Thyroidectomy for hyperthyroidism before the euthyroid state: is it safe?

Area of Science:

• Endocrinology and Metabolic Diseases
• Surgical Oncology
• Thyroid Surgery

Background:

• Current guidelines recommend achieving biochemical euthyroidism before thyroidectomy to mitigate thyroid storm risk.
• Real-world scenarios may present challenges in fully normalizing thyroid hormone levels pre-surgery.
• This study investigates perioperative outcomes in hyperthyroid patients undergoing thyroidectomy with varying degrees of biochemical control.

Purpose of the Study:

• To compare perioperative outcomes between biochemically controlled and uncontrolled hyperthyroid patients undergoing thyroidectomy.
• To evaluate the safety and feasibility of thyroidectomy in patients not fully normalized preoperatively.

Main Methods:

• Retrospective analysis of 110 patients who underwent thyroidectomy for hyperthyroidism (September 2020-2024).
• Patients were categorized as 'controlled' (normal fT3/fT4) or 'uncontrolled' (elevated fT3/fT4) preoperatively.
• Demographic, perioperative, and postoperative data were collected and compared between groups.

Main Results:

• 18% of patients were biochemically uncontrolled pre-thyroidectomy.
• Uncontrolled patients were younger and more likely to have Graves' disease.
• Operative times and complication rates (hypocalcemia, nerve palsy, hematoma) did not significantly differ between controlled and uncontrolled groups.

Conclusions:

• Thyroidectomy can be safely performed in selected uncontrolled hyperthyroid patients without increased complications or thyroid storm.
• These findings support considering surgery in urgent situations or high-volume centers even without complete biochemical control.
• Biochemical normalization remains the standard; results require cautious interpretation due to study limitations (small sample size, single center).