Complications
Occurs in about 1% to 2% of people after subtotal thyroidectomy.[37]
Improvement in hoarseness may take place over several months.
Permanent hypoparathyroidism occurs in 1% to 2% of people after subtotal thyroidectomy.
Transient postoperative hypocalcemia is common. Hypocalcemia in the postoperative period is treated with oral calcium and/or oral calcitriol.
Bone mineral density (BMD) is decreased in untreated patients with hyperthyroidism.[41] Postmenopausal women with untreated hyperthyroidism (including those with multinodular goiter) have a three-to-fourfold increase in fracture rates.[41]
BMD has been shown to improve in patients who have become euthyroid after treatment.[41] The effect on fracture rate is not clear.
There is about a 10% risk over 5 years.[37]
People >60 years with untreated subclinical hyperthyroidism are about 3 times more likely to develop atrial fibrillation over 10 years than euthyroid people.[49] All subclinical hyperthyroid patients have significantly increased risk of dysrhythmia compared with the reference population; however, the risk was higher among patients with severe subclinical hyperthyroidism (TSH <0.1 mU/L [<0.1mIU/L]).[40]
The risk of atrial fibrillation in people >60 years of age with a fully suppressed thyroid-stimulating hormone is about 20% over 10 years.[49]
The risk of systemic embolism is unknown.
Can occur with large goiters.
Gastrointestinal, cardiac, local, or pulmonary causes for symptoms such as choking, dysphagia, or hoarseness should be excluded.[1]
Substernal goiters may cause compressive symptoms without dramatic neck enlargement.
Iodinated contrast CT scans should be avoided in evaluation of goiters, because of risk of iodine-induced hyperthyroidism (Jod-Basedow effect).[50]
Rare severe, life-threatening condition that can occur after an intercurrent illness in people with hyperthyroidism.
Patients may present with weakness, severe tachycardia, and fever.[44]
Treatment includes beta-blockers, antithyroid drugs, supportive care, and corticosteroids; an endocrine specialist should be consulted.
Agranulocytosis occurs in 0.1% to 0.3% of patients treated with antithyroid drugs.[3]
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