Anaesthesia management for thyroidectomy in a non-euthyroid patient following cardiac failure.
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Date
2011
Journal Title
Journal ISSN
Volume Title
Publisher
Medical and Dental Consultants Association of Nigeria
Abstract
We present a 24-year old thyrotoxic student of a tertiary institution who had thyroidectomy in the presence of a persistently elevated thyroxine (T4) and tri-iodothyronine (T3) levels. The patient who did not initially notice that he had an anterior neck swelling was being managed as a case of hypertension at a private hospital. However, his mother’s insistence that he should seek expert management revealed that he had experienced excessive sweating, undue heat intolerance of 3 years duration and easy fatigability of a month’s duration at the time of presentation at our hospital. He had bilateral anterior neck masses on examination. He was subsequently diagnosed as a case of toxic goiter with biochemical evidence of elevated T3 and T4 levels. The patient was commenced on anti-thyroid drugs but he developed cardiac failure after 6 months on medical treatment and was commenced on anti-failure regime. Surgery was postponed several times due to persistently elevated thyroid hormones. A decision to perform thyroidectomy was taken after the patient’s cardiovascular status was optimized in order to prevent further deterioration of his cardiac function. Serial repeat thyroid hormone profiles showed elevated T3 and T4 levels.
The patient eventually had subtotal thyroidectomy uneventfully after 9 months of presentation under general anaesthesia. Contingency plans for managing thyroid storm in the perioperative period were ensured. The anaesthetic management is presented and discussed.
Description
Keywords
toxic goitre, cardiac complications, anaesthetic management, thyroid storm
Citation
Anaesthesia management for thyroidectomy in a non-euthyroid patient following cardiac failure. Nigerian Journal of Clinical Practice, 14(4): 482- 485