Hyperthroidism Pre-Op Flashcards
A 38-year-old lady going for surgery. Pre-op bloods showed. High T3, high T4, low TSH
A 38-year-old lady going for surgery. Pre-op bloods showed. High T3, high T4, low TSH
Q1. Diagnosis?
Hyperthyroidism
Q2. What are the causes of hyperthyroidism?
Most probably is idiopathic,
It could be due to goiter, inflammation like Hashimoto’s in early stages, adenoma of thyroid, viral infection, central due to hypersecreations form pituitary gland
Q5. What are the functions of thyroxine (T4)?
Heart –> chronotropic and inotropic
Adipose tissue – > catabolic (lipolysis)
Muscles – > catabolic (ms break down)
Bone – > developmental
CNS – > developmental
Gut – > metabolic
Lipoprotein – > metabolic
Q6. What are the possible complications if patient went to surgery without
correction?
Thyroid storm
MI
Q7. What are the anaesthetic considerations?
Thyroid storm.
AF
HIGH RISK KF OF MI
Given this ECG :-
Q8. Diagnosis?
ABSENT P WAVE AND IRREGULAR PUSLE SO AF
Q9. What are the clinical picture of thyroid crisis (storm)?
Dehydration
Hyper pyrexia
AF
Restlessness
Hyperglycemia
Confusion
Could lead to Mi
Q10. Management?
CCRISP
O2 - IV fluids - cooling and ice packs – diuretics for cardiac failure – Digoxin in uncontrolled AF – Sedation – IV hydrocortisone
Definitive – > Carbimazole / Lugol’s iodine / propranolol IV 1-2 MG
OR ORAL 40 MG 6HRLY
May give ACEI
Q10. Management?
CCRISP
O2 - IV fluids - cooling and ice packs – diuretics for cardiac failure – Digoxin in uncontrolled AF – Sedation – IV hydrocortisone
Definitive – > Carbimazole / Lugol’s iodine / propranolol IV 1-2 MG
OR ORAL 40 MG 6HRLY
May give ACEI
Q11. What is Lugol’s Iodine? How does it act? How does the radioactive iodine act?
Aqueous iodine in form of potassium iodide and iodine in water
- Inhibit thyroid hormones synthesis and conversion. / Decrease vascularity and inhibit iodine binding.
Cannot use for long term
- radioactive iodine – destroy thyroid tissue and leading to decrease thyroid hormones
Q12. Where to manage patient?
ITU
