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Minimal Invasive Resection of Large Retrosternal Thyroid Goiter
Published on: September 20, 2024
Impact of thyroidectomy on cardiac manifestations of Graves' disease
Jason M Gauthier1, Hossam Eldin Mohamed2, Salem I Noureldine3
1Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Insights
Thyroidectomy rapidly improves cardiovascular issues in Graves' disease (GD) patients, including hypertension and arrhythmias. Surgical outcomes for GD patients with cardiac issues are comparable to those with multinodular goiter, with similar complication rates.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Surgical Oncology
Background:
- Graves' disease (GD) significantly impacts cardiovascular health.
- Cardiac manifestations in GD require careful management and evaluation of treatment outcomes.
Purpose of the Study:
- To assess the effectiveness of thyroidectomy in patients with cardiac manifestations of Graves' disease.
- To evaluate postoperative complications associated with thyroidectomy in GD patients with cardiac involvement.
Main Methods:
- Retrospective analysis of a prospectively collected thyroid surgery database.
- Comparison of 40 GD patients with age-matched controls having multinodular goiter (MNG).
- Analysis of preoperative and postoperative cardiac data, including echocardiograms and ECGs.
Main Results:
- GD patients showed a higher incidence of cardiac manifestations (60%) compared to MNG patients (35%).
- Significant resolution of hypertension (41.7%), tachycardia (68.8%), and atrial fibrillation (100%) was observed in GD patients post-thyroidectomy.
- Two of three GD patients with congestive heart failure (CHF) experienced resolution of CHF with improved ejection fraction.
Conclusions:
- Thyroidectomy provides rapid cardiovascular benefits for Graves' disease patients.
- Surgical treatment leads to significant improvement in hypertension, left ventricular systolic function, and arrhythmias.
- Thyroidectomy by high-volume surgeons has a complication rate similar to surgery for other benign thyroid conditions.
Objectives/Hypothesis:
Graves' disease (GD) has multiple adverse effects on the cardiovascular system. We aimed to examine the outcome of thyroidectomy in patients with cardiac manifestations of GD and evaluate their associated postoperative complications.
Study Design:
Retrospective analysis using a prospectively collected database.
Methods:
A retrospective analysis of our prospectively collected thyroid surgery database was performed. Forty patients with hyperthyroidism due to GD were identified, and each was appropriately age matched to a euthyroid patient with multinodular goiter (MNG). All patients underwent total thyroidectomy. Data relating to cardiac comorbidities were collected from preoperative and postoperative clinic notes, hospital admissions, electrocardiograms, echocardiograms, and blood work. Perioperative biochemical, cardiovascular, and postoperative outcomes were analyzed.
Results:
Twenty-four (60%) GD patients and 14 (35.0%) MNG patients had cardiac manifestations (P = .001). Hypertension resolved in 41.7% of GD patients and 7.7% of MNG patients (P = .00002). Two of the three GD patients with congestive heart failure (CHF) had resolution of CHF with significant improvement in ejection fraction, whereas the one MNG patient with CHF saw no change. Additionally, the majority of GD patients saw a resolution of their tachycardia (68.8%) and atrial fibrillation (100%). Four postoperative complications occurred in both the GD and MNG groups (4/40, 10%).
Conclusions:
Surgical treatment of GD in patients with cardiac manifestations offers rapid clinical improvement of hypertension, impaired left ventricular systolic function, and arrhythmias. When performed by a high-volume surgeon, the complication rate is similar to thyroidectomy for other benign disease.
Level Of Evidence:
4. Laryngoscope, 126:1256-1259, 2016.
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