Thyroid storm after coronary artery bypass grafting

Bish, Lawrence T.; Bavaria, Joseph E.; Augoustides, John

doi:10.1016/j.jtcvs.2010.06.034

Cited by 15 publications

(10 citation statements)

References 9 publications

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“…Onoe et al [13] reported that, in two patients with known thyrotoxicosis, open heart surgery was successfully performed by preoperative and early postoperative anti-thyroid agents. However, in a recent article, Bish et al [14] found thyroid storm developing in a patient after urgent CABG caused by Graves' disease which was unknown before surgery and controlled by immediate potassium iodide and thionamides through nasogastric tube, as well as high-dose intravenous hydrocortisone. In our study, we found no increase in the mortality rate in overt hyperthyroid patients, although we observed increased arrhythmia in this patient group after surgery, compared to the hypothyroid group, which was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Does thyroid dysfunction affect early mortality and morbidity after coronary artery bypass graft surgery?

Tarçın¹

2019

Cardiovasc Surg Int

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This study aims to evaluate to effect of thyroid dysfunction on early mortality and morbidity in patients undergoing coronary artery bypass grafting (CABG). Patients and methods: Between April 2008 and December 2010, a total of 37 patients (20 females, 17 males; mean age 54.9±10.2 years; range, 26 to 76 years) with thyroid dysfunctions who underwent CABG and 11 patients (2 females, 9 males; mean age 46.9±15.5 years; range, 26 to 65 years) without thyroid dysfunction who underwent on-pump CABG as the control group were included in the study. Patients were divided into groups as overt and subclinical hypothyroidism, overt hyperthyroidism, and subclinical hyperthyroidism according to the thyroid function test results. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) scores were evaluated and the Gensini severity scores were calculated according to coronary angiographies. All patients were followed for seven days after surgery. The duration of endotracheal intubation, inotropic support, cardiac complications, duration of stay in the intensive care unit (ICU) and hospital were recorded. Results: There were no statistically significant differences between the groups in terms of the duration of intubation, need of inotropic support, and duration of stay in the ICU and hospital. Arrhythmia was more frequent in the overt hyperthyroid group than in the overt hypothyroid group postoperatively. Thyroid-stimulating hormone (TSH) levels remained unchanged after surgery, whereas free T 3 decreased and free T 4 increased, which was compatible with postoperative euthyroid sick syndrome. The EuroSCORE scores were positively correlated with pre-and postoperative TSH levels, duration of intubation, and duration of ICU and hospital stay, but was negatively correlated with free T 3. Conclusion: Subclinical or overt thyroid dysfunctions do not seem to affect early mortality after CABG. However, overt hyperthyroidism is associated with postoperative arrhythmia complications. Euthyroid sick syndrome may also occur after surgery in certain cases. Pre-and postoperative TSH and free T 3 levels may be useful to identify mortality and morbidity risk in patients undergoing CABG.

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Section: Discussionmentioning

confidence: 99%

Does thyroid dysfunction affect early mortality and morbidity after coronary artery bypass graft surgery?

Tarçın¹

2019

Cardiovasc Surg Int

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“…There have only been a few case reports of thyrotoxicosis and thyroid storm in the perioperative period of open‐heart surgery, all of which occurred in coronary artery bypass grafting and were associated with coronary artery spasm and increased myocardial oxygen demand 4–8 . To the best of our knowledge, this is the first case report of thyroid storm occurring after cardiac valve surgery.…”

Section: Discussionmentioning

confidence: 90%

Thyroid storm after mitral valve repair in a patient with Becker muscular dystrophy

et al. 2020

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A 40-year-old male with Becker muscular dystrophy presented with severe mitral regurgitation and underwent mitral valve repair. Following the surgery, the patient became tachycardic and developed a continuous high-grade fever and hyperbilirubinemia. The patient's condition worsened and we eventually tested his thyroid levels and discovered abnormally high thyroid levels. After diagnosing a severe thyroid storm, the patient was treated with oral administration of Lugol's iodine and thiamazole, as well as an intravenous steroid, which led to an immediate improvement of symptoms. The incidence of thyroid storm after open-heart surgery is extremely rare but highly life-threatening if unrecognized.

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“…Thyroid storm after nonthyroidal surgery, especially CABG, has been rarely reported. Successful treatment with intravenous beta-blocker and high-dose steroid was reported in a patient without preoperative history of hyperthyroidism [4]. According to the recent suggested guidelines, high-dose steroid treatment was recommended, if necessary, but caution is warranted because of a higher infection risk [9].…”

Section: Discussionmentioning

confidence: 99%

“…One of the cardiovascular events caused by thyroid storm following coronary artery bypass graft (CABG) is high output heart failure with extreme tachycardia, which can be fatal. Thyroid storm after nonthyroidal surgery, especially CABG, has been rarely reported, with only one reported case until now [4]. Herein, we present a case of thyroid storm onset in a patient who underwent CABG.…”

Section: Introductionmentioning

confidence: 88%

Thyroid storm after coronary artery bypass surgery: a case report

Lee

2020

J Cardiothorac Surg

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Background: Thyroid storm is a rare, life-threatening disease triggered by an acute event or trauma, such as surgery of the thyroid or another area, and infection. However, recent studies have shown that irregular use or discontinuation of antithyroid drugs is the most common cause of thyroid storm. A cardiovascular event caused by thyroid storm following coronary artery bypass graft (CABG) is high output heart failure with extreme tachycardia, which can be fatal. Thyroid storm after nonthyroidal surgery, especially CABG, has been rarely reported, with only one reported case until now. Herein, we present a case of thyroid storm onset in a patient who underwent CABG. Case presentation: A 74-year-old woman with a history of antithyroid medication discontinuation against medical advice underwent urgent CABG. The patient exhibited extreme tachycardia postoperatively, which is highly suggestive of thyroid storm. Although a higher infection risk is an important consideration, a high-dose steroid was used to control the intractable tachycardia that did not respond to beta-blocker administration. Despite appropriate antibiotic treatment, the patient's condition was exacerbated, and she developed multiple organ failure resulting from adult respiratory distress syndrome progression, and she died on day 8 after surgery. Conclusions: Risk factors for thyroid storm after CABG and its treatment outcomes are rarely reported. Patients with a history of inappropriate antithyroid medication prescription should be in a euthyroid state before surgery. If surgery is imminent, anticipating thyroid storm and its treatment as well as a euthyroid state can improve recovery outcomes postoperatively.

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Thyroid storm after coronary artery bypass grafting

Cited by 15 publications

References 9 publications

Does thyroid dysfunction affect early mortality and morbidity after coronary artery bypass graft surgery?

Does thyroid dysfunction affect early mortality and morbidity after coronary artery bypass graft surgery?

Thyroid storm after mitral valve repair in a patient with Becker muscular dystrophy

Thyroid storm after coronary artery bypass surgery: a case report

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