Thyroid storm in a patient with unknown hyperthyroidism during nonthyroidal surgery-a case report and literature review.

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

BMC Anesthesiology Pub Date : 2024-11-15 DOI:10.1186/s12871-024-02801-5

Peiqi Shao, Jing Li, Danxu Ma, Anshi Wu, Jia Jiang

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引用次数: 0

Abstract

Background: Thyroid storm (TS) is a critical manifestation of hyperthyroidism. In recent years, the risk of perioperative TS is significantly decreased in patients with hyperthyroidism undergoing thyroid surgeries with adequate preoperative preparations. However, those who undergo non-thyroidal operations have higher risk of TS due to easily ignoring the evaluation of thyroid function. The purpose of this case report is to present a patient with TS during nonthyroidal surgery and review similar cases in the literature.

Case presentation: A middle-aged female who received unilateral total knee arthroplasty under general anesthesia developed refractory tachycardia during the operation and was diagnosed with hyperthyroidism via laboratory tests after surgery. She was suggestive of TS based on the Burch and Wartofsky scoring system and relieved after etiological treatments. She was discharged 10 days after surgery and continued to take antithyroid medication.

Conclusion: We recommend that a comprehensive history collection is warranted. The clinical manifestations of TS during operation could be versatile and atypical. Any abnormalities during an operation like abnormal heart rate, blood pressure, body temperature, or even the unusual anesthetics needed, should not be ignored. In surgeries with general anesthesia, it is necessary to be cautious about TS with an atypical manifestation of tachycardia. Once suspected, supportive and resuscitative treatment along with antithyroid medication should be promptly initiated.

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非甲状腺手术期间一名不明甲状腺功能亢进症患者的甲状腺风暴--病例报告和文献综述。

背景：甲状腺风暴（TS）是甲状腺功能亢进症的一种重要表现。近年来，通过充分的术前准备，甲状腺功能亢进症患者在接受甲状腺手术时发生围手术期 TS 的风险明显降低。然而，接受非甲状腺手术的患者由于容易忽视对甲状腺功能的评估，发生 TS 的风险较高。本病例报告旨在介绍一名在非甲状腺手术中出现 TS 的患者，并回顾文献中的类似病例：一名在全身麻醉下接受单侧全膝关节置换术的中年女性在手术过程中出现了难治性心动过速，术后通过实验室检查被诊断为甲状腺功能亢进。根据 Burch 和 Wartofsky 评分系统，她被提示患有 TS，经过病因治疗后症状缓解。她在术后 10 天出院，并继续服用抗甲状腺药物：我们建议应全面收集病史。手术期间 TS 的临床表现可能多种多样，也可能不典型。手术过程中的任何异常情况，如心率、血压、体温异常，甚至所需的麻醉剂异常，都不应被忽视。在使用全身麻醉的手术中，有必要谨慎对待出现异常心动过速表现的 TS。一旦怀疑，应立即启动支持和复苏治疗以及抗甲状腺药物治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Anesthesiology ANESTHESIOLOGY-

CiteScore

3.50

自引率

4.50%

发文量

349

审稿时长

>12 weeks

期刊介绍： BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.