Thyroid Disorders and Hemostasis

Elbers, Laura; Squizzato, Alessandro; Gerdes, Victor E. A.

doi:10.1055/s-0038-1666825

Cited by 18 publications

(12 citation statements)

References 54 publications

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“…Cough during tracheal extubation may lead to several complications, such as hypertension, tachycardia, myocardial ischemia and postoperative bleeding [3–5]. Furthermore, postoperative bleeding in thyroid surgery is still significant and is often associated with severe complications including cervical hematoma, reoperation and cardiac arrest [6]. Various strategies aimed at inhibiting cough, including the administration of lidocaine and dexmedetomidine, have been studied [7, 8].…”

Section: Introductionmentioning

confidence: 99%

Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgery

Wang

et al. 2019

BMC Anesthesiol

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Background Intravenous lidocaine and dexmedetomidine treatments have been proposed as methods for inhibiting cough. We compared the efficacy of intravenous lidocaine and dexmedetomidine treatments on inhibiting cough during the tracheal extubation period after thyroid surgery. Methods One hundred eighty patients undergoing thyroid surgeries were randomly allocated to the LIDO group (received lidocaine 1.5 mg/kg loading, 1.5 mg/kg/h infusion), the DEX group (received dexmedetomidine 0.5 μg/kg loading, 0.4 μg/kg/h infusion) and the CON group (received saline), with 60 cases in each group. The primary outcomes of cough were recorded. Secondary outcomes included hemodynamic variables, awareness time, volume of drainage, the postoperative visual analogue scale and adverse effects were recorded. Results The incidence of cough were significantly lower in the LIDO group (28.3%) and the DEX group (31.7%) than that in the CON group (66.7%) ( P = 0.000). Additionally, both moderate and severe cough were significantly lower in the LIDO group (13.3%) and the DEX group (13.4%) than these in the CON group (43.4%) ( P < 0.05). Compared with the two treatment groups, both mean arterial blood pressure and heart rate were significantly increased in the CON group during tracheal extubation ( P < 0.05). Compared with the CON group, the volume of drainage was significantly reduced in the two treatment groups within 48 h after surgery ( P < 0.05). compared with the CON group, the postoperative visual analogue scale was significantly lower in groups LIDO and DEX after surgery( P < 0.05). Compared with the LIDO group and the CON group, the time to awareness was longer in the DEX group ( P < 0.05). In the DEX group, bradycardia was noted in 35 patients, while no bradycardia was noted in LIDO group and CON group. Conclusion Compared with intravenous infusions of normal saline, both lidocaine and dexmedetomidine had equal effectiveness in attenuating cough and hemodynamic changes during the tracheal extubation period after thyroid surgery, and both of these treatments were able to reduce the volume of postoperative bleeding and provide better analgesic effect after surgery. But intravenous infusions of dexmedetomidine resulted in bradycardia and delayed the time to awareness when compared with lidocaine and normal saline. Trial registration ChiCTR1800017482 . (Prospective registered). Initial registration date was 01/08/2018.

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Section: Introductionmentioning

confidence: 99%

Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgery

Wang

et al. 2019

BMC Anesthesiol

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“…In addition, thyrotoxicosis makes a hypercoagulable and hypofibirinolytic state [ 5 ]. Several pathophysiological mechanisms have been proposed to underlie the relation between thyroid hormone excess and hemostasis [ 5 – 7 ]. One of possible mechanisms is the direct effect on gene transcription of coagulation and fibrinolytic proteins, more specifically via the thyroid hormone receptor β [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Another is the activation of the autoimmune system in thyroid disease. Many thyroid diseases are immune-mediated, and other autoimmune disorders are associated with an increased risk of developing venous thromboembolism [ 5 – 7 ].…”

