propylthiouracil and Postoperative-Complications

From March 1980 to August 1982, 108 patients with Graves' disease participated in a prospective study at Yonsei University College of Medicine. Preoperatively, 22 patients were prepared with propranolol alone (group 1) and 86 with propranolol and propylthiouracil (PTU) (group 2). The duration of preparation averaged 11.5 days for group 1 and 10.8 days for group 2. Bilateral subtotal thyroidectomy was performed, leaving 4 to 6 grams at both upper poles. No significant difference was noted in the average weight of the removed gland or the amount of blood loss between both groups. During the operation, the pulse rate of group 1 was significantly faster than that of group 2 but evened out by the day of discharge. The incidence of high fever during and immediately after operation was 27.3 per cent in group 1 which is greater than the 17.4 per cent in group 2. In group 1, the incidence of postoperative transient hypocalcemia was 27.3 per cent, transient or prolonged hypothyroidism was 13.6 per cent and recurrence of thyrotoxicosis was 4.5 per cent. In group 2, the values were 22.1, 18.6 and 4.7 per cent, respectively. High fever developed in one patient from group 1 during operation and this patient died on the third day postoperatively. From the results of our study, it appears to be more beneficial to administer both propranolol and PTU as preoperative medication to patients with Graves' disease prior to undergoing operation.

Topics: Adult; Clinical Trials as Topic; Drug Therapy, Combination; Female; Fever; Follow-Up Studies; Graves Disease; Humans; Hypocalcemia; Male; Postoperative Complications; Premedication; Preoperative Care; Propranolol; Propylthiouracil; Prospective Studies; Pulse; Random Allocation; Thyroidectomy; Time Factors

Optimal treatment of Graves' disease (GD) remains controversial. The authors retrospectively reviewed the surgical cases of GD at a single academic tertiary center.. Demographic, clinical, and surgical data were analyzed for all patients with GD undergoing thyroidectomy over 25 years, in 3 periods: 1985 to 1993 (n = 32), 1994 to 2002 (n = 91), and 2003 to 2010 (n = 177).. There were 300 patients with GD (85.7% women; mean age, 39.3 years; median length of follow-up, 24.6 months). Overall, perioperative morbidity occurred in 36 patients (12.0%), and there was no mortality. Thyroidectomy-specific morbidity was very low, and the incidental malignancy rate was 10.3%.. Surgical treatment of GD has a very high safety profile, with low perioperative and thyroidectomy-specific morbidity, even in patients with overt hyperthyroidism. Incidental malignancy in patients with GD is not uncommon.

Topics: Ablation Techniques; Adult; Antithyroid Agents; Drainage; Female; Graves Disease; Humans; Incidental Findings; Iodine Radioisotopes; Length of Stay; Male; Massachusetts; Methimazole; Operative Time; Postoperative Complications; Preoperative Care; Propylthiouracil; Retrospective Studies; Thyroid Neoplasms; Thyroidectomy

We describe herein a case of thyrotoxic crisis after esophagectomy in a 64-year-old woman with esophageal carcinoma and well-controlled hyperthyroidism. On the fourth postoperative day, she had palpitations, abdominal pain, fever, and tachycardia, which were similar to the symptoms of an anastomotic leak. There was no evidence to indicate the existence of an anastomotic leak after examination. We were confused at first. After turning to Burch and Wartofsky's scoring system, we finally diagnosed thyrotoxic crisis and then prescribed several agents for emergency treatment, including propylthiouracil, metoprolol tartrate, and hydrocortisone. Afterward, she recovered and was discharged safely.

Topics: Adrenergic beta-1 Receptor Antagonists; Anastomotic Leak; Anti-Inflammatory Agents; Antithyroid Agents; Carcinoma, Squamous Cell; Diagnosis, Differential; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Esophageal Neoplasms; Esophagectomy; Female; Humans; Hydrocortisone; Hyperthyroidism; Metoprolol; Middle Aged; Neoplasm Staging; Postoperative Complications; Propylthiouracil; Thyroid Crisis

We describe an unusual case of acute myocardial infarction (AMI) and cardiogenic shock in a 25-year-old woman. After coronary revascularization, a thyrotoxic storm developed and the patient's cardiac failure changed into a hyperdynamic circulation without obvious changes in the patient's vital signs. This report will focus on three issues: (1) the benefit of advanced hemodynamic monitoring in circulatory unstable patients, (2) the confounding effects of untreated hyperthyroidism on the circulation, and (3) previous cancer treatment as a cause of AMI in young persons.

