Graves’ Disease

Hollander, Jason M.; Davies, Terry F.

doi:10.1016/b978-1-4160-4745-2.00012-2

Cited by 2 publications

(4 citation statements)

References 289 publications

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“…Peak plasma concentration of Methimazole is achieved within 30 mins to 3 hours after ingestion and the half-life is from 3 to 6 hours. 6 Since the persistent tachycardia did not respond to deepening of anaesthesia, additional analgesia, IV fluid challenge, and there was no hypoxaemia or hypercarbia, we feel that it was due to excessive thyroid activity. It is speculated that thyroid hormones have direct effects on the conduction system, possibly via cellular changes in cation transport, including a decrease of atrial excitation threshold, an increase of sinoatrial node firing, and a shortening of conduction tissue refractory time.…”

Section: Discussionmentioning

confidence: 80%

“…4 Corticosteroids produce a rapid fall in T 3 and T 4 and a rise in reverse T 3 when administered to hyperthyroid Grave's disease patients, suggesting a direct inhibition of glandular secretion of thyroid hormone as well as the inhibition of peripheral monodeiodination. 5 Thiopentone also decreases the peripheral conversion of T 4 to T 3 . Our patient had received dexamethasone and thiopentone infusion.…”

Section: Discussionmentioning

confidence: 96%

“…The management of thyroid crisis must proceed as follows (in this order): (1) protect airway, obtain vascular access and stabilize haemodynamics; (2) initiate specific therapy aimed at ameliorating the proximate cause of the crisis (e.g., antibiotics for pneumonia); and (3) reduce thyroid hormone levels and treat the adrenergic signs of thyrotoxicosis. 8 The point at which thyrotoxicosis transforms to thyroid storm is controversial, and is, to some degree, subjective.…”

Section: Discussionmentioning

confidence: 99%

“…In fact it is mentioned that thionamides will provide little immediate relief when used to start the treatment of thyroid crisis. 8 There is a possibility that as the patient was already receiving carbimazole, the dose that we gave through the nasogastric tube was useful to control the thyroid hyperactivity. It may be that β-blockade was more effective after the increase in the plasma level of carbimazole and hence its antithyroid activity.…”

Section: Discussionmentioning

confidence: 99%

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Persistent intraoperative sinus tachycardia: threat of thyroid storm? A case report

et al. 2014

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A 26 year female diagnosed to have spinal cord tumor was posted for laminectomy and excision of tumor. She had complaints of progressively increasing pain and weakness in lower back and both lower limbs since ABSTRACT Sinus tachycardia in a patient undergoing surgery under general anaesthesia is not an uncommon experience in anaesthesia practice. Causes of intraoperative sinus tachycardia can be multi-factorial. Operative causes are pain, surgical stimulation and light depth of anaesthesia. Pharmacological factors include administration of catecholamines, atropine, or ketamine. Medical factors such as sepsis, hypovolaemia, heart failure, anaemia, and thyrotoxicosis should also be considered. We report a case of inadequately controlled hyperthyroidism undergoing surgery for a spinal cord tumour under general anaesthesia who developed unexplained tachycardia intraoperatively.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Persistent intraoperative sinus tachycardia: threat of thyroid storm? A case report

et al. 2014

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Lithium carbonate-induced giant goiter and subclinical hyperthyroidism in a patient with schizophrenia: A case report and review of literature

Chen,

Jiang,

et al. 2024

World J Clin Cases

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BACKGROUND Lithium carbonate is used to manage various mood disorders, but it can cause thyroid abnormalities, including goiter, hypothyroidism, and hyperthyroidism. In rare cases, it can lead to giant goiter and subclinical hyperthyroidism, which may require surgical intervention in severe cases. CASE SUMMARY This case represents a rare development of giant goiter and subclinical hyperthyroidism in a schizophrenia patient who was subjected to prolonged lithium carbonate treatment. The enlarged thyroid gland caused pressure on the airway and recurrent laryngeal nerve, which led to respiratory distress, hoarseness, and dysphagia. The immediate danger of suffocation required urgent surgical intervention. In this report, we describe the case of a 41-year-old Chinese woman. This sheds light on the etiology and challenges associated with managing a giant goiter. The patient underwent a subtotal thyroidectomy to relieve airway compression and facilitate airway expansion. Prior to the procedure, the patient was given iodine to prepare. Concurrently, changes were made to the psychiatric medication regimen. Following surgery, the patient's respiratory function and vocal cord functionality improved significantly, and her mental state remained stable. CONCLUSION It is essential to monitor thyroid function, test thyroid antibody levels, and perform thyroid ultrasounds consistently in all patients undergoing long-term lithium carbonate treatment. This vigilance helps prevent severe and potentially life-threatening thyroid enlargement.

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Graves’ Disease

Cited by 2 publications

References 289 publications

Persistent intraoperative sinus tachycardia: threat of thyroid storm? A case report

Persistent intraoperative sinus tachycardia: threat of thyroid storm? A case report

Lithium carbonate-induced giant goiter and subclinical hyperthyroidism in a patient with schizophrenia: A case report and review of literature

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