scholarly journals Comparison of Intra-Operative Vital Sign Changes during Total Thyroidectomy in Patients with Controlled and Uncontrolled Graves’ Disease

2018 ◽  
Vol 7 (12) ◽  
pp. 566
Author(s):  
Hyeong Yu ◽  
In Bae ◽  
Su-jin Kim ◽  
Young Chai ◽  
Jae Moon ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Total Thyroidectomy ◽  
Vital Sign ◽  
Operation Time ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Free T4 ◽  
Sign Changes ◽  
The Mean

Thyroid storm (TS) is a life-threatening emergency endocrine condition. Thyroid hormones should be normalized before thyroidectomy is performed in patients with Graves’ disease. However, thyroid hormone levels are inevitably high in patients undergoing surgery. This study analyzed differences in vital sign changes during thyroidectomy between patients with controlled and uncontrolled Graves’ disease and assessed thyroid hormone cutoffs for TS. Preoperative levels of the thyroid hormones free T4 (FT4), T3, and thyroid stimulating hormone (TSH) were retrospectively analyzed in patients who underwent total thyroidectomy for Graves’ disease. Patients were divided into those with uncontrolled Graves’ (UG) disease, defined as preoperative TSH <0.3 µIU/mL and FT4 >1.7 ng/dL, those with controlled Graves’ (CG) disease, those with extremely uncontrolled Graves’ (EUG) disease, defined as TSH <0.3 µIU/mL and FT4 >3.4 ng/dL, and finally, those without EUG (non-EUG). The 29 patients with Graves’ disease included 12 with CG group and 17 with UG. FT4 and T3 concentrations were significantly higher in the UG group. There were no differences in vital sign and anesthetic agent. These 29 patients could also be divided into those with (n = 4) and without EUG (n = 25). The mean age was lower (21.5 vs. 40.9 years, p < 0.001) and the mean operation time was shorter (121.4 vs. 208.8 min, p = 0.003) in the EUG group. Requirements for anesthetic agents were greater in the EUG group. Mean FT4 concentration in the EUG group was 3.8 ng/dL, and there were no changes in vital signs during surgery. Vital sign change during thyroid surgery was not observed in patients with uncontrolled Graves’ disease up to the twice upper normal limit of T4 level.

scholarly journals SUN-509 Plasmapheresis Treatment of Thyrotoxicosis in Pregnancy for Preparation of Thyroidectomy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Mohamad Hosam Horani ◽  
Ryan M Brooks ◽  
Bianca Vazques ◽  
Robert Arashahi ◽  
Mustapha Khan
Keyword(s):  
Alkaline Phosphatase ◽  
Thyroid Hormone ◽  
Total Thyroidectomy ◽  
Hormone Replacement ◽  
Cardiac Activity ◽  
First Trimester ◽  
Thyroid Storm ◽  
Free T4 ◽  
Elevated Alkaline Phosphatase ◽  
In Pregnancy

