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 Table of Contents  
LETTER TO THE EDITOR
Year : 2018  |  Volume : 5  |  Issue : 3  |  Page : 259

Perioperative care and hypothyroidism


Department of Neurology, Obstetrics and Gynaecology, Dr S.N. Medical College, Jodhpur, India

Date of Submission13-Sep-2016
Date of Acceptance22-Feb-2017
Date of Web Publication31-Aug-2018

Correspondence Address:
Khichar P Shubhakaran
House No. E-22/13-Umaid Hospital Campus, Jodhpur, Rajasthan - 342 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_80_16

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How to cite this article:
Shubhakaran KP, Khichar RJ. Perioperative care and hypothyroidism. Res Opin Anesth Intensive Care 2018;5:259

How to cite this URL:
Shubhakaran KP, Khichar RJ. Perioperative care and hypothyroidism. Res Opin Anesth Intensive Care [serial online] 2018 [cited 2018 Sep 26];5:259. Available from: http://www.roaic.eg.net/text.asp?2018/5/3/259/240275

The case report entitled ‘occult hypothyroidism and postoperative noninvasive ventilation’ is an important observation and documentation [1]. Hypothyroidism can be subclinical and may be asymptomatic in some patients [2]. There are also reports of cardiac arrest in asymptomatic hypothyroidism in such circumstances [3].

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 [4]. 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 [5].

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Hariharan U. Occult hypothyroidism and postoperative noninvasive ventilation. Res Opin Anesth Intensive Care 2016; 3:89–90.  Back to cited text no. 1
  [Full text]  
2.
Fatourechi V. Subclinical hypothyroidism: an update for primary care physicians. Mayo Clin Proc 2009; 84:65–71.  Back to cited text no. 2
    
3.
Sudha P, Koshy RC, Pillai VS. Undetected hypothyroidism and unexpected anesthetic complications. J Anaesthesiol Clin Pharmacol 2012; 28:276–277.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Burns RB, Bates CK, Hartzband P, Smetana GW. Should we treat for subclinical hypothyroidism?: grand rounds discussion from Beth Israel Deaconess Medical Center. Ann Intern Med 2016; 164:764–770.  Back to cited text no. 4
    
5.
Puri V, Gupta A. Weakness in the critically ill: can we predict and prevent?. Neurol India 2016; 64:606–607.  Back to cited text no. 5
    




 

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