Thyroid Surgery
T.M. Craft, P.M. Upton in Key Topics In Anaesthesia, 2021
Patients may present for thyroid surgery with an enlarged thyroid gland or in a state of abnormal thyroid function. Enlargement of the thyroid gland may be due to a multinodular goitre, Graves disease, autoimmune thyroiditis, a solitary nodule, iodine deficiency or may follow a viral infection. Thyrotoxicosis results from excessive production of the two thyroid hormones thyroxine and tri-iodothyronine. An acute manifestation of all the features of thyrotoxicosis may occur soon after a partial thyroidectomy. It is more common in patients who are still hyperthyroid at the time of surgery. Untreated it results in coma and is frequently fatal. The preoperative use of carbimazole to achieve this may result in depression of the white cell count and a recent history of sore throat or other infection should be sought. A reinforced or armoured tracheal tube is usually passed in patients who are to undergo thyroid surgery.
Rituximab in the Treatment of Thyroid Eye Disease: A Review
Published in Neuro-Ophthalmology, 2015
Rochella A. Ostrowski, Melissa R. Bussey, Yasmin Shayesteh, Walter M. Jay
Graves disease is an autoimmune thyroid disease classically characterised by a clinical triad consisting of hyperthyroidism, diffuse goitre, and thyroid eye disease. Thyroid eye disease is an immunologically mediated condition in which humoral immunity is thought to play a central role. Thyroid eye disease is traditionally treated with high-dose glucocorticosteroids and surgical orbital decompression. However, responses are inadequate and alternative treatment options are needed. Rituximab, an anti-CD20 monoclonal antibody, shows promise as a novel therapeutic option for thyroid eye disease. There are 43 cases of thyroid eye disease treated with rituximab in the medical literature, and larger studies are warranted to determine the long-term effectiveness of rituximab. Rituximab may represent an attractive new treatment option for thyroid eye disease, especially in the case of disease that is refractory to current treatment strategies.
Diplopia in Graves Disease
Published in American Orthoptic Journal, 1988
Stephen Trokel, Sally Moore, Michael Kazim
In view of our inability to reverse the orbital pathology of Graves disease, clinical experience has shown us that it is prudent to defer, insofar as possible, the surgical repair of the residual pathology until the disease is stable. Towards this end, we have found the orthoptic evaluation to be an invaluable objective analysis which produces quantitative data and is a sensitive indicator of active orbitopathy. We have found, and would like to emphasize that prism therapy in those cases in which the deviation is minimal may create sufficient fusion in the primary and reading positions to obviate the need for surgery. As the disease progresses, it is a simpler matter to change a Fresnel prism than to force a monocular state or to operate repeatedly. The use of prisms postoperatively gives a higher degree of patient satisfaction and limits the number of reoperations. The key to strabismus surgery in the setting of Graves disease is to delay surgery as long as possible until all data indicates the disease is stable, recess muscles more than one would do for other strabismus cases in view of the undesireability of resecting the antagonist, use supplementary prisms when tolerated and be prepared to accept at least one field of residual diplopia.
Takotsubo Cardiomyopathy Associated with Hyperthyroidism Treated with Thyroidectomy
Published in Baylor University Medical Center Proceedings, 2015
Sabry Omar, Emad Ali, Haitham Mazek, Tashfeen Mahmood, Suthipong Soontrapa, Jose Suarez
Takotsubo cardiomyopathy is an uncommon clinical entity, also called apical ballooning syndrome, characterized by transient systolic dysfunction of the apical and/or mid segments of the left ventricle. We report a case that highlights takotsubo syndrome in the setting of thyrotoxicosis that required thyroidectomy. The association of takotsubo syndrome and hyperthyroidism has been reported before. We found 13 previously reported cases of thyrotoxicosis-induced cardiomyopathy, most associated with Grave's disease and none treated with thyroidectomy. Awareness of this possible association is important in establishing the diagnosis and instituting proper management.
Related Knowledge Centers
- Autoimmune Diseases
- Exophthalmos
- Eye
- Hyperthyroidism
- Thyroid Hormones
- Graves Ophthalmopathy
- Tsh