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Siddiq A, Naveed AK, Ghaffar N, Aamir M, Ahmed N. Association of Pro-Inflammatory Cytokines with Vitamin D in Hashimoto's Thyroid Autoimmune Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050853. [PMID: 37241088 DOI: 10.3390/medicina59050853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Abstract
Background and objectives: Hashimoto's thyroiditis is an important autoimmune thyroid condition. It is characterized by lymphocytic congestion of the thyroid gland followed by progressive deterioration and fibrous substitution of the thyroid in the parenchymal structure. This study has provided insight into the variations of blood pro-inflammatory cytokine levels in patients with Hashimoto's disease and the key role of vitamin D levels among selected patients. Materials and Methods: A total of 144 participants including healthy controls and patients were studied in the current study in which 118 were female and 26 were male. The thyroid profile was evaluated in patients with Hashimoto's thyroiditis and healthy controls. Results: The mean ± SD Free T4 in the patients was recorded as 14.0 ± 4.9 pg/mL, and TSH was 7.6 ± 2.5 IU/L, whereas the median ± IQR thyroglobulin antibodies (anti-TG) were 285 ± 142. Thyroid peroxidase antibodies (anti-TPO) were 160 ± 63.5, whereas in the healthy controls, the mean ± SD Free T4 was recorded as 17.2 ± 2.1 pg/mL, and TSH was 2.1 ± 1.4 IU/L, whereas the median ± IQR anti-TGs were 56.30 ± 46.06, and anti-TPO was 5.6 ± 5.12. The assessment of pro-inflammatory cytokines (pg/mL) and total Vitamin D levels (nmol/L) in patients with Hashimoto's thyroiditis was recorded with values IL-1B 6.2 ± 0.8, IL-6 9.4 ± 0.4, IL-8 7.5 ± 0.5, IL-10 4.3 ± 0.1, IL-12 3.8 ± 0.5, TNF-α 7.6 ± 1.1, and total vitamin D 21.89 ± 3.5, whereas in healthy controls the mean ± SD IL-1B was 0.6 ± 0.1, IL-6 2.6 ± 0.5, IL-8 3.0 ± 1.2, IL-10 3.3 ± 1.3, IL-12 3.4 ± 0.4, TNF-α 1.4 ± 0.3 and total vitamin D was 42.26 ± 5.5. Conclusions: It was found that individuals with Hashimoto's thyroiditis had raised serum levels of IL-1B, IL-6, IL-8, IL-10, IL-12, and TNF-α as compared to the healthy controls, whereas the total vitamin D levels were remarkably low as compared to health controls. Serum TSH, anti-TG, and anti-TPO levels were typically lower in controls and much higher in individuals with Hashimoto's thyroiditis. The current study's findings might aid in future studies and in the diagnosis and management of autoimmune thyroid disease.
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Affiliation(s)
- Amer Siddiq
- Pathology Department, Islamic International Medical College, Riphah International University, Islamabad 46000, Pakistan
| | - Abdul Khaliq Naveed
- Pathology Department, Islamic International Medical College, Riphah International University, Islamabad 46000, Pakistan
| | - Nabila Ghaffar
- Department of Medical Education, Avicenna Medical College, Lahore 54000, Pakistan
| | - Muhammad Aamir
- Pathology Department, Islamic International Medical College, Riphah International University, Islamabad 46000, Pakistan
| | - Naveed Ahmed
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
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Park JM. Comparison of the effects of sevoflurane and desflurane on the severity score of postoperative pain and discomfort after thyroidectomy: A prospective, double-blinded, randomized controlled study. Medicine (Baltimore) 2022; 101:e31393. [PMID: 36316835 PMCID: PMC9622572 DOI: 10.1097/md.0000000000031393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Thyroidectomy is performed under general anesthesia using inhaled anesthetics such as sevoflurane or desflurane in many cases. The objective of this study was to investigate whether the incidence of postoperative pain and discomfort after thyroidectomy differed with the type of inhaled anesthetic. METHODS Eighty-one female patients who underwent thyroidectomy were randomly assigned to the Sevo group (n = 42) or the Des group (n = 39). On the day of surgery and on the first, third, and seventh days after surgery, one registered nurse in charge of the entire questionnaire survey conducted the questionnaire assessment through face-to-face interviews or phone calls with the patients. The questionnaire evaluated the severity scores for seven items (sore throat, wound pain, nausea and vomiting, dizziness, occipital headache, posterior neck pain, and shoulder pain) regarding postoperative pain and discomfort experienced by patients and assessed which of these seven items caused the greatest discomfort to the patient on each day. RESULTS Except for the severity score for dizziness on the day of surgery, the severity scores of postoperative pain and discomfort experienced by patients on the day of surgery and on the first, third, and seventh days after surgery showed no statistically significant differences between the two groups. In addition, on the day of surgery and on the first, third, and seventh days after surgery, patients reported that sore throat caused the greatest discomfort. CONCLUSION In patients undergoing thyroidectomy under general anesthesia using sevoflurane or desflurane, except for dizziness on the day of surgery, no other manifestation of postoperative pain and discomfort was influenced by the type of inhaled anesthetic. Moreover, after thyroidectomy, postoperative sore throat caused the greatest discomfort to patients from the day of surgery to the seventh day after surgery.
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Affiliation(s)
- Jun-Mo Park
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
- *Correspondence: Jun-Mo Park, Department of Anesthesiology and Pain Medicine, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Bukgu, Daegu 41404, South Korea (e-mail: )
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Tagami M, Honda S, Azumi A. Insights into Current Management Strategies for Dysthyroid Optic Neuropathy: A Review. Clin Ophthalmol 2022; 16:841-850. [PMID: 35330749 PMCID: PMC8939905 DOI: 10.2147/opth.s284609] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/10/2022] [Indexed: 01/20/2023] Open
Abstract
Dysthyroid optic neuropathy (DON) is a potentially sight-threatening eye disease associated with Graves’ orbitopathy (GO). DON is not common in GO patients, reportedly occurring in only about 5% of patients. The pathogenesis of severe DON is considered to involve both muscular nerve strangulation and impaired blood flow. There is some objective grading of physical examination findings and the severity of GO, including a clinical activity score (CAS) and EUropean Group On Graves’ Orbitopathy (EUGOGO), but no specialized protocol completely characterizes DON. Most clinicians have decided that the combination of clinical activity findings, including visual acuity, color vision, and central critical fusion frequency, and radiological findings, including magnetic resonance imaging (MRI), can be used to diagnose DON. MRI has the most useful findings, with T2-weighted and fat-suppressed images using short-tau inversion recovery (STIR) sequences enabling detection of extraocular changes including muscle and/orbital fat tissue swelling and inflammation and, therefore, disease activity. The first-choice treatment for DON is intravenous administration of steroids, with or without radiotherapy. Unfortunately, refractoriness to this medical treatment may indicate the need for immediate orbital decompression within 2 weeks. Especially in the acute phase of DON, thyroid function is often unstable, and the surgeon must always assume the risk of general anesthesia and intra- and post-operative management. In addition, there are currently many possible therapeutic options, including molecular-targeted drugs. The early introduction and combination of these immunomodulators, including Janus kinase inhibitors and insulin-like growth factor-1 receptor antibody (teprotumumab), may be effective for GO with DON. However, this is still under investigation, and the number of case reports is small. It is possible that these options could reduce systemic adverse events due to unfocused glucocorticoid administration. The pathophysiology of DON is not yet fully understood, and further studies of its treatment and long-term visual function prognosis are needed.
