Perioperative considerations of hyperthyroidism in a patient with liver failure: case report

Abstract

Hyperthyroidism is one of the most common endocrinologic disorders. When patients with hyperthyroidism undergo general anesthesia, potential perioperative complications such as atrial fibrillation, congestive heart failure, ischemic heart disease, thrombocytopenia may occur. Hyperthyroidism treatment is mainly divided into three parts: Medical treatment, radioactive iodine therapy, and surgical removal of the thyroid. However, the previous two treatments may not have a significant effect on patients with liver failure. In this report, we present a case where a patient with an underlying disease of uncontrolled hyperthyroidism and liver failure undergoing liver transplantation, where preoperative thyroid levels couldn't be managed aggressively due to liver failure. We managed hyperthyroidism using conservative management before and during surgery; perioperative use of steroids, beta-blockers, calcium channel-blockers, IV (Intravenous) fluids, body temperature regulation, opioid use such as remifentanil and fentanyl, sufficient sedation are all key in ensuring the hemodynamic stability of such a patient.