Emergency thyroidectomy for poorly controlled hyperthyroidism in the context of war in Ukraine

Abstract

The aim of the work is to analyze the results of surgical treatment of patients with hyperthyroidism (Graves’ disease, multinodular toxic goiter, solitary toxic adenomas) in patients who were observed during the period of hostilities in Ukraine.

Materials and methods. The retrospective study included 70 patients operated on for hyperthyroidism in the surgical clinic of the MNE “Kyiv City Clinical Hospital No. 8” during the period of military operations in 2022–2024. All patients underwent a comprehensive clinical and instrumental examination, an assessment of the clinical manifestations of the disease was carried out depending on the wartime migration, the nature of surgical treatment, and the immediate results of the postoperative period. Laryngeal dysfunction, hypocalcemia, hematoma, and bleeding were recorded. All samples of the removed thyroid glands underwent pathological analysis. Data analysis was performed using statistical methods.

Results. Observations of wartime patients showed that unstable, poorly controlled hyperthyroidism in Graves’ disease was more common in people from frontline regions and in evacuated patients. In our observations, 32 (45.7 %) patients required urgent surgery for poorly controlled hyperthyroidism. Planned surgery for well-controlled hyperthyroidism was performed in 38 (54.3 %) patients.

Conclusions. Surgical intervention is the method of choice for rapid final control of hyperthyroidism in Graves’ disease, multinodular toxic goiter, and toxic adenoma. During the period of military operations in Ukraine, patients with hyperthyroidism were predominantly Graves’ disease patients who could not achieve stable drug compensation of thyrotoxicosis, which was an indication for urgent thyroidectomy. Urgent surgical intervention for hyperthyroidism can be safely performed when using effective protocols for accelerated preoperative preparation.