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Comparison between total thyroidectomy and medical therapy for amiodarone-indiced thyrotoxicosis
- Publication Year :
- 2020
-
Abstract
- Context It is not known whether total thyroidectomy is more favorable than medical therapy for patients with amiodarone-induced thyrotoxicosis (AIT). Objective To compare total thyroidectomy with medical therapy on survival and cardiac function in AIT patients. Methods Observational longitudinal cohort study involving 207 AIT patients that had received total thyroidectomy (surgery group, n = 51) or medical therapy (medical therapy group, n = 156) over a 20-year period. AIT types and left ventricular ejection fraction (LVEF) classes were determined at diagnosis of AIT. Cardiac and thyroid function were reevaluated during the study period. Survival was estimated using the Kaplan-Meier method. Results Overall mortality and cardiac-specific mortality at 10 and 5 years, respectively, were lower in the surgery group than in the medical therapy group (P = 0.04 and P = 0.01, respectively). The lower mortality rate of the surgery group was due to patients with moderate to severely compromised LVEF (P = 0.005 vs medical therapy group). In contrast, mortality of patients with normal or mildly reduced LVEF did not differ between the 2 groups (P = 0.281 and P = 0.135, respectively). Death of patients with moderate to severe LV systolic dysfunction in the medical therapy group occurred after 82 days (interquartile range, 56–99), a period longer than that necessary to restore euthyroidism in the surgery group (26 days; interquartile range, 15–95; P = 0.038). Risk factors for mortality were age (hazard ratio [HR] = 1.036) and LVEF (HR = 0.964), whereas total thyroidectomy was shown to be a protective factor (HR = 0.210). LVEF increased in both groups after restoration of euthyroidism, above all in the most compromised patients in the surgery group. Conclusions Total thyroidectomy could be considered the therapeutic choice for AIT patients with severe systolic dysfunction, whereas it is not superior to medical therapy in those with normal or mildly reduced LVEF.
- Subjects :
- Cardiac function curve
Male
medicine.medical_specialty
Endocrinology, Diabetes and Metabolism
medicine.medical_treatment
Clinical Biochemistry
Amiodarone
030209 endocrinology & metabolism
Context (language use)
Thyroid Function Tests
survival
Biochemistry
Ventricular Function, Left
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Endocrinology
Interquartile range
Internal medicine
Medicine
Humans
Longitudinal Studies
Glucocorticoids
Aged
Ejection fraction
business.industry
Biochemistry (medical)
Hazard ratio
AIT
Thyroidectomy
Stroke Volume
Middle Aged
Survival Analysis
Thioamides
Thyrotoxicosis
Treatment Outcome
030220 oncology & carcinogenesis
Cardiology
amiodarone
thyroidectomy
thyrotoxicosis
Female
Thyroid function
business
Cardiomyopathies
Anti-Arrhythmia Agents
medicine.drug
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....1bb2f4897e7fb90a83df05fb33b7c9ec