Anesthetic management of a pregnant patient with uncontrolled hyperthyroidism for emergency caesarean section - a case report

Background and Aims: Uncontrolled hyperthyroid patient in pregnancy for emergency caesarean section under general anaesthesia managed by giving antithyroid agents, beta blockers, dexamethasone preoperatively to inhibit peripheral conversion of T۴ to T۳ and to control symptoms of hyperthyroidism. Case presentation: A ۲۰-year-old primigravida, presented at ۳۷ weeks of gestation with complaints of respiratory difficulty, tremors, excessive sweating, prominent eyes, palpitations and anxiety. Patient was given oral propylthiouracil, lugol’s solution, tablet propranolol, injection dexamethasone and injection pantoprazole intravenous preoperatively. Nasogastric tube was inserted for further administration of antithyroid medications. Arterial blood pressure cannula secured and central venous cannulation done in case thyroid storm occurs which may require large volume resuscitation. Patient was managed successfully under general anaesthesia and monitored for thyroid storm in postoperative period. Discussion: In patients with poorly controlled hyperthyroidism labour, delivery or caesarean section can precipitate life threatening thyroid storm. In case of thyroid storm antithyroid drugs can be administered orally or rectally so Ryle’s tube was inserted preoperatively. General anaesthesia should be considered in patients of uncontrolled hyperthyroidism requiring emergency surgery as it provides less fluctuations in hemodynamic parameters. Sympathetic stimulation should be avoided in perioperative period. Regional anaesthesia can be performed safely if there are no signs of cardiac failure. In the present case there were no signs of cardiac failure but the patient had tachypnoea so a decision to proceed with general anaesthesia with central venous catheterization and invasive blood pressure monitoring was made.

Keywords:

Caesarean section , Emergency , General anaesthesia , hyperthyroidism , Thyrotoxic storm