Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1987 Feb;205(2):182–188. doi: 10.1097/00000658-198702000-00013

The selective beta 1-blocking agent metoprolol compared with antithyroid drug and thyroxine as preoperative treatment of patients with hyperthyroidism. Results from a prospective, randomized study.

A Adlerberth, G Stenström, P O Hasselgren
PMCID: PMC1492817  PMID: 3545108

Abstract

Despite the increasing use of beta-blocking agents alone as preoperative treatment of patients with hyperthyroidism, there are no controlled clinical studies in which this regimen has been compared with a more conventional preoperative treatment. Thirty patients with newly diagnosed and untreated hyperthyroidism were randomized to preoperative treatment with methimazole in combination with thyroxine (Group I) or the beta 1-blocking agent metoprolol (Group II). Metoprolol was used since it has been demonstrated that the beneficial effect of beta-blockade in hyperthyroidism is mainly due to beta 1-blockade. The preoperative, intraoperative, and postoperative courses in the two groups were compared, and patients were followed up for 1 year after thyroidectomy. At the time of diagnosis, serum concentration of triiodothyronine (T3) was 6.1 +/- 0.59 nmol/L in Group I and 5.7 +/- 0.66 nmol/L in Group II (reference interval 1.5-3.0 nmol/L). Clinical improvement during preoperative treatment was similar in the two groups of patients, but serum T3 was normalized only in Group I. The median length of preoperative treatment was 12 weeks in Group I and 5 weeks in Group II (p less than 0.01). There were no serious adverse effects of the drugs during preoperative preparation in either treatment group. Operating time, consistency and vascularity of the thyroid gland, and intraoperative blood loss were similar in the two groups. No anesthesiologic or cardiovascular complications occurred during operation in either group. One patient in Group I (7%) and three patients in Group II (20%) had clinical signs of hyperthyroid function during the first postoperative day. These symptoms were abolished by the administration of small doses of metoprolol, and no case of thyroid storm occurred. Postoperative hypocalcemia or recurrent laryngeal nerve paralysis did not occur in either group. During the first postoperative year, hypothyroidism developed in two patients in Group I (13%) and in six patients in Group II (40%). No patient had recurrent hyperthyroidism. The results suggest that metoprolol can be used as sole preoperative treatment of patients with hyperthyroidism without serious intra- or postoperative complications. Although the data indicate that the risk of postoperative hypothyroidism is higher after preoperative treatment with metoprolol than with an antithyroid drug, a longer follow-up period than 1 year is needed to draw conclusions regarding late results.

