Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-17T19:27:50.254Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Bogazzi, F, Bartalena, L, Gasperi, M, Braverman, LE, Martino, E. The various effects of amiodarone on thyroid function. Thyroid 2001;11:511–19CrossRefGoogle ScholarPubMed
2Harjai, KJ, Licata, AA. Effects of amiodarone on thyroid function. Ann Intern Med 1997;126:63–73CrossRefGoogle ScholarPubMed
3Lombardi, A, Martino, E, Braverman, LE. Amiodarone and the thyroid. Thyroid Today 1990;13:1–7Google Scholar
4Nademanee, K, Piwonka, RW, Singh, BN, Hershman, JM. Amiodarone and thyroid function. Prog Cardiovasc Dis 1989;31:427–37CrossRefGoogle ScholarPubMed
5Trip, MD, Wiersinga, W, Plomp, TA. Incidence, predictability and pathogenesis of amiodarone-associated thyrotoxicosis and hypothyroidism. Am J Med 1991;91:507–11CrossRefGoogle Scholar
6Roti, E, Uberti, ED. Iodine excess and hyperthyroidism. Thyroid 2001;11:493–500CrossRefGoogle ScholarPubMed
7Piga, M, Serra, A, Boi, F, Tanda, ML, Martino, E, Mariotti, S. Amiodarone-associated thyrotoxicosis. A review. Minerva Endocrinol 2008;33:213–28Google Scholar
8Bartalena, L, Brogioni, S, Grasso, L, Bogazzi, F, Burelli, A, Martino, E. Treatment of amiodarone-associated thyrotoxicosis, a difficult challenge: results of prospective study. J Clin Endocrinol Metab 1996;81:2930–3Google Scholar
9Farling, PA. Thyroid disease. Br J Anaesth 2000;85:15–28CrossRefGoogle ScholarPubMed
10Leger, AF, Massin, JP, Laurent, MF, Vincens, M, Auriol, M, Helal, OB et al. Iodine-induced thyrotoxicosis: analysis of eighty-five consecutive cases. Eur J Clin Invest 1984;14:449–55CrossRefGoogle ScholarPubMed
11Pollack, PT, Bouillon, T, Shafer, SL. Population pharmacokinetics of long-term oral amiodarone therapy. Clin Pharmacol Ther 2000;67:642–52CrossRefGoogle Scholar
12Samanta, A, Jones, GR, Burden, AC. Thoracic inlet compression due to amiodarone induced goitre. Postgrad Med J 1985;61:249–50CrossRefGoogle ScholarPubMed
13Houghton, SG, Farley, DR, Brennan, MD. Surgical management of amiodarone associated thyrotoxicosis: Mayo clinic experience. World J Surg 2004;28:1083–7CrossRefGoogle ScholarPubMed
14Franzese, CB, Fan, CY, Stack, BC Jr. Surgical management of amiodarone-associated thyrotoxicosis. Otolaryngol Head Neck Surg 2003;129:565–70Google Scholar
15Gough, I, Meyer-Witting, M. Surgery and anaesthesia for amiodarone-associated thyrotoxicosis. Aust N Z J Surg 2000;70:155–6CrossRefGoogle ScholarPubMed
16Brennan, MD, van Heerden, JA, Carney, JA. Amiodarone-associated thyrotoxicosis (AAT): experience with surgical management. Surgery 1987;102:1062–7Google ScholarPubMed
17Hamoir, E, Meurisse, M, Defechereux, T. Surgical management of amiodarone associated thyrotoxicosis: too risky or too effective? World J Surg 1998;22:537–43CrossRefGoogle ScholarPubMed
18Sutherland, J, Robinson, B, Delbridge, L. Anaesthesia for amiodarone-associated thyrotoxicosis: a case review. Anaesth Intensive Care 2001;29:24–9CrossRefGoogle Scholar
19Eagle, KA, Brundage, BH, Chaitman, BR, Ewy, GA, Fleisher, LA, Hertzer, NR et al. Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol 1996;27:910–48Google Scholar
20Badner, NH, Knill, RL, Brown, JE, Novick, TV, Gelb, AW. Myocardial infarction after non cardiac surgery. Anesthesiology 1998;88:572–8CrossRefGoogle Scholar