Thyrotoxicosis Case Study Essay

There are two primary concerns for the anesthesiologist. The first is thyroid storm is a life-threatening syndrome and requires immediate recognition and treatment. The second is diagnosis and treatment of the underlying disorder causing thyrotoxicosis. Clinical evaluation of patients with suspected thyrotoxicosis is important because it may reveal a specific cause. Attention should be paid to the neck, eyes, neurologic, cardiac, pulmonary, and integumentary systems.8 The plan for a patient with known thyrotoxicosis is to avoid elective surgery. Thyrotoxic patients are at increased risk of perioperative complications including arrhythmias, congestive heart failure, tachycardia, and increased intraoperative bleeding. The patient should be in euthyroid or close to euthryoid state in order to minimize the risk (figure 3). Thyroid function tests should be rechecked within 7-10 days of surgery to ensure the patient is appropriately euthyroid. The patients resting heart rate should be no more than 90 beats per minute and should not increase more than 50% with exercise.9 If these criteria are not met, a beta blocker can be added to the medication regimen to minimize the risk of intraoperative or postoperative thyroid storm. If surgery is deemed emergent, large bore iv access and arterial access is warranted.
Treatment
Treatment of thyroid storm initially involves stabilizing the patient. Large bore intravenous access, arterial line, and aggressive volume resuscitation should be initiated …show more content…
These therapies utilize plasma and albumin and provide new binding sites for circulating free hormones. These therapies reduce circulating T3 and T4 transiently, requiring continued need for definitive therapy.10 Peritoneal dialysis and cholestyramine may also be utilized to provide temporary binding of the thyroid