title: Total Thyroidectomy for Amiodarone-induced Thyrotoxicosis in the Hyperthyroid State.
abstract: Amiodarone is a potent antiarrhythmic agent, indicated for the treatment of refractory arrhythmias, which may lead to thyrotoxicosis. In these patients, thyroidectomy is a valid therapeutic option. Antithyroid therapy in the immediate preoperative setting and the subsequently accepted minimal delay until thyroidectomy have not been clearly defined yet. The aim of the present study was to show, that total thyroidectomy under general anaesthesia in patients with amiodarone-induced thyrotoxicosis (AIT) is safe without necessarily obtaining an euthyroid state preoperatively.We conducted a retrospective cohort study of prospectively gathered data on 11 patients undergoing total thyroidectomy under general anaesthesia between January 2008 and December 2013 for AIT at our University Hospital.All patients were preoperatively treated with carbimazole, steroids and β-receptor antagonists. Additionally, 3 patients received potassium perchlorate and in one patient carbimazole was changed to propylthiouracil. Plasmapheresis was performed in 3 patients. Only one patient was euthyroid at the time of operation. There were no significant intra- and postoperative complications, especially no signs of thyroid storm. One patient could postoperatively be removed from the cardiac transplant waiting list due to improved cardiac function.Improvements in the interdisciplinary surgical management for AIT between cardiologists, endocrinologists, anaesthetists and endocrine surgeons provide the basis of safe total thyroidectomy under general anaesthesia in hyperthyroid state. Early surgery without long delay for medical antithyroid treatment (with its potential negative side effects) is recommended.
authors.affiliation: Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: R M
authors.initials: RM
authors.lastname: Kaderli
authors.affiliation: Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Fahrner
authors.affiliation: Division of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: E R
authors.initials: ER
authors.lastname: Christ
authors.affiliation: Division of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Stettler
authors.affiliation: Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Fuhrer
authors.affiliation: Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Martinelli
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Vogt
authors.affiliation: Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: C A
authors.initials: CA
authors.lastname: Seiler
mesh_terms: D000328:Adult; D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012189:Retrospective Studies; D013965:Thyroidectomy; D013971:Thyrotoxicosis / Q000097:blood / Q000139:chemically induced / Q000628:therapy
chemical_list: D000638:Amiodarone