Anestesia e hipertiroidismo / Anesthesia and hyperthyroidism

Julio 20, 2017. No. 2755

La tiroidectomía total como método de elección en el tratamiento de la enfermedad de Graves - análisis de 1432 pacientes. Total thyroidectomy as a method of choice in the treatment of Graves' disease - analysis of 1432 patients. Bojic T1, Paunovic I2,3, Diklic A4,5, Zivaljevic V6,7, Zoric G8, Kalezic N9,10, Sabljak V11,12, Slijepcevic N13, Tausanovic K14, Djordjevic N15,16, Budjevac D17, Djordjevic L18, Karanikolic A19,20. BMC Surg. 2015 Apr 9;15:39. doi: 10.1186/s12893-015-0023-3. Abstract BACKGROUND: Graves' disease represents an autoimmune disease of the thyroid gland where surgery has an important role in its treatment. The aim of our paper was to analyze the results of surgical treatment, the frequency of microcarcinoma and carcinoma, as well as to compare surgical complications in relation to the various types of operations performed for Graves' disease. METHODS: We analysed 1432 patients (221 male and 1211 female) who underwent surgery for Graves' disease at the Centre for Endocrine Surgery in Belgrade during 15 years (1996-2010). Average age was 34.8 years. Frequency of surgical complications within the groups was analyzed with nonparametric Fisher's test. RESULTS: Total thyroidectomy (TT) was performed in 974 (68%) patients, and Dunhill operation (D) in 221 (15.4). Carcinoma of thyroid gland was found in 146 patients (10.2%), of which 129 (9%) were a microcarcinoma. Complication rates were higher in the TT group, where there were 31 (3.2%) patients with permanent hypoparathyroidism, 9 (0.9%) patients with unilateral recurrent nerve paralysis and 10 (1.0%) patients with postoperative bleeding. Combined complications, such as permanent hypoparathyroidism with bleeding were more common in the D group where there were 2 patients (0,9%), while unilateral recurrent nerve paralysis with bleeding was more common in the TT group where there were 3 cases (0,3%). CONCLUSIONS: Frequency of complications were not significantly statistically different in relation to the type of surgical procedure. Total thyroidectomy represents a safe and efficient method for treating patients with Graves' disease, and it is not followed by a greater frequency of complications in relation to less extensive procedures. PDF  Anestesia y cirugía tiroidea: los interminables desafíos. Anesthesia and thyroid surgery: The never ending challenges. Bajwa SJ1, Sehgal V. Indian J Endocrinol Metab. 2013 Mar;17(2):228-34. doi: 10.4103/2230-8210.109671. Abstract Thyroidectomy is the most common endocrine surgical procedure being carried out throughout the world. Besides, many patients who have deranged thyroid physiology, namely hyperthyroidism and hypothyroidism, have to undergo various elective and emergency surgical procedures at some stage of their life. The attending anesthesiologist has to face numerous daunting tasks while administering anesthesia to such patients. The challenging scenarios can be encountered at any stage, be it preoperative, intra-op or postoperative period. Preoperatively, deranged thyroid physiology warrants optimal preparation, while anticipated difficult airway due to enlarged thyroid gland further adds to the anesthetic challenges. Cardiac complications are equally challenging as also the presence of various co-morbidities which make the task of anesthesiologist extremely difficult. Thyroid storm can occur during intra-op and post-op period in inadequately prepared surgical patients. Postoperatively, numerous complications can develop that include hemorrhage, laryngeal edema, nerve palsies, tracheomalacia, hypocalcemic tetany, pneumothorax, etc., The present review aims at an in-depth analysis of potential risk factors and challenges during administration of anesthesia and possible complications in patients with thyroid disease. KEYWORDS: Airway management; carbimazole; propanolol; thyroid; thyroidectomy; thyroxin; tracheomalacia PDF Anestesia para timectomia en un paciente con miastenia gravis e hipertiroidismo no controlado Anesthetic management of patient with myasthenia gravis and uncontrolled hyperthyroidism for thymectomy. Datt V1, Tempe DK, Singh B, Tomar AS, Banerjee A, Dutta D, Bhandari H. Ann Card Anaesth. 2010 Jan-Apr;13(1):49-52. doi: 10.4103/0971-9784.58835.Abstract The relationship between myasthenia gravis (MG) and other autoimmune disorders like hyperthyroidism is well known. It may manifest earlier, concurrently or after the appearance of MG. The effect of treatment of hyperthyroidism on the control of MG is variable. There may be resolution or conversely, deterioration of the symptoms also. We present a patient who was diagnosed to be hyperthyroid two and half years before the appearance of myasthenic symptoms. Pharmacotherapy for three months neither improved the myasthenic symptoms nor the thyroid function tests. Thymectomy resulted in control of MG as well as hyperthyroidism. In conclusion, effective control of hyperthyroidism in the presence of MG may be difficult. The authors opine that careful peri-operative management of thymectomy is possible in a hyperthyroid state. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Hipotiroidismo / Hypothyroidism

