Preoperative Treatment of Thyrotoxicosis With Antithyroid Drugs and Thyroxine

Bergfelt, G; Ljunggren, Jan‐Gustaf; Hedberg, Kersti

doi:10.1210/jcem-21-1-72

Cited by 18 publications

(7 citation statements)

References 2 publications

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“…Preoperative treatment was carbimazole supplemented with 1-thyroxine to keep the patient euthyroid [20]. When the patients had been euthyroid for at least 1 month they were subjected to subtotal thyroidectomy.…”

Section: Methodsmentioning

confidence: 99%

Thyroid function after subtotal resection for hyper‐thyroidism: a prospective study

Lundström¹,

Gillquist²,

Karlberg³

et al. 1978

Eur J Clin Investigation

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Eight-seven patients treated for thyrotoxicosis by subtotal thyroidectomy were examined 6 weeks, 6 months and 12 months after surgery. Thirty-six of the patients were also examined 24 months after surgery.The patients were divided into two groups according to serum concentration of thyrotrophin (TSH) 6 weeks after surgery. Group I contained fifty-five patients with a normal serum TSH, of whom three developed recurrent hyperthyroidism during the observation period. The remaining fifty-two patients were clinically euthyroid during the entire observation period but had rather low serum thyroxine (T4) levels and normal serum triiodothyronine (T3) levels 6 weeks after surgery. Most patients had a normal TSH response to thyrotrophin-releasing hormone (TRH). T4 levels rose significantly within 6 months after surgery and then remained almost unchanged.Group I1 contained thirty-two patients with a serum TSH above 5 mU/1 6 weeks after surgery. Seven of these patients developed hypothyroidism within 1 year of surgery. The twenty-five remaining patients had low serum T4 with normal serum T3 levels at 6 weeks. TSH response to TRH was pathologically raised. Basal TSH level remained raised during the observation period but serum T4 levels approached those in group I within 12 months.These investigations show that patients with a raised basal serum TSH are at risk of developing hypothyroidism. Normal serum concentrations of thyroid hormones are reached sooner by patients with normal TSH levels than by patients with raised TSH levels. The basal serum TSH level seems to be a better indicator of risk of hypothyroidism than the serum T4 level, which is low in most patients 6 weeks after surgery.

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Section: Methodsmentioning

confidence: 99%

Thyroid function after subtotal resection for hyper‐thyroidism: a prospective study

Lundström¹,

Gillquist²,

Karlberg³

et al. 1978

Eur J Clin Investigation

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“…Many factors other than the total size of the thyroid remnant may, however, influence postoperative thyroid function. Such factors are the morphology of the gland (diffuse or nodular goiter, relative amount of pathologic tissue in the remnant, lymphocyte infiltration), presence of autoantibodies against thyroid tissue [7][8][9][10][11], and the type of preoperative treatment [11][12][13]. Knowledge of how and to what extent these factors influence the postoperative results are of value to the surgeon in determining the amount of tissue to be resected.…”

mentioning

confidence: 99%

The influence of remnant size, antithyroid antibodies, thyroid morphology, and lymphocyte infiltration on thyroid function after subtotal resection for hyperthyroidism

et al. 1987

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The influence of thyroid remnant size, antithyroid antibody titre, thyroid morphology, and lymphocyte infiltration on postoperative thyroid function was studied in 179 patients undergoing subtotal thyroidectomy because of hyperthyroidism. The surgical procedure was strictiy standardized and included determination of the thyroid remnant size. The preoperative medication used was beta-adrenoceptor blocking agents in 101 patients and antithyroid drugs and thyroxine in 78. With remnant size adjusted to 6-10 g (or, in goiters less than 20 g, to 25-30% of initial gland weight), the overall recurrence rate after 2-8 years (mean 5.3 -+ 2.0) of follow-up was 1.7% and the incidence of thyroid hypofunction was 29.6%.In toxic nodular goiter (TNG; n = 63), a significant negative correlation was found between TSH and remnant size after 12 months as well as a significantly lower remnant weight in patients developing postoperative hypothyroidism. In toxic diffuse goiter (TDG; n = I16), there was no difference in remnant size between euthyroid and hypothyroid patients. For patients with TDG treated preoperatively with beta-blockers, the incidence of autoantibodies against thyroid cytoplasm was increased in patients who postoperatively developed thyroid dysfunction. Within the group of TDG developing hypofunction, we found increased titre of autoantibodies and "presence of lymphoid tissue" more often in patients treated preoperatively with beta-blockers compared to thyrostatics. In toxic nodular goiter, the remnant size was considered the parameter most helpful to the surgeon in predicting postoperative thyroid function.

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“…One study was not included in the search because it was unavailable in Pubmed, EMBASE, or Cochrane. 80…”

Section: Resultsmentioning

confidence: 99%

Risk of perioperative thyroid storm in hyperthyroid patients: a systematic review

Mul

Damstra²,

Dijkum

et al. 2021

British Journal of Anaesthesia

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Background: Thyroid storm is a feared complication in patients with hyperthyroidism undergoing surgery. We assessed the risk of thyroid storm for different preoperative treatment options for patients with primary hyperthyroidism undergoing surgery. Methods: Pubmed, EMBASE, and The Cochrane Library were searched systematically for all studies reporting on adult hyperthyroid patients undergoing elective surgery under general anaesthesia. Selected studies were categorised based on preoperative treatment: no treatment, antithyroid medication (thionamides), iodine, b-blocking medication, or a combination thereof. Treatment effect, that is restoring euthyroidism, was extracted from the publications if available. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) or the Cochrane Risk of Bias tool for randomised studies. Results: The search yielded 7009 articles, of which 26 studies published between 1975 and 2020 were selected for critical appraisal. All studies had moderate to critical risk of bias, mainly attributable to risk of confounding, classification of intervention status, and definition of the outcome. All studies reported on thyroidectomy patients. We found no randomised studies comparing the risk of thyroid storm between treated and untreated patients. Cases of thyroid storm were reported in all treatment groups with incidences described ranging from 0% to 14%. Conclusion: Evidence assessing the risk of perioperative thyroid storm is of insufficient quality. Given the seriousness of this complication and the impossibility of identifying patients at increased risk, preoperative treatment of these patients remains warranted.

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Preoperative Treatment of Thyrotoxicosis With Antithyroid Drugs and Thyroxine

Cited by 18 publications

References 2 publications

Thyroid function after subtotal resection for hyper‐thyroidism: a prospective study

Thyroid function after subtotal resection for hyper‐thyroidism: a prospective study

The influence of remnant size, antithyroid antibodies, thyroid morphology, and lymphocyte infiltration on thyroid function after subtotal resection for hyperthyroidism

Risk of perioperative thyroid storm in hyperthyroid patients: a systematic review

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