Frederic Mercier1, Mathieu Bonal1, Florian Fanget1, Laure Maillard1, Nathalie Laplace1, Jean-Louis Peix1, Jean-Christophe Lifante2,3. 1. The Department of Digestive and Endocrine Surgery, CHU Lyon Sud, Hospices Civils de Lyon, University of Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France. 2. The Department of Digestive and Endocrine Surgery, CHU Lyon Sud, Hospices Civils de Lyon, University of Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France. jean-christophe.lifante@chu-lyon.fr. 3. EA 7425 HESPER, Health Services and Performance Research, Université Claude Bernard Lyon 1, Domaine Rockefeller- 4eme étage (aile CD), 8 Avenue Rockefeller, 69373, Lyon 8, France. jean-christophe.lifante@chu-lyon.fr.
Abstract
BACKGROUND: Total thyroidectomy can be performed for Graves' disease after a euthyroid state is achieved using inhibitors of thyroid hormone synthesis (thioamides). However, hypervascularization of the thyroid gland is associated with increased hemorrhage risk, in addition to complicating identification of the recurrent laryngeal nerve and parathyroid gland. Saturated iodine solution (Lugol's solution) has been recommended to reduce thyroid gland hypervascularization and intraoperative blood loss, although this approach is not used at our center based on our experience that it induces thyroid firmness and potentially hypoparathyroidism. METHODS: This retrospective single-center study evaluated patients who underwent total thyroidectomy for Graves' disease between November 2010 and November 2015. The rates of various complications at our center were compared to those from the literature (e.g., cervical hematoma, hypocalcemia, and recurrent laryngeal nerve palsy). RESULTS: Three hundred and eighty consecutive patients underwent total thyroidectomy without preoperative Lugol's solution (311 women [81.84%] and 69 men [18.16%], mean age 43.41 years). No postoperative deaths were reported, although 30 patients (7.89%) experienced recurrent laryngeal nerve palsy and 9 patients experienced permanent injuries (2.37%). Hypoparathyroidism was experienced by 87 patients (25.53%) and 14 patients experienced permanent hypoparathyroidism (3.68%). Four patients required reoperation for cervical hematoma (1.05%; 2 deep and 2 superficial hematomas). CONCLUSION: Despite the recommendation of iodine pretreatment, few of our non-pretreated patients experienced permanent nerve injury (2.37%) or permanent hypoparathyroidism (3.68%). These results are comparable to the outcomes from the literature. Randomized controlled trials are needed to determine whether iodine pretreatment is necessary before surgery for Graves' disease.
BACKGROUND: Total thyroidectomy can be performed for Graves' disease after a euthyroid state is achieved using inhibitors of thyroid hormone synthesis (thioamides). However, hypervascularization of the thyroid gland is associated with increased hemorrhage risk, in addition to complicating identification of the recurrent laryngeal nerve and parathyroid gland. Saturated iodine solution (Lugol's solution) has been recommended to reduce thyroid gland hypervascularization and intraoperative blood loss, although this approach is not used at our center based on our experience that it induces thyroid firmness and potentially hypoparathyroidism. METHODS: This retrospective single-center study evaluated patients who underwent total thyroidectomy for Graves' disease between November 2010 and November 2015. The rates of various complications at our center were compared to those from the literature (e.g., cervical hematoma, hypocalcemia, and recurrent laryngeal nerve palsy). RESULTS: Three hundred and eighty consecutive patients underwent total thyroidectomy without preoperative Lugol's solution (311 women [81.84%] and 69 men [18.16%], mean age 43.41 years). No postoperative deaths were reported, although 30 patients (7.89%) experienced recurrent laryngeal nerve palsy and 9 patients experienced permanent injuries (2.37%). Hypoparathyroidism was experienced by 87 patients (25.53%) and 14 patients experienced permanent hypoparathyroidism (3.68%). Four patients required reoperation for cervical hematoma (1.05%; 2 deep and 2 superficial hematomas). CONCLUSION: Despite the recommendation of iodine pretreatment, few of our non-pretreated patients experienced permanent nerve injury (2.37%) or permanent hypoparathyroidism (3.68%). These results are comparable to the outcomes from the literature. Randomized controlled trials are needed to determine whether iodine pretreatment is necessary before surgery for Graves' disease.
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