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Affiliation(s)
- Mizuki Tagami
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Correspondence: Mizuki Tagami, Department of Ophthalmology and Visual Science, Graduate School of Medicine, Osaka City University, 1-5-7 Asahimachi, Abeno-ku, Osaka-shi, 545-8586, Japan, Tel/Fax +81-6-6645-3867, Email
| | - Shigeru Honda
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Atsushi Azumi
- Ophthalmology Department and Eye Center, Kobe Kaisei Hospital, Kobe, Hyogo, Japan
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Chua AW, Kumar CM, Chua MJ, Harrisberg BP. Anaesthesia for ophthalmic procedures in patients with thyroid eye disease. Anaesth Intensive Care 2020; 48:430-438. [PMID: 33198476 DOI: 10.1177/0310057x20957018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thyroid eye disease is an autoimmune inflammatory disorder of the orbit in adults. It causes inflammation, expansion and fibrosis of orbital fat, muscles and the lacrimal gland, leading to facial disfigurement, functional disability and, in severe cases, blindness. Overall, approximately 20% of affected patients need some form of surgical intervention requiring anaesthesia. This narrative review explores the background of thyroid eye disease, surgical procedures performed and their implications for anaesthesia. General anaesthesia is used for orbital decompression procedures, strabismus correction surgery and complex oculoplastic procedures. Local anaesthetic infiltration or regional anaesthesia under monitored anaesthesia care are the techniques most commonly employed for eyelid retraction surgery. It is important to limit the volume of local anaesthetic agent used during infiltration and continuously monitor the orbital volume and ocular pressure with a ballottement technique. In addition, the contralateral eye should be checked and, if necessary, protected against corneal exposure. Retrobulbar, peribulbar and sub-Tenon's blocks are best avoided. Topical anaesthesia has been used for some strabismus correction surgery but its use is limited to motivated and cooperative patients only.
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Affiliation(s)
- Alfred Wy Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Chandra M Kumar
- Department of Anaesthetics, Khoo Teck Puat Hospital, Singapore.,Newcastle University, Newcastle upon Tyne, UK.,Newcastle University Medical School, Johor, Malaysia
| | - Matthew J Chua
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, Australia
| | - Brian P Harrisberg
- Department of Ophthalmology, Royal Prince Alfred Hospital, Camperdown, Australia
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Mekonen AZ, Negesso M, Kasim HM, Ferede ZA. <p>Perioperative Management of Thyroidectomy After a Failed Antithyroid Therapy in a Resource Limited Setting: A Clinical Case Report</p>. OPEN ACCESS SURGERY 2020. [DOI: 10.2147/oas.s264575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Lewis AL, Chaft J, Girotra M, Fischer GW. Immune checkpoint inhibitors: a narrative review of considerations for the anaesthesiologist. Br J Anaesth 2020; 124:251-260. [PMID: 32007241 PMCID: PMC7890563 DOI: 10.1016/j.bja.2019.11.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/04/2019] [Accepted: 11/15/2019] [Indexed: 02/08/2023] Open
Abstract
Immunotherapy has revolutionised the treatment of oncologic malignancies. Immune checkpoint inhibitors represent a new class of immunotherapy drugs. Although these drugs show promise, they are associated with immune-related adverse reactions. An increasing number of patients who undergo surgery will have had treatment with immune checkpoint inhibitors. In this narrative review article, we discuss their mechanism of action, therapeutic effects, pertinent toxicities, and address specific perioperative considerations for patients treated with immune checkpoint inhibitors.
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Affiliation(s)
- Alexandra L Lewis
- Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Jamie Chaft
- Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Girotra
- Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Gregory W Fischer
- Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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El-Asmar JM, Naja AS, Al-Halabi E. Surgical Treatment of Amiodarone-Induced Thyrotoxicosis in an Adult with Congenital Heart Disease: An Anesthetists Perspective. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e917350. [PMID: 32024812 PMCID: PMC7020752 DOI: 10.12659/ajcr.917350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Male, 19-year-old Final Diagnosis: Amiodarone induced thyrotoxicosis Symptoms: Tachycardia Medication:— Clinical Procedure: Total thyroidectomy Specialty: Anesthesiology
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Affiliation(s)
- Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Salaheddine Naja
- Division of Orthopedics, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eliane Al-Halabi
- Department of Anesthesia, American University of Beirut Medical Center, Beirut, Lebanon
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Abstract
Although endocrine emergencies are not common occurrences, their identification and careful perioperative management are of paramount importance for reduction of patient morbidity and mortality. The most common critical endocrine abnormalities are associated with functional tumors, such as pheochromocytomas, insulinomas, and carcinoid tumors, leading to carcinoid syndrome, abnormal thyroid function, or disturbances in the hypothalamus-pituitary-adrenal axis, causing adrenal insufficiency. This article aims to discuss the pathophysiology, diagnosis, and perioperative management of pheochromocytomas, hyperthyroidism, hypothyroidism, adrenal insufficiency, carcinoid disease, and insulinomas.
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Affiliation(s)
- Dasun Peramunage
- Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue, B2-AN, Seattle, WA 98101, USA
| | - Sara Nikravan
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue, B2-AN, Seattle, WA 98101, USA; Division of Critical Care Medicine, Virginia Mason Medical Center, 1100 Ninth Avenue, B2-AN, Seattle, WA 98101, USA.
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Alharbi F, Ahmed MR. Experience of thyroid surgery at tertiary referral centers in Jazan Hospitals, Saudi Arabia. Interv Med Appl Sci 2019; 10:198-201. [PMID: 30792912 PMCID: PMC6376351 DOI: 10.1556/1646.10.2018.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Benign multinodular goiter (BMNG) is a common disease of the thyroid gland with palpable thyroid nodules that may be detected in 0.8%–1.5% of men and 5.3%–6.4% of women. Three major complications could be detected after total thyroidectomy: hemorrhage, recurrent laryngeal paralysis, and hypoparathyroidism. Aims The aim of this study was to review and assess the experience of total thyroidectomy in patients with BMNG at tertiary referral centers in Jazan Hospitals, Saudi Arabia. Methods A retrospective study was conducted on 320 patients diagnosed with BMNG and subjected to primary total thyroidectomy. Operative mortality and major complications [bleeding, recurrent laryngeal nerve (RLN) injury, and hypoparathyroidism] were recorded. Results Postoperative hemorrhage was reported in four patients (1.25%). Bilateral RLN injuries occurred in two patients (0.6%), whereas unilateral RLN injuries occurred in nine patients (2.8%). Permanent hypoparathyroidism was diagnosed in three patients (0.9%), while transient hypoparathyroidism occurred in eight patients (2.5%) and improved after 4 months. Conclusions Total thyroidectomy represents today the treatment of choice for BMNG. Proper preoperative preparations, meticulous surgical dissection with careful follow-up of patients will improve the surgical results and reduce postoperative complications.
