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Total thyroidectomy for amiodarone-associated thyrotoxicosis: should surgery always be delayed for pre-operative medical preparation?

Published online by Cambridge University Press:  22 May 2012

C Pierret ,
J-P Tourtier ,
Y Pons ,
S Merat ,
V Duverger  and
E Perrier
C Pierret*
Affiliation:
Department of Visceral and Vascular Surgery, Military Hospital Val-de-Grâce, Paris, France
J-P Tourtier
Affiliation:
Fire Brigade of Paris, France Department of Anesthesiology, Military Hospital val-de-Grâce, Paris, France
Y Pons
Affiliation:
Department of Laryngology and Otology, Military Hospital Percy, Clamart, France
S Merat
Affiliation:
Intensive care, Military Hospital Begin, Saint-Mandé, France
V Duverger
Affiliation:
Department of Visceral and Vascular Surgery, Military Hospital Begin, Saint-Mandé, France
E Perrier
Affiliation:
Medical Centre of Aircrew Expertise, Military Hospital Percy, Clamart, France
*
Address for correspondence: Dr Charles Pierret, Département de Chirurgie Vasculaire, HIA du Val de Grâce, 74 Bd de Port-Royal, 75005 Paris, France Fax: +33 140514513 E-mail: charlespierret@laposte.net
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Abstract

Objective:

Amiodarone can induce severe hyperthyroidism that justifies its withdrawal and the introduction of antithyroid drugs. Continuing amiodarone use, failure to control hyperthyroidism and poor clinical progress may require thyroidectomy. This study aimed to evaluate patients’ post-operative development and mid-term outcome after thyroidectomy for amiodarone-associated thyrotoxicosis.

Study design:

Prospective case series.

Setting:

Tertiary care centre.

Subjects and methods:

We prospectively collected cases of amiodarone-associated thyrotoxicosis requiring thyroidectomy due to failure of antithyroid treatment, despite amiodarone discontinuation. Post-thyroidectomy complications were compared immediately, 30 days and one year post-operatively, and also for scheduled versus emergency surgery cases.

Results:

Of 11 total cases, nine scheduled thyroidectomy cases had no morbidity after elective surgery. Two cases required emergency surgery for multiple organ failure and cardiac problems. Immediate post-operative complications (mostly haemodynamic) occurred in both cases (emergency vs routine surgery, p = 0.018).

Conclusion:

In such cases, pre-operative medical treatment is vital to limit peri- and post-operative complications, but surgery should not be delayed if the haemodynamic status deteriorates. Surgery, with careful anaesthesia, is the cornerstone of the treatment.

Keywords

AmiodaroneThyrotoxicosisThyroidectomy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 7 , July 2012 , pp. 701 - 705
Copyright
Copyright © JLO (1984) Limited 2012

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