Anaesthesia Management of Patient With Hyperthyroidism UnderwentLaparoscopic Cholecystectomy Operation

MUTIA AGUSTRIA; Mayang Indah Lestari

doi:10.64531/qg9b5e70

Authors

MUTIA AGUSTRIA UNIVERSITAS SRIWIJAYA Author
Mayang Indah Lestari Author

DOI:

https://doi.org/10.64531/qg9b5e70

Keywords:

Anaesthesia, Anaesthesia Management, Hyperthyroidism, Cholecystectomy, Laparoscopic Cholecystectomy

Abstract

Background : Hyperthyroidism is a common endocrine disorder that can significantly impact perioperative management, particularly in patients undergoing major surgery. This case report discusses the anaesthetic management of a hyperthyroid patient undergoing laparoscopic cholecystectomy, emphasizing the challenges and strategies employed to optimize perioperative care.

Case Illustration : A 53-year-old male presented with progressive jaundice, weight loss,

palpitations, and heat intolerance. Clinical evaluation revealed hyperthyroidism with a Wayne Index score of 21 and a Burch and Wartofsky score of 40, indicating an impending thyroid storm. Laboratory findings confirmed suppressed TSH levels and elevated free T4 levels. Additional comorbidities included atrial fibrillation with a normal ventricular response, first- degree atrioventricular block, and obstructive jaundice due to suspected choledocholithiasis. The patient was classified as ASA III and scheduled for laparoscopic cholecystectomy under general anaesthesia.

Preoperative optimization included the administration of thiamazole, beta-blockers, Lugol’s solution, and corticosteroids to mitigate the risk of intraoperative thyroid storm. Anesthesia induction was performed using thiopental, fentanyl, and rocuronium, followed by endotracheal intubation and maintenance with inhalational agents. Intraoperatively, hemodynamic stability was maintained with meticulous fluid management and beta-blockade. The procedure was completed successfully with an estimated blood loss of 50 mL, and the patient was transferred to the ICU for postoperative monitoring.

Postoperatively, the patient experienced transient delirium and hemodynamic fluctuations, requiring continued sedation and ventilatory support. Thyroid function was closely monitored, and medical therapy was continued. The patient remained hemodynamically stable and was gradually weaned off mechanical ventilation.

Conclusion : Anaesthesia management in hyperthyroid patients undergoing surgery requires a multidisciplinary approach, with careful preoperative preparation to prevent thyroid storm, intraoperative hemodynamic control, and vigilant postoperative monitoring. This case highlights the importance of optimizing thyroid function and cardiovascular stability in hyperthyroid patients to improve surgical outcomes.

References

1. Balucan, F. (2012) ‘Indonesian Clinical Practice Guidelines for Hyperthyroidism’,

Journal of the ASEAN Federation of Endocrine Societies, 27(1), pp. 34–39. doi:

10.15605/jafes.027.01.05.

2. Ariani, D. (2016) ‘Ny. Z Usia 47 Tahun dengan Penyakit Graves’, Jurnal Medula

Unila, 4, p. 30.

3. Kravets, I. (2016) ‘Hyperthyroidism: Diagnosis and Treatment’, American Family

Physician, 93(5), pp. 363–370.

4. Ale, A. et al. (2019) ‘Bone Fractures Among Adult Nigerians with Hyperthyroidism: Risk Factors, Pattern, and Frequency’, Journal of Endocrinology, Metabolism and Diabetes of South Africa, 24(1), pp. 28–31. doi: 10.1080/16089677.2018.1541669.

5. Giannelli, F. R. (2015) ‘Hyperthyroidism’, Journal of the American Academy of

Physician Assistants, 28(8), pp. 57–58. doi: 10.1097/01.JAA.0000469441.82819.43.

6. Ross, D. S. et al. (2016) ‘2016 American Thyroid Association Guidelines for

Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis’,

Thyroid, 26(10), pp. 1343–1421. doi: 10.1089/thy.2016.0229.

7. McDermott, M. T. (2020) ‘Hyperthyroidism’, American College of Physicians, pp.

101–114. doi: 10.7326/aitc202004070.

8. Choi, Y. S., Kim, T. W., Chang, M. J., Kang, S. B. and Chang, C. B. (2022) ‘Enhanced Recovery After Surgery for Major Orthopedic Surgery: A Narrative Review’, Knee Surgery and Related Research, 34.

9. Qashqary, M. et al. (2020) ‘Prevalence of Suspected Cases of Hyperthyroidism in

Jeddah by Using Wayne’s Scoring Index’, Cureus, 12(11). doi: 10.7759/cureus.11538.

10. Kementerian Kesehatan RI (2015) Infodatin: Situasi dan Analisis Penyakit Tiroid [Internet]. Pusat Data dan Informasi Kementerian Kesehatan RI, pp. 1–8. Available at: https://www.kemkes.go.id/folder/view/01/structurepublikasi-pusdatin-info-datin.html.

11. Han, Shuping, et al. “A Model for Predicting Significant Hyperbilirubinemia in Neonates from China.” Pediatrics, vol. 136, no. 4, 1 Oct. 2015, pp. e896–e905, https://doi.org/10.1542/peds.2014-4058. Accessed 12 Jan. 2023.

12. Butterworth JF, Mackey DC, Wasnick JD. Perioperative Cardiovascular Evaluation and Preparation for Noncardiac Surgery. In: MoW. Anesthesia for Patients with Cardiovascular Disease In: Morgan & Mikhail’s Clinical Anesthesiology. 7th ed. New York: McGraw-Hill Education; 2022.

13. Atkinson, Tamara M., et al. “Cardiovascular and Ventilatory Consequences of Laparoscopic Surgery.” Circulation, vol. 135, no. 7, 14 Feb. 2017, pp. 700–710, https://doi.org/10.1161/circulationaha.116.023262.

14. Butterworth JF, Mackey DC, Wasnick JD. Preoperative Assessment, Premedication, & Perioperative Documentation. In: Morgan & Mikhail’s Clinical Anesthesiology. 7th

ed. New York: McGraw-Hill Education; 2022.

15. Butterworth JF, Mackey DC, Wasnick JD. Intravenous Anesthetics. In: Morgan & Mikhail’s Clinical Anesthesiology. 7th ed. New York: McGraw-Hill Education; 2022.

16. Butterworth JF, Mackey DC, Wasnick JD. Neuromuscular Blocking Agents. In: Morgan & Mikhail’s Clinical Anesthesiology. 7th ed. New York: McGraw-Hill Education; 2022.

17. Butterworth JF, Mackey DC, Wasnick JD. Cholinesterase Inhibitors & Other Pharmacological Antagonists to Neuromuscular Blocking Agents. In: Morgan & Mikhail’s Clinical Anesthesiology. 7th ed. New York: McGraw-Hill Education; 2022.

18. Moitra, V. Drugs for the Treatment of Hypothyroidism and Hyperthyroidism. In Stoelting’s Pharmacology & Physiology in Anesthetic Practice Fifth Edition. 2015. Philadelphia : Wolters Kluwer