Multi-disciplinary treatment of Graves’ disease with huge-size thyroid during peri-operative period_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Hongfeng ¹ , LIAO Quan ¹ , GAO Weisheng ¹ , XIE Yong ¹ , YANG Ning ² , LIAN Xiaolan ³ , ZHU Huijuan ³ , LI Xiaoyi ¹ ,  LIU Yuewu ¹

1. Department of General Surgery, Pekin Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P. R. China;
2. Department of Radiology, Pekin Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P. R. China;
3. Department of Endocrine, Pekin Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P. R. China;

Corresponding author：

LIU Yuewu, Email: liuyuewu615@vip.sina.com

Keywords：

Graves’ disease; huge-size thyroid; multi-disciplinary treatment; perioperative period

DOI：

10.7507/1007-9424.201806010

Video：

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Objective To explore the effect of multi-disciplinary treatment of the Graves’ disease (GD) with huge-size thyroid during perioperative period. Methods Retrospectively analyzed the clinical data of 8 GD patients with huge-size thyroid who got treatment in Pekin Union Medical College Hospital during Jan. 2006 to Dec. 2016. All patients underwent comprehensive preparation before operation and underwent total thyroidectomy. To explore the changes of thyroid function and culture after anti-thyroid drug (ATD)/iodine preparation/arterial embolization before operation, and to summarize situation of the bleeding loss intraoperation, neck-drainage, thyroid function, and relapses after operation. Results All cases got a satisfactory operation result after standard ATD, iodine preparation (Lugol’s solution 10–15 drops for 3–4 weeks, combined with ATDs for 2–3 weeks ), and main arterial embolization of thyroid in 24 h preoperation. They got shorter operative time (2.5–4.5 h), less bleeding intraoperation (4 cases≤100 mL), less neck-drainage, and almost normal retention time. No severe or permanent complications, for example thyroid storm, abnormal voice, and hypoparathyroid occurred. They were followed as outpatients for 18–133 months, and were found a perfect long-term effect without complication and relapse. Conclusions Perioperative period management is very important to those GD patients with huge-sized thyroid, and multi-disciplinary treatment can decrease theintraoperation bleeding, as well as occurrence of thyroid storm effectively. In addition, operated subtly during surgery can protect the recurrent laryngeal nerve and parathyroid effectively.

Citation： LIU Hongfeng, LIAO Quan, GAO Weisheng, XIE Yong, YANG Ning, LIAN Xiaolan, ZHU Huijuan, LI Xiaoyi, LIU Yuewu. Multi-disciplinary treatment of Graves’ disease with huge-size thyroid during peri-operative period. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(10): 1194-1200. doi: 10.7507/1007-9424.201806010 Copy

