Thyroidectomy in thyrotoxic crisis: is a euthyroid state required? A case series.

IF 0.5 Q4 SURGERY

Journal of Surgical Case Reports Pub Date : 2025-09-30 eCollection Date: 2025-09-01 DOI:10.1093/jscr/rjaf765

Guillermo Guzmán, Andres O Garcia, Oriana A Valderrama, Stefania Calderón, Julián A Molano, William Victoria, Luis F Tintinago, Juan L O Giraldo

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Abstract

Thyrotoxic crisis is a life-threatening emergency where refractory cases require thyroidectomy. Achieving preoperative euthyroidism is difficult, and optimal surgical timing is debated. This study assessed outcomes of early thyroidectomy regardless of preoperative thyroid levels. A retrospective review included patients ≥18 years (2011-2020) meeting thyroid storm criteria (Japanese Thyroid Association and Burch-Wartofsky >25). Twelve women (median age 36) were included, primarily for medical treatment failure (83.3%). All received beta-blockers; median heart rate decreased from 110 to 76.5 bpm. All underwent total thyroidectomy with 100% parathyroid preservation. Complications included transient hypocalcemia and hypoparathyroidism (41.67% each). There was no mortality, thromboembolism, or need for renal replacement. Early thyroidectomy is a viable option for medically refractory thyrotoxic crisis. Strict heart rate control appears more critical than achieving preoperative euthyroidism, supporting its safety and feasibility.

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甲状腺毒性危象的甲状腺切除术：是否需要甲状腺功能正常？一个案例系列。

甲状腺毒性危机是危及生命的紧急情况，难治性病例需要甲状腺切除术。实现术前甲状腺功能亢进是困难的，最佳手术时机是有争议的。本研究评估了早期甲状腺切除术的结果，而不考虑术前甲状腺水平。回顾性研究纳入≥18岁（2011-2020年）符合甲状腺风暴标准的患者（日本甲状腺协会和Burch-Wartofsky bbb25）。纳入12名女性（中位年龄36岁），主要是因为医疗失败（83.3%）。所有患者均接受β受体阻滞剂治疗；中位心率从每分钟110次下降到76.5次。所有患者均行甲状腺全切除术，甲状旁腺100%保留。并发症包括短暂性低钙血症和甲状旁腺功能低下（41.67%）。没有死亡、血栓栓塞或需要肾脏替代。早期甲状腺切除术是医学上难治性甲状腺毒性危机的可行选择。严格的心率控制似乎比实现术前甲状腺功能亢进更为关键，支持其安全性和可行性。

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