SUN-505 Total Thyroidectomy in Severe Hyperthyroidism

Abstract

Introduction: Patients with hyperthyroidism may be treated with ATDs, RAI therapy or thyroidectomy; in some cases like thyroid storm, plasmapheresis can be used to remove excess hormones prior to surgery. In some cases, such as those with complications derived from ATDs (agranulocytosis, hepatotoxicity), or those with large goiters with l symptomatic compression of surrounding organs within the neck, surgical treatment is considered. Clinical cases: Seven patients were treated with total thyroidectomy for the definitive control of the hyperthyroidism. Six were female, 4 used thionamides, 1 lithium and 2 discontinued treatment. All diffuse goiter (60-160 gr), 2 with autoimmune ophthalmopathy and, 4 had thyroid storm. The thyroid ultrasonography of thyroid evidenced hypoechogenicity and hypervascularity and in 4 cases tracheal compression. All patients had suppressed TSH and free T4 within 2,6-7,76 ng /dl (N: 0.7-1.7). Previous to surgery, six received glucocorticoids and beta-adrenergic blockade, five lugol solution, four thionamides (30-90mg/d), four lithium (3 with agranulocytosis) and two calcium with vitamin D. One patient received plasmapheresis which had a poorly response for thyroid storm treatment.After surgery 2presented hungry bone syndrome, two transient hypoparathyroidism and two permanent hypoparathyroidism. One patient was re-admitted for surgery. Pathological examination reported autoimmunity characteristics (cylindrical thyrocytes, vacuolated colloid, papillae formation and / or lymphocytic infiltrate) in 4 cases. In 3 cases, nodules were found without malignancy signs. Conclusions: Thyroidectomy is a definitive therapeutic option in severe hyperthyroidism with difficult management, particularly in those cases with contraindication to the use of thionamides, large goiters compromising the upper airway, because it leads to faster control of the hyperthyroid state. Hypocalcemia is a frequent postoperative complication that can be attenuated with the pre-operative vitamin D and calcium supplements.