Tracheotomy opens up concerns over thyroid hormones

By Sally Robertson, B.Sc.Jul 31 2012

Patients who undergo tracheotomy should be carefully monitored for a while after surgery, say Turkish researchers.

Surgeons should be aware of the significant increases in thyroid hormones that can occur during the procedure and the cardiovascular effects such increases could have on patients, they say.

"The tracheotomy is a life saving operation but is performed in the neighborhood of vital organs," write Murat Karaman (Ümraniye State Hospital for Research and Training, Istanbul) and colleagues in Auris Nasus Larynx.

"The thyroid gland together with important vessels is in close relation to the operation side," they explain. Any procedure penetrating that area could potentially affect the thyroid gland and therefore the cardiac and systemic circulation.

The team found that among 20 patients with respiratory problems who underwent surgical tracheotomy, the mean free thyroxine and free triiodothyronine levels were significantly increased in the third hour after surgery, by 0.08 ng/dL and 0.32 pmol/L, respectively, compared with levels before surgery. In contrast, no such significant increases were observed among 20 individuals who received percutaneous tracheotomy, they report.

"The interference with the thyroid gland can be more necessary in the surgical tracheotomy than the percutaneous tracheotomy; thus this may cause this significant difference," suggest Karaman et al.

However, mean levels of thyroglobulin were found to be significantly increased in the first and third hour after surgery regardless of whether patients had undergone surgical or percutaneous tracheotomy.

Finally, analysis of thyroid stimulating hormone showed that postoperative first- and third-hour mean levels were not significantly increased compared with preoperative levels after either procedure.

The researchers say that increases in the thyroid hormones due to tracheotomy should not be forgotten and should be taken into account during the process.

As significant increases in thyroid hormone levels may cause unwanted cardiac effects, especially in patients with arrhythmic disorders, patients who undergo surgical or percutaneous tracheotomy should be observed for a certain period after these processes, they conclude.

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