Abstract Introduction: Thyrotoxicosis in pregnancy presents the challenge of maintaining a normal level of maternal free thyroid hormone, while minimizing adverse drug effects, obstetric complications, and the risk fetal hypothyroidism. Propylthiouracil is used for treatment in the first trimester with thyroidectomy typically performed in the second trimester if PTU/ MTZ are intolerable or if thyrotoxicosis persists. When thyroidectomy is indicated, thyroid hormone levels must be normalized prior to the operation, as there is risk of thyroid storm that can occur during and up to several hours postoperatively. In such cases, preoperative plasmapheresis may be considered. Case Presentation: We present a 24 year old G2P0101 Hispanic female who reported to the ED with throat pain, chills, tachycardia, and shortness of breath who was found to have a TSH less than 0.005, free T4 3.15, elevated alkaline phosphatase, and an incidentally discovered early pregnancy approximately 4 - 6 weeks gestation. Medical history includes hyperthyroidism with over ten hospitalizations for thyrotoxicosis within the last three years and preterm delivery during her first pregnancy. A recent thyroid biopsy in 2017 showed a benign multinodular goiter. She had been taking methimazole and current CT of the neck demonstrated marked thyroid goiter with mild tracheal narrowing and mild tonsillitis. She was discharged on propylthiouracil 100 mg TID, metoprolol 25 mg TID, and augmentin 875 mg BID with the goal of decreasing her free T4 and T3 in preparation for thyroidectomy. Four days later, the patient returned to the ED with similar symptoms. Labs revealed TSH 0.001, free T4 3.70, FreeT3 15.1 WBC 3.1, platelets 103, and elevated total bilirubin, transaminases, and alkaline phosphatase. EKG demonstrated sinus tachycardia with minimal diffuse ST depression. Ultrasound showed a 0.34 cm round hypoechoic focus in the endometrial cavity without a fetal pole or cardiac activity. Chest X-ray demonstrated minor bibasilar atelectasis. The patient was admitted and PTU was discontinued due to leukopenia and elevated transaminases. Dexamethasone was started and metoprolol was continued. Total thyroidectomy was planned for when free T4 less 2.0 The patient received two treatments of plasmapheresis, which decreased free T4 to 2.11 and then to 1.40. The thrombocytopenia and transaminitis resolved A total thyroidectomy was performed and well tolerated. patient had full term pregnancy, uneventful delivery while on thyroid hormone replacement. Conclusion : Preoperative plasmapheresis can be considered for the normalization of free T4 if thionamides fail or cannot be tolerated. This case demonstrates the successful management of thyrotoxicosis with plasmapheresis in the first trimester of pregnancy.to Our knowledge Plasmapheresis was not used before in Pregnancy in preparation for thyroidectomy.

scholarly journals Rescue pre-operative treatment with Lugol’s solution in uncontrolled Graves’ disease

2017 ◽  
Vol 6 (4) ◽  
pp. 200-205 ◽  
Author(s):  
Jan Calissendorff ◽  
Henrik Falhammar
Keyword(s):  
Heart Rate ◽  
Thyroid Hormone ◽  
Side Effects ◽  
Definitive Treatment ◽  
Graves Disease ◽  
Free T4 ◽  
Hormone Levels ◽  
Free T3 ◽  
Adherence To Medication ◽  
Thyroid Hormone Levels

Background Graves’ disease is a common cause of hyperthyroidism. Three therapies have been used for decades: pharmacologic therapy, surgery and radioiodine. In case of adverse events, especially agranulocytosis or hepatotoxicity, pre-treatment with Lugol’s solution containing iodine/potassium iodide to induce euthyroidism before surgery could be advocated, but this has rarely been reported. Methods All patients hospitalised due to uncontrolled hyperthyroidism at the Karolinska University Hospital 2005–2015 and treated with Lugol’s solution were included. All electronic files were carefully reviewed manually, with focus on the cause of treatment and admission, demographic data, and effects of iodine on thyroid hormone levels and pulse frequency. Results Twenty-seven patients were included. Lugol’s solution had been chosen due to agranulocytosis in 9 (33%), hepatotoxicity in 2 (7%), other side effects in 11 (41%) and poor adherence to medication in 5 (19%). Levels of free T4, free T3 and heart rate decreased significantly after 5–9 days of iodine therapy (free T4 53–20 pmol/L, P = 0.0002; free T3 20–6.5 pmol/L, P = 0.04; heart rate 87–76 beats/min P = 0.0007), whereas TSH remained unchanged. Side effects were noted in 4 (15%) (rash n = 2, rash and vomiting n = 1, swelling of fingers n = 1). Thyroidectomy was performed in 26 patients (96%) and one was treated with radioiodine; all treatments were without serious complications. Conclusion Treatment of uncontrolled hyperthyroidism with Lugol’s solution before definitive treatment is safe and it decreases thyroid hormone levels and heart rate. Side effects were limited. Lugol’s solution could be recommended pre-operatively in Graves’ disease with failed medical treatment, especially if side effects to anti-thyroid drugs have occurred.

