Endocrine Abstracts

Background

Thyrotoxicosis with Graves’ Disease is treated with thionamide, radio-iodine treatment and thyroidectomy. Surgery is an important choice, especially when Graves’ Disease is complicated by thyroid orbitopathy. Pre- and post-operative protocols for thyroidectomy are imperative.

Aims

1) To assess pre-operative preparation of patients, with potassium iodide, vitamin D, beta blockade, and the pre-operative thyroid function.

2) To assess the post-operative monitoring and complications.

Method

The patient cohort came from a large UK tertiary centre from 2014-19. Every thyroidectomy is recorded in the BAETS database which facilitated ascertainment of subjects. The anonymised data were analysed to calculate percentages for each parameter within the aims of the audit.

Results

Ninety-two patients were included in the cohort, aged 19–74 years. It was found that 85% of patients were euthyroid pre-operatively, with 2% hyperthyroid pre-operatively and 13% hypothyroid. 48% received pre-operative vitamin D; 49% received pre-operative potassium iodide; and 53% were on a beta-blocker or alternative. Post-operative calcium checks took place the same and following days, performed in 99% and 100% respectively. Post-operative parathyroid checks took place the same and following days, performed in 97% and 98% respectively. Post-operative hypocalcaemia occurred in 26% but was temporary in 92%. Vocal cord palsy was reported in 11%, but in all cases was a temporary neuropraxia. The rate recorded in the BAETS 2017 national database is 7.8% for temporary vocal cord palsy, although the database notes that this is likely an underestimation due to lack of post-operative laryngoscopies (1). The national rate for persistent vocal cord palsy, over 6 months, is 1.2% for total thyroidectomy (1).

Discussion

The results show low complication rates in this cohort, with the majority of complications being temporary. Post-operative investigation for calcium and parathyroid hormone was achieved in almost all cases. Pre-operative optimisation with vitamin D, potassium iodide and beta blockers was not always achieved in more urgent cases. A proforma is presented, to ensure not only that pre-operative optimisation occurs, but that it is also clearly documented for each patient. This audit would suggest that if done by experienced surgeons, surgical management of Graves’ Disease confers low complication rates and can be an effective option in the management of Graves’ Disease.

References

1) Chadwick D, Kinsman R, Walton P. The British Association of Endocrine and Thyroid Surgeons. Fifth National Audit Report 2017. Available online: https://www.baets.org.uk/wp-content/uploads/BAETS-Audit-National-Report-2017.pdf. Accessed January 2021.