Adlerberth A, Stenström G, Hasselgren P O
Ann Surg. 1987 Feb;205(2):182-8. doi: 10.1097/00000658-198702000-00013.
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.
尽管单独使用β受体阻滞剂作为甲状腺功能亢进患者术前治疗的应用越来越多，但尚无对照临床研究将该方案与更传统的术前治疗进行比较。30例新诊断且未经治疗的甲状腺功能亢进患者被随机分为术前接受甲巯咪唑联合甲状腺素治疗组（I组）或β1受体阻滞剂美托洛尔治疗组（II组）。选择美托洛尔是因为已证明β受体阻滞剂在甲状腺功能亢进中的有益作用主要归因于β1受体阻滞。比较两组患者的术前、术中和术后过程，并在甲状腺切除术后对患者进行1年的随访。诊断时，I组血清三碘甲状腺原氨酸（T3）浓度为6.1±0.59 nmol/L，II组为5.7±0.66 nmol/L（参考区间1.5 - 3.0 nmol/L）。两组患者术前治疗期间的临床改善情况相似，但仅I组血清T3恢复正常。I组术前治疗的中位时长为12周，II组为5周（p<0.01）。两个治疗组在术前准备期间药物均未出现严重不良反应。两组的手术时间、甲状腺的质地和血运以及术中失血情况相似。两组手术过程中均未发生麻醉或心血管并发症。I组1例患者（7%）和II组3例患者（20%）在术后第1天出现甲状腺功能亢进的临床体征。给予小剂量美托洛尔后这些症状消失，且未发生甲状腺危象。两组均未发生术后低钙血症或喉返神经麻痹。在术后第1年，I组2例患者（13%）和II组6例患者（40%）发生甲状腺功能减退。无患者出现甲状腺功能亢进复发。结果表明，美托洛尔可作为甲状腺功能亢进患者唯一的术前治疗药物，且不会出现严重的术中或术后并发症。尽管数据表明术前使用美托洛尔治疗后发生术后甲状腺功能减退的风险高于使用抗甲状腺药物，但需要超过1年的更长随访期才能得出关于远期结果的结论。
