Impact of surgery versus medical management on cardiovascular manifestations in Graves disease

Elnahla, Ahmed; Attia, Abdallah S.; Khadra, Helmi; Munshi, Ruhul; Shalaby, Hosam; Lee, Grace S.; Kandil, Emad

doi:10.1016/j.surg.2020.03.023

Cited by 8 publications

(9 citation statements)

References 23 publications

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“…These findings were largely consistent with our results reporting that surgery resulted in lower mortality and CVD risks than RAI therapy. Meanwhile, compared to ATD, significant clinical improvement was observed in the performance of hypertension, tachyarrhythmias including AF, and heart failure after thyroidectomy therapy among GD patients with CVD comorbidity 14 . This further echoed our finding that surgery had lower CVD risk than ATD treatment in the long-term.…”

Section: Discussionsupporting

confidence: 68%

“…12 Recent studies reported that patients managed by either ATD or RAI were at increased risk of cardiovascular disease (CVD) and all-cause mortality when compared to those managed by surgery. 13,14 A recent study suggested that surgery could modify long-term cardiac risks by improving coexisting hypertension and arrhythmias. 15 Therefore, it is becoming evident that surgery may have a reduced risk of cardiac events in the long-term.…”

mentioning

confidence: 99%

“…Some GD patients with poorly-controlled hyperthyroidism can develop heart-related complications and diseases 12 . Recent studies reported that patients managed by either ATD or RAI were at increased risk of cardiovascular disease (CVD) and all-cause mortality when compared to those managed by surgery 13,14 . A recent study suggested that surgery could modify long-term cardiac risks by improving co-existing hypertension and arrhythmias 15 .…”

mentioning

confidence: 99%

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Outcomes of Graves’ Disease Patients Following Antithyroid Drugs, Radioactive Iodine, or Thyroidectomy as the First-line Treatment

Liu¹,

Wong

Chan

et al. 2021

Annals of Surgery

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Section: Discussionsupporting

confidence: 68%

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confidence: 99%

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confidence: 99%

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Outcomes of Graves’ Disease Patients Following Antithyroid Drugs, Radioactive Iodine, or Thyroidectomy as the First-line Treatment

Liu¹,

Wong

Chan

et al. 2021

Annals of Surgery

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“…The current standard of care for the definitive management of hyperthyroidism caused by AFTNs is surgery and RAI ablation. Thyroidectomy allows definitive cure, however it by default carries with it a relatively large risk of permanent hypothyroidism, recurrent laryngeal nerve injury, and hypoparathyroidism ( 30 , 31 ). RAI, while effective, treats a patient with exogenous radioactive elements which, according to a recent meta-analysis, displays a linear-dose response relationship with solid cancer mortality ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation as a novel modality in the USA for treating toxic thyroid nodules: case series and literature review

Kandil¹,

Omar²,

Attia³

et al. 2022

Gland Surg

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Background: Radiofrequency ablation (RFA) is widely accepted as a treatment for non-functioning benign thyroid nodules, mainly to reduce compressive symptoms. In addition to potential compressive symptoms, autonomously functioning thyroid nodules (AFTNs) can cause palpitations, weight loss, diarrhea, increased appetite, flushing, irritability, tiredness, poor sleep, and long-term cardiovascular and musculoskeletal consequences. Currently, there are no United States based RFA practice guidelines for the treatment of AFTNs. However, several reports from Asia and Europe have described the resolution of hyperthyroidism secondary to AFTNs with RFA.Case Description: Three patients with toxic thyroid nodules presented with symptomatic hyperthyroidism, suppressed thyroid-stimulating hormone (TSH), and increased uptake on nuclear medicine thyroid scan. These patients were treated with RFA. At 3 months following ablation, TSH normalized to 2.09, 1.91, and 1.34 mIU/mL respectively. However, temporary hypothyroidism was encountered at 1 month following ablation. All patients discontinued their antithyroid medications following ablation. Nodules exhibited significant volume reductions of 38%, 32%, and 54% from the baseline at 1-month follow-up.Conclusions: RFA potentiates as a safe and effective treatment of toxic thyroid nodules. Though it carries a risk of temporary hypothyroidism following ablation, long-term consequences appear to be minimal.Future study with larger sample size and longer follow-up are encouraged to identify factors predicting response.

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“…Recently, Elnahla et al. demonstrated significant and rapid improvements of hypertension (45% in surgical treatment vs. 18% in medical treatment), tachyarrhythmia (86% vs. 66%), and HF (75% vs. 50%) among patients receiving total thyroidectomy for Graves’ disease compared to those with ATD therapy in a retrospective study ( 26 ). However, surgical treatment tends to be less cost-effective compared to medical therapy and RAIT based on studies conducted in the United States and United Kingdom ( 27 ), and postsurgical complications, including hypoparathyroidism and recurrent laryngeal nerve injury can occur in 1–4% of patients ( 28 , 29 ).…”

Section: Discussionmentioning

confidence: 99%

Graves’ disease, its treatments, and the risk of atrial fibrillation: A Korean population-based study

et al. 2022

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BackgroundAtrial fibrillation (AF) is occasionally diagnosed in individuals with Graves’ disease. Definite treatments, including radioactive iodine therapy (RAIT) or surgery might lower the risk of AF in the literature. However, no studies have compared the effects of anti-thyroid drugs (ATDs), RAIT, and surgery on the risk of AF.MethodsThis retrospective cohort study included 94,060 newly diagnosed Graves’ disease patients and 470,300 controls from the Korean National Health Insurance database. The incidence of AF was evaluated in patients and controls. Patients were categorized based on treatment method into ATD (95.6%), RAIT (3.5%), and surgery (0.9%) groups. In the ATD group, the dose and duration of ATDs were calculated for each patient. In the RAIT and surgery groups, remission was defined as levothyroxine prescription.ResultsGraves’ disease patients had a 2.2-fold higher risk of developing AF than controls. Regardless of demographic factors, the patient group had a consistently higher risk of AF than controls, with the highest risk of AF (HR, 5.49) in the younger patient group. The surgery group had a similar risk of AF compared with controls, whereas the ATD (HR, 2.23) and RAIT (HR, 2.00) groups had increased risks of AF, even in patients reaching hypothyroid status after RAIT. Patients with higher dose or longer treatment duration of ATDs were at greater risk of AF.ConclusionWe observed differing risks of AF according to methods of treatment for Graves’ disease, and that definite treatment can be an option for subjects needing sustained medical treatment considering the risk of AF.

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Impact of surgery versus medical management on cardiovascular manifestations in Graves disease

Cited by 8 publications

References 23 publications

Outcomes of Graves’ Disease Patients Following Antithyroid Drugs, Radioactive Iodine, or Thyroidectomy as the First-line Treatment

Outcomes of Graves’ Disease Patients Following Antithyroid Drugs, Radioactive Iodine, or Thyroidectomy as the First-line Treatment

Radiofrequency ablation as a novel modality in the USA for treating toxic thyroid nodules: case series and literature review

Graves’ disease, its treatments, and the risk of atrial fibrillation: A Korean population-based study

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