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Thyroidectomy for Amiodarone-Induced Thyrotoxicosis: Mayo Clinic Experience
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 non...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Endocrine Society
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198926/ https://www.ncbi.nlm.nih.gov/pubmed/30370394 http://dx.doi.org/10.1210/js.2018-00259 |
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author | Kotwal, Anupam Clark, Jennifer Lyden, Melanie McKenzie, Travis Thompson, Geoffrey Stan, Marius N |
author_facet | Kotwal, Anupam Clark, Jennifer Lyden, Melanie McKenzie, Travis Thompson, Geoffrey Stan, Marius N |
author_sort | Kotwal, Anupam |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-6198926 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Endocrine Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-61989262018-10-26 Thyroidectomy for Amiodarone-Induced Thyrotoxicosis: Mayo Clinic Experience Kotwal, Anupam Clark, Jennifer Lyden, Melanie McKenzie, Travis Thompson, Geoffrey Stan, Marius N J Endocr Soc Clinical Research Article 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. Endocrine Society 2018-09-06 /pmc/articles/PMC6198926/ /pubmed/30370394 http://dx.doi.org/10.1210/js.2018-00259 Text en Copyright © 2018 Endocrine Society https://creativecommons.org/licenses/by-nc-nd/4.0/ This article has been published under the terms of the Creative Commons Attribution Non-Commercial, No-Derivatives License (CC BY-NC-ND; https://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Clinical Research Article Kotwal, Anupam Clark, Jennifer Lyden, Melanie McKenzie, Travis Thompson, Geoffrey Stan, Marius N Thyroidectomy for Amiodarone-Induced Thyrotoxicosis: Mayo Clinic Experience |
title | Thyroidectomy for Amiodarone-Induced Thyrotoxicosis: Mayo Clinic Experience |
title_full | Thyroidectomy for Amiodarone-Induced Thyrotoxicosis: Mayo Clinic Experience |
title_fullStr | Thyroidectomy for Amiodarone-Induced Thyrotoxicosis: Mayo Clinic Experience |
title_full_unstemmed | Thyroidectomy for Amiodarone-Induced Thyrotoxicosis: Mayo Clinic Experience |
title_short | Thyroidectomy for Amiodarone-Induced Thyrotoxicosis: Mayo Clinic Experience |
title_sort | thyroidectomy for amiodarone-induced thyrotoxicosis: mayo clinic experience |
topic | Clinical Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198926/ https://www.ncbi.nlm.nih.gov/pubmed/30370394 http://dx.doi.org/10.1210/js.2018-00259 |
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