番茄社区

People with hyperthyroidism did not seem to have worse thyroidectomy outcomes than those with normal thyroid functioning, researchers in France reported.

In a nonrandomized study of adults with hyperthyroidism or euthyroidism, neither patient group saw a significantly higher rate of complications after total thyroidectomy, according to Eric Mirallié, MD, of the Centre Hospitalier Universitaire Nantes, and colleagues.

Specifically, a total of 10.4% patients experienced postoperative abnormal vocal cord mobility identified with a vocal cord examination with nasofibroscopy, which included 10.3% of the euthyroid group and 11% of the hyperthyroidism group (difference 0.70%, 95% CI -0.05% to 0.04%), they reported in a

Additionally, definitive recurrent nerve palsy occurred in 1% of all surgical patients, which manifested in 1% of the euthyroid group and 0.8% of the hyperthyroid group (difference 0.22%, 95% CI -0.01% to 0.02%).

About half of these patients who developed recurrent nerve palsy opted not to undergo postoperative laryngoscopy at the 6-month mark.

A total of 20% of all thyroidectomy patients experienced postoperative hypocalcemia -- a common complication of this surgery -- defined as a serum calcium level below 8.0 mg/dL at the second postoperative day. This occurred in 19.7% of euthyroid patients and 21.1% of hyperthyroid patients (difference 1.50%, 95% CI -0.08% to 0.04%).

As for the last post-surgical outcome assessed, definitive hypocalcemia was diagnosed in a total of 2% of all patients, representing 1.9% of euthyroid patients and 2.4% of hyperthyroid patients (difference 0.48%, 95% CI -0.03% to 0.02%).

"These morbidity results may be surprising, given that one would expect a substantial difference between patients with preoperative hyperthyroidism and those with euthyroidism," Mirallié's group wrote, but then added that these findings are generally consistent with prior literature.

"Medical treatment should precede surgery," they recommended. "However, the results of this large nonrandomized clinical trial may encourage endocrine surgeons to reassure and motivate patients to undergo total thyroidectomy as a definitive treatment for hyperthyroidism."

For this analysis, the researchers drew upon data collected in the representing 1,250 patients, 80% of whom were euthyroid and 20% of whom had hyperthyroidism. All patients with overt hyperthyroidism were treated with antithyroid drugs prior to surgery. The vast majority of patients were female with an average age of 51.

All patients included underwent a total thyroidectomy for Graves disease, euthyroid or hyperthyroid goiter, or any thyroid nodule requiring total thyroidectomy via cervicotomy.

A study limitation was a lack of data on all hormone levels -- thyroid-stimulating hormone, triiodothyronine hormone, or thyroxine hormone levels -- on the day of surgery.

Comment