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Affiliation(s)
- Fahd Alharbi
- Faculty of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Jazan University, Jazan, Saudi Arabia.,Faculty of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Prince Mohammed bin Nasser Hospital, Jazan, Saudi Arabia
| | - Mohammed Rifaat Ahmed
- Faculty of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Prince Mohammed bin Nasser Hospital, Jazan, Saudi Arabia.,Faculty of Medicine, Department of Otolaryngology-Head & Neck Surgery, Suez University, Ismailia, Egypt
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Olusomi BB, Aliyu SZ, Babajide AM, Sulaiman AO, Adegboyega OS, Gbenga HO, Adebisi RG. Goitre-Related Factors for Predicting Difficult Intubation in Patients Scheduled for Thyroidectomy in a Resource-Challenged Health Institution in North Central Nigeria. Ethiop J Health Sci 2018; 28:169-176. [PMID: 29983514 PMCID: PMC6016344 DOI: 10.4314/ejhs.v28i2.8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Airway management problems may arise when intubating patients with goitre scheduled for thyroidectomy. Goitres are not uncommon in sub-Saharan Africa, thyroidectomy being the main treatment. The aim of this study was to determine incidences of difficult intubation (DI), failed intubation (FI) and predictors of DI using a modified intubation difficulty score (IDS). Methods One hundred and twenty-five consenting patients with goitre scheduled for thyroidectomy were recruited. Goitre-related factors (GRF) of duration of illness, diagnosis, neck circumference, tracheal deviation and narrowing and retrosternal extension were recorded as well as Mallampati classification and BMI. At intubation, modified IDS was determined for each patient. Patients with modified IDS ≤ 5 were categorized as easy intubation group (E), and those with modified IDS >5 were categorized as difficult intubation group (D). The GRF of all patients in group D were compared with matched patients in group E. Results Incidence of DI was 13.6% with 2 (1.6%) cases of failed intubation. Comparing groups D and E, duration of illness was 4.28 ± 3.78 years in group D versus 7.44 ± 7.63 years group E, p = 0.1353. Neck circumference was 41.42 ±5.30 cm in group D versus 37.43±2.68 cm in group E, p = 0.0200. Tracheal deviation, narrowing and retrosternal extension, and surgical diagnosis were not significantly different among both groups. Conclusion Incidence of DI was 13.6% and that of FI was 1.6%. Neck circumference was found to be a predictor of difficult intubation in goitre patients scheduled for thyroidectomy using the modified IDS.
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Affiliation(s)
- Bolaji Benjamin Olusomi
- Departments of Anaesthesia, Faculty of Clinical Sciences, College of Health Sciences, University of Ilorin and the University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Suleiman Zakari Aliyu
- Departments of Anaesthesia, Faculty of Clinical Sciences, College of Health Sciences, University of Ilorin and the University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Adegboye Majeed Babajide
- Departments of Anaesthesia, Faculty of Clinical Sciences, College of Health Sciences, University of Ilorin and the University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Agodirin Olayide Sulaiman
- Departments of Surgery, Faculty of Clinical Sciences, College of Health Sciences, University of Ilorin and the University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olatoke Samuel Adegboyega
- Departments of Surgery, Faculty of Clinical Sciences, College of Health Sciences, University of Ilorin and the University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Habeeb Olufemi Gbenga
- Departments of Surgery, Faculty of Clinical Sciences, College of Health Sciences, University of Ilorin and the University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Rahman Ganiyu Adebisi
- Departments of Surgery, Faculty of Clinical Sciences, College of Health Sciences, University of Ilorin and the University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Aghajanzadeh M, Asgary MR, Mohammadi F, Darvishi H, Safarpour Y. An investigation into symptoms, diagnosis, treatment, and treatment complications in patients with retrosternal goiter. J Family Med Prim Care 2018; 7:224-229. [PMID: 29915764 PMCID: PMC5958574 DOI: 10.4103/jfmpc.jfmpc_286_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Retrosternal goiter refers to any thyroid enlargement in which over 50% of the thyroid permanently located under the thoracic inlet or the lower pole of thyroid is not palpable with the neck in hyperextended position. Due to the increasing number of surgical procedures of retrosternal goiter, the present study was carried out to examine the symptoms, diagnosis, treatment, and treatment complications in retrosternal goiter patients. Materials and Methods: Data related to demographic data (age and gender), clinical symptoms (dyspnea, dysphagia, dysphonia, lumps in neck, and hoarseness), methods of diagnosis (computed tomography [CT], chest X-ray [CXR], ultrasonography, and magnetic resonance imaging), and postoperative complications (bleeding, early and late dysphonia, early and late dyspnea, transient and permanent hypocalcemia, transient, and permanent recurrent laryngeal nerve paralysis) were collected. Results: According to the results 71.4% of patients were women and most of the participants (67.1%) aged 45–60 years. Mass in the neck was the most frequent symptoms before surgery (88.6%). The most common incision for thyroidectomy (95/7%) was neck Collar incision. Diagnosis method in 82.9% and 17.1% of cases was, respectively, based on CT scans with CXR and CT scans with CXR and ultrasound. According to the postoperative pathologic findings, 58.5% of the cases were multinodular goiter, 22.9% were papillary cell carcinoma, 7.1% were medullary carcinoma, 5.7% were anaplastic carcinoma, 5.7% were thyroid lymphoma, and only 1.4% were thyroid adenoma. Postoperative complications occurred in 47.14% of patients. Most common complication was early transient dysphonia. Conclusion: This study recommends that retrosternal goiter should be operated early under suitable conditions, and the best diagnosis tool and best surgery methods are CT scan and surgery with collar incision, respectively.
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Affiliation(s)
- Manouchehr Aghajanzadeh
- Inflammatory Lung Disease Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Science, Rasht, Iran
| | - Mohammad Reza Asgary
- Inflammatory Lung Disease Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Science, Rasht, Iran
| | - Fereshteh Mohammadi
- Inflammatory Lung Disease Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Science, Rasht, Iran
| | - Haniye Darvishi
- Inflammatory Lung Disease Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Science, Rasht, Iran
| | - Yasaman Safarpour
- Inflammatory Lung Disease Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Science, Rasht, Iran
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Tutuncu AC, Erbabacan E, Teksoz S, Ekici B, Koksal G, Altintas F, Kaya G, Ozcan M. The Assessment of Risk Factors for Difficult Intubation in Thyroid Patients. World J Surg 2017; 42:1748-1753. [DOI: 10.1007/s00268-017-4391-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Parry Z, Macnab R. Thyroid disease and thyroid surgery. ANAESTHESIA & INTENSIVE CARE MEDICINE 2017. [DOI: 10.1016/j.mpaic.2017.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zahra A, Abdallah O, Farag GA. Giant Cervical Goiter With Posterior Mediastinal Extension. Cureus 2017; 9:e1450. [PMID: 28929034 PMCID: PMC5590704 DOI: 10.7759/cureus.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Most cervico-mediastinal goiters are situated in the anterior mediastinal compartment, but according to the literature, 10–15 percent of them are located in the posterior mediastinum. Although most anterior mediastinal goiters can be removed by using the transcervical approach, cervico-mediastinal goiters in the posterior mediastinal may require additional extracervical incisions. We report the case of a huge cervico-mediastinal goiter extending from the neck retrotracheally to the posterior mediastinum. Surgical removal is the treatment of choice in such cases. We performed an operation using a transcervical and right posterolateral thoracotomy approach. Histopathological examination confirmed the diagnosis of a large toxic goiter. The patient recovered well and was discharged in one week. While most retrosternal goiters can be resected through a transcervical approach, those extending beyond the aortic arch are better dealt with by either sternotomy or thoracotomy. This report describes the use of transcervical and posterolateral thoracotomy with an excellent postoperative result.
