Hyperthyroidism is usually caused by multinodular diffuse enlargement of the gland in Graves disease and can be associated with pregnancy. Ideally, appropriate medical therapy establishes a euthyroid state prior to anesthesia. However, if emergency surgery becomes necessary in an unprepared patient, the anesthesiologist must avoid situations that may exacerbate the disease and should prevent thyroid storm during perianesthetic period. In this case, a 26 years old female with poorly controlled thyrotoxicosis was scheduled for emergency Cesarean-section. The patient was successfully managed by epidural anesthesia and discharged uneventfully at the 9th postoperative day.
Adult ; Anesthesia ; Anesthesia, Epidural* ; Cesarean Section* ; Emergencies* ; Female ; Graves Disease ; Humans ; Hyperthyroidism ; Pregnancy ; Thyroid Crisis ; Thyrotoxicosis

Pericardial effusion is a rare complication of Graves’ disease. A pregnant Filipino woman with diffuse goiter and hyperthyroid symptoms was initially treated as a case of Graves’ disease. She was readmitted for exertional dyspnea, orthopnea, and bipedal edema; an echocardiogram revealed a massive pericardial effusion. Workup for other causes of the effusion was unremarkable. The pericardial effusion resolved after pericardiostomy and anti-thyroid medications. This highlights the clinician’s role in determining the association between the two disease entities.
Graves Disease ; Thyrotoxicosis ; Hyperthyroidism ; Pericardial Effusion ; Pregnancy

Hyperthyroidism is one of the causes of thyrotoxicosis and the most common cause of hyperthyroidism in Korea is Graves disease. The diagnosis and treatment of Graves disease are different according to geographical area. Recently, the American Thyroid Association and the American Association of Clinical Endocrinologists suggested new management guidelines for hyperthyroidism. However, these guidelines are different from clinical practice in Korea and are difficult to apply. Therefore, the Korean Thyroid Association (KTA) conducted a survey of KTA members regarding the diagnosis and treatment of hyperthyroidism, and reported the consensus on the management of hyperthyroidism. In this review, we summarized the KTA report on the contemporary practice patterns in the diagnosis and management of hyperthyroidism, and compared this report with guidelines from other countries.
Consensus* ; Diagnosis* ; Graves Disease ; Hyperthyroidism* ; Korea* ; Thyroid Gland* ; Thyrotoxicosis

Hyperthyroidism is one of the causes of thyrotoxicosis and the most common cause of hyperthyroidism in Korea is Graves disease. The diagnosis and treatment of Graves disease are different according to geographical area. Recently, the American Thyroid Association and the American Association of Clinical Endocrinologists suggested new management guidelines for hyperthyroidism. However, these guidelines are different from clinical practice in Korea and are difficult to apply. Therefore, the Korean Thyroid Association (KTA) conducted a survey of KTA members regarding the diagnosis and treatment of hyperthyroidism, and reported the consensus on the management of hyperthyroidism. In this review, we summarized the KTA report on the contemporary practice patterns in the diagnosis and management of hyperthyroidism, and compared this report with guidelines from other countries.
Consensus* ; Diagnosis* ; Graves Disease ; Hyperthyroidism* ; Korea* ; Thyroid Gland* ; Thyrotoxicosis

A 22-year-old woman with severe Graves' disease was referred from a local clinic because of her refractory hyperthyroidism. She presented with exophthalmos, diffuse goiter, and tachycardia. She was treated with a maximal dose of methimazole and a beta-blocker for 2 months. However, her thyroid function test (TFT) did not improve. TFT showed a free T4 level of 74.7 ng/dL and a thyroid stimulating hormone (TSH) level of 0.007 µIU/mL. She was then administered cholestyramine (4 g thrice daily), hydrocortisone (300 mg/day) and methimazole (100 mg/day) which prepared the patient for surgery by reducing the free T4 level (4.7 ng/dL). The patient underwent a total thyroidectomy without experiencing thyrotoxic crisis. This case describes the use of cholestyramine for the first time in Korea in treating Graves' disease and provides limited evidence that cholestyramine can be an effective option.
Cholestyramine Resin* ; Exophthalmos ; Female ; Goiter ; Graves Disease* ; Humans ; Hydrocortisone ; Hyperthyroidism ; Korea ; Methimazole ; Tachycardia ; Thyroid Crisis ; Thyroid Function Tests ; Thyroidectomy ; Thyrotoxicosis ; Thyrotropin ; Young Adult

