The effect of anti-thyroid drug treatment duration on thyroid gland microvessel density and intraoperative blood loss in patients with Graves' disease

• Published in: Surgery 2008-02, Vol.143 (2), p.216-225
• Main Authors: Erbil, Yeşim, Giriş, Murat, MSc, Salmasloglu, Artur, MD, Ozluk, Yasemin, MD, Barbaros, Umut, MD, Yank, Burcu Tulumoğlu, MD, Kapran, Yersu, Abbasoglu, Semra Dogru, Ozarmagan, Selcuk
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antithyroid Agents - therapeutic use; Biological and medical sciences; Blood Flow Velocity - drug effects; Blood Loss, Surgical; Endocrinopathies; Female; General aspects; Graves Disease - diagnostic imaging; Graves Disease - drug therapy; Graves Disease - surgery; Humans; Male; Medical sciences; Methimazole - therapeutic use; Microcirculation - drug effects; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Preoperative Care; Propylthiouracil - therapeutic use; Reference Values; Surgery; Thyroid Gland - blood supply; Thyroid Gland - diagnostic imaging; Thyroid. Thyroid axis (diseases); Thyroidectomy; Ultrasonography, Doppler, Color
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2007.07.036

Background Preoperative preparation of the patient with Graves' disease (GD) is crucial to avoid intraoperative or postoperative complications associated with anesthesia or surgery. We aimed to evaluate thyroid blood flow and microvessel density in patients with GD according to antithyroid drug (ATD) treatment, preoperatively. Method Forty-three patients were divided into two groups according to the ATD type. Patients in group 1 (n = 25) were treated with methimazole, whereas patients in group 2 (n = 18) were treated with propylthiouracil, preoperatively. Blood flow through the thyroid arteries was measured by color flow Doppler ultrasonography. The microvessel density (MVD) was assessed immunohistochemically and via Western blot analysis using the level of CD-34expression in thyroid tissue. Results There was a positive correlation between blood loss and thyroid volume (rs = 0.953, P = .0001) and blood flow (rs = 0.720, P = .0001) and CD-34 expression (rs = 0.331, P = .03) and MVD (rs = 0.442, P = .003). No correlation was observed between ATD type and thyroid vascularity. In patients with longer treatment duration before operation, thyroid vascularity was significantly lower relative to patients with shorter treatment durations. According to logistic regression analysis, longer treatment duration had a 142-fold decreased rate of intraoperative blood loss independent of ATD type. Conclusion Preoperative ATD treatment duration may predict intraoperative blood loss during thyroidectomy. Longer treatment duration might be useful in reducing intraoperative bleeding, allowing better visualization and preservation of the nerves and parathyroid glands.