Topics: Acute Disease; Adrenal Cortex Hormones; Adult; Antithyroid Agents; Catheterization, Swan-Ganz; Coma; Coronary Disease; Electric Countershock; Female; Hemodynamics; Humans; Myocardial Infarction; Myocardial Revascularization; Postoperative Complications; Propylthiouracil; Pulmonary Edema; Thyroid Crisis; Thyroxine

The medicolegal impact of adverse events in surgical endocrine disease has not been described previously. This study was undertaken to determine the causes, costs, and outcomes of endocrine malpractice litigation.. Jury verdict reports from the U.S. civil court system from 1985 through 1991 were reviewed. Sixty-two malpractice cases were identified from 21 states.. The 62 cases were classified into three categories, totaling 63 adverse events: (1) complications (n = 34, 54%) from thyroid (n = 32, 51%) or parathyroid (n = 2, 3%) surgery; (2) delayed diagnosis (n = 22, 35%) of thyroid cancer (n = 11, 18%), adrenal tumors (n = 9, 14%), and hyperparathyroidism (n = 2, 3%); and (3) medical morbidity (n = 7, 11%) from radioactive iodine (n = 5, 8%) or from propylthiouracil (n = 2, 3%). Surgical injuries, mostly recurrent nerve injuries by general surgeons, accounted for the greatest number of cases and the highest cost of litigation.. Medical malpractice involving endocrine disease results in expensive litigation, a result of serious harm. Technical misadventures account for most cases, followed closely by delays in diagnosis. These data may aid design of risk prevention strategies in endocrine disease.

Topics: Costs and Cost Analysis; Diagnostic Errors; Endocrine System Diseases; Humans; Information Systems; Iodine Radioisotopes; Malpractice; Postoperative Complications; Propylthiouracil

Thyroid surgery in the pediatric age patient accounts for a small minority of all thyroid surgery. Batsakis and Nishiyama reported only 136 patients under the age of 18 who underwent thyroid surgery in 27 years at the University of Michigan. In most series involving the pediatric age group, the majority of thyroid procedures are performed on adolescents. Thyroid surgery in the young child requires special precautions in addition to those routinely associated with thyroidectomy in the adult. The techniques and perioperative management of the pediatric thyroidectomy employed at our institution has evolved as experience is gained. Our experience with five such patients with adequate follow-up will be presented.

Topics: Adenoma; Adolescent; Age Factors; Child; Child, Preschool; Drainage; Female; Follow-Up Studies; Graves Disease; Humans; Hypothyroidism; Iodine; Male; Postoperative Care; Postoperative Complications; Preoperative Care; Propylthiouracil; Thyroid Hormones; Thyroid Neoplasms; Thyroidectomy

Iodine-induced hyperthyroidism has been frequently described when iodine is introduced into an iodine-deficient area. However, it may also occur in patients with and without previous thyroid disease residing in iodine-sufficient areas. Five patients with iodine-induced hyperthyroidism seen in a 12-month period are described. All were exposed to iodine in the form of commonly used drugs (Betadine, Iodo-Niacin, amiodarone, and radiographic contrast dyes). The cause of iodine-induced hyperthyroidism is unclear, but it is probably more common in patients with goiters containing previously existing areas of autonomous function or iodine-poor thyroglobulin. Iodine-induced hyperthyroidism usually abates after iodine withdrawal in patients with multinodular goiters or normal thyroid glands. The hyperthyroidism is usually treated with beta-blockers and antithyroid thionamide drugs, although reinstitution of iodine to block thyroid hormone release or corticosteroids occasionally may be necessary. Iodine-containing drugs should be given with caution to patients with underlying thyroid disease.