Julio 21, 2017. No. 2756

Hipotiroidismo subclínico y su asociación con el aumento de la mortalidad cardiovascular: Llamado a la acción. Sub-Clinical Hypothyroidism and Its Association With Increased Cardiovascular Mortality: Call for Action. Hassan A1, Altamirano-Ufion A1, Zulfiqar B1, Boddu P2. Cardiol Res. 2017 Apr;8(2):31-35. doi: 10.14740/cr524w. Epub 2017 May 3. Abstract Thyroid hormones play an important role in regulating different functions regarding metabolism and performance in multiple organs. Any change in the thyroid hormones axis can lead to profound effect on the vital organ stability especially the cardiovascular system. Hypothyroidism is classified according to the clinical presentation as overt and subclinical. Currently, there exists a paucity of evidence on the beneficial effects of thyroxine hormone replacement on cardiovascular mortality outcomes in subclinical hypothyroidism. Also, the clinical relevance of measuring and treating supra-normal thyroid-stimulating hormone levels in newly diagnosed heart failure patients with preserved ejection fraction requires further study. Here we review the current evidence regarding the prognostic significance of sub-clinical hypothyroidism in patients with heart failure with preserved ejection fraction. KEYWORDS: Cardiovascular mortality; Heart failure with preserved ejection fraction; Sub-clinical hypothyroidism PDF Deficiencia de iodo. Manifestaciones clínicas Iodine deficiency: Clinical implications. Niwattisaiwong S1, Burman KD2, Li-Ng M3. Cleve Clin J Med. 2017 Mar;84(3):236-244. doi: 10.3949/ccjm.84a.15053. Abstract Iodine is crucial for thyroid hormone synthesis and fetal neurodevelopment. Major dietary sources of iodine in the United States are dairy products and iodized salt. Potential consequences of iodine deficiency are goiter, hypothyroidism, cretinism, and impaired cognitive development. Although iodine status in the United States is considered sufficient at the population level, intake varies widely across the population, and the percentage of women of childbearing age with iodine deficiency is increasing. Physicians should be aware of the risks of iodine deficiency and the indications for iodine supplementation, especially in women who are pregnant or lactating. PDF Avances recientes en enfermedades autoinmunes de la tiroides Recent Advances in Autoimmune Thyroid Diseases. Yoo WS1, Chung HK2. Endocrinol Metab (Seoul). 2016 Sep;31(3):379-385. doi: 10.3803/EnM.2016.31.3.379. Epub 2016 Aug 26. Abstract Autoimmune thyroid disease (AITD) includes hyperthyroid Graves disease, hypothyroid autoimmune thyroiditis, and subtle subclinical thyroid dysfunctions. AITD is caused by interactions between genetic and environmental predisposing factors and results in autoimmune deterioration. Data on polymorphisms in the AITD susceptibility genes, related environmental factors, and dysregulation of autoimmune processes have accumulated over time. Over the last decade, there has been progress in the clinical field of AITD with respect to the available diagnostic and therapeutic methods as well as clinical consensus. The updated clinical guidelines allow practitioners to identify the most reasonable and current approaches for proper management. In this review, we focus on recent advances in understanding the genetic and environmental pathogenic mechanisms underlying AITD and introduce the updated set of clinical guidelines for AITD management. We also discuss other aspects of the disease such as management of subclinical thyroid dysfunction, use of levothyroxine plus levotriiodothyronine in the treatment of autoimmune hypothyroidism, risk assessment of long-standing antithyroid drug therapy in recurrent Graves' hyperthyroidism, and future research needs. PDF Manejo de enfermedades endocrinológicas. Hiponatremia asociada a hipotiroidismo: mecanismos, implicaciones y manejo MANAGEMENT OF ENDOCRINE DISEASE: Hypothyroidism-associated hyponatremia: mechanisms, implications and treatment. Liamis G1, Filippatos TD2, Liontos A1, Elisaf MS1. Eur J Endocrinol. 2017 Jan;176(1):R15-R20. Epub 2016 Aug 2. Abstract SUMMARY: The aim of this short review is the presentation of the mechanisms of hyponatremia and of the available data regarding its implications and treatment in patients with hypothyroidism. Hypothyroidism is one of the causes of hyponatremia, thus thyroid-stimulating hormone determination is mandatory during the evaluation of patients with reduced serum sodium levels. The main mechanism for the development of hyponatremia in patients with chronic hypothyroidism is the decreased capacity of free water excretion due to elevated antidiuretic hormone levels, which are mainly attributed to the hypothyroidism-induced decrease in cardiac output. However, recent data suggest that the hypothyroidism-induced hyponatremia is rather rare and probably occurs only in severe hypothyroidism and myxedema. Other possible causes and superimposed factors of hyponatremia (e.g. drugs, infections, adrenal insufficiency) should be considered in patients with mild/moderate hypothyroidism. Treatment of hypothyroidism and fluid restriction are usually adequate for the management of mild hyponatremia in patients with hypothyroidism. Patients with possible hyponatremic encephalopathy should be urgently treated according to current guidelines. CONCLUSIONS: Severe hypothyroidism may be the cause of hyponatremia. All hypothyroid patients with low serum sodium levels should be evaluated for other causes and superimposed factors of hyponatremia and treated accordingly. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org