Document Detail

Sequential defunctionalization followed by thyroxine supplementation as preoperative preparation of hyperthyroid patients undergoing thyroidectomy.
MedLine Citation:
PMID:  19080266     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Preparing hyperthyroid patients for thyroid surgery with a combination of antithyroid drugs and thyroxine has long been controversial because this combination usually results in only partial inhibition of thyroid function. We therefore used large doses of antithyroid drugs to completely inhibit the synthesis of thyroxine and render the thyroid gland defunctionalized. We then administered physiologic doses of thyroxine to inhibit thyroid-stimulating hormone secretion. We have named this treatment "sequential thyroid defunctionalization followed by thyroxine supplementation." METHODS: Four hundred and seventy-one hyperthyroid patients seen at our hospital were divided into experimental and control groups. The control group was treated preoperatively with antithyroid drugs and iodine preparation. The experimental group was further divided into four subgroups and treated with "sequential thyroid defunctionalization followed by thyroxine supplementation". Each of the four subgroups received different doses of antithyroid drugs and thyroxine for differing time periods. Thyroid function was assessed at each stage of treatment, as were operative blood loss volumes and postoperative complications. RESULTS: Compared to the control group, the four experimental groups showed less thyroid congestion and surface varices at surgery. Patients in subgroup A also had thyroid glands that were almost histologically normal. The mean operative blood loss volume of the experimental group was less than that of the control group (326 +/- 163) ml in the control group; (196 +/- 57) ml in subgroup A; (230 +/- 71) ml in subgroup B; (240 +/- 80) ml in subgroup C; and (312 +/- 97) ml in subgroup D). The postoperative complication rate of the experimental group was 8.64% (21/243) whereas that of the control group was 17.54% (40/228). CONCLUSIONS: Sequential thyroid defunctionalization followed by thyroxine supplementation is effective in reducing the bleeding volume and postoperative complication rate in selected hyperthyroid patients undergoing thyroidectomy.
Jing-qiang Zhu; Zhi-hui Li; Ri-xiang Gong; Tao Wei; Heng Zhang; Wen-yan Zhang; Xiao-yan Yang; Yan-li Luo; Shu Gong; Xiao-ying Wu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chinese medical journal     Volume:  121     ISSN:  0366-6999     ISO Abbreviation:  Chin. Med. J.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-12-16     Completed Date:  2009-01-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7513795     Medline TA:  Chin Med J (Engl)     Country:  China    
Other Details:
Languages:  eng     Pagination:  2010-5     Citation Subset:  IM    
Department II of General Surgery West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
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MeSH Terms
Hyperthyroidism / physiopathology,  surgery*
Middle Aged
Thyroid Gland / pathology,  physiopathology*
Thyroxine / administration & dosage*
Reg. No./Substance:

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