scholarly journals A Brief Exposure to Moderate Passive Smoke Increases Metabolism and Thyroid Hormone Secretion

2007 ◽  
Vol 92 (1) ◽  
pp. 208-211 ◽  
Author(s):  
Giorgos S. Metsios ◽  
Andreas D. Flouris ◽  
Athanasios Z. Jamurtas ◽  
Andres E. Carrillo ◽  
Demetrios Kouretas ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Passive Smoking ◽  
Repeated Measures ◽  
Hormone Secretion ◽  
Free T4 ◽  
Hormone Levels ◽  
Urine Cotinine ◽  
The Mean ◽  
Thyroid Hormone Levels ◽  
Serum And Urine

Abstract Context: Active smoking influences normal metabolic status and thyroid function. Objective: The objective was to assess experimentally the effects of 1 h of moderate passive smoking in a controlled simulated bar/restaurant environment on the metabolism and thyroid hormone levels in healthy nonsmokers. Participants: Eighteen (nine females, nine males) healthy individuals (mean ± sd: age, 25.3 ± 3.1 yr; height, 174.0 ± 10.1 cm; weight, 65.2 ± 13.7 kg) participated in the study. Design: In repeated-measures randomized blocks, participants visited the laboratory on 2 consecutive days. In the experimental condition, they were exposed to 1 h of moderate passive smoking at a carbon monoxide concentration of 23 ± 1 ppm in an environmental chamber, whereas in the control condition participants remained in the same chamber for 1 h breathing normal atmospheric air. Main Outcome Measures: In both conditions, cotinine serum and urine levels, resting energy expenditure (REE), as well as concentration of T3, free T4, and TSH were assessed before participants entered the chamber and immediately after their exit. Heart rate and blood pressure were tested in 10-min intervals during all REE assessments. Results: The mean ± sd difference of serum and urine cotinine levels (−0.27 ± 3.94 vs. 14.01 ± 6.54 and 0.05 ± 2.07 vs. 7.23 ± 3.75, respectively), REE (6.73 ± 98.06 vs. 80.58 ± 120.91) as well as T3 and free T4 (0.05 ± 0.11 vs. 0.13 ± 0.12 and 0.02 ± 0.15 vs. 0.22 ± 0.20) were increased in the experimental compared with the control condition at baseline and follow-up (P &lt; 0.05). No statistically significant variation was observed in the mean difference of the remaining parameters (P &gt; 0.05). Serum and urine cotinine values were linearly associated with REE (P &lt; 0.05). Conclusion: One hour of passive smoking at bar/restaurant levels is accompanied by significant increases in metabolism and thyroid hormone levels.

scholarly journals A Patient with Graves’ Disease Scheduled for Thyroidectomy with High Risk for Thyroid Storm Caused by Severe Medication Nonadherence: Anaesthetic and Surgical Considerations

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Adrian Reber ◽  
Laura Valenti ◽  
Stephan Müller
Keyword(s):  
Case Report ◽  
High Risk ◽  
Total Thyroidectomy ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Hormone Regulation ◽  
Medication Nonadherence ◽  
Organ Complications

In patients with failed hormone regulation who are scheduled for indispensable total thyroidectomy, the risk of thyroid storm with severe end-organ complications has to be anticipated. This case report presents the successful surgical and anaesthesiological management of a patient with Graves’ disease, without any signs of perioperative thyroid storm. Possible recommendations for treatment are presented.

