Since thyroid storm can be life-threatening and requires immediate medical attention, in many cases, healthcare providers diagnose and start treating people who have signs of thyroid storm before they get blood results back indicating the level of thyroid hormones in their blood. ; Hemithyroidectomy or thyroid lobectomy: This involves the removal of one of the two lobes of the thyroid gland. Nafisa K Kuwajerwala, MD Staff Surgeon, Breast Care Center, William Beaumont Hospital Pankaj Chaturvedi, MBBS, MS, FACS Professor of Head and Neck Surgery, Department of Head and Neck Surgery, Tata Memorial Hospital, India Complications after thyroid surgery are rare but can be serious and potentially life threatening. Using an over-the-counter (OTC) numbing throat spray, such as Chloraseptic, or numbing lozenges, such as Cepacol, can help with the discomfort until you are healed. [QxMD MEDLINE Link]. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Division of Endocrinology, The University of Texas Health Science Center at Houston, USA, Correspondence: Mohammed Hamdi, Division of Endocrinology, The University of Texas Health Science Center at Houston, USA, Received: September 03, 2021 | Published: September 20, 2021, Citation: Hamdi M, Chaudhri A, Shah N, et al. [Full Text]. Using pain medication after surgery may reduce discomfort, making it easier for you to keep moving your neck so that you have less stiffness later on. PTU also blocks peripheral conversion of T4 to T3 and hence is preferred in thyroid storm over MMI. Side effects of thyroid surgery are common and include neck pain, a sore throat, difficulty swallowing, hoarseness, and temporary hypoparathyroidism that usually resolves within a few weeks. Clinical features and hospital outcomes in thyroid storm: a retrospective cohort study. The neck is put in an extended position during surgery, and many people avoid moving their necks afterward. Otolaryngol Head Neck Surg. Nafisa K Kuwajerwala, MD is a member of the following medical societies: American College of Surgeons, American Society of Breast Surgeons, American Society of Breast DiseaseDisclosure: Nothing to disclose. American Thyroid Association statement on outpatient thyroidectomy. Heart rate faster than 140 beats/min, hypotension, atrial dysrhythmias, congestive heart failure, 3. Clinical features and hospital outcomes in thyroid storm: a retrospective cohort study. . government site. She later received external beam radiation therapy for brain metastases. 46(2):149-52. If you have hyperthyroidism and are having thyroid surgery (thyroidectomy), your provider will most likely give you certain medication before the surgery to try to prevent thyroid storm. American Thyroid Association. [Full Text]. Thyroid storm is a medical emergency that is fatal if its not treated. This article explores common side effects of thyroid surgery, what to expect during the recovery process, and warning signs of complications. Gunateet Goswami, MD is a member of the following medical societies: American Medical Association, American Society of Echocardiography, Michigan State Medical SocietyDisclosure: Nothing to disclose. If in remission, the patient should be closely monitored for 6 months, as relapse is more common during this period after discontinuation of therapy. While complications can affect anyone, there are some risk factors that increase the chance of the adverse effects. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Gently tilt your head to the right and then to the left. think functional metastatic thyroid cancer. 2016 Feb. 95(7):e2848. Heart rate faster than 140 beats/min, hypotension, atrial dysrhythmias, congestive heart failure, 3. [QxMD MEDLINE Link]. Failure of esmolol to control tachycardia associated with thyroid storm after subtotal thyroidectomy. 2009 Feb. 102(2):193-5. [QxMD MEDLINE Link]. While around 1% of people may have damage to the nerves supplying the vocal cords, around 5% to 10% of people will have temporary symptoms due to irritation of the nerves during surgery or inflammation around the nerves afterward. 