Section: Discussionmentioning

confidence: 99%

Massive pulmonary thromboembolism combined with transient thyrotoxicosis in an 18 year old girl

et al. 2020

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Background: Pulmonary thromboembolism (PTE) is thought to usually stem from deep vein thrombosis (DVT). However, evidence of DVT could not be found in many cases. Furthermore, transient thyrotoxicosis is a rare but potentially life-threatening emergency involving a systemic hypercoagulable state. We report on an 18 year-old-girl with transient thyrotoxicosis with massive PTE without DVT. Case presentation: An 18-year-old girl was admitted to the hospital with syncope. Patient had no history of trauma, any known underlying disease or oral contraceptives use. Chest computed tomography (CT) showed massive PTE in both central pulmonary arteries and diffuse goiter. However, a low extremity Doppler sonogram did not detect DVT. To manage the PTE, we administered low molecular weight heparin. On the other hands, thyroid function test indicated a state of thyrotoxicosis. In addition, patient had a partial protein S deficiency but no other immunologic abnormality. Therefore, the patient was diagnosed with massive PTE, thyrotoxicosis, and partial protein S deficiency. Patient was discharged with oral warfarin and methimazole. A follow-up echocardiogram obtained 3 months after anticoagulation therapy demonstrated normal dimensions and systolic function. After thyrotoxicosis was treated with methimazole for a month, a euthyroid state was achieved and the goiter decreased to a normal size. The methimazole was gradually tapered off and stopped at 4 months. At a 6-month follow up visit, PTE and pulmonary hypertension had disappeared but the patient still had a partial protein S deficiency. We decided to stop all medication with careful monitoring. During a 4year follow-up period after the episode, she was asymptomatic without any evidence of recurrent systemic thromboembolism or hyperthyroidism. Conclusions: Early recognition and appropriate treatment of PTE combined with transient thyrotoxicosis were vital to preventing other complications.

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“…19,32,37,59 Several other aspects remain to be elucidated such as the frequency of thyroid cancer and the existence of a relationship between thyroid dysfunction, cardiovascular diseases, components of metabolic syndrome (insulin resistance) 14,15,102 and coagulation disorders. 103,104 Therefore, further studies are needed to explain these emerging issues. commonly encountered in iron-overloaded patients with thalassemia and is defined as failure of the thyroid gland to produce sufficient thyroid hormone to meet the metabolic demands of the body.…”

Section: Treatmentmentioning

confidence: 99%

Guest Editor: Raffaella Origa THYROID DISORDERS IN HOMOZYGOUS β-THALASSEMIA: CURRENT KNOWLEDGE, EMERGING ISSUES AND OPEN PROBLEMS

Sanctis¹,

Soliman

Canatan³

et al. 2019

Mediterr J Hematol Infect Dis

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Abstract. Changes in thyroid function and thyroid function tests occur in patients with β-thalassemia major (TM). The frequency of hypothyroidism in TM patients ranges from 4% to 29 % in different reports. The wide variation has been attributed to several factors such as patients' genotype, age, ethnic variations, treatment protocols of transfusions and chelation, and varying compliance to treatment. Hypothyroidism is the result of primary gland failure or insufficient thyroid gland stimulation by the hypothalamus or pituitary gland. The main laboratory parameters of thyroid function are the assessments of serum thyroid-stimulating hormone (TSH) and serum free thyroxine (FT4). It is of primary importance to interpret these measurements within the context of the laboratory-specific normative range for each test. An elevated serum TSH level with a normal range of serum FT4 level is consistent with subclinical hypothyroidism. A low serum FT4 level with a low, or inappropriately normal, serum TSH level is consistent with secondary hypothyroidism. Doctors caring for TM patients most commonly encounter subjects with subclinical primary hypothyroidism in the second decade of life. Several aspects remain to be elucidated as the frequency of thyroid cancer and the possible existence of a relationship between thyroid dysfunction on one hand, cardiovascular diseases, components of metabolic syndrome (insulin resistance) and hypercoagulable state on the other hand. Further studies are needed to explain these emerging issues. Following a brief description of thyroid hormone regulation, production and actions, this article is conceptually divided into two parts; the first reports the spectrum of thyroid disease occurring in patients with TM, and the second part focuses on the emerging issues and the open problems in TM patients with thyroid disorders.

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Thyroid Disorders and Hemostasis

Cited by 18 publications

References 54 publications

Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgery

Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgery

Massive pulmonary thromboembolism combined with transient thyrotoxicosis in an 18 year old girl

Guest Editor: Raffaella Origa THYROID DISORDERS IN HOMOZYGOUS β-THALASSEMIA: CURRENT KNOWLEDGE, EMERGING ISSUES AND OPEN PROBLEMS

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