Thyroid hormone concentrations in the plasma of fed and fasted Brahman and Hereford steers

1994 ◽  
Vol 34 (4) ◽  
pp. 439
Author(s):  
JC O'Kelly ◽  
WG Spiers
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Plasma Concentrations ◽  
Free T4 ◽  
Rumen Metabolism ◽  
Body Tissues ◽  
Breed Differences ◽  
Feeding Regimes ◽  
Ad Libitum ◽  
Brahman Steers

Plasma concentration patterns of thyroxine (TJ, free T4 (FT4), triiodothyronine (T3), and free T3 (FT3) were determined in Brahman steers fed lucerne hay ad libitum and in Brahman and Hereford steers fed restricted intakes of lucerne hay at the rate of either 208 g/h before fasting for 72 h or 250 g/h before fasting for 96 h. In Brahmans fed ad libitum, the plasma concentrations of all thyroid hormone fractions were significantly (P<0.01) correlated with one another and with feed intake. Within breeds, the concentrations of thyroid hormones were higher (P<0.001) when animals were fed at 250 g k than at 208 g/h. During both hourly feeding regimes T4, FT4, T3, and FT3 concentrations were higher (P<0.001) in Brahmans than in Herefords. Fasting after both hourly feeding regimes lowered (P<0.001) the concentrations of T4 about 53% in Brahmans and 30% in Herefords, while FT4, T3, and FT3 were lowered about 68% in Brahmans and 50% in Herefords. Consequently, thyroid hormone concentrations were significantly lower in Brahmans than in Herefords after 72 h fasting but did not differ significantly between breeds after 96 h fasting. The present results, together with those of our previous work showing breed differences in rumen metabolism, support the concept that, in Hereford and Brahman steers fed the same amount of hay in a thermoneutral environment, breed differences in plasma concentrations of thyroid hormones originate from quantitative differences in the supply of nutrients from the rumen to body tissues.

scholarly journals Emergent thyroidectomy with sternotomy due to acute respiratory failure with severe thyroid storm

2018 ◽  
Vol 100 (8) ◽  
pp. e223-e225
Author(s):  
A Matsushita ◽  
S Hosokawa ◽  
D Mochizuki ◽  
J Okamura ◽  
K Funai ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Airway Obstruction ◽  
Total Thyroidectomy ◽  
Upper Airway ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Nasal Intubation ◽  
Threatening Condition ◽  
Life Threatening

Huge cervical and mediastinal masses may lead to acute respiratory failure caused by laryngotracheal compression and airway obstruction. Thyroid storm is also a life-threatening endocrine emergency originating almost exclusively from uncontrolled Graves’ disease. We report a case of a 42-year-old man with acute upper airway obstruction and tachycardia from progressive swelling of a giant thyroid, in conjunction with thyroid storm resulting from uncontrolled Graves’ disease. Fibreoptic-assisted nasal intubation was performed while the patient was awake, immediately followed by emergency total thyroidectomy via a cervical and sternal approach. The patient had an uneventful postoperative course and recovered well. Respiratory failure due to swelling of a giant thyroid is a life-threatening condition and should be treated immediately with endotracheal intubation while the patient is awake following emergent total thyroidectomy, even with a sternotomy.

scholarly journals THERAPEUTIC PLASMA EXCHANGE AS A BRIDGE TO TOTAL THYROIDECTOMY IN PATIENTS WITH SEVERE THYROTOXICOSIS

2020 ◽  
Vol 6 (1) ◽  
pp. e14-e18
Author(s):  
Kelsey Tieken ◽  
Ameena Madan Paramasivan ◽  
Whitney Goldner ◽  
Ana Yuil-Valdes ◽  
Abbey L. Fingeret
Keyword(s):  
Total Thyroidectomy ◽  
Plasma Exchange ◽  
Medical Management ◽  
Response To Therapy ◽  
Therapeutic Plasma Exchange ◽  
Thyroid Storm ◽  
Antithyroid Drugs ◽  
Average Percentage ◽  
The Mean ◽  
Definitive Management

