Objective: This audit aims to review cases of inpatient emergency thyroidectomies performed at Blacktown Hospital, including patient characteristics and post-operative complications.
Methods: The medical records of all patients who underwent thyroidectomy at Blacktown Hospital between June 2016 and August 2021 were reviewed. Operative indications, laboratory evaluation, pre-operative medications, clinical features (including Burch-Wartofsky Point Scale (BWPS)), histopathology and post-operative complications were determined for patients who underwent emergency thyroidectomy.
Results: Of the 181 patients who underwent total thyroidectomy at Blacktown Hospital, 9 (5%) were performed as emergency surgeries. 8 patients were female, and 1 patient was male, with an age range of 24-53 years. The predominant underlying pathology was Graves’ disease (8 patients) and toxic multinodular goitre (1 patient). Pre-operative free T4 ranged between 19.2-52.5 pmol/L and free T3 ranged between 9.6-46.0 pmol/L. 8 patients received pre-operative Lugol’s iodine and all patients received beta blockade. Indications for surgery included thionamide-related complications (6 patients) and uncontrolled thyrotoxicosis despite thionamide therapy (3 patients). Thionamide-related complications included severe pruritis and rash, leukopaenia, transaminitis, pancreatitis and febrile neutropaenia. The BWPS was calculated for each patient and ranged between 5-40 points, with the most common feature being tachycardia. There was no evidence of malignancy on histopathology. Post-operatively, symptomatic hypocalcaemia occurred in 2 patients and asymptomatic hypocalcaemia occurred in a further 2 patients, all of which were transient. All patients were vitamin D replete with a serum level > 50 nmol/L. Post-operative hypocalcaemia occurred in the 4 patients with the highest pre-operative free T4 and T3 levels amongst the cohort.
Conclusion: In our experience at Blacktown Hospital, the overall rate of emergency thyroidectomy is low. The most common indication for emergency thyroidectomy was thionamide intolerance and the most common underlying pathology was Graves’ disease. Post-operative hypocalcaemia occurred in the patients with the more severe pre-operative biochemical hyperthyroidism.