Anesthetic management of a patient with hyperthyroidism due to hydatidiform mole

Abstract

Secondary hyperthyroidism can often complicate gestational trophoblastic disease, a malignant uterine cancer. We report here the perioperative management of hyperthyroidism due to hydatidiform mole. A 53-year-old woman underwent emergency surgery due to suspicion of hydatidiform mole. Tachycardiac atrial fibrillation was detected by electrocardiography at the preoperative examination. No abnormalities were found in blood count, coagulation, biochemical tests, chest radiographs, or respiratory function. General anesthesia with nitrous oxide, oxygen, and sevoflurane, combined with fentanyl and 1% mepivacaine, was administered intermittently from an epidural catheter. Intraoperative events included hypotension and tachycardia, although in general, tachycardia was prevented with antiarrhythmic agents and transfusion with a plasma expander and crystalloid fluid. Hyperthyroidism was highly suspected from the patient's clinical course and was confirmed by high levels of preoperative serum free triiodothyronine (T3) and thyroxine (T4). The patient became euthyroid within a few days after mole evacuation and did not require an antiarrhythmic agent after her return to the inpatient ward.

Thyroid function among women with gestational trophoblastic diseases. A cross-sectional study

“…Uncontrolled hyperthyroidism may transform into a thyroid crisis or cause serious arrhythmia during the perioperative period. [22][23] Gestational trophoblastic neoplasia N = number; SD = standard deviation; TSH = thyroid-stimulating hormone; fT4 = free T4; fT3 = free T3; TT4 = total T4; TT3 = total T3; Beta-HCG = beta-human chorionic gonadotropin. is one of the most rapidly metastasizing tumors.…”

Advanced gestational trophoblastic disease: A case report of medical management prior to surgical intervention

“…There are several reports of intraoperative thyroid storm and cardiac failure due to thyrotoxicosis. Untreated thyroid crisis is known to be fatal in the perioperative period, particularly in the setting of emergency surgery [ [2] , [3] , 11 ]. Thus, it was decided that control of her hypermetabolic state and thyroid status prior to anesthetic administration and surgical intervention would minimize the risk of these complications, and result in a better long-term outcome than immediate surgical intervention [ 3 ].…”

An Esthetic Management of Gestational Trophoblastic Disease With Hyperthyroidism

“…Crucial to anesthesia management is the perioperative prevention of thyrotoxic crisis and control of sympathetic stimulation secondary to hyperthyroidism. 12 In actively bleeding, hypotensive patients, and general anesthesia has to be used to facilitate evacuation. However, uterine relaxation may increase blood loss and inhaled anesthetics with known tocolytic effect such as halothane, sevoflurane, enflurane and isoflurane should therefore only be used in low concentrations.…”