title: Total thyroidectomy for amiodarone-associated thyrotoxicosis: should surgery always be delayed for pre-operative medical preparation?
abstract: OBJECTIVE
  Amiodarone can induce severe hyperthyroidism that justifies its withdrawal and the introduction of antithyroid drugs. Continuing amiodarone use, failure to control hyperthyroidism and poor clinical progress may require thyroidectomy. This study aimed to evaluate patients' post-operative development and mid-term outcome after thyroidectomy for amiodarone-associated thyrotoxicosis.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Tertiary care centre.
  
  
  METHODS
  We prospectively collected cases of amiodarone-associated thyrotoxicosis requiring thyroidectomy due to failure of antithyroid treatment, despite amiodarone discontinuation. Post-thyroidectomy complications were compared immediately, 30 days and one year post-operatively, and also for scheduled versus emergency surgery cases.
  
  
  RESULTS
  Of 11 total cases, nine scheduled thyroidectomy cases had no morbidity after elective surgery. Two cases required emergency surgery for multiple organ failure and cardiac problems. Immediate post-operative complications (mostly haemodynamic) occurred in both cases (emergency vs routine surgery, p = 0.018).
  
  
  CONCLUSIONS
  In such cases, pre-operative medical treatment is vital to limit peri- and post-operative complications, but surgery should not be delayed if the haemodynamic status deteriorates. Surgery, with careful anaesthesia, is the cornerstone of the treatment.
authors.affiliation: Department of Visceral and Vascular Surgery, Military Hospital Val-de-Grâce, Paris, France. charlespierret@laposte.net
authors.forename: C
authors.initials: C
authors.lastname: Pierret
authors.forename: J-P
authors.initials: JP
authors.lastname: Tourtier
authors.forename: Y
authors.initials: Y
authors.lastname: Pons
authors.forename: S
authors.initials: S
authors.lastname: Merat
authors.forename: V
authors.initials: V
authors.lastname: Duverger
authors.forename: E
authors.initials: E
authors.lastname: Perrier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D013956:Antithyroid Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D010472:Perchlorates / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology; D017680:Potassium Compounds / Q000627:therapeutic use; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013963:Thyroid Hormones / Q000378:metabolism; D013965:Thyroidectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D013971:Thyrotoxicosis / Q000139:chemically induced / Q000378:metabolism / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D013956:Antithyroid Agents; D005938:Glucocorticoids; D010472:Perchlorates; D017680:Potassium Compounds; D013963:Thyroid Hormones; C009006:potassium perchlorate; D000638:Amiodarone; D008775:Methylprednisolone