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Affiliation(s)
- Ashraf Zahra
- Head of Cardiothoracic Surgery Department, Shebin El Kom Teaching Hospital
| | | | - Gamal A Farag
- MD, Assistant Professor Cardiothoracic Surgery, Al-azhar University, Damitta Branch
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Hope N, Kelly A. Pre-Operative Lugol's Iodine Treatment in the Management of Patients Undergoing Thyroidectomy for Graves' Disease: A Review of the Literature. Eur Thyroid J 2017; 6:20-25. [PMID: 28611944 PMCID: PMC5465802 DOI: 10.1159/000450976] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/21/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To undertake a review of the relevant English literature published on the pre-operative use of Lugol's iodine in the management of patients undergoing thyroidectomy for Graves' disease. SEARCH STRATEGY We reviewed all relevant papers found through Ovid Medline, PubMed, EMBASE and the American Thyroid Association website. Searches were limited to the English language only. EVALUATION METHOD The critical appraisal tool CASP was used to help analyse the papers. Following this, the evidence was ranked using the Harbour and Miller classification of hierarchy. RESULTS Four papers were deemed appropriate for analysis. The evidence contained within the review is considered weak. The literature available in the public domain regarding the use of iodinated solutions in the pre-operative period for those patients about to undergo thyroidectomy for Graves' disease is scant. CONCLUSION Having undertaken an extensive literature review, we are of the opinion that the evidence on which the American Thyroid Association's guidance on the use of preoperative Lugol's iodine is based is tenuous. There appears to be little in the way of sound clinical evidence that post-operative outcomes are any different following a course of Lugol's iodine. Given the lack of robust clinical evidence regarding the clinical need for iodine solution in the pre-operative period, it appears clear that a larger, prospective, randomised controlled trial of all relevant outcomes - clinical and scientific - is required to answer whether or not patient preparation with Lugol's iodine is in fact necessary prior to operative intervention for Graves' disease.
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Alghazo JM. Optimized FPGA Implementation of the Thyroid Hormone Secretion Mechanism Using CAD Tools. J Med Syst 2017; 41:35. [DOI: 10.1007/s10916-016-0680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
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Al-Habsi AS, Al-Sulaimani AAK, Taqi KM, Al-Qadhi HA. Comparison of Postoperative Drain Insertion versus No Drain Insertion in Thyroidectomies: Retrospective case-control study from the Sultan Qaboos University Hospital, Muscat, Oman. Sultan Qaboos Univ Med J 2016; 16:e464-e468. [PMID: 28003893 DOI: 10.18295/squmj.2016.16.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/11/2016] [Accepted: 06/30/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES A thyroidectomy is a frequently performed surgical procedure which can result in life-threatening complications. The insertion of a drain after a thyroidectomy has been suggested to prevent such complications. This study aimed to evaluate the use of surgical drains following thyroidectomies in relation to postoperative complications and mass sizes. METHODS This retrospective case-control study included all thyroidectomies conducted at the Sultan Qaboos University Hospital, Muscat, Oman, from January 2011 to December 2013. Length of hospital stay, readmission, postoperative complications and mass size were evaluated. RESULTS During the study period, 250 surgeries were carried out on 241 patients. The majority of patients were female (87.2%). Drains were inserted postoperatively after 202 surgeries (80.8%) compared to 48 surgeries (19.2%) without drains. A total of 32 surgeries (12.8%) were conducted on patients with thyroid masses <1 cm, 138 (55.2%) on those with masses between 1-4 cm and 80 (32.0%) on those with masses >4 cm. The association between drain use and mass size was not significant (P = 0.439). Although postoperative complications were more prevalent in patients with drains, the relationship between these factors was not significant (P >0.050). Length of hospital stay was significantly longer among patients with postoperative drains (P <0.010). CONCLUSION The routine insertion of drains after thyroid surgeries was found to result in longer hospital stays and did not reduce rates of post-thyroidectomy complications. Thyroid mass size should not be used as an indicator for the insertion of a drain after thyroidectomy.
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Affiliation(s)
- Asma S Al-Habsi
- Department of Surgery, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Al-Anood K Al-Sulaimani
- Department of Surgery, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Kadhim M Taqi
- General Surgery Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Hani A Al-Qadhi
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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Sarıtaş A, Sarıtaş PU, Kurnaz MM, Çelik A. Spectrum and Prevalence of Thyroid Disorders in Patients Admitted to the Anaesthesiology Outpatient Clinic for Surgery. Turk J Anaesthesiol Reanim 2016; 43:240-5. [PMID: 27366505 DOI: 10.5152/tjar.2015.03206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/12/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE An anaesthetic approach and surgery are important treatment strategies in patients with thyroid dysfunction due to potential complications. We investigated the prevalence of thyroid disorders, the significance of thyroid function tests (TFTs) with respect to anaesthesia in the preoperative period and the need for routine examinations. METHODS A total of 10,600 patients who were admitted to the anaesthesiology outpatient clinic for surgery were retrospectively screened and enrolled between 2011 and 2013. Evident hypothyroidism was defined as free tetra-iodothyronine (fT4) <0.7 ng dL(-1) and thyroid-stimulating hormone (TSH) >4 mIU mL(-1), and subclinical hypothyroidism was defined as TSH >4 mIU mL(-1) with normal free hormone levels. Evident hyperthyroidism was defined as fT4 >1.7 ng dL(-1) and TSH <0.1 mIU mL(-1), and subclinical hyperthyroidism was defined as TSH <0.1 mIU mL(-1) with normal free hormone levels. Statistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 17.0. Independent samples t-test and one-way analysis of variance were used to compare the difference between groups. RESULTS Of the participants, 8.5% were found to have hypothyroidism, 2.5% had hyperthyroidism, 3.5% received treatment and 2.5% had their treatment postponed. The likelihood of hypothyroidism was greater among females, and no difference was found between genders with respect to hyperthyroidism. CONCLUSION We believe that TFTs are important because of regional factors. However, given the high cost of TFTs and because thyroid dysfunction risk increases with age, we concluded that routine TFTs in young patients with normal physical examination findings are not mandatory.
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Affiliation(s)
- Aykut Sarıtaş
- Department of Anaestesiology and Reanimation, Prof. Dr. A. İlhan Özdemir State Hospital, Giresun, Turkey
| | - Pelin Uzun Sarıtaş
- Department of Anaestesiology and Reanimation, Prof. Dr. A. İlhan Özdemir State Hospital, Giresun, Turkey
| | - Muhammed Murat Kurnaz
- Department of Anaestesiology and Reanimation, Prof. Dr. A. İlhan Özdemir State Hospital, Giresun, Turkey
| | - Abdullah Çelik
- Department of Cardiothoracic Surgery, Giresun University Faculty of Medicine, Giresun, Turkey
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Liao Z, Xiong Y, Luo L. Low-dose spinal-epidural anesthesia for Cesarean section in a parturient with uncontrolled hyperthyroidism and thyrotoxic heart disease. J Anesth 2016; 30:731-4. [PMID: 27216206 DOI: 10.1007/s00540-016-2186-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 05/04/2016] [Indexed: 12/16/2022]
Abstract
A 29-year-old woman at 34 weeks' gestation with uncontrolled hyperthyroidism and thyrotoxic heart disease was admitted to urgency Cesarean section. After preoperative sedation and good communication, low-dose spinal anesthesia (7.5 mg 0.5 % bupivacaine) combined with epidural anesthesia (6 ml 2 % lidocaine) was performed through L3-4 inter-vertebral. Opioids were given intravenously to the mother for sedation after delivery of the baby. Satisfactory anesthesia and sedation was provided during surgery. The mother and the neonate were safe and no special complication was found after surgery. Our case demonstrated that low-dose spinal anesthesia combined with epidural anesthesia with intravenous opioids can provide satisfactory anesthesia and sedation, and reduce the risk of heart failure and thyroid storm.
