Journal of Anaesthesia & Critical Care Case Reports

Vol 5 | Issue 2 | May-Aug 2019 | page: 20-22  | Santhosh. V, Balaji. T, Suresh. J, Mukunthakrishnan. L

Authors: Santhosh. V [1], Balaji. T [1], Suresh. J [1], Mukunthakrishnan. L [1]

[1] Department of Anaesthesia and Critical care, Preethi institute of medical sciences and research, uthangudi, Madurai 107, India.

Address of Correspondence

Dr. Suresh.J,
Department of Anaesthesia and Critical care,
Preethi institute of medical sciences and research,
uthangudi, Madurai 107, India.
E-mail: sureshchills03@gmail.com.

Abstract

We report a case of 22yr/M admitted for knee arthroscopic procedure and medial Patello-femoral ligament repair. Postoperatively patient developed high grade fever, tachycardia, hypertension for which sepsis was suspected and relevant investigations done. Further clinical manifestations made us to think of other hyper metabolic states. Hence Thyroid function test was done which revealed thyrotoxicosis. A diagnosis of thyroid storm was made in our case according to Burch-Wartofsky score and Japanese thyroid association criteria. Patient was treated with antithyroid drugs, beta-blockers and steroids. Timely recognition and aggressive management is needed to prevent high mortality and morbidity in such cases. Mortality is as high as 10-30% even with early recognition and aggressive management.
Key words: Thyrotoxic crisis, postoperative thyroid storm, postoperative fever, hyperthyroidism

References

1. Braverman L, Utiger R. In: The Thyroid. 9th ed. Braverman L, Utiger R, editors. Philadelphia: Lippincott Williams & Wilkins; 2005. Introduction to thyrotoxicosis; pp. 453–455.
2. Bennett MH, Wainwright AP. Acute thyroid crisis on induction of anaesthesia. Anaesthesia. 1989;44:28–30.
3. Ono Y1, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y Factors Associated With Mortality of Thyroid Storm: Analysis Using a National Inpatient Database in Japan Medicine (Baltimore). 2016 Feb;95(7):e2848.
4. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am. 1993;22(2):263–277
5. Takashi Akamizu Thyroid Storm: A Japanese Perspective thyroid 2018 Jan 1; 28(1): 32–40
6. Akamizu T, Satoh T, Isozaki O, Suzuki A, Wakino S, Iburi T. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Thyroid. official journal of the American Thyroid Association.
2012;22(7):661-79
7. Scholz GH, Hagemann E, Arkenau C, Engelmann L, Lamesch P, Schreiter D, Schoenfelder M. et al. Is there a place for thyroidectomy in older patients with thyrotoxic storm and cardiorespiratory failure? Thyroid. 2003;13(10):933 940.
8. Nqo SY, Chew HC. When the storm passes unnoticed – a case series of thyroid storm. Resuscitation 2007; 73 (3): 485-90
9. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA. 2016. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 26:1343–1421
10. Vydro L, Joglekar S, Sheh S, Yau H, Naing S. 2015. Choice of antithyroid drugs and the outcome of patients with thyroid storm. 15th International Thyroid Congress, Orlando, FL
11. Ansaldo GL, Pretolesi F, Varaldo E, Meola C, Minuto M, Borgonovo G, Derchi LE, Torre GC. Doppler evaluation of intrathyroid arterial resistances during preoperative treatment with Lugol’s iodide solution in patients with diffuse toxic goiter.J Am Coll Surg. 2000 Dec;191(6):607-12.
12. Satoh T, Isozaki O, Suzuki A, Wakino S. Guidelines for the management of thyroid storm from the japan thyroid association and japan endocrine society. Endocrine Journal. 2016;63(12):1025-64.
13. Bianco AC, Nunes MT, Hell NS, et al. The role of glucocorticoids in the stress-induced reduction of extrathyroidal 3,5,3’-triiodothyronine generation in rats. Endocrinology 1987;120:1033-8. 10.1210/endo-120-3-
1033
14. Tsatsoulis A, Johnson EO, Kalogera , Seferiadis K, Tsolas . The effect of thyrotoxicosis on adrenocortical reserve. Eur J endocrinol. 2000;142(3):231–235
15. Muller C1, Perrin P, Faller B, Richter S, Chantrel F. Role of plasma exchange in the thyroid storm. Ther Apher Dial. 2011 Dec; 15(6):522-3

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