Predictive factors for intraoperative excessive bleeding in Grave’s disease


  • A. Srinivas Department of General Surgery, Prathima Institute of Medical Sciences, Nagunoor, Karimnagar, Telangana



Grave’s disease, Intra-operative excessive bleeding, AIOBL


Background: Grave’s disease frequently results in and is the most common cause of hyperthyroidism. It also often results in an enlarged thyroid. It also known as toxic diffuse goiter, is an autoimmune disease that affects the thyroid. This study evaluates all the factors that cause intra-operative blood loss and how it affects the grave’s disease.

Methods: This study was conducted on 100 patients with Grave’s disease, who underwent thyroidectomy during the period from May 2010 to April 2016.

Results: The majority of patients were females which constitute about 76.3% with a median age of 33 years. The median period between the onset of the disease and operation was 15 months. Weight of thyroid in grams was 40. Post-operative hospital stay was 3 days. Univariate analysis revealed that the strongest correlation of amount of intraoperative blood loss (AIOBL) was noted with the weight of thyroid (p<0.001). Additionally, AIOBL was correlated positively with the period be- tween disease onset and surgery (p<0.001) and negatively with preoperative free T4 (p<0.01). Occurrences of postoperative complications, such as recurrent laryngeal nerve palsy or hypoparathyroidism, and postoperative hospital stay were not correlated with AIOBL.

Conclusions: For Grave’s disease, for excessive bleeding during surgery, a large goiter presented as a predictive factor, and transfusion of blood should be considered in cases in which goiter weighs more than 200 g.

Author Biography

A. Srinivas, Department of General Surgery, Prathima Institute of Medical Sciences, Nagunoor, Karimnagar, Telangana

general surgery


Graves' disease. Available at: Accessed on 2 April 2015.

Menconi F, Marcocci C, Marinò M. Diagnosis and classification of Graves' disease. Autoimmun Rev. 2014;13(4):398-402.

Brent D, Gregory A. Clinical practice. Graves' disease. New England J Med. 2012;358(24):2594-605.

Burch HB. Management of graves disease: A review. JAMA. 2015;314(23):2544-54.

Nikiforov F, Yuri E, Biddinger PW. Diagnostic pathology and molecular genetics of the thyroid (2nd ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams and Wilkins. 2012:69.

Yamanouchi K, Minami S, Hayashida N, Sakimura C, Kuroki T, Eguchi T. Predictive factors for intra-operative excessive bleeding in Grave’s disease. 2015;38(1):1-5.

Grodski S, Stalberg P, Robinson BG, Delbridge LW. Surgery versus radioiodine therapy as definitive management for graves' disease: the role of patient preference. Thyroid. 2007;17(2):157-60.

Erbil Y, Giris‚ M, Salmaslioglu A. The effect of anti-thyroid drug treatment duration on thyroid gland microvessel density and intraoperative blood loss in patients with Graves’ disease. Surg. 2008;143:216-25.

Karamanakos SN, Markou KB, Panagopoulos K. Complications and risk factors related to the extent of surgery in thyroidectomy. Results from 2,043 procedures. Hormones. 2010;9:318-25.

Allannic H, Fauchet R, Orgiazzi J. Antithyroid drugs and graves’ disease: a prospective randomized evaluation of the efficacy of treatment duration. J Clin Endocrinol Metab. 1990;70:675-9.






Original Research Articles