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Long-Acting β-Adrenergic Antagonists as Preparation for Surgery in Thyrotoxicosis

Long-Acting β-Adrenergic Antagonists as Preparation for Surgery in Thyrotoxicosis Abstract • This report describes our experience with 12 patients with thyrotoxic Graves' disease who were prepared for thyroidectomy using only a long-acting orally administered β-adrenergic blocking agent (nadolol or atenolol); iodides were not used. This form of preparation proved to be very effective, fast acting, and economical. It permitted rapid preparation of patients for surgery and resulted in excellent control of the manifestations of hyperthyroidism in the perioperative period. The surgery was relatively easy and bloodless, and there were no operative complications. We recommend that these longacting β-adrenergic blocking agents be considered as the preferred medication for the preparation of thyrotoxic patients for surgery. (Arch Surg 1986;121:838-840) References 1. Becker DV: Choice of therapy for Graves' hyperthyroidism . N Engl J Med 1984;311:464-466.Crossref 2. Astwood EB: Treatment of hyperthyroidism with thiourea and thiouracil . JAMA 1943;122:78.Crossref 3. Plummer HS: Results of administering iodine to patients having exophthalmic goiter . JAMA 1923;80:1955. 4. Hamburger JI: Is long-term antithyroid drug therapy for Graves' disease cost effective? in Hamburger JI, Miller JM (eds): Controversies in Clinical Thyroidology . New York, Springer-Verlag, 1981, pp 119-157. 5. Becker DV, Hurley JR: Current status of radio-iodine (131-I) treatment of hyperthyroidism , in Freeman LM, Weissman HS (eds): Nuclear Medicine Annual . New York, Raven Press, 1982, pp 265-290. 6. Zonszein J, Santangelo RP, Mackin JF, et al: Propranolol therapy in thyrotoxicosis: A review of 84 patients undergoing surgery . Am J Med 1979;66:411-416.Crossref 7. Lee TC, Coffey RJ, Currier BM, et al: Propranolol and thyroidectomy in the treatment of thyrotoxicosis . Ann Surg 1982;195:766-773.Crossref 8. Feek CM, Sawers SA, Irvine WJ, et al: Combination of potassium iodide and propranolol in preparation of patients with Graves' disease for thyroid surgery . N Engl J Med 1980;302:883-885.Crossref 9. Peden NR, Gunn A, Browning MCK, et al: Nadolol and potassium iodide in combination in the surgical treatment of thyrotoxicosis . Br J Surg 1982;69:638-640.Crossref 10. Surgrue D, McEvoy M, Freely J, et al: Hyperthyroidism in the land of Graves: Results of treatment by surgery, radio-iodine, and carbimazole in 837 cases . Q J Med 1980;49:51-61. 11. Dunn JT: Choice of therapy in young adults with hyperthyroidism of Graves' disease: A brief, case-directed poll of 54 thyroidologists . Ann Intern Med 1984;100:891-893.Crossref 12. McGavach TH, Chevalley J: Untoward hematologic responses to the antithyroid compounds . Am J Med 1954;17:36-40.Crossref 13. Furth ED, Becker DV, Schwartz MS: Significance of rate of response of basal metabolic rate and serum cholesterol in hyperthyroid patients receiving neomercazole . J Clin Endocrinol Metabol 1963;23:1130-1140.Crossref 14. Utiger RD: β-Adrenergic—antagonist therapy for hyperthyroid Graves' disease . N Engl J Med 1984;310:1597-1598.Crossref 15. Feely J, Stevenson IH, Crooks J: Increased clearance of propranolol in thyrotoxicosis . Ann Intern Med 1981;94:472-474.Crossref 16. McDevitt DG, Nelson JK: Comparative trial of atenolol and propranolol in hyperthyroidism . Br J Clin Pharmacol 1978;6:233-237.Crossref 17. Nilsson OR, Karlberg BE, Kagedad B, et al: Non-selective and selective β-1 adrenoreceptor blocking agents in the treatment of hyperthyroidism . Acta Med Scand 1979;206:21-25.Crossref 18. Wilkin TJ, Beck JS, Michie W: Does preoperative iodide treatment for thyrotoxicosis bring about involution? J Clin Pathol 1977;30:99-102.Crossref 19. Coyle PH, Mitchell JE: Thyroidectomy: Is Lugol's iodine necessary? Ann R Coll Surg Engl 1982;64:334-335. 20. Emerson CH, Anderson AJ, Howard WJ, et al: Serum thyroxine and triiodothyronine concentrations during iodine treatment of hyperthyroidism . J Clin Endocrinol Metabol 1975;40:33-36.Crossref 21. Perrild H, Molholm HJ, Skousted L, et al: Different effects of propranolol, alprenolol, and metoprolol on serum T-3 and serum rT-3 in hyperthyroidism . Clin Endocrinol 1983;18:139-142.Crossref 22. Coulombe P, Dussalt JH, Walker P: Catecholamine metabolism in thyroid disease: II. Norepinephrine secretion rate in hyperthyroidism and hypothyroidism . J Clin Endocrinol Metabol 1977;44:1185-1189.Crossref 23. Tse J, Wrenn RW, Kuo JF: Thyroxine-induced changes in characteristics and activities of β-adrenergic receptors and adenosine 3′,5′-monophosphate and guanosine 3′,5′-monophosphate systems in the heart may be related to reputed catecholamine supersensitivity in hyperthyroidism . Endocrinology 1980;107:6-16.Crossref 24. Levey GS: The heart and hyperthyroidism: Use of β-adrenergic blocking drugs . Med Clin North Am 1975;59:1193-1201. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Long-Acting β-Adrenergic Antagonists as Preparation for Surgery in Thyrotoxicosis

