Acute thyroid crisis on induction of anaesthesia

Bennett, Marvin H.; Wainwright, A. P.

doi:10.1111/j.1365-2044.1989.tb11093.x

Cited by 41 publications

(17 citation statements)

References 7 publications

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“…There is increasing evidence that hyperthyroidism may occur as a result of infection, or following an increase in consumption of iodine-containing foods or drugs [15]. Because surgery is such a complicated process of physiologic change, it is unlikely that we will be able to distinguish a sole factor in surgery that affects thyroid function, when even anesthesia and preoperative preparation of the perineum and vagina with Betadine have been reported to induce hyperthyroidism [16]. In short, hyperthyroidism is a heterogeneous syndrome for which a unitary underlying pathologic mechanism cannot be postulated.…”

Section: Discussionmentioning

confidence: 99%

Acute Psychotic State due to Hyperthyroidism Following Excision of a Mandible Bone Tumor: A Case Report

Yang

Wang

Chen

2003

The Kaohsiung J of Med Scie

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The etiology of psychotic symptoms that emerge following surgery needs to be sought to allow physicians to provide effective treatment. We present the case of a patient who developed hyperthyroidism shortly after excision of a mandible bone tumor and discuss its clinical features, course, and management. A 48-year-old female without previous thyroid disease accidentally found a tumor over her left mandible bone and underwent excision of the tumor. Soon after surgery, she suffered from anxiety, mood swings, insomnia, and even auditory hallucinations. Through careful differential diagnosis and a series of examinations, she was shown to be in a hyperthyroid state. Her condition improved after short-term use of haloperidol, lithium, and methimazole. Her thyroid function recovered and she was free from any psychiatric symptoms during the 1-year follow-up. Hyperthyroidism following surgery is not uncommon and its possibility should be considered when making differential diagnoses.

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Section: Discussionmentioning

confidence: 99%

Acute Psychotic State due to Hyperthyroidism Following Excision of a Mandible Bone Tumor: A Case Report

Yang

Wang

Chen

2003

The Kaohsiung J of Med Scie

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“…There are several reports of cases of life-threatening thyrotoxicosis during anesthesia that have mimicked malignant hyperthermia [9][10][11][12][13][14][15][16]. After the introduction of antithyroid drugs, however, the incidence of perioperative thyroid crises was reduced.…”

Section: Discussionmentioning

confidence: 99%

“…However, since the advent of dantrolene, it has dropped to less than 5% [25]. In addition to the well defined role in the treatment of malignant hyperthermia, dantrolene has been used in the treatment of thyroid crisis, achieving clinical improvement without adverse effects [11,12]. The clinical presentations are similar between thyroid crisis and malignant hyperthermia and to distinguish them is not easy especially when the muscle rigidity and the respiratory acidosis typical of malignant hyperthermia are not prominent.…”

Section: Discussionmentioning

confidence: 99%

Malignant Hyperthermia in a Patient with Graves' Disease during Subtotal Thyroidectomy.

et al. 2001

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Abstract.We report the case of a 31-year-old man with Graves' disease who manifested malignant hyperthermia during subtotal thyroidectomy. His past medical history and family history were unremarkable. Before surgery, his condition was well controlled with propylthiouracil, ,l-adrenergic blocker and iodine. During the operation, anesthesia was induced by intravenous injection of vecuronium and thiopental, followed by suxamethonium for endotracheal intubation.Anesthesia was maintained with nitrous oxide and sevoflurane. One hour after induction of anesthesia, his end tidal carbon dioxide concentration (ETC02) increased from 40 to 50 mmHg, heart rate increased from 90 to 100 beats per min and body temperature began to rise at a rate of 0.3°C per 15 min. Suspecting thyroid storm, propranolol 0.4 mg and methylprednisolone 1,500 mg were administered, which, however, had little effect. Despite the lack of muscular rigidity, the diagnosis of malignant hyperthermia was made based on respiratory acidosis. Sevoflurane was discontinued and dantrolene was given by intravenous bolus. Soon after the treatment, ETC02, heart rate and body temperature started to fall to normal levels. His laboratory findings showed abnormally elevated serum creatine phosphokinase and myoglobin but normal thyroid hormone levels. Since dantrolene is efficacious in thyrotoxic crisis and malignant hyperthermia, an immediate intravenous administration of dantrolene should be considered when a hypermetabolic state occurs during anesthesia in surgical treatment for a patient with Graves' disease.

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“…Vitamin supplements should be added to the intravenous fluids to replace probable coexistent deficiencies. Use of the skeletal muscle relaxant dantrolene was associated with clinical improvement in one case [42], but significant risk associated with its use precludes routine recommendation.…”

Section: Therapy Directed Against Systemic Decompensationmentioning

confidence: 99%

Thyrotoxic Storm

Stathatos

Wartofsky

2002

J Intensive Care Med

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Stathatos N, Wartofsky L. Thyrotoxic storm. J Intensive Care Med 2002;17:1–7. Thyrotoxic storm is a syndrome of exaggerated thyrotoxicosis with systemic decompensation seen in 1–2% of hospital admissions for thyrotoxicosis. The diagnosis is based on recognition of typical cardinal manifestations, but even when diagnosed and treated, mortality rates are high. Results of thyroid function tests may be no more abnormal than those seen in uncomplicated thyrotoxicosis. Often, there is a history of partially treated thyrotoxicosis, and/or decompensation related to a precipitating event such as infection, stroke, pulmonary embolism, or radioiodine therapy. Treatment must be aggressive and includes volume repletion with i.v. glucose and saline, and pressor agents may be needed. Patients belong in an intensive care unit, with a cooling blanket for hyperpyrexia. Appropriate cardiac medications are employed to control ventricular rate in those with atrial fibrillation. The thyroid is blocked by large doses of antithyroid agent. In patients unable to swallow, tablets can be crushed and given by nasogastric tube or per rectum. After antithyroid drugs are started, stable iodine as Lugol's solution is given to block further hormone release from the gland. Sodium ipodate can be used instead of iodine and has the advantage of inhibiting conversion of T4 to T3. In severe cases, thyroid hormone may be removed from the circulation by peritoneal dialysis or plasmapheresis, and cholestyramine resin may be used to bind T4 and T3 within the gastrointestinal tract. β‐adrenergic antagonists such as propranolol are given, or the very short‐acting β‐adrenergic blocker, esmolol, has also been used with success. A Swan‐Ganz catheter is used to monitor central hemodynamics, especially in patients receiving high‐dose propranolol, pressors, digoxin, diuretics, and fluids. Large doses of dexamethasone have been given based on presumed increased glucocorticoid requirements in thyrotoxicosis and because adrenal reserve may be reduced. Therapy must be continued until a normal metabolic state is achieved, at which time iodine is progressively withdrawn and plans made for definitive treatment.

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Acute thyroid crisis on induction of anaesthesia

Cited by 41 publications

References 7 publications

Acute Psychotic State due to Hyperthyroidism Following Excision of a Mandible Bone Tumor: A Case Report

Acute Psychotic State due to Hyperthyroidism Following Excision of a Mandible Bone Tumor: A Case Report

Malignant Hyperthermia in a Patient with Graves' Disease during Subtotal Thyroidectomy.

Thyrotoxic Storm

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