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Affiliation(s)
- Zhimin Liao
- Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Key Laboratory of Obstetric Gynecologic and Pediatric Diseases and Birth Defects, Ministry of Education, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yaqin Xiong
- Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Key Laboratory of Obstetric Gynecologic and Pediatric Diseases and Birth Defects, Ministry of Education, Chengdu, 610041, Sichuan, People's Republic of China
| | - Linli Luo
- Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China. .,Key Laboratory of Obstetric Gynecologic and Pediatric Diseases and Birth Defects, Ministry of Education, Chengdu, 610041, Sichuan, People's Republic of China.
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Anaesthetic Management of a Patient with Thyrotoxicosis for Nonthyroid Surgery with Peripheral Nerve Blockade. Case Rep Anesthesiol 2016; 2016:9824762. [PMID: 26885409 PMCID: PMC4738992 DOI: 10.1155/2016/9824762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 12/22/2015] [Indexed: 02/05/2023] Open
Abstract
Thyrotoxicosis is a hypermetabolic condition caused by an elevation in thyroid hormone levels. The disorder has a variety of causes, manifestations, and therapies. Several clinical features of thyrotoxicosis are due to sympathetic stimulation with increased beta-adrenoreceptor upregulation and sensitization to catecholamine. Anaesthetic management of thyrotoxicosis patients using neuraxial block has been described in literature; however, to our knowledge, there are no reports of peripheral nerve block utilization. Here, we report on the anaesthetic management of a patient with thyroiditis-associated thyrotoxicosis undergoing emergency surgery via a femoral and sciatic nerve block.
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Raval CB, Rahman SA. Difficult airway challenges-intubation and extubation matters in a case of large goiter with retrosternal extension. Anesth Essays Res 2015; 9:247-50. [PMID: 26417136 PMCID: PMC4563954 DOI: 10.4103/0259-1162.152421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thyroid diseases have an anesthetic implication that includes difficult airway management, uncontrolled hyperthyroidism, hypothyroidism and postthyroidectomy complications. Securing airway: Intubation and extubation both require skillful management and timely decision to reduce morbidity and mortality in the case of large goiter with retrosternal extension that leads to tracheal compression and deviation. We present the anesthetic management in a patient with a large goiter with retrosternal extension leading to tracheal compression and deviation. We managed the case with an awake fiberoptic intubation and guided extubation.
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Affiliation(s)
- Chetankumar B Raval
- Department of Anesthesiology, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Syed Abdul Rahman
- Department of Anesthesiology, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar
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Sanapala A, Nagaraju M, Rao LN, Nalluri K. Management of bilateral recurrent laryngeal nerve paresis after thyroidectomy. Anesth Essays Res 2015; 9:251-3. [PMID: 26417137 PMCID: PMC4563973 DOI: 10.4103/0259-1162.152419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Bilateral recurrent laryngeal nerve (RLN) injury is rare for benign thyroid lesions (0.2%). After extubation-stridor, respiratory distress, aphonia occurs due to the closure of the glottic aperture necessitating immediate intervention and emergency intubation or tracheostomy. Intra-operative identification and preservation of the RLN minimizes the risk of injury. It is customary to expect RLN problems after thyroid surgery especially if malignancy, big thyroid, distorted anatomical problems and difficult airway that can lead to intubation trauma. Soon after extubating, it is essential to the anesthetist to check the vocal cord movements on phonation and oropharyngeal reflexes competency. But this case is specially mentioned to convey the message that in spite of absence of above mentioned predisposing factors for complications and good recovery profile specific to thyroid, there can be unanticipated airway compromise that if not attended to immediately may cost patient's life. This is a case of postextubation stridor following subtotal thyroidectomy due to bilateral RLN damage and its management.
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Affiliation(s)
- Anitha Sanapala
- Department of Anesthesiology, Katuri Medical College and Hospital, Chinakondrupadu, Guntur, Andhra Pradesh, India
| | - Male Nagaraju
- Department of Anesthesiology, Katuri Medical College and Hospital, Chinakondrupadu, Guntur, Andhra Pradesh, India
| | - Lella Nageswara Rao
- Department of Anesthesiology, Katuri Medical College and Hospital, Chinakondrupadu, Guntur, Andhra Pradesh, India
| | - Koteswar Nalluri
- Department of Otolaryngology, Katuri Medical College and Hospital, Chinakondrupadu, Guntur, Andhra Pradesh, India
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Mantha S, Jonnavithala N, Mohammad R, Padhy N, Kanithi G. Cervical epidural block in emergency hand surgery for a patient with untreated severe hypothyroidism. J Anaesthesiol Clin Pharmacol 2015; 31:424-5. [PMID: 26330740 PMCID: PMC4541208 DOI: 10.4103/0970-9185.161737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Srinivas Mantha
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Nirmala Jonnavithala
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Rahamathullah Mohammad
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Narmada Padhy
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Geetha Kanithi
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
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Wong P, Chieh Liew GH, Kothandan H. Anaesthesia for goitre surgery: A review. PROCEEDINGS OF SINGAPORE HEALTHCARE 2015. [DOI: 10.1177/2010105815596095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Goitres are relatively common and, in extreme cases, present unique challenges (particularly in airway management) for the anaesthetist. There are no specific guidelines from the Difficult Airway Society (United Kingdom) or the American Society of Anesthesiologists for the management of the obstructed airway. We therefore present the principles governing the provision of safe anaesthesia for goitre surgery including formulating a plan ABC for patients with a stable airway and for those presenting with acute airway obstruction.
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Affiliation(s)
- Patrick Wong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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Abstract
The gateways to advancements in medical fields have always been accessed through the coalition between various specialties. It is almost impossible for any specialty to make rapid strides of its own. However, the understanding of deeper perspectives of each specialty or super specialty is essential to take initiatives for the progress of the other specialty. Endocrinology and anesthesiology are two such examples which have made rapid progress in the last three decades. Somehow the interaction and relationship among these medical streams have been only scarcely studied. Diabetes and thyroid pathophysiologies have been the most researched endocrine disorders so far in anesthesia practice but even their management strategies have undergone significant metamorphosis over the last three decades. As such, anesthesia practice has been influenced vastly by these advancements in endocrinology. However, a comprehensive understanding of the relationship between these two partially related specialties is considered to be an essential cornerstone for further progress in anesthesia and surgical sciences. The current review is an attempt to imbibe the current and the changing perspectives so as to make the understanding of the relationship between these two medical streams a little simple and clearer.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Gurpreet Kaur
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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26
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Tapley PL, McCombe K, Bell JC. Management of Hyperthyroidism in a Prolonged Nil by Mouth State 3C00. J Intensive Care Soc 2014. [DOI: 10.1177/175114371401500118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Kate McCombe
- Consultant Anaesthetist, Basingstoke Hospital, Frimley Park Hospital NHS Foundation Trust
| | - John C Bell
- Consultant Anaesthetist, Basingstoke Hospital, Hampshire Hospitals NHS Foundation Trust
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Guerrero-Domínguez R, López-Herrera-Rodríguez D, Domínguez-Blanco A, Medina-de Moya I, Sánchez-Carrillo F. [Perioperative treatment for the urgent orbital decompression surgery in a 30-weeks pregnant woman with Graves' orbitopathy]. ACTA ACUST UNITED AC 2013; 61:342-5. [PMID: 23835254 DOI: 10.1016/j.redar.2013.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 05/02/2013] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Abstract
Thyroid ophthalmopathy is a rare extra-thyroid complication usually associated with Graves' disease. This disease can occur in the euthyroid pregnant patient. Graves' orbitopathy is characterized by eyelid retraction, proptosis, extraocular muscle dysfunction, and periorbital edema. In some cases an emergency surgical repair may be required to avoid irreversible vision loss. We present the case of a 35-year-old woman in her 30th gestational week, who suffered from Graves' ophthalmopathy, severe exophthalmia, and visual acuity decrease. Following consultations among anesthesiologists, ophthalmologists, maxillofacial surgeons, endocrinologists, obstetricians and the patient, it was decided to perform a surgical orbital wall decompression. The anesthetic and perioperative implications associated with gestational age and the considerations for this surgical procedure, and how to avoid increasing intraocular pressure are discussed.
