|LETTER TO THE EDITOR
|Year : 2018 | Volume
| Issue : 3 | Page : 259
Perioperative care and hypothyroidism
Khichar P Shubhakaran, Rekha J Khichar
Department of Neurology, Obstetrics and Gynaecology, Dr S.N. Medical College, Jodhpur, India
|Date of Submission||13-Sep-2016|
|Date of Acceptance||22-Feb-2017|
|Date of Web Publication||31-Aug-2018|
Khichar P Shubhakaran
House No. E-22/13-Umaid Hospital Campus, Jodhpur, Rajasthan - 342 001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shubhakaran KP, Khichar RJ. Perioperative care and hypothyroidism. Res Opin Anesth Intensive Care 2018;5:259
The case report entitled ‘occult hypothyroidism and postoperative noninvasive ventilation’ is an important observation and documentation . Hypothyroidism can be subclinical and may be asymptomatic in some patients . There are also reports of cardiac arrest in asymptomatic hypothyroidism in such circumstances .
We present the case of a 17 year old girl who suffered a cardiac arrest when undergoing incision and drainage of an abscess. The patient before arrest was quite stable with normal cardiorespiratory functions. The patient was administered 1 mg/kg body weight of midazolam infusion and a stat dose of 0.2 mg of glycopyrollate. Thereafter, the patient was administered ketamine 1.5 mg/kg total dose. Incision was uneventful, but at the near completion of drainage the patient developed cardiac arrest, which was managed with a single intravenous dose of atropine and adrenaline along with mouth-to-mouth, ambu bag respiratory support and cardiac massage. The patient was revived immediately and put on synchronized intermittent mechanical ventilation (SIMV) mode respiratory support.
Just after resuscitation, the patient was drowsy but in arousable state. The patient was further taken care of in the ICU and the cause of respiratory compromise was not evident. We tried to look into various reasons of cardiac arrest in an otherwise young female. The patient’s pulse rate was around 60–62 on repeated observations. This clue led us to think of as cardiac status after revival was normal and hypoxemic anoxic encephalopathy part was also recovering dramatically on ventilatory support. We performed the thyroid function tests, and the thyroid-stimulating hormone level was 56.47 IU. The patient was maintained on thyroid replacement therapy and had an excellent recovery in the next 2–3 days and the patient weaned off of the ventilatory support very smoothly.
American Association of Clinical Endocrinologists and American Thyroid Association advocate aggressive case finding and recommend screening of individuals with certain clinical conditions or characteristics rather than the general population. These societies argue that subclinical hypothyroidism adversely affects cardiovascular outcomes and thus merits case finding . Recognition of this state and screening of such patients preoperatively or perioperatively can save many lives and prevent from developing debilitating complications, which further adds to the complications .
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Conflicts of interest
There are no conflicts of interest.
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