Perioperative Management for Non-Thyroidal Surgery in Thyroid Dysfunction

Malhotra, Bhanu; Bhadada, Sanjay

doi:10.4103/ijem.ijem_273_22

Cited by 4 publications

(2 citation statements)

References 51 publications

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“…Optimal use of laboratory and biochemical tests to diagnose and evaluate patients with thyroid nodules or thyroid-different malignant lesions is limited and requires studying and an appreciation of the pathophysiology and the factors implicated in both thyroid hyperplasia and neoplasia (especially thyrotropin, TSH), activating mutations of the TSH receptor, and the oncogenic transformations [ 12 , 13 ]. Routine preoperative thyroid function tests are usually requested for patients preparing for surgery to achieve an euthyroid state not for detecting the thyroid nodular malignancy [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Fine-Needle Aspiration Cytology (FNAC) in Thyroid Nodule Excision Cases

Alzahrani,

Alghamdi

2024

Cureus

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Introduction: Fine needle aspiration cytology (FNAC) for thyroid nodules has a high diagnostic accuracy, according to several studies worldwide. Patients who experienced preoperative FNAC had more optimal surgical treatment than others who did not perform FNAC. Therefore, achieving an accurate FNAC procedure appears to be an important tool for the proper management of thyroid nodules. We aimed to study the accuracy and challenges of the thyroid FNAC diagnostic tool in the Al-Baha region, Kingdom of Saudi Arabia.Methods: The study involves 52 patients with thyroid nodules who underwent preoperative FNAC and postoperative histopathology with the same surgery and pathology team at Al-Baha region in 2022-2023. Results and Conclusion:The mean age of the included patients was 47.7 years, with a female predominance. The diagnostic accuracy was 90%, and the main cause of inaccurate diagnosis was processing challenges, where the majority of cases were taken on the palpation-only technique, a few cases were ultrasoundguided, and the only technique used in the laboratory was conventional smears. The applied interrater reliability Cohen kappa coefficient (κ) for the clinical-histopathological agreement was "moderate agreement". We recommend using and evaluating more cytological techniques in addition to the currently used conventional smears in pathology laboratories to enhance the efficacy of the FNAC diagnosis of thyroid lesions.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Fine-Needle Aspiration Cytology (FNAC) in Thyroid Nodule Excision Cases

Alzahrani,

Alghamdi

2024

Cureus

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“…Thus, the goal of therapy in the perioperative patient should be to achieve a euthyroid state and when that is not feasible, to use other measures that will increase hemodynamic stability and prevent decompensation. [17]…”

Section: Figure 2 Ro Chestmentioning

confidence: 99%

Pre-Procedure Intervention of Subclinical Hypothyroidism: Case Report

Tantri¹,

Syafril²

2023

JETROMI

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Background: Subclinical hypothyroidism (SH) is a very common disorder in the general population. In patients with known hypothyroidism or hypothyroidism who have been undergoing treatment, a TSH test should be included in the preoperative assessment to determine the adequacy of treatment and to ensure that thyroid therapy is optimized before surgery. Case Presentation: A 39 years old woman complains about a weakness that has been 4 years interfering with activities. Shortness of breath if doing strenuous activities, walking long distances, and climbing stairs, and shortness of breath decreases after rest. Sore throat found since 1 week of hospitalization, and fever for 1 day. A lump in the neck is not found. Previously, the patient had been treated for 8 days in the Department of Cardiology and planned the installation of a temporary pacemaker due to bradycardia that persisted until cardiac arrest. Conclusion: Subclinical hypothyroid patients undergoing pre-procedure intervention are predisposed to anemia, electrophysiologic disturbances, and hypotension, all of which can precipitate cardiovascular collapse. The goal of therapy in the perioperative patient with thyroid dysfunction centers around the attempt to normalize hormone levels before surgical intervention whenever possible and, when that is not feasible, to use other measures that will maximize hemodynamic stability and prevent decompensation.

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Management of perioperative thyrotoxicosis – what to do when standard therapy is contraindicated or fails?

Tian,

Liang,

Yew

et al. 2024

Front. Endocrinol.

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BackgroundCurrent guidelines recommend that hyperthyroid patients should be rendered euthyroid prior to surgical procedures. These guidelines rely heavily on the use of ATDs as the primary medication, and do not give recommendations for patients who have contraindications to ATDs, or for whom standalone ATD treatment is inadequate.ObjectivesTo evaluate the efficacy and safety of adjunctive pharmacological therapy and/or therapeutic plasma exchange (TPE) in the perioperative management of patients with thyrotoxicosis who were intolerant to ATD or for whom standalone ATD therapy was inadequate to achieve euthyroidism prior to surgery.MethodsA comprehensive search of MEDLINE, Google Scholar, Embase and CENTRAL up to 31 December 2023 retrieved 12,876 records. After screening titles, abstracts and full manuscripts, 16 reports were enrolled. The study quality was evaluated using the Newcastle-Ottawa Scale (NOS).ResultsPatients were primarily female (78.5%), aged between 35 and 52 years. The predominant thyroid condition was Graves’ disease (89.7%). Majority underwent thyroidectomy (99.3%). Patients treated pre-operatively with 2nd line pharmacotherapy with/without therapeutic plasma exchange (TPE) underwent surgery safely with no reports of perioperative thyroid storm. Pre-operative treatment achieved mean percentage reduction of free thyroxine and free triiodothyronine levels of 52.6 ± 8.2% and 68.1 ± 9.3% respectively. One study reported a patient who suffered from myocardial infarction and tachyarrhythmia and subsequently demised.ConclusionPreoperative management of hyperthyroidism with second line pharmacotherapy and/or TPE can be effectively and safely implemented in patients with intolerance to or ineffective treatment with ATDs. The treatment modalities were generally safe, though some complications were observed.

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Perioperative Management for Non-Thyroidal Surgery in Thyroid Dysfunction

Cited by 4 publications

References 51 publications

Diagnostic Accuracy of Fine-Needle Aspiration Cytology (FNAC) in Thyroid Nodule Excision Cases

Diagnostic Accuracy of Fine-Needle Aspiration Cytology (FNAC) in Thyroid Nodule Excision Cases

Pre-Procedure Intervention of Subclinical Hypothyroidism: Case Report

Management of perioperative thyrotoxicosis – what to do when standard therapy is contraindicated or fails?

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