100(2):451-9. She is the author of "The Thyroid Diet Revolution. Thyroid storm is a serious and life-threatening medical condition. What Is the Recovery Time for Appendicitis Surgery? While there is no specific treatment for this hoarseness, it's helpful for your loved ones to be aware of the problem so that you don't feel the need to talk loudly or more often than is comfortable. The researches theorized that the decreased mortality rates were due to improved intensive care and increasing use of mechanical circulatory devices such as the intra-aortic balloon pump (IABP) and extra corporeal mechanical ventilation (ECMO). If you experience itching, applying scar gel or aloe may provide relief, but talk to your surgeon before doing so. There are many symptoms of hypothyroidism, but some of the more common ones include: Side effects of thyroid surgery are common and often include neck pain, a sore throat, difficulty swallowing, and hoarseness. Discussion The pathophysiology of thyroid storm is well known. As only one of the four parathyroid glands is needed to regulate calcium levels, the condition is uncommon, affecting roughly 2% of people who have a thyroidectomy. Although thyroid storm can develop if you have long-term untreated or undertreated hyperthyroidism, its often caused by a sudden and intense (acute) event or situation. [6] The incidence of thyroid storm is approximately 0.65 cases per 100,000 persons per year and 5.2 per 100,000 hospitalized patients per year. Complications are rare but can be serious and even potentially life-threatening if they do occur. [QxMD MEDLINE Link]. After improvement of thyroid function, which generally occurs within 24 hours, iodine can be gradually discontinued and glucocorticoids tapered and discontinued. [Full Text]. Advertising on our site helps support our mission. Feeling agitated, irritable and/or anxious. [QxMD MEDLINE Link]. Plasmapheresis, plasma exchange, peritoneal dialysis exchange transfusion, and charcoal plasma perfusion are other techniques used to remove excess circulating hormone. Some of these require prompt treatment, so it's important to be aware of them. Thyroid storm. What You Need to Know Thyroid cancer, thyroid nodules and other conditions may require thyroidectomy. Please confirm that you would like to log out of Medscape. MMI is the common agent used in hyperthyroidism. We do not endorse non-Cleveland Clinic products or services. Healthcare providers may also rely on a physical examination to check for physical signs of thyroid storm, including: Since thyroid storm is a medical emergency, youll need to be treated for it in a hospital. Serially monitor patients until the thyroid gland is sufficiently depleted of its hormone to allow radioiodine therapy. 2012 Sep. 109(3):466-7. Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine A 2018 study found that when a solution of potassium iodide was given prior to thyroid surgery for those with Grave's diseasea condition that can lead to an overactive thyroidit was associated with less temporary hypoparathyroidism and hoarseness. sharing sensitive information, make sure youre on a federal [QxMD MEDLINE Link]. 22(7):661-79. Confusion, agitation, delirium, frank psychosis, seizures, stupor, or coma. Unauthorized use of these marks is strictly prohibited. They commonly include: Most often calcium levels improve in a few weeks but may continue to be low for up to six months. Medicine. These include: While a total thyroidectomy is more extensive surgery than a subtotal thyroidectomy, several studies suggest that the safety of the two procedures is similar with regard to complications, though temporary low calcium levels (and hypothyroidism due to the removal of the entire thyroid) are more common with the total procedure. Thyroid storm is a life-threatening condition that is generally considered to be a contradiction to surgical intervention. -, J Clin Gastroenterol. Galindo RJ, Hurtado CR, Pasquel FJ, Garcia Tome R, Peng L, Umpierrez GE. 2013;23(10):1193-202. doi:10.1089/thy.2013.0049. 1133- Budapest. Int J Endocrinol Metab. Six hours after the end of surgery, oral propylthi-ouracil was resumed, and 12 hours after surgery, the patient's heart rate came down to 100 beats per minute. Laryngoscope. Use of a cooled humidified oxygen tent is advised. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event. 2016 Oct. 26(10):1343-1421. [QxMD MEDLINE Link]. The majority of patients with PDTC die of metastatic disease. eCollection 2022 May. Thyroid. Symptoms of thyroid storm (severe thyrotoxicosis) include: Having a very rapid heartbeat. Thyroid Surgery Recovery, Side Effects, and Complications. Counsel patients to promptly contact their health care provider for the following signs or symptoms: fatigue, weakness, vague abdominal pain, loss of appetite, itching, easy bruising, or yellowing of the eyes or skin. American Association of Endocrine Surgeons, American Association for the Advancement of Science, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Association for Physician Leadership. This nerve controls the muscles that move the vocal cords. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Intravenous administration of propranolol requires continuous monitoring of cardiac rhythm. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Gently turn your head to the right, then roll your head so that you are looking at the floor, then gently roll your head to the left. Surgery. Thyroid surgery: common questions and concerns. See the image below. However, there are some things that everyone can expect with any type of thyroid surgery. 12(2):e13539. Effective Preoperative Plasmapheresis Treatment of Severe Hyperthyroidism in a Patient with Giant Toxic Nodular Goiter and Methimazole-Induced Agranulocytosis. You are being redirected to 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. [QxMD MEDLINE Link]. A precipitating factor usually is found with thyroid storm. THYROID. Once your thyroid is removed you are now considered to be HYPOTHYROID. [Full Text]. Hypothyroidism PTU and MMI block the incorporation of iodine into thyroglobulin within 1 hour of ingestion. The iodinated x-ray contrast agent, sodium ipodate, can be administered instead of iodine and also inhibits peripheral conversion of T4 to T3. Having a high fever. Bone and lung metastases are the most common sites for functional lesions. Before The primary reason for concern is that neck bleeding, which can be life-threatening, may occur after a person has returned home after outpatient surgery. They may be due to irritation from the breathing tube inserted into the windpipe during surgery, or the result of nerve irritation caused by the procedure. Thyroidectomy then and now: a 50-year Australian perspective. Iodine therapy should be administered after approximately 1 hour following administration of PTU or MMI; iodine used alone helps to increase thyroid hormone stores and may increase the thyrotoxic state. Add glucose to IV fluids for nutritional support. https://www.ncbi.nlm.nih.gov/books/NBK448095/. If youre experiencing symptoms of thyroid storm, such as a high fever and a fast heart rate, get to the nearest hospital immediately. [QxMD MEDLINE Link]. Treatment targeted against thyroid hormone creation and release. Tower 1, Capital Square, Vci t 76. The most common cause of hypoparathyroidism is damage to the glands during thyroid surgery. Dont wait for your symptoms to get worse. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. The FDA recommends the following criteria be considered for prescribing PTU. This excessive hypermetabolic state, with increased intestinal transit and tachypnea, leads to immense fluid loss. Swee du S, Chng CL, Lim A. During this time, the staff will monitor you closely for any signs of neck swelling that could indicate a neck hematoma. this could lead to a dangerous condition of thyroid storm (a form of severe hyperthyroidism). [QxMD MEDLINE Link]. 2016; 26(10): 1343-1421. Possible complications of general anesthesia may also occur since most thyroidectomies require it. If you are not given calcium, it's important to be aware of the symptoms of hypocalcemia. Fortunately, if nausea does develop, there are treatments that can alleviate your symptoms, and the use of medications such as dexamethasone has greatly reduced vomiting. Multiorgan dysfunction accompanied with metimazole and thyroid storm. Unable to load your collection due to an error, Unable to load your delegates due to an error. 216.444.6568 Appointments & Locations Request an Appointment Virtual Visits for Diabetes The thyroid gland releases thyroid hormone, which controls many critical functions of the body. T4 is levothyroxine. Kulaksizoglu M, Gonen MS, Kebapcilar L, et al. [Guideline] Satoh T, Isozaki O, Suzuki A, et al. The decision was made to proceed with thyroidectomy. We herein describe the case of a 37-year-old patient with a history of Graves' disease who was transferred to Tottori University Hospital with thyroid storm. [QxMD MEDLINE Link]. Thyroidectomy is the main surgical treatment for thyroid cancer and is a treatment option for certain thyroid conditions, including: Thyroid nodules: A thyroid nodule is a growth (lump) of thyroid cells in your thyroid gland. Pathophysiologic mechanisms of Graves disease relating thyroid-stimulating immunoglobulins to hyperthyroidism and ophthalmopathy. and transmitted securely. Together, they are referred to as thyroid hormones, and they regulate your body temperature and control your heart rate and metabolism. Thyroidectomy should be considered for anyone with Graves' disease (GD) and moderate-to-severe eye disease, or smokers with GD due to increased risk of exacerbation of eye disease after radioactive iodine. official website and that any information you provide