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.
Key words
total thyroidectomy - amiodarone-induced thyrotoxicosis - hyperthyroidism - interdisciplinary
management
