Early
thyroidectomy is the treatment of choice for
thyrotoxic storm in patients with thyroid autonomy often induced by
iodine. However, older patients who are mostly affected by this condition often have underlying chronic cardiopulmonary diseases, apparently contradicting surgical intervention. The published evidence for suitable treatment strategies in these patients is limited. We report the outcome of a series of older
critically ill patients who were treated by
thyroidectomy because of
thyrotoxic storm. We retrospectively analyzed the outcome of 10 patients (4 males, 6 females; 70 years of age, range, 54-79, Burch-Wartofsky point scale, 61; range, 40-85) with
thyrotoxic storm, thyroid autonomy, and severe cardiorespiratory and
renal failure with
cardiac arrhythmia, coronary artery or
chronic obstructive pulmonary disease, or acute
inflammation.
Thyroidectomy was performed for the following reasons: symptoms of
thyrotoxic storm deteriorated or did not improve within 24-48 hours despite intensive medical treatment, or patients developed thionamide-induced
agranulocytosis or severe
thrombocytopenia. All patients with severe accompanying diseases survived
thyroidectomy (early post-operative mortality, 0%). The two oldest patients died 2-3 weeks after
thyroidectomy because of
myocardial infarction or
respiratory failure (late postoperative mortality, 20%). In contrast, in the few previous reports of patients who underwent
thyroidectomy for
thyrotoxic storm and severe accompanying diseases (n = 7), late postoperative mortality was 43%. The overall mortality for all reported patients including our own, who underwent
thyroidectomy for
thyrotoxic storm with and without severe accompanying disease (n = 49) was 10%. Our results suggest that early total
thyroidectomy should be considered as the method of choice for older,
chronically ill patients with
thyrotoxic storm complicated by cardiorespiratory and
renal failure, especially if high-dose thionamide treatment,
iopanoic acid,
glucocorticoids, and
intensive care fail to improve the patient's conditions within 12-24 hours.