37 Pradnicka Street, 31-202 Kraków, Poland.
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Lorberboym M, Schachter P. Drug-induced thyrotoxicosis: the surgical option. Isr Med Assoc J 2007; 9:79-82. [PMID: 17348476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Drug-induced thyrotoxicosis is not uncommon. It may worsen life-threatening arrhythmias and may be refractory to medical treatment. Near-total thyroidectomy presents a valid alternative to medical therapy and should be considered early in the management of the disease. OBJECTIVES To assess whether near-total thyroidectomy was a viable approach for our patients. METHODS Twelve patients--7 men and 5 women, aged 63 to 82 years--presented with drug-induced fulminant thyrotoxicosis following 1 to 12 months of amiodarone treatment (11 patients, mean 7 months) and after a 6 months course of interferon-alpha treatment (one patient). Medical therapy included propylthiouracil in doses up to 1200 mg/day in all patients and a beta-receptor antagonist in seven. Five patients had to stop amiodarone treatment and start high doses of steroids. A thyroid scan was performed in all patients using 5 mCi of Tc-99m pertechnetate. The thyroid scan showed absent uptake of the tracer in the thyroid bed in all patients, precluding the use of radioablation. RESULTS Four patients (three with AIT and one with interferon therapy) who did not respond to 3 months of medical therapy required surgical thyroidectomy due to severe unremitting thyrotoxicosis. A near-total thyroidectomy resulted in rapid correction of thyrotoxicosis, enabling continuation of the anti-arrhythmic drug. There were no intraoperative or postoperative arrhythmias. Subsequently, all patients recovered rapidly and remained well and euthyroid on thyroxine replacement therapy. CONCLUSIONS Since surgery results in rapid control of thyrotoxicosis and permits continued therapy with amiodarone, we suggest that near-total thyroidectomy warrants consideration as a definitive treatment for resistant amiodarone or interferon-induced thyrotoxicosis.
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Kellermayer R, Kim ST, Perez M, Tatevian N, Dishop M, Abrams S, Kitagawa S, Gilger MA. Cytomegalovirus esophagitis preceding the diagnosis of systemic lupus erythematosus. Endoscopy 2007; 39 Suppl 1:E218. [PMID: 17614070 DOI: 10.1055/s-2007-966413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- R Kellermayer
- Section of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, Texas, USA.
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Abstract
BACKGROUND Thyrotropin (TSH)-secreting pituitary adenomas (TSHomas) are rare tumours that can be invasive. It has been suggested that thyroid surgery or radioiodine treatment should not be considered in patients with such tumours as these treatments may facilitate rapid and aggressive tumour expansion. AIM To study the effects of thyroid ablative treatment on tumour size and thyroid status in two patients with TSHomas in whom the size of the adenoma was clearly documented before treatment was started. METHODS Patients studied were: (1) a female patient with a TSHoma who declined to undergo pituitary surgery and underwent a total thyroidectomy instead and (2) a male patient who opted for radioiodine treatment for his recurrent TSHoma. Changes in tumour size on serial magnetic resonance imaging scans, and restoration of euthyroidism were studied. RESULTS No marked changes in tumour size or features of aggressiveness occurred in these patients over periods of 8 and 12 years. Euthyroidism was restored and maintained in both patients. CONCLUSIONS Ablative thyroid treatment can be a safe and successful option to treat TSHomas, but long-term and close follow-up of these patients is mandatory to ensure that the size and behaviour of the tumours do not change markedly.
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Affiliation(s)
- C Daousi
- Diabetes and Endocrinology Research Group, University Hospital Aintree, Clinical Sciences Centre, 3rd Floor, Lower Lane, Liverpool L9 7AL, UK.
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Gietka-Czernel M, Jastrzebska H, Dudek A, Szczepkowski M, Zgliczyński W. [Thyroidectomy as the last chance treatment for life threatening thyrotoxicosis. Case report]. Endokrynol Pol 2007; 58:52-6. [PMID: 17354205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The case of 54-year old woman with severe Graves thyrotoxicosis and antithyroid drugs intolerance is presented. She was admitted to Endocrinology Department and therapy with propranolol, lithium, glucocorticoids, iodine contrast media was instituted. Then ablative dose of radioiodine was given; all these appeared to be ineffective. To avoid thyrotoxic storm thyroidectomy was undertaken. Surgical procedure was uneventful and successful. Surgical intervention should be considered in severe life-threatening cases of thyrotoxicosis.
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Berti P, Materazzi G, Bogazzi F, Ambrosini CE, Martino E, Miccoli P. Combination of minimally invasive thyroid surgery and local anesthesia associated to iopanoic acid for patients with amiodarone-induced thyrotoxicosis and severe cardiac disorders: a pilot study. Langenbecks Arch Surg 2006; 392:709-13. [PMID: 17103224 DOI: 10.1007/s00423-006-0112-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2006] [Accepted: 08/29/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Amiodarone-induced thyrotoxicosis is a life-threatening condition. A prompt control of thyrotoxicosis is obtained by thyroidectomy. Preparation with iopanoic acid proved to be very effective in reducing cardiovascular complications. Nevertheless, general anesthesia and extensive surgery may affect negatively patients also after adequate preparation. Safety and efficacy of minimally invasive video-assisted thyroidectomy performed under regional anesthesia (bilateral modified deep cervical block) in patients with amiodarone-induced thyrotoxicosis was evaluated. PATIENTS AND METHODS Eight patients with amiodarone-induced thyrotoxicosis (three with type I and five with type II), mean age 66.2 years, were prepared with iopanoic acid. There were five men and three women. Three patients had dilatative cardiomyopathy, three had heart failure secondary to severe myocardial infarction, and two had refractory unstable rhythm disorders. RESULTS Minimally invasive video-assisted thyroidectomy was performed under regional anesthesia. Mean operative time was 55.5 min. During surgery, lung and heart function remained well and no surgical complications occurred. After surgery, all patients remained on amiodarone therapy and two patients were subsequently removed from the checklist for heart transplantation. CONCLUSION Minimally invasive video-assisted thyroidectomy under regional anesthesia can be proposed as resolution of amiodarone-induced thyrotoxicosis in high risk patients with severe cardiac disorders, after preparation with iopanoic acid.
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Affiliation(s)
- Piero Berti
- Department of General Surgery, University of Pisa, Pisa, Italy
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