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Hemodynamic Instability during Thyroidectomy in Graves' Disease.

Sami Acar1, Candas Ercetin2, Nuri Alper Sahbaz3

  • 1Department of General Surgery, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Journal of Investigative Surgery : the Official Journal of the Academy of Surgical Research
|April 28, 2021
PubMed
Summary

Graves' disease patients undergoing thyroidectomy face hemodynamic instability risks, particularly with shorter disease duration and high thyroid-stimulating hormone receptor antibodies (TRAb). Careful surgical and anesthetic management is crucial for these patients.

Keywords:
Graves diseaseantithyroid agentshemodynamicshyperthyroidismthyroidectomythyrotropin

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Area of Science:

  • Endocrinology
  • Surgical Anesthesia

Background:

  • Graves' disease (GD) management often involves thyroidectomy.
  • Intraoperative monitoring of vital signs and hemodynamics is critical during GD thyroidectomy.

Purpose of the Study:

  • To investigate changes in vital signs and hemodynamic status during intraoperative thyroidectomy in Graves' disease patients.
  • To identify risk factors for intraoperative hemodynamic instability in GD patients.

Main Methods:

  • A cohort of 71 patients with Graves' disease undergoing thyroidectomy was studied.
  • Patients were operated on in a euthyroid state, with indications including compressive goiters, pregnancy, ATD intolerance, or patient preference.
  • Data on disease duration, gland weight, and TRAb levels were collected.

Main Results:

  • Eighteen patients (25.4%) experienced hemodynamic instability during surgery.
  • Disease duration, gland weight, and TRAb levels were associated with hemodynamic instability.
  • Shorter disease duration (<21 months) increased instability risk 11-fold (P=0.037).
  • TRAb levels >11.5 increased instability risk 235-fold (p<0.001).

Conclusions:

  • High TRAb levels and recent disease onset (<21 months) are risk factors for intraoperative hemodynamic instability.
  • Larger thyroid glands increase surgical instability risk.
  • Anesthesiologists and surgical teams must carefully consider these risks for optimized patient management.