Hemodynamic Instability during Thyroidectomy in Graves' Disease

Background The aim of this study was to investigate the changes in vital signs and hemodynamic status that occur in patients during the intraoperative course of thyroidectomy in Graves' Disease (GD). Methods A total of 71 patients were included in the study. Patients were directed to surgery when they had large goiters with compressive symptoms or suspicious nodules, were pregnant or lactating, were unresponsive or intolerant to antithyroid drugs (ATDs), or expressed a preference to have surgery. All patients scheduled for operations underwent surgery while in the euthyroid state. Results Hemodynamic instability was observed in 18 patients during thyroidectomy. Disease duration, sample weight, and thyroid-stimulating hormone receptor antibodies (TRAb) levels were found to be effective on hemodynamic instability. Logistic regression analysis revealed an 11-fold increase in the instability risk in patients with a period of disease shorter than 21 months (P = 0.037). A TRAb value >11.5 increased the risk by 235fold (p < 0.001). Conclusion High levels of TRAb values and new onset of disease with shorter periods of ATDs use may be risk factors for hemodynamic instability during thyroidectomy. Patients with larger thyroid glands are at greater risk for instability during surgery. Those risks should be taken into account during surgery, and the surgical and anesthetic management of the patient should be made more carefully in concordance with the anesthesia team

The function of obesity related miR223-3p as a potential biomarker for weight loss prediction following bariatric surgery

The objective was to determine how miRNA expression levels related to obesity and weight loss interacted, to forecast how much weight patients could lose after surgery, and to maximize the advantages of a scheduled procedure. 17 patients who planned laparoscopic sleeve gastrectomy were included. Demographic variables, comorbid conditions, and postoperative excess weight loss rates (EWL%) were evaluated. Both intraoperative adipose tissue samples and blood samples were taken. The gene expression levels of the miRNAs (miR27b-3p, miR122- 5p, and miR223-3p) linked to diabetes and obesity were investigated. Mean body mass index was 49.17.6 kg/m2. Six individuals had diabetes mellitus, and their mean blood sugar and HbA1c levels were 133±59.4 mg/dl and 6.4±1.3%, respectively. All preoperative groups had considerably higher levels of miR223-3p expression, it was discovered. Blood samples taken before and after surgery showed considerably higher levels of miR223-3p gene expression than those of miR27b-3p and miR122-5p. Additionally, it was discovered that in individuals with diabetes mellitus, miR122-5p gene expression in fatty tissue was lower than that of miR223-3p and miR27b-3p. MiR223-3p expression has been linked to morbidly obese patients, particularly those with EWLs of 50% and above. After bariatric surgery, the miR223-3p gene may be utilized as a potential biomarker to predict a patient&apos;s capacity to lose weight. It is possible to identify patients who will not benefit from surgery and decide to perform a different kind of operation on them. However, additional research involving more patients, additional miRNAs, and various bariatric surgery techniques is required. [Med-Science 2023; 12(2.000): 557-61