Anesthetic management of a pregnant patient with uncontrolled hyperthyroidism for an emergency caesarean section: a case report

Document Type : Case Report

Authors

1 Department of Anaesthesia and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India

2 Department of Anaesthesia, N C Medical College, Panipat, Haryana, India

Abstract

Background: Thyroid medications, beta-blockers, and dexamethasone are administered preoperatively to patients with uncontrolled hyperthyroidism undergoing emergency cesarean section under general anesthesia to inhibit peripheral conversion of T4 to T3 and control hyperthyroid symptoms.
Case presentation: A 20-year-old primigravida presented to the hospital at 37 weeks of gestation with symptoms of respiratory difficulty, tremors, excessive sweating, prominent eyes, palpitations, and anxiety-all indicative of untreated hyperthyroidism. The patient was urgently treated with an oral dose of propylthiouracil, Lugol's solution, a tablet of propranolol, an injection of dexamethasone, and an injection of pantoprazole intravenously. Given the severity of symptoms, a nasogastric tube was inserted to facilitate the administration of antithyroid medications. Arterial blood pressure cannula fixation and central venous cannulation are performed in the event a thyroid storm occurs that may require high-volume resuscitation. The patient was successfully treated under general anesthesia and monitored for thyroid storms in the postoperative period.
Discussion: In patients with poorly controlled hyperthyroidism, labor, delivery, or cesarean section can cause a life-threatening thyroid storm. In cases of thyroid storm, antithyroid drugs can be administered orally or rectally, so the Ryle tube was inserted before surgery. General anesthesia should be considered in patients with uncontrolled hyperthyroidism requiring emergency surgery, as it causes fewer fluctuations in hemodynamic parameters. Sympathetic stimulation should be avoided during the perioperative period. Regional anesthesia can be performed safely if there are no signs of heart failure. In the present case, there were no signs of heart failure, but the patient suffered from tachypnea. The decision was therefore made to proceed with general anesthesia, central venous catheterization, and invasive blood pressure monitoring.

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