Iodine-induced thyrotoxicosis ? A case for subtotal thyroidectomy in severely ill patients

Abstract

Iodine-induced thyrotoxicosis (IIT), due to iodine application in high amounts in patients with circumscript or disseminated thyroid autonomy, is complicated by a prolonged course, mainly due on the body's resistance to conservative therapy with thiourea derivates. Therefore, we decided to perform subtotal thyroidectomy in 16 thyrotoxic patients. This is in contrast to the common opinion that surgery should only be performed after normalization of thyroid hormones. In all 16 patients with severe IIT, including three patients with thyroid storm, hormone levels decreased within a few days after surgery to normal or subnormal values and the clinical picture of thyrotoxicosis disappeared. In the case of thyroid storm the signs of disorientation normalized within 1-3 days. One patient died 5 weeks after surgery due to severe concomitant diseases. One patient exhibited transitory respiration distress and another had postoperative hypocalcaemia. In nine patients L-thyroxine replacement became necessary because of subclinical or clinical hypothyroidism. Only by this procedure will the high intrathyroidal storage of iodine and performed hormone be extracted. Surgery as a treatment for thyrotoxicosis should be reserved for patients with severe IIT, where conservative treatment has been shown to be ineffective. Furthermore, in rare selected cases, when a rapid normalization is required, surgery without preoperative treatment seems to be justified. The effect of surgery was impressive in all our cases and there were only minor perioperative complications. Thus, it could be shown that subtotal thyroidectomy may be a rational and effective treatment in severe IIT which should be carefully considered and weighed against other types of therapy.

Amiodarone: A Common Source of Iodine-Induced Thyrotoxicosis

“…The use of radioactive iodine and thyroidectomy, sug gested by some authors [70], is questionable for several reasons. First, AIIT may be selflimiting [9,15,53,60], thus not necessarily requiring definitive treatment.…”

Is There a Place for Thyroidectomy in Older Patients with Thyrotoxic Storm and Cardiorespiratory Failure?

“…Subsequently a successful outcome of subtotal, near-total, or total thyroidectomies in patients with thyrotoxic storm was repeatedly reported (2,5,10,(24)(25)(26)(27)(28)(29)(30).…”

“…Because of the large intrathyroidal iodine pool in iodine-induced hyperthyroidism, even high-dose thionamide or iodine therapy is less effective and the onset of the effect of other antithyroid drug therapy or iopanoic acid may take too long to reverse the hyperthyroid condition (4). Therefore, early total or early near-total thyroidectomy, even without prolonged preoperative preparation and without reaching euthyroidism has been suggested as the method of choice for the treatment of iodine-induced thyrotoxic storm (2)(3)(4)(5)(6)(7)(8)(9). Early total or early near-total thyroidectomy in iodineinduced hyperthyroidism was subsequently associated with low mortality (2).…”

Zur chirurgischen Therapie der Amiodaron (Cordarex)-induzierten Hyperthyreose und thyreotoxischen Krise

“…Galt ein thyreotoxischer Patient früher als inoperabel, wird die Thyreoidektomie zur Beherrschung der jodinduzierten Hyperthyreose oder thyreotoxischen Krise seit Mitte der 80er Jahre zunehmend durchgeführt [17][18][19]. Diese Entwicklung wurde durch die Einführung intensivmedizinischer Verfahren in die anästhesiologischen Überwachung und Therapie sowie neue Anästhetika mit minimalen kardiozirkulatorischen Nebenwirkungen unter Verzicht auf Narkosegase (total intravenöse Anästhesie, TIVA) möglich.…”