is encrypted Gunateet Goswami, MD Consulting Staff, Internal Medicine Associates, Mount Clemens, Michigan; Consulting Staff, Department of Cardiology, Henry Ford Hospital Patients with a BurchWartofsky Point Scale (BWPS) of 45 or Japanese Thyroid Association (JTA) categories of thyroid storm 1 (TS1) or thyroid storm 2 (TS2) with evidence of systemic decompensation require aggressive therapy. Thyroid storm If a thyroidectomy is done to treat a very overactive gland, there may be a surge of thyroid hormones into the blood. Like your heart is going to beat out of your chest. This is a very rare complication because medications are given before surgery to prevent this problem. It doesn't matter WHY your thyroid was removed, once it is removed you now have a sluggish thyroid. Prior to radioiodine therapy or surgery, a patient should be made euthyroid with antithyroid drugs and propranolol. Alahmad M, Al-Sulaiti M, Abdelrahman H, El-Menyar A, Singh I, Tabeb A, Al-Thani H. J Surg Case Rep. 2022 May 17;2022(5):rjac131. Acetaminophen is the drug of choice, as aspirin may displace thyroid hormone from binding sites and increase severity of thyroid storm. [QxMD MEDLINE Link]. Endocr J. In the meantime, be sure to contact your thyroid-care team if you have any questions regarding your recovery process. Symptoms include weight loss, palpitations, and weakness but patients don't have ophthalmopathy. As with any surgery, it's normal to have questions, concerns, and maybe even feel a little bit of anxiety going into it. World J Surg. Surgical management of an atypical presentation of a thyroid storm. Possible recommendations for . In addition, hormone levels may rise rapidly when the gland is manipulated during surgery, during vigorous palpation during examination, or from damaged follicles following RAI therapy. Thyroid Hormone Reference Range May Not Apply for Cancer Patients, FDA OKs Pembrolizumab for Adjuvant Treatment of NSCLC, Recognizing the Signs: Heart Failure and Type 2 Diabetes, Myopathies: Muscling Your Way to the Diagnosis. 2009 Feb. 102(2):193-5. 22(2):263-77. [QxMD MEDLINE Link]. Prediction of permanent hypoparathyroidism after total thyroidectomy. Thyroid surgery: common questions and concerns, Impact of potassium iodide on thyroidectomy for Graves disease: Implications for safety and operative difficulty, Factors associated with neck hematoma after thyroidectomy: a retrospective analysis using a japanese inpatient database. Guanethidine or reserpine can be used instead in these cases. Disclaimer. Rare cases of embryopathy, including aplasia cutis, have been reported with methimazole during pregnancy. [QxMD MEDLINE Link]. Dysphagia, or swallowing problems, are common after thyroid surgery, though they usually don't last long, often resolving within two weeks. Having a rapid heart rate (tachycardia) that can exceed 140 beats per minute. Treatment usually includes IV antibiotics, which are medications to kill bacteria that are delivered through a vein. Endoscopic thyroidectomy using the EZ-VANS method. Mimi S Kokoska, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Association for Physician Leadership, American College of Surgeons, American Head and Neck SocietyDisclosure: Nothing to disclose. Endocrinol Metab Clin North Am. Keep in mind, as well, that the likelihood of a complication occurring is much less with an experienced surgeon. Terris DJ, Snyder S, Carneiro-pla D, et al. [1], ATA guidelines also recommend that patients undergoing thyroidectomy be rendered euthyroid with methimazole preoperatively and that potassium iodide (KI) be given in the immediate preoperative period. Because of this, your healthcare provider may give you antithyroid medication before you have surgery to try to prevent thyroid storm. Initially, glucocorticoids were used to treat potential relative insufficiency due to accelerated production and degradation owing to the hypermetabolic state. 2018 Jan. 28(1):32-40. 22(7):661-79. MOJ Clin Med Case Rep. 2021;11(5):136. Treatment includes immediate surgery to remove the hematoma and address any areas of bleeding. Examples include foods with sauces or gravy, cooked vegetables, and casseroles. 388(10047):906-918. doi: 10.1093/jscr/rjac131. 