A 22-year-old woman with severe Graves' disease was referred from a local clinic because of her refractory hyperthyroidism. She presented with exophthalmos, diffuse goiter, and tachycardia. She was treated with a maximal dose of methimazole and a beta-blocker for 2 months. However, her thyroid function test (TFT) did not improve. TFT showed a free T4 level of 74.7 ng/dL and a thyroid stimulating hormone (TSH) level of 0.007 µIU/mL. She was then administered cholestyramine (4 g thrice daily), hydrocortisone (300 mg/day) and methimazole (100 mg/day) which prepared the patient for surgery by reducing the free T4 level (4.7 ng/dL). The patient underwent a total thyroidectomy without experiencing thyrotoxic crisis. This case describes the use of cholestyramine for the first time in Korea in treating Graves' disease and provides limited evidence that cholestyramine can be an effective option.
Cholestyramine Resin* ; Exophthalmos ; Female ; Goiter ; Graves Disease* ; Humans ; Hydrocortisone ; Hyperthyroidism ; Korea ; Methimazole ; Tachycardia ; Thyroid Crisis ; Thyroid Function Tests ; Thyroidectomy ; Thyrotoxicosis ; Thyrotropin ; Young Adult

Hyperthyroidism is diagnosed when a patient is presented with typical symptoms, such as weight loss, palpitation, and hand tremor. However, early diagnosis is difficult in elders, because they have no typical symptoms, but only cardiovascular or muscular symptoms. In hyperthyroidism, there are often with neurologic changes, leading to various neurologic symptoms. Generalized or focal seizures are rarely reported in thyrotoxicosis and thyrotoxic crisis. Further, cases of hyperthyroidism presented as generalized seizure attack are extremely rare. We report a case of hyperthyroidism. A patient is presented at the hospital with mental change, as well as generalized seizure, who was finally diagnosed to have Graves' disease. A 56-year-old male was admitted to the hospital because of mental change with generalized seizure attack. Initial neurologic evaluations, including a brain magnetic resonance imaging and electroencephalogram proved to be normal. But, thyroid function test showed abnormal results. We diagnosed him as Graves' disease and prescribed anti-thyroid drug. Thereafter, there has been no recurrence of neurologic symptoms for 12 months.
Brain ; Early Diagnosis ; Electroencephalography ; Graves Disease ; Hand ; Humans ; Hyperthyroidism ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurologic Manifestations ; Recurrence ; Seizures ; Thyroid Crisis ; Thyroid Function Tests ; Thyrotoxicosis ; Tremor ; Weight Loss

Thyrotoxic storm is an extreme state of thyrotoxicosis and a medical emergency. The clinical presentation of thyrotoxic storm includes tachycardia, fever, organ effect of central nervous system, cardiovascular system, and gastrointestinal system dysfunction. It usually occurs in patients with untreated or partially treated Graves' disease. Although it is rare, its mortality rate has reached 10-20%. There are no specific tests for establishing the diagnosis; it can only be diagnosed based on the clinical expression and laboratory results. Rapid diagnosis and treatment are necessary when it unexpectedly occurs during the perioperative period. We report a case of unnoticed hyperthyroidism that was diagnosed due to thyrotoxic storm-induced tachycardia in the post anesthesia care unit.
Anesthesia ; Cardiovascular System ; Central Nervous System ; Diagnosis ; Emergencies ; Fever ; Graves Disease ; Humans ; Hyperthyroidism ; Liver Transplantation ; Living Donors ; Mortality ; Perioperative Period ; Tachycardia* ; Thyroid Crisis* ; Thyrotoxicosis

It is uncommon that anesthesiologists experience patients with thyroid storms. In our case, the patient had been medicated for 5 years, however, she developed agranulocytosis. Anti-thyroid drugs were stopped and hyperthyroidism progressed. Her symptoms and laboratory results revealed manifestation of thyroid storm: TSH of < 0.005 IU/L, free T4 of > 7.77 ng/dl, T3 of 403.1 ng/dl, and T4 of 22.15 microg/dl. The euthyroid state had not been achieved before the surgery. From the judgment of difficulty controls of hyperthyroidism, the surgeon requested for an emergency operation. We report a case of total intravenous anesthesia with propofol and remifentanil which achieved hemodynamic stability.
Agranulocytosis ; Anesthesia, Intravenous* ; Emergencies ; Hemodynamics ; Humans ; Hyperthyroidism ; Judgment ; Propofol ; Thyroid Crisis ; Thyrotoxicosis*

No abstract available.
Hyperthyroidism*