| Clinical Study of Postoperative Liver Dysfunction in Graves` Hyperthyroidism . |
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Yang Sik Shin, Ki Young Lee, Kwang Won Park, Chung Hyun Cho |
1Department of Anesthesiology, Yonsei University College of Medicine, Seoul, Korea.
2Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. |
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| Abstract |
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Thyroidectomy is one method of treatment for patients with Craves' disease. However, these compromised patients are challenged by many factors including thyroid hormones, antithyroid agents, a deoreaaed splanchnic blood supply, anti hepatotoxic anesthetics which mar cause or contribute to postoperative liver dysfunotion. When triiodothyronine (T3) is administered to experimental animals, the resultant hyperth- yroid state amplifies the liver damage caused by hepatotoxic agents including anesteetics. The purpose of this study was to determine if patients with Craves' disease are clinicslly vulnerable to Postoperative liver dysfunction. Patients were divided into two groups; those with nontoxic goiters were the control group with 14 patients, while those with Graves' disease compromised the experimental group with 30 patients. There was no history of any aystemic or liver diaease in either group. The antithyroid agents propylthiouracil propranolol and Lugol's solution were admi-nistered to patients in the experimental group for 1 to 2 weeks prior to surgery, Levels of thyroid hormones and liver ensrmes were measured preoperativelr, and on the 1 st and 7 th Postoperative day(POD) . The results are as follows : 1) Halothane was administered to all bot eight patients who were given enflurane. Patients in the control group were anesthetized for 176.67+/-34.47 minutes, and those in the experimental group for 176.67+/-34.47 minutes. There was no difference between the two groups in maximum body temperature during operation. 2) The lowest MAP measures during aurgerr wha 79.92+/-9.89 and 76.15+/-9.73 mmHg in the control and experimental groups. The volume of loss during surgery , and there were no significant differences in each group. The volume of blood loss during surgerr in the experimental group(74.13+/- -5.28 ml) but postoperative than that in the control group(74.13+/-5.28 ml), butt Postoperative hematocrits in bosh groups were within normal limits. 3) In the experimental group, the preoperative levels of T3 and T4(429.15+/-242.99 ng/dl and 16.01+/-7.70ug/dl, respectively) were elevated. but returned to normal by the 1 st clOD. 4) Preoperative SGOT and SGPT levels in the experimental group(18.70+/-6.21 and 24.20 +/-9,36 lu/7, respectively) were significantly higher than those in the control group, 7ut these valuea were within normal limit? 5) The preoperative mean LDH valueg of both groups were within normal limits. 6) In the control group, the value of SGOT on the 7 th POD twas lees than the preope- rative value and LDH levels on the 7 th POD were higher than the preoperative levels, but Within normal limits. 7) Preoperatively, the bevel of alkaline phosphatase in the experimental group(153.27+/- 79.28 lu/7) wha higher than that of the control group(54,28+/-14.25 lU/L) . 8) On 7he 1st and 7 th POD, only the level of alkaline phosphatase in the experimental group was elevated, but others were within normal limit? In conclusion, no overt clinical evidence of liver damage following thyr7idect7mr under the general inhalation anesthesia as a treatment for Orates'hyperthyroidism wart found, The elevated levels of alkaline .The aphatase present in patients with Graves' diaease, indi. -oative of liver dysfunction, were probably due to thyroid hormones or antithyroid agents. An increase in the incidence and severity of postoperative liver damage in patients with 7raves'dlaease is suggested when other factors which contribute t? liter dysfunction are simultaneously present. |
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