10th ed.,Philadelphia: Lippincott Williams & Wilkins (LWW), 2012. In thyroid storm, intensive management as described below improves the chance of survival. [6]. However, guanethidine and reserpine cannot be used in the presence of cardiovascular collapse or shock. Bethesda, MD 20894, Web Policies MeSH Trends in the incidence and in-hospital outcomes of cardiogenic shock complicating thyroid storm. [QxMD MEDLINE Link]. Thyroid. This can include changes in blood pressure or heart problems. Researchers arent yet sure why certain factors can result in thyroid storms. [QxMD MEDLINE Link]. Perioperative risk as it relates to the degree of thyroid dysfunction is also discussed separately. Kandil E, Khalek MA, Thethi T, Abd Elmageed Z, Khan A, Jaffe BM. While the fluid is often reabsorbed by the body, large seromas may need to be drained. Patient was treated for thyroid storm with propylthiouracil, hydrocortisone, potassium iodide and propranolol. Transient (temporary) hypoparathyroidism can happen after thyroid surgery. excessive release of thyroid hormones (THs), American Association of Endocrine Surgeons, American Association for the Advancement of Science, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Association for Physician Leadership. After initiation of antithyroid therapy, hormone release can be inhibited by large doses of iodine, which reduce thyroidal iodine uptake. Nausea, vomiting, severe diarrhea, abdominal pain, hepatocellular dysfunction-jaundice, 4. The site is secure. Dean Toriumi, MD Associate Professor, Department of Otolaryngology, University of Illinois Medical CenterDisclosure: Nothing to disclose. Thabet Abbarah, MD, FACS is a member of the following medical societies: American College of SurgeonsDisclosure: Nothing to disclose. Serious liver injury has been identified with methimazole in 5 cases (3 resulting in death). Unlike iodine, lithium is not subject to the escape phenomenon; lithium blocks the release of thyroid hormone throughout its administration. Venkata Subramanian Kanthimathinathan, MD Fellow in Bariatric/Advanced Laparoscopic Surgery, University of Missouri HealthcareDisclosure: Nothing to disclose. When only part of it is removed, it may continue to function as normal without medication but it may not. Am J Med Sci. Am J Med Sci. when to consider thyroid storm Presently, the most common cause of thyroid storm is intercurrent illness or infection. Pokhrel B, Aiman W, Bhusal K. Thyroid Storm. Thyroid Hormone Reference Range May Not Apply for Cancer Patients, FDA OKs Pembrolizumab for Adjuvant Treatment of NSCLC, Recognizing the Signs: Heart Failure and Type 2 Diabetes, Myopathies: Muscling Your Way to the Diagnosis. The decision to include a boxed warning was based on the FDA's review of postmarketing safety reports and meetings held with the American Thyroid Association, the National Institute of Child Health and Human Development, and the pediatric endocrine clinical community. 2012 Sep. 109(3):466-7. 1993 Jun;22(2):263-77 Mohananey D, Smilowitz N, Villablanca PA, et al. Dare to Compare: Do You Know the Latest on Immuno-Oncology in Advanced Non-Small Cell Lung Cancer? Symptoms usually improve in the first few weeks but may persist up to six months after surgery. Trends in the incidence and in-hospital outcomes of cardiogenic shock complicating thyroid storm. When you have your follow-up appointment, your surgeon will check your blood calcium level. Thyroid storm (also called thyroid crisis and thyrotoxic crisis) happens when your thyroid gland releases a large amount of thyroid hormone in a short amount of time. By Mary Shomon In patients with failed hormone regulation who are scheduled for indispensable total thyroidectomy, the risk of thyroid storm with severe end-organ complications has to be anticipated. Prediction of permanent hypoparathyroidism after total thyroidectomy. Treatment in the intensive care unit includes cooling, intravenous fluids, medications such as propylthiouracil (PTU), and management of arrhythmias. She is the author of "The Thyroid Diet Revolution.". Multivitamins, especially vitamin B-1, are added to prevent Wernicke encephalopathy. Post Operative Expectations. [15]. Anatomic characteristics, identification, and protection of the nonrecurrent laryngeal nerve during thyroidectomy. In a series of 24 patients with iodine-induced hyperthyroidism who underwent surgical thyroidectomy after medical therapy failed, all but one patient survived. This is very common and expected during the first week or two after surgery. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Thyroid surgery is often done under general anesthesia with a breathing tube placed in the windpipe, or trachea, to breathe for you. Before doing these, however, make sure to ask your surgeon about their appropriateness for you, any additional exercises they believe might be helpful, how often you should perform them, and whether there are any exercises you should avoid. [QxMD MEDLINE Link]. Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine The first paper reports on post-surgical hypoparathyroidism in children, while the second paper focuses on adults. Thyroid storm If a thyroidectomy is done to treat a very overactive gland, there may be a . 2012 Apr. It's also important to talk about how to properly take your medication, as food and many drugs and supplements can interfere with absorption. Braverman, MD, Lewis E., and Robert D. Utiger, MD. Endocr Pract. Iodine solution to stop your thyroid from releasing thyroid hormone. 2017 Aug. 354(2):159-64. Recommended exercises may include: Suggested frequency: 10 repetitions, three times day. Lancet. Martin D. Disseminated intravascular coagulation precipitated by thyroid storm. [Full Text]. Discuss what's on your mind with your healthcare provider. Although the exact pathogenesis of thyroid storm is not fully understood, the following theories have been proposed: Patients with thyroid storm reportedly have relatively higher levels of free THs than patients with uncomplicated thyrotoxicosis, although total TH levels may not be increased. FOIA Thyroidectomy is an option when other treatments fail or are contraindicated, or when a goiter is causing compressive symptoms. Closely monitor PTU therapy for signs and symptoms of liver injury, especially during the first 6 months after initiation of therapy. 2524 N. Broadway Edmond Oklahoma 73034. Muller C, Perrin P, Faller B, Richter S, Chantrel F. Role of plasma exchange in the thyroid storm. This can lead to a sore throat and the sensation of a lumplike something is stuck in your throatwith swallowing. Therefore, invasive monitoring is advisable in elderly patients and in those with congestive cardiac failure. 2015 Feb. 21(2):182-9. 2020 June 20. Thyroid storm is a rare, life-threatening condition characterized by severe clinical manifestations of thyrotoxicosis [ 1 ]. . The recommendation to render patients euthyroid with antithyroid medication is an effort to reduce the risk of thyroid storm that the stress of surgery could precipitate. Thyroidectomy then and now: a 50-year Australian perspective. Br J Anaesth. Transfus Apher Sci. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). If untreated, thyroid storm is almost invariably fatal in adults (90% mortality rate). A biopsy was diagnostic for follicular variant of papillary thyroid carcinoma, and total thyroidectomy was performed. Thabet Abbarah, MD, FACS is a member of the following medical societies: American College of SurgeonsDisclosure: Nothing to disclose. For patient education resources, see theThyroid and Metabolism Center as well as Thyroid Problems,Thyroid Storm, and Graves Disease. 2003 Oct;13(10):933-40 Kulaksizoglu M, Gonen MS, Kebapcilar L, et al. Propranolol is the drug of choice to counter peripheral action of thyroid hormone. Ther Apher Dial. 2019 Jan. 29(1):36-43. Closely monitor digoxin levels to prevent toxicity. Post operative expectations. Common symptoms include having a high fever and a rapid heart rate. You should also avoid any heavy lifting or strenuous activities, such as many sports, for a few weeks. In addition to persistent hoarseness, injury to the recurrent laryngeal nerve may lead to other symptoms after surgery. [10]. Pre-operative Lugols iodine treatment in the management of patients undergoing thyroidectomy for Graves disease: a review of the literature, Safety and effectiveness of total thyroidectomy and its comparison with subtotal thyroidectomy and other thyroid surgeries: a systematic review, Outpatient versus inpatient thyroidectomy: A systematic review and meta-analysis. thyroid storm with propylthiouracil, hydrocortisone, potassium iodide and propranolol. There has been some controversy over inpatient vs. outpatient thyroidectomies, especially with the recent trend toward same-day surgery. Total or near-total thyroidectomy: This involves the removal of all or most of the thyroid gland.This surgery is often indicated for large thyroid cancers, large goiters, and Graves' disease. Lugol solution or saturated solution of potassium iodide can be used. [QxMD MEDLINE Link]. The four parathyroid glands lie on the back of the thyroid gland and are sometimes injured or removed during surgery. South Med J. Antithyroid compounds propylthiouracil (PTU) and methimazole (MMI) are used to block the synthesis of the thyroid hormone. Thyroid storm can lead to serious complications if treatment is delayed or if its untreated, including: If youre experiencing symptoms of thyroid storm such as a high fever and a rapid heart rate, get to the nearest emergency room as soon as possible. Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y.