ECE2022 Poster Presentations Thyroid (136 abstracts)
Surgical outcomes and related complications in Graves’ disease (GD)
Miguel Paja Fano 1,2 , Ignacio Merlo-Pascual 3 , Josune Rodríguez-Soto 3 , Natalia C. Iglesias-Hernández 3 , Jon Izquierdo-Coca 3 , Iñigo Hernando-Alday 3 , Ana J. Isusquiza-Etxezárraga 3 , Estíbaliz Ugarte-Abásolo 3 , Cristina Moreno-Rengel 3 , Aitzol Lizarraga-Zufiaurre 3 , Javier Espiga-Alzola 3 , M. Teresa Gutiérrez-Rodríguez 4 , Amaya Expósito-Rodríguez 4 & Amelia Oleaga-Alday 3
1OSI Bilbao-Basurto. Basurto University Hospital, Endocrinology, Bilbao, Spain; 2 Basque Country University (UPV-EHU), Medicine, Spain; 3 OSI Bilbao-Basurto. Basurto University Hospital, Endocrinology, Bilbao, Spain; 4 OSI Bilbao-Basurto. Basurto University Hospital, Endocrine Surgery, Bilbao, Spain
Despite being the most successful definitive treatment for GD and offering the best response in terms of quality of life, thyroidectomy is rarely performed worldwide. Few studies evaluate its complication rate and potential prognostic factors for complications. We report our last ten years’ experience. Incidence of temporary and permanent hypoparathyroidism, temporary and permanent recurrent laryngeal nerve (RLN) injury and incidental malignancy were recorded, looking for predictors of their occurrence. Biochemical trends of TSI and TSH levels after surgery were also examined. From 1798 thyroid surgeries, 162 patients undergoing total thyroidectomy for GD were collected. Median age was 44.4 years and 78.4% were female. Thirty percent of the patients needed calcitriol at discharge, and one year later this rate was 5.2%. Twelve percent of patients had injury to one RLN following surgery, with permanent damage in 1.9%. Active Graves’ orbitopathy (GO) was the second leading reason for surgery (26 cases). GO activity improved in 50% but worsened after thyroidectomy in 6 cases. Mean thyroid weight was 41.4 g and 13 glands showed incidental malignancy, all but one PTC. Prior to surgery, 94.8% of patients had measurable TSI titres (ELISA) and these were persistent 6 and 12 months after surgery in 86% and 62%, with lower titres. Median time to halve TSI titres was four months. One month after surgery, previously suppressed TSH was detectable in 75.2% of patients. There were no recurrences of hyperthyroidism. Univariate analysis showed that glandular weight, lower postoperative calcium, higher preoperative alkaline phosphatase, and parathyroid tissue in the surgical specimen were associated with immediate postoperative hypoparathyroidism, whereas higher TSI titres were associated with a higher incidence of RLN damage. Incidental carcinomas were associated with the presence of severe OG. In multivariate logistic regression, only perioperative PTH and calcium dynamics predicted the need for calcitriol, whereas preoperative [TSI] maintained the predictive value of RLN damage (OR per 1 IU/l: 1.07). OG lost predictive value for the detection of incidental cancers. Neither the finding of incidental malignancy nor the presence of parathyroid glands, nodular disease or germinal centres in histological specimen were associated with increased complication rates. Underused thyroidectomy is a safe alternative to radioiodine in GD, with a low rate of complications. It discloses occult carcinoma in 8% of GD. Surgical hypoparathyroidism is associated with perioperative calcium and PTH dynamics and this study finds a novel association between preoperative TSI level and transient LNR damage.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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