Thyroidectomy for Amiodarone-Induced Thyrotoxicosis: Mayo Clinic Experience

被引:21
|
作者
Kotwal, Anupam [1 ]
Clark, Jennifer [2 ]
Lyden, Melanie [3 ]
McKenzie, Travis [3 ]
Thompson, Geoffrey [3 ]
Stan, Marius N. [1 ]
机构
[1] Mayo Clin, Div Endocrinol Diabet Metab & Nutr, 200 First St SW, Rochester, MN 55905 USA
[2] Mayo Clin, Dept Internal Med, Rochester, MN 55905 USA
[3] Mayo Clin, Dept Surg, Rochester, MN 55905 USA
来源
JOURNAL OF THE ENDOCRINE SOCIETY | 2018年 / 2卷 / 11期
关键词
amiodarone induced thyrotoxicosis; thyroidectomy; thyroid surgery;
D O I
10.1210/js.2018-00259
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: Amiodarone-induced thyrotoxicosis (AIT) is a difficult diagnostic and management challenge, especially during severe thyrotoxicosis accompanied by cardiovascular compromise. Objective: To evaluate thyroidectomy for the management of AIT. Design: Retrospective cohort study of adults with noncongenital heart disease with AIT after >3 months of amiodarone who underwent thyroidectomy from 1 November 2002 to 31 December 2016. Setting: Referral center. Patients: The group was comprised of 17 patients. Main Outcome Measures: Thyroid function, left ventricular ejection fraction (LVEF), and surgical complications were the main outcome measures. Results: Patients had median age of 60 years, 82.4% were male, and 47% had systolic heart failure. At diagnosis, median TSH was 0.005 mIU/L, median free T4 was 3.25 ng/dL, and total T3 was 198.5 ng/dL. We classified five patients as type 1 and type 2 and two patients as mixed; five patients remained undefined. The most common surgical indications were medically refractory disease, worsening cardiac status, and severe thyrotoxicosis requiring prompt resolution. Within 1 week post-thyroidectomy, median TSH was 0.565 mIU/L, and free T4 was 1.8 ng/dL. Median LVEF improved by 8% in patients with systolic heart failure. Seven patients had a complication within 30 days postsurgery (rehospitalization, n = 4; cervical hematoma, n = 2; recurrent arrhythmia, n = 2; symptomatic hypocalcemia, n = 1; death, n = 1). A larger thyroid gland was a risk factor for complications. Conclusions: Thyroidectomy resulted in rapid resolution of thyrotoxicosis. Its complication rate was higher than for non-AIT indications but lower than previously reported in a similar population of high-risk surgical patients. Copyright (C) 2018 Endocrine Society.
引用
收藏
页码:1226 / 1235
页数:10
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