Objective: Graves disease is the most common cause of thyrotoxicosis. Medical management is the first-line treatment but may be contraindicated or ineffective. In patients with severe, refractory thyrotoxicosis therapeutic plasma exchange (TPE) may be indicated as a bridge to thyroidectomy. Methods: We present 3 cases of thyrotoxicosis refractory to medical management that were successfully treated with TPE and subsequent total thyroidectomy, and provide an analysis of the response to therapy via a change in free thyroxine (fT4) levels throughout their treatment course. Results: The average change in fT4 per liter of fluid exchanged was 0.37 ng/dL (SD = 0.08) and the average percentage change of fT4 after each treatment was 20.7% (SD = 8.28). The mean decrease in fT4 after 4 TPE treatments was 57.4%. All patients successfully underwent total thyroidectomy without complication and were discharged from the hospital. Conclusion: TPE should be considered for thyrotoxic patients with severe hyperthyroidism or thyroid storm refractory to medical management or contraindications to antithyroid drugs who need a bridge to total thyroidectomy. In these cases, TPE was a safe and effective treatment that enabled definitive management with thyroidectomy and may be considered in other patients with severe refractory hyperthyroidism or thyrotoxicosis.

Autoantibodies to thyroxin and triiodothyronine in the immunoglobulin G fraction of serum.

1988 ◽  
Vol 34 (12) ◽  
pp. 2561-2562 ◽  
Author(s):  
L Li Calzi ◽  
S Benvenga ◽  
S Battiato ◽  
F Santini ◽  
F Trimarchi
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Human Serum ◽  
Immunoglobulin G ◽  
Subacute Thyroiditis ◽  
Total Serum ◽  
Graves Disease ◽  
Carrier Proteins ◽  
Weak Binding ◽  
Idiopathic Myxedema

Abstract Thyroid hormone antibodies (THAbs)--i.e., antibodies to thyroxin (T4) and triiodothyronine (T3)--are detected rarely in human serum, where they are searched for, possibly because of a quantitatively minimal interaction between thyroid hormones (the haptens) and serum IgGs (the antibodies). The weak binding could result from these facts: (a) there are already six physiological carrier proteins for thyroid hormones; (b) THAbs usually account for a very small fraction of the total serum IgGs; (c) THAbs may have--as reported in the literature--a relatively low affinity. To ascertain whether THAbs could pass undetected in serum, we measured antibodies to T3 and T4 in both the serum and the corresponding IgG fraction of six normal persons and 45 patients with various thyroid diseases (Graves' disease, idiopathic myxedema, Hashimoto's thyroiditis, subacute thyroiditis, tumors), using radioimmunoprecipitation. The prevalence of antibodies to T4 was 0/51 in both the sera and the IgG fractions; the prevalence of antibodies to T3 was 1/51 in both materials. Because all of the sera that tested THAb negative were confirmed to be so in the THAb assay of the IgG fraction, we conclude that the prevalence of serum THAbs is not underestimated and that autoimmunization against thyroid hormones is really a rare phenomenon.

scholarly journals Dendritic cells produce interleukin-12 in hyperthyroid mice

1999 ◽  
pp. 625-629 ◽  
Author(s):  
M Tamura ◽  
B Matsuura ◽  
S Miyauchi ◽  
M Onji
Keyword(s):  
Dendritic Cells ◽  
Thyroid Hormone ◽  
Mouse Model ◽  
Thyroid Hormones ◽  
Normal Subjects ◽  
Interleukin 12 ◽  
Graves Disease ◽  
Hyperthyroid State ◽  
Thyroid Glands

We previously reported that serum interleukin-12 (IL-12) levels were significantly increased in patients with hyperthyroid Graves' disease and in normal subjects after administration of thyroid hormone. In the present study, we investigated which cells produce IL-12 and the interactions between IL-12 and thyroid hormones, using a hyperthyroid mouse model. Thyroid hormones induced IL-12 production, and IL-12 was mainly produced by dendritic cells outside the thyroid glands in a hyperthyroid state.

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