Thyrotoxic crisis in Graves' disease: indication for immediate surgery

Area of Science:

• Endocrinology
• Internal Medicine
• Surgical Management

Background:

• Thyrotoxic crisis (thyroid storm) is a rare but serious complication of hyperthyroidism.
• Management strategies for thyroid storm remain a subject of debate.
• It can arise from various hyperthyroid states, including Graves' disease.

Purpose of the Study:

• To report on the necessity and outcomes of surgical intervention in elderly patients with Graves' disease experiencing thyrotoxic crisis.
• To highlight the potential for nonspecific or monosymptomatic presentations of thyroid storm in the elderly.
• To evaluate the efficacy of surgery in achieving euthyroidism and resolving neurological deficits.

Main Methods:

• Retrospective case series of four elderly female patients (mean age 75) with Graves' disease.
• Patients developed thyrotoxic crisis despite antithyroid drug therapy.
• Surgical intervention (thyroidectomy) was performed due to the severity of the condition and neurological symptoms.

Main Results:

• All four patients presented with nonspecific symptoms and severe neurological deficits, including coma.
• Thyroid hormone levels were significantly elevated preoperatively.
• Three patients achieved euthyroidism within two days post-surgery, and neurological symptoms resolved within four days.
• All patients experienced complete recovery without major postoperative complications.

Conclusions:

• Thyroid storm in the elderly can present with subtle or nonspecific symptoms, masking its severity.
• Surgical intervention is a viable and effective treatment option for thyrotoxic crisis in elderly patients, even when preoperative euthyroidism is not achieved.
• Prompt surgical management can lead to rapid improvement in both thyroid status and neurological function, with complete patient recovery.