Jason M Gauthier1, Hossam Eldin Mohamed2, Salem I Noureldine3, Timo Z Nazari-Shafti4, Tina K Thethi5,6, Emad Kandil2. 1. Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. 2. Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana. 3. Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 4. Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, Texas. 5. Division of Endocrinology, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana. 6. Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS: Graves' disease (GD) has multiple adverse effects on the cardiovascular system. We aimed to examine the outcome of thyroidectomy in patients with cardiac manifestations of GD and evaluate their associated postoperative complications. STUDY DESIGN: Retrospective analysis using a prospectively collected database. METHODS: A retrospective analysis of our prospectively collected thyroid surgery database was performed. Forty patients with hyperthyroidism due to GD were identified, and each was appropriately age matched to a euthyroid patient with multinodular goiter (MNG). All patients underwent total thyroidectomy. Data relating to cardiac comorbidities were collected from preoperative and postoperative clinic notes, hospital admissions, electrocardiograms, echocardiograms, and blood work. Perioperative biochemical, cardiovascular, and postoperative outcomes were analyzed. RESULTS: Twenty-four (60%) GD patients and 14 (35.0%) MNG patients had cardiac manifestations (P = .001). Hypertension resolved in 41.7% of GD patients and 7.7% of MNG patients (P = .00002). Two of the three GD patients with congestive heart failure (CHF) had resolution of CHF with significant improvement in ejection fraction, whereas the one MNG patient with CHF saw no change. Additionally, the majority of GD patients saw a resolution of their tachycardia (68.8%) and atrial fibrillation (100%). Four postoperative complications occurred in both the GD and MNG groups (4/40, 10%). CONCLUSIONS: Surgical treatment of GD in patients with cardiac manifestations offers rapid clinical improvement of hypertension, impaired left ventricular systolic function, and arrhythmias. When performed by a high-volume surgeon, the complication rate is similar to thyroidectomy for other benign disease. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1256-1259, 2016.
OBJECTIVES/HYPOTHESIS: Graves' disease (GD) has multiple adverse effects on the cardiovascular system. We aimed to examine the outcome of thyroidectomy in patients with cardiac manifestations of GD and evaluate their associated postoperative complications. STUDY DESIGN: Retrospective analysis using a prospectively collected database. METHODS: A retrospective analysis of our prospectively collected thyroid surgery database was performed. Forty patients with hyperthyroidism due to GD were identified, and each was appropriately age matched to a euthyroid patient with multinodular goiter (MNG). All patients underwent total thyroidectomy. Data relating to cardiac comorbidities were collected from preoperative and postoperative clinic notes, hospital admissions, electrocardiograms, echocardiograms, and blood work. Perioperative biochemical, cardiovascular, and postoperative outcomes were analyzed. RESULTS: Twenty-four (60%) GDpatients and 14 (35.0%) MNG patients had cardiac manifestations (P = .001). Hypertension resolved in 41.7% of GDpatients and 7.7% of MNG patients (P = .00002). Two of the three GDpatients with congestive heart failure (CHF) had resolution of CHF with significant improvement in ejection fraction, whereas the one MNG patient with CHF saw no change. Additionally, the majority of GDpatients saw a resolution of their tachycardia (68.8%) and atrial fibrillation (100%). Four postoperative complications occurred in both the GD and MNG groups (4/40, 10%). CONCLUSIONS: Surgical treatment of GD in patients with cardiac manifestations offers rapid clinical improvement of hypertension, impaired left ventricular systolic function, and arrhythmias. When performed by a high-volume surgeon, the complication rate is similar to thyroidectomy for other benign disease. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1256-1259, 2016.
Authors: Narcis Tribulova; Lin Hai Kurahara; Peter Hlivak; Katsuya Hirano; Barbara Szeiffova Bacova Journal: Int J Mol Sci Date: 2020-04-19 Impact factor: 5.923