IV Steroid Before Thyroidectomy Prevents Complications

Just one preoperative dose of dexamethasone proved of benefit for thyroidectomy patients, according to a randomized clinical trial in Pakistan.

In a study of 192 patients, those who received dexamethasone prior to surgery saw significantly lower rates of hypocalcemia and voice dysfunction following thyroidectomy, reported Adeel Abbas Dhahri, MS, of the Royal Infirmary Hospital of Edinburgh in Scotland, and colleagues in JAMA Otolaryngology-Head & Neck Surgery.

During the initial 24 hours following thyroidectomy, 36.5% of the placebo group versus 12.5% of the dexamethasone group developed hypocalcemia — defined as an adjusted serum calcium level of less than 8 mg/dL (2 mmol/L) post-surgery. By day 3, 4.2% in the placebo group still had hypocalcemia while all cases in the dexamethasone group had resolved.

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Overall, the rate of symptomatic hypocalcemia, the most common complication after total thyroidectomy, was 19 percentage points lower in the intervention group, with all 18 cases occurring in placebo patients.

Rate of voice dysfunction at 24 hours post-surgery — defined as a subjective score of less than 50 on a Voice Analog Score scale of 0 to 100 points — was 25 percentage points lower among patients who received a prophylactic dose of the glucocorticoid compared to the placebo group (8.3% vs 33.3%, respectively).

Dhahri and co-authors noted that previous research has suggested that a preoperative dose of dexamethasone can help prevent temporary, recurrent laryngeal nerve palsy after thyroidectomy, and subsequently help prevent voice dysfunction.

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“Dexamethasone is a corticosteroid and has a well-established immune-modulating effect at the surgical site; it reduces inflammation, edema, and physiological stress,” the group explained. “However, to our knowledge, no clear guidelines have been published about its use in the prevention of hypocalcemia and vocal cord dysfunction.”

The double-blind trial, conducted at the Holy Family Hospital in Rawalpindi, included patients undergoing thyroidectomy from 2014 to 2019 for a benign condition, with all performed by the same surgeon. Average age of the participants was 39, and about 81% were female. Recurrent laryngeal nerve monitoring was not used during the procedures; instead, the nerve was anatomically identified during the procedure.

None of the participants had any history of preoperative corrected hypocalcemia or voice or vocal quality dysfunction. Among the exclusion criteria were prior thyroid or neck surgery, known laryngoscopy, hearing problems, history of gastroesophageal reflux or stomach ulcer disease, or contraindications to steroid use.

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The 96 patients in the treatment group received a 2 mL intravenous dose of dexamethasone (8 mg), and the 96 in the placebo group received 2 mL of intravenous normal saline (0.9%).

“Although we administered dexamethasone 1 hour before the induction of anesthesia, the exact timing of its preinduction administration is still not clear,” the researchers noted.

Study limitations, the team said, included the short follow-up period of only a few days after surgery.

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  • Kristen Monaco is a staff writer, focusing on endocrinology, psychiatry, and dermatology news. Based out of the New York City office, she’s worked at the company for nearly five years.

Disclosures

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Dhahri and co-authors reported no disclosures.

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