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Out of the blue! Thyroid crisis.

Parasa M, Chinthakunta BK, Vemuri NN, Shaik MS - Anesth Essays Res (2015 Jan-Apr)

Bottom Line: Thyromegaly noticed during placement of central venous catheter was suspected to be the etiology for his cardiovascular status and was successfully managed.Thyroid crisis in an undiagnosed case of hyperthyroidism poses a diagnostic and therapeutic challenge.Timely and aggressive management is essential to correct the homeostatic decompensation characteristic of thyroid storm.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, NRI Medical College, Guntur, Andhra Pradesh, India.

ABSTRACT
A 45-year-old male patient with an irregularly irregular rhythm and fast ventricular rate was posted for an emergency laparotomy for hollow viscus perforation. His history was not suggestive of any systemic disorders. An echocardiography revealed left ventricular dysfunction with an ejection fraction of 47% without any valvular or chamber abnormality. Thyromegaly noticed during placement of central venous catheter was suspected to be the etiology for his cardiovascular status and was successfully managed. Thyroid crisis in an undiagnosed case of hyperthyroidism poses a diagnostic and therapeutic challenge. Timely and aggressive management is essential to correct the homeostatic decompensation characteristic of thyroid storm.

No MeSH data available.


Related in: MedlinePlus

Intra-operative hemodynamic parameters: Heart rate, oxygen saturation, blood pressure, Central venous pressure and end-tidal carbon dioxide concentration
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Figure 1: Intra-operative hemodynamic parameters: Heart rate, oxygen saturation, blood pressure, Central venous pressure and end-tidal carbon dioxide concentration

Mentions: Thyromegaly noticed during placement of right subcalvian vein cannulation for central venous access led us to suspect thyrotoxicosis precipitated by hollow viscus perforation to be the etiology for the cardiovascular manifestations. A blood sample was sent for analyzing thyroid profile and troponins. The recorded central venous pressure through the right subclavian was 14 mmHg. Intra-operatively the heart rate surged to 220/min, which was treated with aliquots of 1 mg metoprolol repeated thrice with only mild reduction in heart rate to 180/min. AF with fast ventricular rate persisted throughout the intra-operative period. Blood pressure was maintained at around 110/60 mmHg and SpO2 was 100% throughout the surgical procedure [Figure 1]. A volume of 1500 ml of intravenous (IV) fluids were administered with a urine output of 75 ml over an hour.


Out of the blue! Thyroid crisis.

Parasa M, Chinthakunta BK, Vemuri NN, Shaik MS - Anesth Essays Res (2015 Jan-Apr)

Intra-operative hemodynamic parameters: Heart rate, oxygen saturation, blood pressure, Central venous pressure and end-tidal carbon dioxide concentration
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4383116&req=5

Figure 1: Intra-operative hemodynamic parameters: Heart rate, oxygen saturation, blood pressure, Central venous pressure and end-tidal carbon dioxide concentration
Mentions: Thyromegaly noticed during placement of right subcalvian vein cannulation for central venous access led us to suspect thyrotoxicosis precipitated by hollow viscus perforation to be the etiology for the cardiovascular manifestations. A blood sample was sent for analyzing thyroid profile and troponins. The recorded central venous pressure through the right subclavian was 14 mmHg. Intra-operatively the heart rate surged to 220/min, which was treated with aliquots of 1 mg metoprolol repeated thrice with only mild reduction in heart rate to 180/min. AF with fast ventricular rate persisted throughout the intra-operative period. Blood pressure was maintained at around 110/60 mmHg and SpO2 was 100% throughout the surgical procedure [Figure 1]. A volume of 1500 ml of intravenous (IV) fluids were administered with a urine output of 75 ml over an hour.

Bottom Line: Thyromegaly noticed during placement of central venous catheter was suspected to be the etiology for his cardiovascular status and was successfully managed.Thyroid crisis in an undiagnosed case of hyperthyroidism poses a diagnostic and therapeutic challenge.Timely and aggressive management is essential to correct the homeostatic decompensation characteristic of thyroid storm.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, NRI Medical College, Guntur, Andhra Pradesh, India.

ABSTRACT
A 45-year-old male patient with an irregularly irregular rhythm and fast ventricular rate was posted for an emergency laparotomy for hollow viscus perforation. His history was not suggestive of any systemic disorders. An echocardiography revealed left ventricular dysfunction with an ejection fraction of 47% without any valvular or chamber abnormality. Thyromegaly noticed during placement of central venous catheter was suspected to be the etiology for his cardiovascular status and was successfully managed. Thyroid crisis in an undiagnosed case of hyperthyroidism poses a diagnostic and therapeutic challenge. Timely and aggressive management is essential to correct the homeostatic decompensation characteristic of thyroid storm.

No MeSH data available.


Related in: MedlinePlus