Topics: Adult; Amiodarone; Chlorobutanol; Coloring Agents; Coronary Artery Bypass; Drug Combinations; Female; Goiter, Nodular; Graves Disease; Humans; Hyperthyroidism; Iodine; Iodine Radioisotopes; Male; Middle Aged; Niacinamide; Postoperative Complications; Povidone-Iodine; Propylthiouracil; Radiographic Image Enhancement; Sodium Iodide; Thyroid Hormones

The results of medical and surgical therapy were determined in 107 hyperthyroid children. After surgery, 85% of patients were rendered free of hyperthyroidism; however, 62% became hypothyroid. After medical treatment, 30% of patients were euthyroid and 2% became hypothyroid. The relapse rate, however, was higher after medical (22%) than after surgical (9%) therapy. Serious drug-related complications (arthritis-, hepatitis-, and collagen disease-like syndromes) occurred in 14% of patients. Complications occurred in 9% of surgically treated patients, but recurrent laryngeal nerve injury or permanent hypoparathyroidism did not occur. In medically treated patients, both a goiter size less than three times normal prior to treatment and a reduction in goiter size to less than two times normal at the completion of therapy correlated with a successful outcome.

Topics: Adolescent; Arthritis; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Collagen Diseases; Female; Humans; Hyperthyroidism; Hypothyroidism; Male; Methimazole; Postoperative Complications; Propylthiouracil; Thyroidectomy

From 1959 to 1970, 272 operations for thyrotoxicosis were performed. Most of the patients received anti-thyroid drugs and thyroid hormones preoperatively. The patients were continuously followed up. The primary results with low morbidity and no mortality as well as the long term results with a low rate of recurrence and a relatively high incidence of thyroid substitution are discussed. A safe and effective programme for surgical treatment of thyrotoxicosis is described. Anti-thyroid drugs and thyroid hormones should be administered as the method of choice in preparing these patients for surgery.

Topics: Adolescent; Adult; Aged; Antithyroid Agents; Carbimazole; Child; Female; Goiter; Humans; Hyperthyroidism; Hypocalcemia; Hypothyroidism; Laryngoscopy; Length of Stay; Male; Methimazole; Middle Aged; Paralysis; Postoperative Complications; Preoperative Care; Propylthiouracil; Recurrent Laryngeal Nerve; Thyroxine; Triiodothyronine

Topics: Adolescent; Female; Goiter; Hemorrhage; Humans; Hyperthyroidism; Hypoparathyroidism; Hypothyroidism; Iodine; Methylthiouracil; Postoperative Care; Postoperative Complications; Potassium Iodide; Preoperative Care; Propylthiouracil; Thyroid Diseases; Thyroidectomy; Thyroiditis; Time Factors; Vocal Cord Paralysis

Topics: Adolescent; Child; Female; Graves Disease; Humans; Hyperthyroidism; Hypocalcemia; Laryngeal Edema; Male; Methimazole; Methods; Postoperative Complications; Potassium Iodide; Propranolol; Propylthiouracil; Thyroid Hormones; Thyroidectomy

Topics: Adolescent; Adult; Aged; Antithyroid Agents; Child; Female; Humans; Hyperthyroidism; Hypothyroidism; Iodine; Male; Middle Aged; Organ Size; Postoperative Complications; Preoperative Care; Propylthiouracil; Thyroid Gland; Thyroidectomy; Voice

Topics: Adolescent; Anesthesia, General; Carbimazole; Female; Follow-Up Studies; Goiter; Halothane; Horner Syndrome; Humans; Hyperthyroidism; Hypoparathyroidism; Laryngeal Edema; Male; Nitrous Oxide; Oxygen; Postoperative Complications; Preoperative Care; Propylthiouracil; Thyroidectomy; Thyroxine; Tracheotomy

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Hyperthyroidism; Hypothyroidism; Infant; Laryngeal Edema; Male; Postoperative Complications; Propylthiouracil; Thyroidectomy; Vocal Cord Paralysis

Topics: Adolescent; Adult; Aged; Antibodies; Female; Follow-Up Studies; Humans; Hyperthyroidism; Hypothyroidism; Iodine; Iodine Isotopes; Male; Middle Aged; Myxedema; Postoperative Complications; Propylthiouracil; Solutions

Topics: Adolescent; Calcium; Calcium, Dietary; Child; Drug Therapy; Humans; Hyperthyroidism; Hypoparathyroidism; Infant; Postoperative Complications; Propylthiouracil; Thyroid Hormones; Thyroidectomy; Thyrotoxicosis; Vitamin D; Vocal Cord Paralysis