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Affiliation(s)
- R Guerrero-Domínguez
- FEA Anestesiología y Reanimación, Hospitales Universitarios Virgen del Rocío, Sevilla, España.
| | | | - A Domínguez-Blanco
- FEA Anestesiología y Reanimación, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - I Medina-de Moya
- FEA Anestesiología y Reanimación, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - F Sánchez-Carrillo
- FEA Anestesiología y Reanimación, Hospitales Universitarios Virgen del Rocío, Sevilla, España
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Abstract
Thyroidectomy is the most common endocrine surgical procedure being carried out throughout the world. Besides, many patients who have deranged thyroid physiology, namely hyperthyroidism and hypothyroidism, have to undergo various elective and emergency surgical procedures at some stage of their life. The attending anesthesiologist has to face numerous daunting tasks while administering anesthesia to such patients. The challenging scenarios can be encountered at any stage, be it preoperative, intra-op or postoperative period. Preoperatively, deranged thyroid physiology warrants optimal preparation, while anticipated difficult airway due to enlarged thyroid gland further adds to the anesthetic challenges. Cardiac complications are equally challenging as also the presence of various co-morbidities which make the task of anesthesiologist extremely difficult. Thyroid storm can occur during intra-op and post-op period in inadequately prepared surgical patients. Postoperatively, numerous complications can develop that include hemorrhage, laryngeal edema, nerve palsies, tracheomalacia, hypocalcemic tetany, pneumothorax, etc., The present review aims at an in-depth analysis of potential risk factors and challenges during administration of anesthesia and possible complications in patients with thyroid disease.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Vishal Sehgal
- Department of Internal Medicine, The Commonwealth Medical College Scranton, PA 18510, USA
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Prakash KS, James JN, Kumar K, Chandy TT. Anaesthetic considerations in a prematurely born infant with congenital hypothyroidism presenting for cataract surgery. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2013. [DOI: 10.1080/22201173.2013.10872909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- KS Prakash
- Department of Anaesthesiology, CMC Vellore, India
| | - JN James
- Department of Anaesthesiology, CMC Vellore, India
| | - K Kumar
- Department of Anaesthesiology, CMC Vellore, India
| | - TT Chandy
- Department of Anaesthesiology, CMC Vellore, India
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Total thyroidectomy for amiodarone-associated thyrotoxicosis: should surgery always be delayed for pre-operative medical preparation? The Journal of Laryngology & Otology 2012; 126:701-5. [PMID: 22613770 DOI: 10.1017/s0022215112000722] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Amiodarone can induce severe hyperthyroidism that justifies its withdrawal and the introduction of antithyroid drugs. Continuing amiodarone use, failure to control hyperthyroidism and poor clinical progress may require thyroidectomy. This study aimed to evaluate patients’ post-operative development and mid-term outcome after thyroidectomy for amiodarone-associated thyrotoxicosis.Study design:Prospective case series.Setting:Tertiary care centre.Subjects and methods:We prospectively collected cases of amiodarone-associated thyrotoxicosis requiring thyroidectomy due to failure of antithyroid treatment, despite amiodarone discontinuation. Post-thyroidectomy complications were compared immediately, 30 days and one year post-operatively, and also for scheduled versus emergency surgery cases.Results:Of 11 total cases, nine scheduled thyroidectomy cases had no morbidity after elective surgery. Two cases required emergency surgery for multiple organ failure and cardiac problems. Immediate post-operative complications (mostly haemodynamic) occurred in both cases (emergency vs routine surgery, p = 0.018).Conclusion:In such cases, pre-operative medical treatment is vital to limit peri- and post-operative complications, but surgery should not be delayed if the haemodynamic status deteriorates. Surgery, with careful anaesthesia, is the cornerstone of the treatment.
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Testini M, Logoluso F, Lissidini G, Gurrado A, Campobasso G, Cortese R, De Luca GM, Franco IF, De Luca A, Piccinni G. Emergency total thyroidectomy due to non traumatic disease. Experience of a surgical unit and literature review. World J Emerg Surg 2012; 7:9. [PMID: 22494456 PMCID: PMC3383489 DOI: 10.1186/1749-7922-7-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 04/11/2012] [Indexed: 11/10/2022] Open
Abstract
Background Acute respiratory failure due to thyroid compression or invasion of the tracheal lumen is a surgical emergency requiring urgent management. The aim of this paper is to describe a series of six patients treated successfully in the emergency setting with total thyroidectomy due to ingravescent dyspnoea and asphyxia, as well as review related data reported in literature. Methods During 2005-2010, of 919 patients treated by total thyroidectomy at our Academic Hospital, 6 (0.7%; 4 females and 2 men, mean age: 68.7 years, range 42-81 years) were treated in emergency. All the emergency operations were performed for life-threatening respiratory distress. The clinical picture at admission, clinical features, type of surgery, outcomes and complications are described. Mean duration of surgery was 146 minutes (range: 53-260). Results In 3/6 (50%) a manubriotomy was necessary due to the extension of the mass into the upper mediastinum. In all cases total thyroidectomy was performed. In one case (16.7%) a parathyroid gland transplantation and in another one (16.7%) a tracheotomy was necessary due to a condition of tracheomalacia. Mean post-operative hospital stay was 6.5 days (range: 2-10 days). Histology revealed malignancy in 4/6 cases (66.7%), showing 3 primitive, and 1 secondary tumors. Morbidity consisted of 1 transient recurrent laryngeal palsy, 3 transient postoperative hypoparathyroidism, and 4 pleural effusions, treated by medical therapy in 3 and by drains in one. There was no mortality. Conclusion On the basis of our experience and of literature review, we strongly advocate elective surgery for patients with thyroid disease at the first signs of tracheal compression. When an acute airway distress appears, an emergency life-threatening total thyroidectomy is recommended in a high-volume centre.
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Affiliation(s)
- Mario Testini
- Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari "Aldo Moro", Bari, Italy.
