Thyroidectomy in thyrotoxic crisis: is a euthyroid state required? A case series

Thyrotoxic crisis is a life-threatening emergency where refractory cases require thyroidectomy. Achieving preoperative euthyroidism is difficult, and optimal surgical timing is debated. This study assessed outcomes of early thyroidectomy regardless of preoperative thyroid levels. A retrospective review included patients ≥18 years (2011-2020) meeting thyroid storm criteria (Japanese Thyroid Association and Burch-Wartofsky >25). Twelve women (median age 36) were included, primarily for medical treatment failure (83.3%). All received beta-blockers; median heart rate decreased from 110 to 76.5 bpm. All underwent total thyroidectomy with 100% parathyroid preservation. Complications included transient hypocalcemia and hypoparathyroidism (41.67% each). There was no mortality, thromboembolism, or need for renal replacement. Early thyroidectomy is a viable option for medically refractory thyrotoxic crisis. Strict heart rate control appears more critical than achieving preoperative euthyroidism, supporting its safety and feasibility.