The preoperative thyroid function and perioperative course in patients with Graves’ disease

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  • Yamanouchi Kosho
    Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences Department of Surgery, Nagasaki Medical Center, National Hospital Organization
  • Kuba Sayaka
    Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Sakimura Chika
    Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Morita Michi
    Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Hayashida Naomi
    Division of Strategic Collaborative Research, Center for Promotion of Collaborative Research on Radiation and Environment Health Effects, Atomic Bomb Disease Institute
  • Kanetaka Kengo
    Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Takatsuki Mitsuhisa
    Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Eguchi Susumu
    Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences

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Graves’ disease is an autoimmune disorder that induces increase in thyroid hormone production and release. Although euthyroid should be desirable to ensure a safe operation, some patients still undergo thyroidectomy with hyperthyroidism. The aim of this study was to evaluate our preoperative strategies in patients with Graves’ disease. A total of 186 patients underwent thyroidectomy for Graves’ disease between 2003 and 2017. We gave all of these patients potassium iodide (KI) in order to decrease their thyroid hormone levels. We compared the clinical factors among three groups defined by the value of serum free triiodothyronine (FT3) after the administration of KI: (1) the good control group (n=126) with ≤ 6.0 pg/mL, (2) the fair control group (n=35) with > 6.0 but ≤ 10.0 pg/mL, and (3) the poor control group (n=25) with > 10.0 pg/mL. KI decreased the serum levels of thyroid hormone. However, some patients still had hyperthyroidism, and the subsequent administration of corticosteroid reduced FT3 but not thyroxine. Regarding the intraoperative course, the heart rate at 1 h after beginning general anesthesia was higher in the poor control group than in the good control group (p < 0.05), and the proportion of patients given adrenergic beta-blocker was higher in the poor control group than in the other groups (p < 0.01 each). One patient in the fair control group experienced suspected thyroid storm after total thyroidectomy. The occurrence rate of other deteriorations was identical among the three groups. With preparative KI and corticosteroid administration, almost all patients with Graves’ disease were able to undergo thyroidectomy safely.

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