Thyroidectomy using local anesthesia in critically ill patients with amiodarone-induced thyrotoxicosis: a review and description of the technique.

Hyperthyroidism caused by amiodarone is a well-known and accepted side effect of therapy. This problem can frequently be treated by medical means if patients are stable. In some patients, particularly those who are critically ill with cardiac disease the addition of hyperthyroidism can be particularly detrimental. These patients present with an interesting paradox because they are frequently on amiodarone because of life-threatening arrhythmias not responsive to other regimens, yet the amiodarone can precipitate hyperthyroidism that can acutely worsen the progression of their disease and prevalence of arrhythmias. In these patients, prompt treatment of their hyperthyroidism by total thyroidectomy may be the best option. Unfortunately, this also raises another treatment paradox in that these patients are at particularly high risk for complications from general anesthesia. In this subset of patients, total thyroidectomy under local anesthesia may be the best treatment option. Herein, we present a review of amiodarone-induced hyperthyroidism and our technique and review of our experience in its management with total thyroidectomy performed under local anesthesia.