Intraoperative Hemodynamics of Hyperthyroidism: Controlled versus Uncontrolled Graves Disease

Area of Science:

• Endocrinology
• Surgical Oncology
• Anesthesiology

Background:

• Previous research indicates high-volume endocrine surgeons can safely perform total thyroidectomy on hyperthyroid patients without preoperative normalization of thyroid levels.
• This study investigates perioperative hemodynamic management in hyperthyroid patients undergoing thyroidectomy.

Purpose of the Study:

• To characterize perioperative hemodynamic management in hyperthyroid patients undergoing thyroidectomy.
• To inform clinical decision-making and risk mitigation strategies for this patient population.

Main Methods:

• Retrospective review of 242 patients undergoing thyroidectomy for hyperthyroidism (December 2016-January 2024).
• Patients stratified into euthyroid and hyperthyroid groups based on preoperative laboratory values.
• Comparison of intraoperative heart rate, blood pressure, and antihypertensive medication use.

Main Results:

• Hyperthyroid patients (23.1%) had higher intraoperative heart rates (110 vs. 101 bpm) and increased need for antihypertensives (56.8% vs. 22.7%).
• No significant differences in blood pressure trends, steroid/vasopressor use, arrhythmias, or blood loss were observed.
• No patients developed thyroid storm.

Conclusions:

• Hyperthyroid patients undergoing thyroidectomy experience higher heart rates and require more antihypertensives but face no increased perioperative risk.
• Thyroidectomy can be safely performed on hyperthyroid patients with careful intraoperative monitoring, without requiring biochemical euthyroidism.