Influence of Preoperative Thyroid Status on Clinical Outcomes in Graves' Disease Undergoing Thyroidectomy

Guidelines recommend achieving a euthyroid state before thyroidectomy to minimize surgical complications. However, this is not always attainable due to drug intolerance, refractory disease, or surgical urgency. This study aims to evaluate the impact of preoperative thyroid status, particularly thyrotoxicosis, on surgical outcomes in patients with Graves' disease.

This retrospective study included patients with Graves' disease who underwent thyroidectomy at Taipei Veterans General Hospital, Taiwan, between 2019 and 2023. Data on demographics, day-of-surgery vital signs, thyroid function, comorbidities, biochemical parameters, perioperative management, complications, and hospital stay were collected. Surgical outcomes were compared between patients with preoperative thyrotoxicosis and those who were euthyroid.

A total of 81 patients (79.0% female; mean age: 45.1 ± 12.2 years) were analyzed, with 33.3% (n = 27) presenting with preoperative thyrotoxicosis. The thyrotoxic group had higher Burch-Wartofsky Point Scale scores, lower thyrotropin levels, elevated thyrotropin receptor antibody titers, increased alanine aminotransferase levels, and more frequent use of Lugol's solution, lithium, and hydrocortisone preoperatively. Surgical outcomes, including hypocalcemia, hematoma, hoarseness, intraoperative blood loss, and operation time, were comparable between groups. No cases of thyroid storm or mortality occurred. Hospital stay duration did not differ significantly between the thyrotoxic and euthyroid groups (median total stay: 11.0 [5.5-21.5] vs. 5.0 [4.0-6.0] days, p = 0.314; median postoperative stay: 5.0 [4.0-7.5] vs. 4.0 [3.0-5.0] days, p = 0.518).

Thyroidectomy can be safely performed in patients with preoperative thyrotoxicosis when optimal preparation is provided, supporting its feasibility in selected cases where complete biochemical euthyroidism may not be achieved.