1.	Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid, 2016, 26(10): 1343-1421.
2.	Ventrella S, Klein I. Beta-adrenergic receptor blocking drugs in the management of hyperthyroidism. Endocrinologist, 1994, 4: 391-399.
3.	Tagami T, Yambe Y, Tanaka T, et al. Short-term effects of β-adrenergic antagonists and methimazole in new-onset thyrotoxicosis caused by Graves’ disease. Intern Med, 2012, 51(17): 2285-2290.
4.	朱预. 甲状腺功能亢进的外科治疗及展望. 中国实用外科杂志, 2006, 26(7): 485-486.
5.	吴维敏, 余书勇, 尹俊峰. Graves 病外科治疗应注意的几个问题. 中华内分泌外科杂志, 2009, 3(5): 332-335.
6.	Erbil Y, Ozluk Y, Giriş M, et al. Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves’ disease. J Clin Endocrinol Metab, 2007, 92(6): 2182-2189.
7.	Ansaldo GL, Pretolesi F, Varaldo E, et al. Doppler evaluation of intrathyroid arterial resistances during preoperative treatment with Lugol’s iodide solution in patients with diffuse toxic goiter. J Am Coll Surg, 2000, 191(6): 607-612.
8.	苏国森, 何友钊. 甲状腺功能亢进症围手术期处理与 T3、T4 变化的临床观察. 中国普外基础与临床杂志, 2000, 7(1): 57.
9.	Shinall MC Jr, Broome JT, Baker A, et al. Is potassium iodide solution necessary before total thyroidectomy for Graves disease? Ann Surg Oncol, 2013, 20(9): 2964-2967.
10.	王东, 乔天凤, 刘启榆, 等. 甲状腺功能亢进症的介入治疗. 中国普外基础与临床杂志, 2001, 8(3): 176-178.
11.	Langley RW, Burch HB. Perioperative management of the thyrotoxic patient. Endocrinol Metab Clin North Am, 2003, 32(2): 519-534.
12.	Erbil Y, Ozluk Y, Giriş M, et al. Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves’ disease. J Clin Endocrinol Metab, 2007, 92(6): 2182-2189.
13.	Ansaldo GL, Pretolesi F, Varaldo E, et al. Doppler evaluation of intrathyroid arterial resistances during preoperative treatment with Lugol’s iodide solution in patients with diffuse toxic goiter. J Am Coll Surg, 2000, 191(6): 607-612.
14.	Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am, 1993, 22(2): 263-277.
15.	Akamizu T, Satoh T, Isozaki O, et al. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Thyroid, 2012, 22(7): 661-679.
16.	Angell TE, Lechner MG, Nguyen CT, et al. Clinical features and hospital outcomes in thyroid storm: a retrospective cohort study. J Clin Endocrinol Metab, 2015, 100(2): 451-459.
17.	Swee du S, Chng CL, Lim A. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am, 2006, 35(4): 663-686.
18.	Nayak B, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am, 2006, 35(4): 663-686.
19.	饶惠民, 孙羽, 邱堃. 76 例青少年原发性甲状腺功能亢进的外科治疗. 中国普外基础与临床杂志, 2008, 15(5): 327-328.
20.	闫利英, 李随勤, 施秉银, 等. 甲状腺功能亢进症的外科治疗. 中华耳鼻咽喉头颈外科杂志, 2006, 41(8): 595-598.
21.	Palit TK, Miller CC 3^rd, Miltenburg DM. The efficacy of thyroidectomy for Graves' disease: a meta-analysis. J Surg Res, 2000, 90(2): 161-165.
22.	Guo Z, Yu P, Liu Z, et al. Total thyroidectomy vs bilateral subtotal thyroidectomy in patients with Graves’ diseases: a meta-analysis of randomized clinical trials. Clin Endocrinol (Oxf), 2013, 79(5): 739-746.
23.	Sung TY, Lee YM, Yoon JH, et al. Long-term effect of surgery in Graves’ disease: 20 years experience in a single institution. Int J Endocrinol, 2015, 2015: 542641.
24.	Wilhelm SM, McHenry CR. Total thyroidectomy is superior to subtotal thyroidectomy for management of Graves’ disease in the United States. World J Surg, 2010, 34(6): 1261-1264.
25.	黄初东, 胡明, 李志辉, 等. 甲亢手术后骨饥饿综合征. 中国普外基础与临床杂志, 2011, 18(10): 1098-1099.
26.	张金星, 周俊强, 蔺辉琦. 手术治疗甲状腺功能亢进症21例报告. 中国普外基础与临床杂志, 2003, 10(3): 214.

1. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid, 2016, 26(10): 1343-1421.
2. Ventrella S, Klein I. Beta-adrenergic receptor blocking drugs in the management of hyperthyroidism. Endocrinologist, 1994, 4: 391-399.
3. Tagami T, Yambe Y, Tanaka T, et al. Short-term effects of β-adrenergic antagonists and methimazole in new-onset thyrotoxicosis caused by Graves’ disease. Intern Med, 2012, 51(17): 2285-2290.
4. 朱预. 甲状腺功能亢进的外科治疗及展望. 中国实用外科杂志, 2006, 26(7): 485-486.
5. 吴维敏, 余书勇, 尹俊峰. Graves 病外科治疗应注意的几个问题. 中华内分泌外科杂志, 2009, 3(5): 332-335.
6. Erbil Y, Ozluk Y, Giriş M, et al. Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves’ disease. J Clin Endocrinol Metab, 2007, 92(6): 2182-2189.
7. Ansaldo GL, Pretolesi F, Varaldo E, et al. Doppler evaluation of intrathyroid arterial resistances during preoperative treatment with Lugol’s iodide solution in patients with diffuse toxic goiter. J Am Coll Surg, 2000, 191(6): 607-612.
8. 苏国森, 何友钊. 甲状腺功能亢进症围手术期处理与 T3、T4 变化的临床观察. 中国普外基础与临床杂志, 2000, 7(1): 57.
9. Shinall MC Jr, Broome JT, Baker A, et al. Is potassium iodide solution necessary before total thyroidectomy for Graves disease? Ann Surg Oncol, 2013, 20(9): 2964-2967.
10. 王东, 乔天凤, 刘启榆, 等. 甲状腺功能亢进症的介入治疗. 中国普外基础与临床杂志, 2001, 8(3): 176-178.
11. Langley RW, Burch HB. Perioperative management of the thyrotoxic patient. Endocrinol Metab Clin North Am, 2003, 32(2): 519-534.
12. Erbil Y, Ozluk Y, Giriş M, et al. Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves’ disease. J Clin Endocrinol Metab, 2007, 92(6): 2182-2189.
13. Ansaldo GL, Pretolesi F, Varaldo E, et al. Doppler evaluation of intrathyroid arterial resistances during preoperative treatment with Lugol’s iodide solution in patients with diffuse toxic goiter. J Am Coll Surg, 2000, 191(6): 607-612.
14. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am, 1993, 22(2): 263-277.
15. Akamizu T, Satoh T, Isozaki O, et al. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Thyroid, 2012, 22(7): 661-679.
16. Angell TE, Lechner MG, Nguyen CT, et al. Clinical features and hospital outcomes in thyroid storm: a retrospective cohort study. J Clin Endocrinol Metab, 2015, 100(2): 451-459.
17. Swee du S, Chng CL, Lim A. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am, 2006, 35(4): 663-686.
18. Nayak B, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am, 2006, 35(4): 663-686.
19. 饶惠民, 孙羽, 邱堃. 76 例青少年原发性甲状腺功能亢进的外科治疗. 中国普外基础与临床杂志, 2008, 15(5): 327-328.
20. 闫利英, 李随勤, 施秉银, 等. 甲状腺功能亢进症的外科治疗. 中华耳鼻咽喉头颈外科杂志, 2006, 41(8): 595-598.
21. Palit TK, Miller CC 3^rd, Miltenburg DM. The efficacy of thyroidectomy for Graves' disease: a meta-analysis. J Surg Res, 2000, 90(2): 161-165.
22. Guo Z, Yu P, Liu Z, et al. Total thyroidectomy vs bilateral subtotal thyroidectomy in patients with Graves’ diseases: a meta-analysis of randomized clinical trials. Clin Endocrinol (Oxf), 2013, 79(5): 739-746.
23. Sung TY, Lee YM, Yoon JH, et al. Long-term effect of surgery in Graves’ disease: 20 years experience in a single institution. Int J Endocrinol, 2015, 2015: 542641.
24. Wilhelm SM, McHenry CR. Total thyroidectomy is superior to subtotal thyroidectomy for management of Graves’ disease in the United States. World J Surg, 2010, 34(6): 1261-1264.
25. 黄初东, 胡明, 李志辉, 等. 甲亢手术后骨饥饿综合征. 中国普外基础与临床杂志, 2011, 18(10): 1098-1099.
26. 张金星, 周俊强, 蔺辉琦. 手术治疗甲状腺功能亢进症21例报告. 中国普外基础与临床杂志, 2003, 10(3): 214.

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Multi-disciplinary treatment of Graves’ disease with huge-size thyroid during peri-operative period

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