Perioperative Management of Thyroidectomy After a Failed Antithyroid Therapy in a Resource Limited Setting: A Clinical Case Report

Abstract

Background:

Thyroidectomy is the most common endocrine surgical procedure being performed throughout the world. Thyroidectomy in a non-controlled or poorly controlled toxic state may lead to thyroid storm. But, if surgery is the only option all precautions with detail risk-benefit analysis involving a multi-disciplinary team is mandatory.

Case Presentation:

A 24-year-old female patient who had anterior neck swelling of 4 years duration was taking antithyroid medication of a varying dose for the past 2 years. However, there was no improvement in the clinical feature and deranged biochemical tests. Subtotal thyroidectomy was performed.

Conclusion:

Even though there are challenges of performing surgery in non-euthyroid patients in a resource-limited area, poor adherence, failure of antithyroid therapy due to long duration of therapy with side effects and complications with persistent toxic state necessitate surgical intervention. The thyroidectomy procedure was performed uneventfully with the available resources after careful risk-benefit analysis. There was no apparent perioperative complication.

Keywords:

• thyrotoxicosis
• failed antithyroid therapy
• perioperative

Abbreviations

BID, Twice In a Day; DBP, Diastolic Blood Pressure; ECG, Electro Cardio Gram; HR, Heart Rate; NIBP, Non-Invasive Blood Pressure; PACU, Post Anesthesia Care Unit; PTU, propylthiouracil; T3, triiodothyronine; T4, thyroxine; TID, Triple in a Day; TSH, Thyroid-stimulating hormone; SBP, Systolic Blood Pressure; Spo2, Arterial oxygen saturation.

Data Sharing Statement

Authors are willing to share the data upon requests.

Consent for Publication

Informed consent was taken from the patient for publication of this report.

Acknowledgment

We would like to acknowledge the staff of the department of surgery, and anesthesiology for their professional support during the patient treatment. We would also like to acknowledge individuals who supported us during the write-up of this case report.

Disclosure

The authors have no conflicts of interest to declare for this work.