Full text

PDF
186

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderberg B., Kågedal B., Nilsson O. R., Smeds S., Tegler L., Gillquist J. Propranolol and thyroid resection for thyperthyroidism. Acta Chir Scand. 1979;145(5):297–303. [PubMed] [Google Scholar]
  2. CROOKS J., MURRAY I. P., WAYNE E. J. Statistical methods applied to the clinical diagnosis of thyrotoxicosis. Q J Med. 1959 Apr;28(110):211–234. [PubMed] [Google Scholar]
  3. Dial P., Hastings P. R. The use of a selective beta-adrenergic receptor blocker for the preoperative preparation of thyrotoxic patients. Ann Surg. 1982 Dec;196(6):633–635. doi: 10.1097/00000658-198212001-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Eriksson M., Rubenfeld S., Garber A. J., Kohler P. O. Propranolol does not prevent thyroid storm. N Engl J Med. 1977 Feb 3;296(5):263–264. doi: 10.1056/NEJM197702032960509. [DOI] [PubMed] [Google Scholar]
  5. Feely J., Crooks J., Forrest A. L., Hamilton W. F., Gunn A. Propranolol in the surgical treatment of hyperthyroidism, including severely thyrotoxic patients. Br J Surg. 1981 Dec;68(12):865–869. doi: 10.1002/bjs.1800681211. [DOI] [PubMed] [Google Scholar]
  6. Feely J., Peden N. Use of beta-adrenoceptor blocking drugs in hyperthyroidism. Drugs. 1984 May;27(5):425–446. doi: 10.2165/00003495-198427050-00003. [DOI] [PubMed] [Google Scholar]
  7. Hasselgren P. O., Adlerberth A., Angerås U., Stenström G. Protein metabolism in skeletal muscle tissue from hyperthyroid patients after preoperative treatment with antithyroid drug or selective beta-blocking agent. Results from a prospective, randomized study. J Clin Endocrinol Metab. 1984 Nov;59(5):835–839. doi: 10.1210/jcem-59-5-835. [DOI] [PubMed] [Google Scholar]
  8. Hedley A. J., Michie W., Duncan T., Hems G., Crooks J. The effect of remnant size on the outcome of subtotal thyroidectomy for thyrotoxicosis. Br J Surg. 1972 Jul;59(7):559–563. doi: 10.1002/bjs.1800590715. [DOI] [PubMed] [Google Scholar]
  9. Heimann P., Martinson J. Surgical treatment of thyrotoxicosis: results of 272 operations with special reference to preoperative treatment with anti-thyroid drugs and L-thyroxine. Br J Surg. 1975 Sep;62(9):683–688. doi: 10.1002/bjs.1800620903. [DOI] [PubMed] [Google Scholar]
  10. Jamison M. H., Done H. J. Post-operative thyrotoxic crisis in a patient prepared for thyroidectomy with propranolol. Br J Clin Pract. 1979 Mar;33(3):82–83. [PubMed] [Google Scholar]
  11. Kapur M. M., Sarin R., Kumar V., Ananthakrishnan N., Joshi K. D. Evaluation of propranolol in the preoperative control of thyrotoxicosis. Indian J Med Res. 1978 Mar;67:453–461. [PubMed] [Google Scholar]
  12. Larsson S., Svedmyr N. Tremor caused by sympathomimetics is mediated by beta2-adrenoreceptors. Scand J Respir Dis. 1977;58(1):5–10. [PubMed] [Google Scholar]
  13. Lee K. S., Kim K., Hur K. B., Kim C. K. The role of propranolol in the preoperative preparation of patients with Graves' disease. Surg Gynecol Obstet. 1986 Apr;162(4):365–369. [PubMed] [Google Scholar]
  14. Lee T. C., Coffey R. J., Currier B. M., Ma X. P., Canary J. J. Propranolol and thyroidectomy in the treatment of thyrotoxicosis. Ann Surg. 1982 Jun;195(6):766–773. doi: 10.1097/00000658-198206000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Lee T. C., Coffey R. J., Mackin J., Cobb M., Routon J., Canary J. J. The use of propranolol in the surgical treatment of thyrotoxic patients. Ann Surg. 1973 Jun;177(6):643–647. [PMC free article] [PubMed] [Google Scholar]
  16. Lennquist S., Jörtsö E., Anderberg B., Smeds S. Betablockers compared with antithyroid drugs as preoperative treatment in hyperthyroidism: drug tolerance, complications, and postoperative thyroid function. Surgery. 1985 Dec;98(6):1141–1147. [PubMed] [Google Scholar]
  17. Ljunggren J. G., Persson B. Preoperative treatment of thyrotoxicosis with a beta-adrenergic blocking agent. Acta Chir Scand. 1975;141(8):715–718. [PubMed] [Google Scholar]
  18. McNeill A. D., Thomson J. A. Long-term follow-up of surgically treated thyrotoxic patients. Br Med J. 1968 Sep 14;3(5619):643–646. doi: 10.1136/bmj.3.5619.643. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Michie W., Hammer-Hodges D. W., Pegg C. A., Orr F. G., Bewsher P. D. Beta-blockade and partial thyroidectomy for thyrotoxicosis. Lancet. 1974 May 25;1(7865):1009–1011. doi: 10.1016/s0140-6736(74)90414-0. [DOI] [PubMed] [Google Scholar]
  20. Michie W. Whither thyrotoxicosis? Br J Surg. 1975 Sep;62(9):673–682. doi: 10.1002/bjs.1800620902. [DOI] [PubMed] [Google Scholar]
  21. Murchison L. E., How J., Bewsher P. D. Comparison of propranolol and metoprolol in the management of hyperthyroidism. Br J Clin Pharmacol. 1979 Dec;8(6):581–587. doi: 10.1111/j.1365-2125.1979.tb01048.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Skinner C., Gaddie J., Palmer K. N. Comparison of effects of metoprolol and propranolol on asthmatic airway obstruction. Br Med J. 1976 Feb 28;1(6008):504–504. doi: 10.1136/bmj.1.6008.504. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. THOREN A., WIJNBLADH H. Operative treatment of thyrotoxicosis; follow-up results in four hundred and thirty-four cases after four to seven years. Acta Endocrinol (Copenh) 1956 Jul;22(3):224–245. [PubMed] [Google Scholar]
  24. Toft A. D., Irvine W. J., McIntosh D., MacLeod D. A., Seth J., Cameron E. H., Lidgard G. P. Propranolol in the treatment of thyrotoxicosis by subtotal thyroidectomy. J Clin Endocrinol Metab. 1976 Dec;43(6):1312–1316. doi: 10.1210/jcem-43-6-1312. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES