scholarly journals A Patient with Graves’ Disease Scheduled for Thyroidectomy with High Risk for Thyroid Storm Caused by Severe Medication Nonadherence: Anaesthetic and Surgical Considerations

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Adrian Reber ◽  
Laura Valenti ◽  
Stephan Müller
Keyword(s):  
Case Report ◽  
High Risk ◽  
Total Thyroidectomy ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Hormone Regulation ◽  
Medication Nonadherence ◽  
Organ Complications

In patients with failed hormone regulation who are scheduled for indispensable total thyroidectomy, the risk of thyroid storm with severe end-organ complications has to be anticipated. This case report presents the successful surgical and anaesthesiological management of a patient with Graves’ disease, without any signs of perioperative thyroid storm. Possible recommendations for treatment are presented.

scholarly journals Emergent thyroidectomy with sternotomy due to acute respiratory failure with severe thyroid storm

2018 ◽  
Vol 100 (8) ◽  
pp. e223-e225
Author(s):  
A Matsushita ◽  
S Hosokawa ◽  
D Mochizuki ◽  
J Okamura ◽  
K Funai ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Airway Obstruction ◽  
Total Thyroidectomy ◽  
Upper Airway ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Nasal Intubation ◽  
Threatening Condition ◽  
Life Threatening

Huge cervical and mediastinal masses may lead to acute respiratory failure caused by laryngotracheal compression and airway obstruction. Thyroid storm is also a life-threatening endocrine emergency originating almost exclusively from uncontrolled Graves’ disease. We report a case of a 42-year-old man with acute upper airway obstruction and tachycardia from progressive swelling of a giant thyroid, in conjunction with thyroid storm resulting from uncontrolled Graves’ disease. Fibreoptic-assisted nasal intubation was performed while the patient was awake, immediately followed by emergency total thyroidectomy via a cervical and sternal approach. The patient had an uneventful postoperative course and recovered well. Respiratory failure due to swelling of a giant thyroid is a life-threatening condition and should be treated immediately with endotracheal intubation while the patient is awake following emergent total thyroidectomy, even with a sternotomy.

scholarly journals Thyroid storm associated with Graves' disease covered by diabetic ketoacidosis: A case report

2011 ◽  
Vol 4 (1) ◽  
pp. 8 ◽  
Author(s):  
Erika Osada ◽  
Naoki Hiroi ◽  
Mariko Sue ◽  
Natsumi Masai ◽  
Ryo Iga ◽  
...  
Keyword(s):  
Case Report ◽  
Diabetic Ketoacidosis ◽  
Thyroid Storm ◽  
Graves Disease

CASE REPORT-Delayed Cutaneous Manifestations of Graves’ disease, ADecade Post-Total Thyroidectomy

2020 ◽  
Vol 3 (2) ◽  
pp. 1-4
Keyword(s):  
Case Report ◽  
Total Thyroidectomy ◽  
Lower Limbs ◽  
Graves Disease ◽  
Cutaneous Manifestations ◽  
Digital Clubbing ◽  
Pretibial Myxoedema

Pretibial myxoedema and thyroid acropachy are rare manifestations of Graves’ disease. Clinically, pretibial myxoedema is characterised by hyper-pigmented,asymmetrical, indurated non-pitting lesions of the lower limbs, whilst thyroidacropachy presents as digital clubbing and swelling of digits and toes. We describe a59-year-old female, who presents with pretibial myxoedema and thyroid acropachy,a decade post-thyroidectomy for Graves’ disease.

scholarly journals Hypnosis and superficial cervical anesthesia for total thyroidectomy in a high-risk patient – A case report

2020 ◽  
Vol 72 ◽  
pp. 133-136 ◽  
Author(s):  
P. Makovac ◽  
A. Potié ◽  
A. Roukain ◽  
L. Pucci ◽  
T. Rutz ◽  
...  
Keyword(s):  
Case Report ◽  
High Risk ◽  
Total Thyroidectomy ◽  
High Risk Patient ◽  
Risk Patient

scholarly journals SUN-525 Successful Surgical Management of Graves’ Disease in Pregnancy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Dalal Ali ◽  
Gabriela Balan ◽  
Wan Aizad Wan Mahmood ◽  
Enda McDermott ◽  
Rachel Crowley
Keyword(s):  
Total Thyroidectomy ◽  
Beta Blockers ◽  
Left Lobe ◽  
Adverse Outcomes ◽  
Panic Attacks ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Free Triiodothyronine ◽  
Neonatal Icu ◽  
In Pregnancy

Abstract Background: Total thyroidectomy in pregnancy is not a widely used approach for management of Graves’ disease (GD) but is indicated when thyrotoxicosis persists in spite of efforts to optimise thyroid status. Clinical case: A 27-year-old lady with history of GD, presented at the 9th week of her second pregnancy. She had been counselled about anti-thyroid medications but was on carbimazole (CBZ) 30 mg tds and propranolol LA 80 mg od at presentation. She complained of palpitations, heat intolerance, irritability, weight loss and difficulty swallowing. On clinical examination, she had a heart rate of > 100/min and diffusely enlarged goiter with a bruit. Thyroid Ultrasound showed a right lobe of 6.5 x 2.8 x 2.7 cm and left lobe 5.3 x 2.6 x 2.4 cm. Free thyroxine (FT4) was 42.3 pmol/L (12–22), free triiodothyronine (FT3) 9.09 nmol/L (1.3–3.1), and TSH < 0.01 mIU/L (0.27–4.2). TRAB titer was >40 IU/L (0.0–1.75). She was advised to switch to propylthiouracil (PTU) and labetalol to minimize fetal adverse outcomes. She reported that she was unable to afford PTU and requested a switch back to CBZ. During her course of therapy, she had recurrent admissions with thyrotoxicosis, tachycardia, panic attacks and difficulty in swallowing. A decision was made to manage her with total thyroidectomy in the second trimester. She was treated with Lugol’s iodine, beta blockers and CBZ 2 weeks prior to her surgery and there were no immediate post-operative adverse events. Histology was consistent with GD. Her post-op TRAB titer remained >40 IU/L until present. She delivered at 28 weeks of gestation due to threatened premature labor a baby boy who had neonatal thyrotoxicosis, required admission to the neonatal ICU and therapy with flecanide and CBZ. His TSH was 0.09 mIU/L, (FT4) 68.7 pmol/L and TRAB 19.4 IU/L. He is currently 18 months old, well and not on any medications. Conclusion: Poor control of thyrotoxicosis is associated with pregnancy loss, prematurity, stillbirth, thyroid storm, and maternal congestive heart failure. Therefore, pre-pregnancy counseling is crucial to establish Euthyroid state for the safety of mother and fetus. Reference: (1) Davis LE, Lucas MJ, Hankins GD, Roark ML, Cunningham FG. Thyrotoxicosis complicating pregnancy. Am J Obstet Gynecol. 1989;160:63–70. doi: 10.1016/0002-9378(89)90088-4. (2) Vini L, Hyer S, Pratt B, et al. Management of differentiated thyroid cancer diagnosed during pregnancy. Eur J Endocrinol. 1999;140:404–406.

scholarly journals Graves’ disease in a mediastinal mass presenting after total thyroidectomy for nontoxic multinodular goiter: a case report

2016 ◽  
Vol 10 (1) ◽  
Author(s):  
Filipe Manuel Cunha ◽  
Elisabete Rodrigues ◽  
Joana Oliveira ◽  
Ana Saavedra ◽  
Luís Sá Vinhas ◽  
...  
Keyword(s):  
Case Report ◽  
Total Thyroidectomy ◽  
Multinodular Goiter ◽  
Mediastinal Mass ◽  
Graves Disease

scholarly journals Comparison of Intra-Operative Vital Sign Changes during Total Thyroidectomy in Patients with Controlled and Uncontrolled Graves’ Disease

2018 ◽  
Vol 7 (12) ◽  
pp. 566
Author(s):  
Hyeong Yu ◽  
In Bae ◽  
Su-jin Kim ◽  
Young Chai ◽  
Jae Moon ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Total Thyroidectomy ◽  
Vital Sign ◽  
Operation Time ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Free T4 ◽  
Sign Changes ◽  
The Mean

Thyroid storm (TS) is a life-threatening emergency endocrine condition. Thyroid hormones should be normalized before thyroidectomy is performed in patients with Graves’ disease. However, thyroid hormone levels are inevitably high in patients undergoing surgery. This study analyzed differences in vital sign changes during thyroidectomy between patients with controlled and uncontrolled Graves’ disease and assessed thyroid hormone cutoffs for TS. Preoperative levels of the thyroid hormones free T4 (FT4), T3, and thyroid stimulating hormone (TSH) were retrospectively analyzed in patients who underwent total thyroidectomy for Graves’ disease. Patients were divided into those with uncontrolled Graves’ (UG) disease, defined as preoperative TSH <0.3 µIU/mL and FT4 >1.7 ng/dL, those with controlled Graves’ (CG) disease, those with extremely uncontrolled Graves’ (EUG) disease, defined as TSH <0.3 µIU/mL and FT4 >3.4 ng/dL, and finally, those without EUG (non-EUG). The 29 patients with Graves’ disease included 12 with CG group and 17 with UG. FT4 and T3 concentrations were significantly higher in the UG group. There were no differences in vital sign and anesthetic agent. These 29 patients could also be divided into those with (n = 4) and without EUG (n = 25). The mean age was lower (21.5 vs. 40.9 years, p < 0.001) and the mean operation time was shorter (121.4 vs. 208.8 min, p = 0.003) in the EUG group. Requirements for anesthetic agents were greater in the EUG group. Mean FT4 concentration in the EUG group was 3.8 ng/dL, and there were no changes in vital signs during surgery. Vital sign change during thyroid surgery was not observed in patients with uncontrolled Graves’ disease up to the twice upper normal limit of T4 level.

A thyroid storm in a context of diabetic ketoacidosis: case report

2017 ◽  
Author(s):  
Ghizlane El Mghari ◽  
Loubna Oukit ◽  
Nawal El Ansari
Keyword(s):  
Case Report ◽  
Diabetic Ketoacidosis ◽  
Thyroid Storm
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