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Chen CH, Xirasagar S, Lin CC, Wang LH, Kou YR, Lin HC. Risk of adverse perinatal outcomes with antithyroid treatment during pregnancy: a nationwide population-based study. BJOG 2011; 118:1365-73. [DOI: 10.1111/j.1471-0528.2011.03019.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kundra P, Kumar V, Srinivasan K, Gopalakrishnan S, Krishnappa S. Laryngoscopic techniques to assess vocal cord mobility following thyroid surgery. ANZ J Surg 2010; 80:817-21. [PMID: 20969690 DOI: 10.1111/j.1445-2197.2010.05441.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Assessment of vocal cord mobility using Macintosh laryngoscope is frequently performed after extubation following thyroid surgery to rule out laryngeal nerve palsy. This study compared patient comfort and assessment accuracy of post-operative vocal fold mobility with Macintosh laryngoscope and fibreoptic endoscope. METHODS One hundred four physically fit patients undergoing thyroid surgery were included for the study. Tele-laryngoscopy was done to rule out pre-existing vocal cord palsy. Direct laryngoscopy (DL) was performed to each patient after extubation, followed by nasal fibreoptic endoscopy (NFE) to assess the vocal cord mobility. Tele-laryngoscopic assessment was repeated after 1 week to compare the DL and NFE findings. Patient reactivity score (PRS) and haemodynamic parameters were recorded with each technique. RESULTS Macintosh laryngoscope could pick up 4 (50% sensitivity and 88% specificity) and fibreoptic endoscope 7 (87.9% sensitivity and 98.9% specificity) out of the 8 vocal cord palsies identified by tele-laryngoscopy. Patients had significant discomfort during DL (PRS median 3) when compared with NFE and tele-laryngoscopy (PRS median 2), P<0.05. Grade 1 view of larynx in 92.1% patients during intubation worsened to grade 2 (76.3%) and grade 3 (15.8%) during extubation with DL, and a significant rise in mean arterial pressure and heart rate was observed from the baseline value till 5 min and when compared with NFE (P<0.05). CONCLUSION NFE provides accurate assessment of vocal fold mobility with reasonable patient comfort in the immediate post-operative period. Macintosh laryngoscope fails to give optimum visualization and predisposes the patient to significant discomfort and stress.
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Affiliation(s)
- Pankaj Kundra
- Department of Anaesthesiology and Critical Care Surgery ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India.
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Mallat J, Robin E, Pironkov A, Lebuffe G, Tavernier B. Goitre and difficulty of tracheal intubation. ACTA ACUST UNITED AC 2010; 29:436-9. [PMID: 20547033 DOI: 10.1016/j.annfar.2010.03.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 03/11/2010] [Indexed: 11/15/2022]
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Carron M, Veronese S, Ori C. Tetraplegia following thyroidectomy in a patient with spinal meningioma. Br J Anaesth 2010; 104:786-7. [PMID: 20460575 DOI: 10.1093/bja/aeq106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hakumoto Y, Takasugi Y, Kamamoto H, Shigemori S, Koga Y, Mori K. Tracheal intubation in a patient with undetectable tracheal narrowing on chest radiography. J Anesth 2010; 24:128-31. [DOI: 10.1007/s00540-009-0841-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zimmermann E, Ribas-Filho JM, Malafaia O, Ribas CAPM, Nassif PAN, Stieven Filho E, Przysiezny PE. Tracheal suture in rats with hypothyroidism: wound healing study. Acta Cir Bras 2009; 24:282-9. [DOI: 10.1590/s0102-86502009000400007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 04/28/2009] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: To evaluate the influence of hypothyroidism in tracheal wound healing process. METHODS: A controlled study was designed with 48 male Wistar rats, divided into two groups: study and control groups. In the first one hypothyroidism was surgically induced and 10 weeks after, a tracheal opening followed by suture was performed in both groups, subdivided into 7, 14, and 21 days in accordance with the date of animals death. A laboratorial evaluation was performed to prove the decreased in thyroid function in the study group. Also a macroscopic evaluation through a stablished protocol and a microscopic analysis with Hematoxylin-eosin and Sirius-Red staining methods were done. RESULTS: The laboratorial evaluation certified suppressed thyroid function in the study group. The macroscopic evaluation showed the presence of suture blockade in the study group in all the evaluated days. Microscopic analysis showed a prolongated inflammatory process and less collagen with delay in organization in the study group comparing to control group. All these data were statistic significant. CONCLUSION: Hypothyroidism had an influence in tracheal wound healing process, promoting delay in the inflammatory and organization processes and diminished tissue collagen quantity.
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Verma A, Bhaskaran K, Sitaram AK, Santhosham R. Femoro-Femoral Cardiopulmonary Bypass for Tracheostomy in Critical Airway Obstruction. APOLLO MEDICINE 2008. [DOI: 10.1016/s0976-0016(11)60148-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Peña JJ, Marqués JI, Mateo E, Llagunes J, Aguar F, de Andrés J. [Perioperative management of a ruptured sinus of Valsalva aneurysm]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2008; 55:175-178. [PMID: 18401992 DOI: 10.1016/s0034-9356(08)70536-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Congenital sinus of Valsalva aneurysms are extremely rare in Spain. The lesion consists of a defect that allows the aortic media to separate from the annulus fibrosus of the aortic valve, causing it to dilate with arterial pressure. The natural course of the aneurysm involves the risk of complication due to bacterial endocarditis, with conduction blocks or myocardial ischemia. Rupture of the aneurysm, usually into a right chamber, causes a left-right shunt that leads to heart failure and death if untreated. We present the case of a previously asymptomatic 60-year-old woman who presented with a clinical picture that led to a diagnosis of hyperthyroidism, and in whom there occurred a coincident rupture of a congenital sinus of Valsalva aneurysm. We describe the anesthetic procedure and emphasize the importance of intraoperative echocardiography throughout the resection of the aneurysm.
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Affiliation(s)
- J J Peña
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia.
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Sloan PA. Interference of bispectral index monitoring with intraoperative use of the electromyograph endotracheal tube. Can J Anaesth 2007; 54:1028-9. [DOI: 10.1007/bf03016641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Leelanukrom R, Wacharasint P, Kaewanuchit A. Perioperative management for surgical correction of frontoethmoidal encephalomeningocele in children: a review of 102 cases. Paediatr Anaesth 2007; 17:856-62. [PMID: 17683404 DOI: 10.1111/j.1460-9592.2007.02216.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Frontoethmoidal encephalomeningocele (FEEM) is a congenital neural tube defect characterized by herniation of brain and meninges through an anterior skull defect. The extruding mass results in a cutaneous expanding lesion and facial deformity. The objective of this study was to review perioperative management for surgical correction of this condition. METHODS We reviewed the charts of FEEM children who were treated by surgical correction in King Chulalongkorn Memorial Hospital during 1995-2005. The collected data were categorized into preoperative, intraoperative and postoperative data. In addition, average blood loss was calculated. RESULTS A total of 102 charts were reviewed. Preoperative data: The mean age of the patients was 4.62 years. Forty-six patients (45%) were smaller than average weight or height. Preoperative-associated abnormal conditions were found in 69 cases (68%). Intraoperative data: The mean duration of the anesthesia and surgery were 6.35 h and 5.51 h, respectively. The estimated mean red cell mass loss was 13.04 ml.kg(-1). There is one case of difficult intubation. No major anesthetic complication was found. Postoperative data: The average intensive care unit stay and hospital stay were 1.55 days and 11.51 days, respectively. The main postoperative complications were tonic-clonic seizure and serious infection including septic shock from wound infection and meningitis. CONCLUSIONS We reported perioperative management in 102 FEEM children. Comprehensive care during preoperative, intraoperative and postoperative period is essential for successful outcome.
