Duration of Exposure to Thyrotoxicosis Increases Mortality of Compromised AIT Patients: the Role of Early Thyroidectomy
| Autor: | Giulia Marconcini, Fausto Bogazzi, Luca Manetti, Claudio Urbani, Agostino Maria Di Certo, Riccardo Morganti, Enio Martino, Daniele Cappellani, Gabriele Materazzi, Piermarco Papini, Maria Laura Tanda, Luigi Bartalena, Giada Cosentino |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
Left ventricular ejection fraction medicine.medical_specialty Time Factors Endocrinology Diabetes and Metabolism medicine.medical_treatment Clinical Biochemistry Amiodarone 030209 endocrinology & metabolism Context (language use) 030204 cardiovascular system & hematology Biochemistry Cohort Studies Ventricular Dysfunction Left 03 medical and health sciences 0302 clinical medicine Endocrinology Interquartile range Early Medical Intervention Internal medicine medicine Humans Euthyroid Mortality Aged Retrospective Studies business.industry Mortality rate Biochemistry (medical) Hazard ratio AIT Thyroidectomy Amiodarone-induced thyrotoxicosis Retrospective cohort study Prophylactic Surgical Procedures Middle Aged Thyrotoxicosis Disease Progression Cardiology Female business medicine.drug |
| Zdroj: | The Journal of Clinical Endocrinology & Metabolism. 105:e3427-e3436 |
| ISSN: | 1945-7197 0021-972X |
| DOI: | 10.1210/clinem/dgaa464 |
| Popis: | Context Patients with amiodarone-induced thyrotoxicosis (AIT) and severely reduced left ventricular ejection fraction (LVEF) have a high mortality rate that may be reduced by total thyroidectomy. Whether in this subset of patients thyroidectomy should be performed early during thyrotoxicosis or later after restoration of euthyroidism has not yet been settled. Objectives Mortality rates, including peritreatment mortality and 5-year cardiovascular mortality, and predictors of death, evaluated by Cox regression analysis. Methods Retrospective cohort study of 64 consecutive patients with AIT selected for total thyroidectomy from 1997 to 2019. Four groups of patients were identified according to serum thyroid hormone concentrations and LVEF: Group 1 (thyrotoxic, LVEF Results Among patients with low LVEF (Groups 1 and 3), mortality was higher in patients undergoing thyroidectomy after restoration of euthyroidism (Group 3) than in those submitted to surgery when still thyrotoxic (Group 1): peritreatment mortality rates were 40% versus 0%, respectively (P = .048), whereas 5-year cardiovascular mortality rates were 53.3% versus 12.3%, respectively (P = .081). Exposure to thyrotoxicosis was longer in Group 3 than in Group 1 (112 days, interquartile range [IQR] 82.5-140, vs 76 days, IQR 24.8-88.5, P = .021). Survival did not differ in patients with LVEF ≥40% submitted to thyroidectomy irrespective of being thyrotoxic (Group 2) or euthyroid (Group 4): in this setting, peritreatment mortality rates were 6.3% versus 4% (P = .741) and 5-year cardiovascular mortality rates were 12.5% and 20% (P = .685), respectively. Age (hazard ratio [HR] 1.104, P = .029) and duration of exposure to thyrotoxicosis (HR 1.004, P = .039), but not presurgical serum thyroid hormone concentrations (P = .577 for free thyroxine, P = .217 for free triiodothyronine), were independent predictors of death. Conclusions A prolonged exposure to thyrotoxicosis resulted in increased mortality in patients with reduced LVEF, which may be reduced by early thyroidectomy. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|