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LETTER TO EDITOR
Year : 2012  |  Volume : 6  |  Issue : 3  |  Page : 305

Airway emergency post thyroidectomy: The role of thyroid hormone pharmacokinetics and compliance with treatment


Department of Anesthesiology, Children's National Medical Center, George Washington University, Washington DC, USA

Correspondence Address:
Abdallah Claude
Division of Anesthesiology, Assistant Professor of Anesthesiology and Pediatrics, The George Washington University Medical Center, 111 Michigan Avenue, N.W., Washington D.C. 20010-2970
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-354X.101232

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Date of Web Publication21-Sep-2012
 


How to cite this article:
Claude A, Susan V. Airway emergency post thyroidectomy: The role of thyroid hormone pharmacokinetics and compliance with treatment. Saudi J Anaesth 2012;6:305

How to cite this URL:
Claude A, Susan V. Airway emergency post thyroidectomy: The role of thyroid hormone pharmacokinetics and compliance with treatment. Saudi J Anaesth [serial online] 2012 [cited 2020 Sep 18];6:305. Available from: http://www.saudija.org/text.asp?2012/6/3/305/101232

Sir,

We would like to caution caregivers to be vigilant about the possibility of occurrence of a thyroid storm in the postoperative period even after total thyroidectomy. This risk may be more pronounced in adolescents noncompliant to medication intake. It is caused by the sudden excessive release of thyroid gland hormones into the circulation and may mimic malignant hyperthermia, but often lack muscle rigidity, severe acidosis and myoglobinuria. Treatment of a thyroid storm must be immediate, and should occur in an intensive care setting. The diagnosis of a thyrotoxic crisis is made on clinical findings. Most importantly, there is no difference in thyroid hormone levels between patients with "uncomplicated" thyrotoxicosis and those undergoing a thyroid storm. Any delay in therapy, e.g. by awaiting additional laboratory results, must be strictly avoided, because the mortality rate may rise to 75%. In adolescents and young adults, the fractional rate of turnover of T4 in the periphery is normally about 10%/d (half-life, 6.7 days), [1] and the half-life of thyroxine is inversely related to the initial serum thyroxine levels. [2] Large quantities of thyroglobulin are released into the blood during surgical manipulation of the thyroid, [3] and metabolic and hemodynamic manifestations of thyrotoxicosis may be masked intraoperatively by anesthetics and sedation. Monitoring in an acute care setting with tight control of blood pressure is often needed to manage a developing thyroid storm. The possibility of acute postoperative thyroid storm leading to acute airway loss from an expanding neck hematoma should be considered in patients with poor medical compliance

 
  References Top

1.Reed Larson P, Davies T, Hay I. The thyroid gland: Williams Textbook of Endocrinology. 9 th edition. W.B. Saunders Company; p. 389-504.2008. Philadelphia, PA.  Back to cited text no. 1
    
2.Zonszein J, Santangelo RP, Mackin JF, Lee TC, Coffey RJ, Canary JJ. Propranalol therapy in Thyrotoxicosis: A Review of 84 patients undergoing surgery. Am J Med 1979;66:411-6.  Back to cited text no. 2
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3.Izumi M, Larsen PR. Correlation of sequential changes in serum thyroglobulin, triiodothyronine, and thyroxine in patients with Graves'disease and subacute thyroiditis. Metabolism 1978;27:449-60.  Back to cited text no. 3
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