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Affiliation(s)
- Ruenreong Leelanukrom
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Cornish JA, Smellie WJB. Urgent complications of thyroidectomy. Br J Hosp Med (Lond) 2006. [DOI: 10.12968/hmed.2006.67.sup12.22500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- JA Cornish
- Surgical Department, Chelsea and Westminster Hospital, London SW10 9NH
| | - WJB Smellie
- Surgical Department, Chelsea and Westminster Hospital, London SW10 9NH
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43
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Ould-Ahmed M, Drouillard I, Lions C, Wey PF, Eve O, Pons Y. [Recurrent laryngeal nerve injury after thyroidectomy and preoperative nerve monitoring]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2006; 25:909-10. [PMID: 16859877 DOI: 10.1016/j.annfar.2006.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Accepted: 06/12/2006] [Indexed: 05/11/2023]
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Stannard L, Slater RM, Leatherbarrow B. Orbital decompression surgery for thyroid eye disease. Eur J Anaesthesiol 2006; 23:183-9. [PMID: 16430788 DOI: 10.1017/s0265021505001900] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2005] [Indexed: 11/07/2022]
Abstract
The management of thyroid-associated eye disease is reviewed with particular reference to surgical management and its implications for anaesthetists. Experience from a unit undertaking such surgery is presented.
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Affiliation(s)
- L Stannard
- Manchester Royal Infirmary, Department of Anaesthetics, Manchester, UK
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Li Pi Shan W, Hatzakorzian R, Sherman M, Backman SB. Upper airway compromise secondary to edema in Graves’ disease. Can J Anaesth 2006; 53:183-7. [PMID: 16434760 DOI: 10.1007/bf03021825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE We report an unusual case of upper airway compromise in a patient with Graves' disease. We speculate that this complication may be due, in part, to poorly controlled hyperthyroidism. CLINICAL FEATURES A 26-yr-old female suffering from Graves' disease underwent a total thyroidectomy. Awake fibreoptic intubation was attempted because of a large goiter and orthopnea. Upper airway edema impeded the passage of an armored 7.5 mm endotracheal tube. She was subsequently intubated awake with a regular 7.5 mm endotracheal tube under direct laryngoscopy over an Eschmann bougie. The patient was extubated in the operating room over a tube exchanger. Two hours later she developed stridor and upper airway obstruction. Using direct laryngoscopy, she was reintubated with difficulty because of upper airway edema. At this time, she manifested signs of thyrotoxicosis which were managed medically. On postoperative day three she underwent a tracheostomy after failing a trial of extubation. The upper airway was edematous with minimal vocal cord movement. On postoperative day nine the tracheostomy was downsized and the patient was sent home. The vocal cords were still edematous with minimal movement. Three weeks later, she demonstrated normal right vocal cord movement and weak left vocal cord movement, and the tracheostomy was decannulated. CONCLUSIONS Uncontrolled hyperthyroid patients with large goiters secondary to Graves' disease may develop edema of the upper airway. A high degree of vigilance for airway obstruction is necessary, with a carefully planned approach at each stage of the patient's hospital course to treat this potentially life-threatening situation.
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Affiliation(s)
- William Li Pi Shan
- Department of Anesthesia, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada.
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Nemergut EC, Dumont AS, Barry UT, Laws ER. Perioperative management of patients undergoing transsphenoidal pituitary surgery. Anesth Analg 2005; 101:1170-1181. [PMID: 16192540 DOI: 10.1213/01.ane.0000166976.61650.ae] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Pituitary adenomas often present with the symptoms of hormonal hypersecretion, and although medical therapy is available for most hyperfunctioning states, it is not curative. As a result, transsphenoidal pituitary surgery has become a commonly performed neurosurgical procedure with unique challenges for the anesthesiologist due to the distinct medical comorbidities associated with various adenomas. Any type of pituitary tumor may also produce hypopituitarism and local mass effects secondary to the expanding intrasellar mass. Here we review the perioperative concerns surrounding surgery to remove adenomas and decompress the sellar space. Special attention is given to Cushing's disease (hypercortisolism secondary to an adrenocorticotropic hormone-secreting adenoma), acromegaly (secondary to a growth hormone-secreting adenoma), and hyperthyroidism in the setting of thyrotropic adenomas. Operative risks, including bleeding, diabetes insipidus, the syndrome of inappropriate antidiuretic hormone secretion, and hypopituitarism, are addressed in detail. Understanding preoperative assessment, intraoperative management, potential complications, their management, and strategies for avoidance are fundamental to successful perioperative patient care and avoidance of morbidity and mortality.
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Affiliation(s)
- Edward C Nemergut
- Departments of *Anesthesiology and †Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
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Sapra H, Farling P. A response to 'The Glidescope system: a clinical assessment of performance'. Anaesthesia 2005; 60:524. [PMID: 15819794 DOI: 10.1111/j.1365-2044.2005.04212.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Williams syndrome, initially described by Williams, Barratt-Boyes, and Lowe in 1961, consists of characteristic dysmorphic features, congenital heart disease, and distinctive behavioral and emotional traits. In addition to acquired and congenital heart disease, manifestations in the renal, endocrine, musculoskeletal, and central nervous system may have implications during the perioperative period. Congenital and acquired heart disease can be a significant issue as sudden death, related to abnormalities of the coronary arteries, has been reported perioperatively in these patients. The authors present a 7-month-old infant, previously diagnosed with Williams syndrome, who required anesthetic care for repair of subaortic and supravalvular aortic stenosis. The potential perioperative implications of Williams syndrome are discussed.
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Affiliation(s)
- John Medley
- Department of Anesthesiology, The University of Missouri, Columbia, MO 65212, USA
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Varela A, Yuste A, Villazala R, Garrido J, Lorenzo A, López E. Spinal anesthesia for emergency abdominal surgery in uncontrolled hyperthyroidism. Acta Anaesthesiol Scand 2005; 49:100-3. [PMID: 15675992 DOI: 10.1111/j.1399-6576.2004.00554.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patients with uncontrolled hyperthyroidism presenting as an emergency are at considerable risk. The anesthetic management of a thyrotoxic patient undergoing incidental emergency surgery is discussed. We focus on the intraoperative problems and, above all, postoperative pain management with regional anesthesia.
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Affiliation(s)
- A Varela
- Department of Anesthesia and Intensive Care, Gregorio Marañón General Hospital, Madrid, Spain.
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Abstract
A 53- year-old woman without a previous history of thyroid disease was scheduled for mastectomy. On arrival in the operating theatre unpremedicated she appeared restless and tachycardic. Midazolam and fentanyl was administered intravenously. Concomitantly, sinus tachycardia developed and a flush reaction was observed in the skin of the thoracic region and neck. The blood pressure increased to 265/160 mmHg and the patient lost consciousness and became apnoeic. Unconsciousness and apnoea lasted for approximately 25 min and the operation was postponed. Further investigations revealed an elevated serum free thyroxine level and suppressed serum thyrotropin diagnostic of hyperthyroidism. The serum TSH receptor antibody concentration was elevated, indicating that the patient was suffering from Graves' disease. We present a case of a previously unknown hyperthyroid patient, with breast cancer, presenting as a thyroid crisis on induction of anaesthesia. Although being quite a rare occurrence, unsuspected thyroid disease should be borne in mind when an agitated patient enters the operating theatre.
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Affiliation(s)
- E A Hirvonen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Finland.
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