Our Summary

This study looks at patients who had urgent surgery to remove their thyroid, a procedure called a thyroidectomy, due to a condition called thyrotoxicosis which is an excess of thyroid hormones in the body. The majority of these patients were female, Black, and had an average age of 41.

Most of these patients had very low or undetectable levels of a hormone that regulates the thyroid, and over a quarter of them were diagnosed with a severe form of thyrotoxicosis called thyroid storm. Many of these patients also had other serious health conditions such as heart and liver failure. Most of them were diagnosed with Graves’ disease, a common cause of an overactive thyroid.

The typical stay in hospital before surgery was about 8 days. The main reasons for surgery were bad reactions to medication, medications not working properly, and worsening heart failure.

After the surgery, a few patients needed another operation due to bleeding in the neck, some had temporary issues with their parathyroid glands which are located near the thyroid and help regulate calcium levels in the body, and some had voice changes.

However, half of the patients with a type of heart issue called atrial fibrillation saw improvements after surgery, and half of those with a specific type of heart failure also saw improvements.

Within a month of surgery, 20% of patients visited the emergency department but none because of complications from the thyroidectomy, and some were readmitted for other health issues. One patient died from liver failure.

The study concludes that patients who need an urgent thyroidectomy often have other serious, life-threatening health conditions, particularly heart disease. However, removing the thyroid can potentially help manage these conditions by restoring a more normal balance of hormones in the body.

FAQs

  1. What were the common comorbidities in patients who underwent urgent thyroidectomy in the study?
  2. What were the common indications for urgent thyroidectomy surgery in the study?
  3. What were the postoperative complications and outcomes in patients who underwent urgent thyroidectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about thyroidectomy is to closely follow postoperative instructions, including taking prescribed medications, attending follow-up appointments, and monitoring for any signs of complications such as hoarseness or neck swelling. It is important to communicate any concerns or changes in symptoms to your healthcare provider promptly to ensure a smooth recovery process.

Suitable For

Patients who are typically recommended for thyroidectomy include those with severe or life-threatening complications of hyperthyroidism, such as thyroid storm or heart failure. Other indications for thyroidectomy may include adverse reactions to medication, inadequate response to medical therapy, or worsening of comorbidities such as atrial fibrillation or liver failure. Patients who require urgent thyroidectomy often have significant comorbidities that may benefit from the surgical intervention, such as improved cardiac function or resolution of symptoms related to hyperthyroidism. It is important for these patients to be closely monitored postoperatively for potential complications and to ensure appropriate management of their underlying conditions.

Timeline

  • Before thyroidectomy:

  • Patient is diagnosed with thyrotoxicosis

  • Admitted to hospital nonelectively

  • Majority of patients are female and Black, with a mean age of 41

  • Undetectable thyrotropin levels and some diagnosed with thyroid storm

  • Common comorbidities include atrial fibrillation, heart failure, and liver failure

  • Graves’ disease diagnosed in majority of patients

  • Median hospital stay before surgery is 8 days

  • Indications for surgery include adverse medication events, inadequate therapeutic effect by medication, and worsening heart failure

  • After thyroidectomy:

  • Some patients require reoperation for neck hematoma

  • Temporary hypoparathyroidism and hoarseness may occur

  • Resolution of atrial fibrillation in 50% of patients

  • Improvement in heart failure with reduced ejection fraction in 50% of patients

  • 20% visit emergency department within 30 days, none due to thyroidectomy complications

  • 13.3% readmitted for comorbidities

  • One patient (3.3%) dies from liver failure

Overall, urgent thyroidectomy in patients with life-threatening comorbidities can potentially create clinical homeostasis for further management of their conditions.

What to Ask Your Doctor

  1. What is the reason for the urgency of the thyroidectomy in my case?
  2. What are the potential risks and complications associated with this procedure?
  3. How long will I need to stay in the hospital after the surgery?
  4. Will I need to take thyroid hormone replacement medication after the thyroidectomy?
  5. How will the surgery affect my current medications and comorbidities, such as heart failure or liver failure?
  6. What is the likelihood of experiencing temporary or permanent complications such as hoarseness or hypoparathyroidism?
  7. Will I need to follow up with a specialist or undergo additional treatments after the surgery?
  8. How will the surgery impact my current symptoms of thyrotoxicosis or thyroid storm?
  9. Are there any lifestyle changes or restrictions I should be aware of after the thyroidectomy?
  10. What is the long-term outlook for my thyroid health following the surgery?

Reference

Authors: Song Z, Akhund R, Wu C, Wang R, Lindeman B, Fazendin J, Gillis A, Chen H. Journal: World J Surg. 2024 Dec;48(12):2892-2898. doi: 10.1002/wjs.12312. Epub 2024 Aug 12. PMID: 39134403