Endocrine Abstracts

Background: Traditional method in Sheffield involved preoperative admission and use of an intensive regimen. The pandemic led to the development and implementation of an outpatient-based protocol (SPROG - ‘Sheffield Peri-operative Rapid Optimisation in Graves’ disease (GD)’) for patients’ intolerant to thionamides and/or with uncontrolled disease requiring thyroidectomy. Control was achieved using sequential addition and dose-escalation of drugs such as Lugol’s iodine, cholestyramine, beta blockers and steroids (with or without thionamides) with close monitoring 10-14 days pre-surgery.

Aims: To evaluate the safety and efficacy of the SPROG protocol followed by thyroidectomy.

Methods: Patients underwent thyroidectomy for poorly controlled GD between November 2020 and January 2022 were identified. Demographics, clinical and biochemical data as well as outcomes including incidence of peri-operative thyroid storm, post-surgical hypoparathyroidism (PoSH) and recurrent laryngeal nerve palsy were recorded.

Results: 7 females and 1 male with a median age of 43 years (range:15-47) were included. Indications using SPROG protocol were thyroid eye disease (5/8; 62%)), neutropenia (2/8; 25%)) and relapse with uncontrolled thyrotoxicosis (1/8; 13%). Pre-protocol median (range) free T4 (fT4) and T3 (fT3) were 70.5 pmo/l (23.2–100) and 27.6 pmo/l (7.7-50), respectively. Following treatment, levels of free hormones were significantly reduced (P=0.012) with median (range) fT4 of 21.2 [10.5–37.9] pmo/l and fT3 of 6.9 [4.4–11.1] pmo/l. None developed perioperative thyroid storm or PoSH. Recurrent laryngeal palsy persisted in 1 patient whilst another developed steroid-induced adrenal insufficiency.

Conclusion: SPROG protocol was safe, efficient, and cost-effective during the pandemic. A close collaboration between medical and surgical teams was key to optimise thyroid function pre-surgery.