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1986.01400070108022
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Abstract

Abstract • This report describes our experience with 12 patients with thyrotoxic Graves' disease who were prepared for thyroidectomy using only a long-acting orally administered β-adrenergic blocking agent (nadolol or atenolol); iodides were not used. This form of preparation proved to be very effective, fast acting, and economical. It permitted rapid preparation of patients for surgery and resulted in excellent control of the manifestations of hyperthyroidism in the perioperative period. The surgery was relatively easy and bloodless, and there were no operative complications. We recommend that these longacting β-adrenergic blocking agents be considered as the preferred medication for the preparation of thyrotoxic patients for surgery. (Arch Surg 1986;121:838-840) References 1. Becker DV: Choice of therapy for Graves' hyperthyroidism . N Engl J Med 1984;311:464-466.Crossref 2. Astwood EB: Treatment of hyperthyroidism with thiourea and thiouracil . JAMA 1943;122:78.Crossref 3. Plummer HS: Results of administering iodine to patients having exophthalmic goiter . JAMA 1923;80:1955. 4. Hamburger JI: Is long-term antithyroid drug therapy for Graves' disease cost effective? in Hamburger JI, Miller JM (eds): Controversies in Clinical Thyroidology . New York, Springer-Verlag, 1981, pp 119-157. 5. Becker DV, Hurley JR: Current status of radio-iodine (131-I) treatment of hyperthyroidism , in Freeman LM, Weissman HS (eds): Nuclear Medicine Annual . New York, Raven Press, 1982, pp 265-290. 6. Zonszein J, Santangelo RP, Mackin JF, et al: Propranolol therapy in thyrotoxicosis: A review of 84 patients undergoing surgery . Am J Med 1979;66:411-416.Crossref 7. Lee TC, Coffey RJ, Currier BM, et al: Propranolol and thyroidectomy in the treatment of thyrotoxicosis . Ann Surg 1982;195:766-773.Crossref 8. Feek CM, Sawers SA, Irvine WJ, et al: Combination of potassium iodide and propranolol in preparation of patients with Graves' disease for thyroid surgery . N Engl J Med 1980;302:883-885.Crossref 9. Peden NR, Gunn A, Browning MCK, et al: Nadolol and potassium iodide in combination in the surgical treatment of thyrotoxicosis . Br J Surg 1982;69:638-640.Crossref 10. Surgrue D, McEvoy M, Freely J, et al: Hyperthyroidism in the land of Graves: Results of treatment by surgery, radio-iodine, and carbimazole in 837 cases . Q J Med 1980;49:51-61. 11. Dunn JT: Choice of therapy in young adults with hyperthyroidism of Graves' disease: A brief, case-directed poll of 54 thyroidologists . Ann Intern Med 1984;100:891-893.Crossref 12. McGavach TH, Chevalley J: Untoward hematologic responses to the antithyroid compounds . Am J Med 1954;17:36-40.Crossref 13. Furth ED, Becker DV, Schwartz MS: Significance of rate of response of basal metabolic rate and serum cholesterol in hyperthyroid patients receiving neomercazole . J Clin Endocrinol Metabol 1963;23:1130-1140.Crossref 14. Utiger RD: β-Adrenergic—antagonist therapy for hyperthyroid Graves' disease . N Engl J Med 1984;310:1597-1598.Crossref 15. Feely J, Stevenson IH, Crooks J: Increased clearance of propranolol in thyrotoxicosis . Ann Intern Med 1981;94:472-474.Crossref 16. McDevitt DG, Nelson JK: Comparative trial of atenolol and propranolol in hyperthyroidism . Br J Clin Pharmacol 1978;6:233-237.Crossref 17. Nilsson OR, Karlberg BE, Kagedad B, et al: Non-selective and selective β-1 adrenoreceptor blocking agents in the treatment of hyperthyroidism . Acta Med Scand 1979;206:21-25.Crossref 18. Wilkin TJ, Beck JS, Michie W: Does preoperative iodide treatment for thyrotoxicosis bring about involution? J Clin Pathol 1977;30:99-102.Crossref 19. Coyle PH, Mitchell JE: Thyroidectomy: Is Lugol's iodine necessary? Ann R Coll Surg Engl 1982;64:334-335. 20. Emerson CH, Anderson AJ, Howard WJ, et al: Serum thyroxine and triiodothyronine concentrations during iodine treatment of hyperthyroidism . J Clin Endocrinol Metabol 1975;40:33-36.Crossref 21. Perrild H, Molholm HJ, Skousted L, et al: Different effects of propranolol, alprenolol, and metoprolol on serum T-3 and serum rT-3 in hyperthyroidism . Clin Endocrinol 1983;18:139-142.Crossref 22. Coulombe P, Dussalt JH, Walker P: Catecholamine metabolism in thyroid disease: II. Norepinephrine secretion rate in hyperthyroidism and hypothyroidism . J Clin Endocrinol Metabol 1977;44:1185-1189.Crossref 23. Tse J, Wrenn RW, Kuo JF: Thyroxine-induced changes in characteristics and activities of β-adrenergic receptors and adenosine 3′,5′-monophosphate and guanosine 3′,5′-monophosphate systems in the heart may be related to reputed catecholamine supersensitivity in hyperthyroidism . Endocrinology 1980;107:6-16.Crossref 24. Levey GS: The heart and hyperthyroidism: Use of β-adrenergic blocking drugs . Med Clin North Am 1975;59:1193-1201.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1986

References