Combination of minimally invasive thyroid surgery and local anesthesia associated to iopanoic acid for patients with amiodarone-induced thyrotoxicosis and severe cardiac disorders: a pilot study.
OBJECTIVE
Amiodarone-induced thyrotoxicosis is a life-threatening condition. A prompt control of thyrotoxicosis is obtained by thyroidectomy. Preparation with iopanoic acid proved to be very effective in reducing cardiovascular complications. Nevertheless, general anesthesia and extensive surgery may affect negatively patients also after adequate preparation. Safety and efficacy of minimally invasive video-assisted thyroidectomy performed under regional anesthesia (bilateral modified deep cervical block) in patients with amiodarone-induced thyrotoxicosis was evaluated.


METHODS
Eight patients with amiodarone-induced thyrotoxicosis (three with type I and five with type II), mean age 66.2 years, were prepared with iopanoic acid. There were five men and three women. Three patients had dilatative cardiomyopathy, three had heart failure secondary to severe myocardial infarction, and two had refractory unstable rhythm disorders.


RESULTS
Minimally invasive video-assisted thyroidectomy was performed under regional anesthesia. Mean operative time was 55.5 min. During surgery, lung and heart function remained well and no surgical complications occurred. After surgery, all patients remained on amiodarone therapy and two patients were subsequently removed from the checklist for heart transplantation.


CONCLUSIONS
Minimally invasive video-assisted thyroidectomy under regional anesthesia can be proposed as resolution of amiodarone-induced thyrotoxicosis in high risk patients with severe cardiac disorders, after preparation with iopanoic acid.
Berti
Piero
P
Department of General Surgery, University of Pisa, Pisa, Italy.
Materazzi
Gabriele
G
Bogazzi
Fausto
F
Ambrosini
Carlo Enrico
CE
Martino
Enio
E
Miccoli
Paolo
P
D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use / Q000633:toxicity*; D000772:Anesthesia, Local; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use / Q000633:toxicity*; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000188:drug therapy; D001340:Autonomic Nerve Block; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000188:drug therapy; D005260:Female; D006044:Goiter, Nodular / Q000097:blood / Q000139:chemically induced* / Q000601:surgery*; D006305:Health Status Indicators; D006331:Heart Diseases / Q000150:complications* / Q000188:drug therapy*; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007480:Iopanoic Acid / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy; D011292:Premedication; D013965:Thyroidectomy / Q000379:methods*; D013971:Thyrotoxicosis / Q000097:blood / Q000139:chemically induced* / Q000601:surgery*; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood; D020535:Video-Assisted Surgery / Q000379:methods*
D000889:Anti-Arrhythmia Agents; D014284:Triiodothyronine; D007480:Iopanoic Acid; D000638:Amiodarone; D013974:Thyroxine