ECE2022 Poster Presentations Thyroid (136 abstracts)
Keep calm and call the surgeon: a case series of urgent thyroidectomy in thyrotoxicosis
Tanja Rezic 1 , Tomislav Novosel 2 , Mirjana Kardum-Pejic 1 , Ivan Oreski 1 , Drago Boscic 2 , Srecko Marusic 1 & Vlatka Pandzic Jaksic 1
1Clinical Hospital Dubrava, Endocrinology, Diabetes and Clinical Pharmacology, Zagreb, Croatia; 2 Clinical Hospital Dubrava, Zagreb, Croatia
Introduction: The standard management of Graves’ disease includes initial use of antithyroid drugs, while radioactive iodine ablation or thyroid surgery are later definitive treatment options. Management of thyrotoxicosis secondary to the use of amiodarone can be challenging as patients may not promptly respond to antithyroid or corticosteroid therapy, and thyrotoxicosis may be more harmful in those patients owing to the underlying cardiac disease. In rare thyrotoxicosis cases, conventional treatment fails, and urgent thyroidectomy is the way to restore euthyroid state. Case series: We report three patients with thyrotoxicosis who underwent successful urgent thyroidectomy with rapid preoperative preparation. Two patients with Graves’ disease were treated with methimazole which led to severe agranulocytosis in the first, and severe cholestatic hepatotoxicity in the second patient. In addition to propranolol and corticosteroids, potassium iodine (Lugol’s solution) was used to render these patients euthyroid before thyroidectomy. Finally, third patient with severe cardiomyopathy requiring cardiac transplantation presented with type II amiodarone-induced thyrotoxicosis. Plasma exchange was performed to reduce thyroid hormones and to allow stabilisation of this patient prior to urgent thyroid surgery.
Conclusion: Urgent thyroidectomy is the only option for treatment of thyrotoxicosis in selected patients and careful preoperative preparation is essential to optimise surgical outcomes.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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