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Perioperative considerations of hyperthyroidism in a patient with liver failure: case report
Med Biol Sci Eng 2019;2(2):60-63
Published online July 31, 2019
© 2019 Medical Biological Science and Engineering.

Byung Hwa Kim, Yun Hee Kim, Yoon Sook Lee, Woon Young Kim, Jae Hwan Kim

Department of Anesthesiology and Pain Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
Correspondence to: Jae Hwan Kim
Department of Anesthesiology and Pain Medicine, Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea
Tel: +82-31-412-5297
Fax: +82-31-412-5294
E-mail: anejhkim@korea.ac.kr
ORCID: https://orcid.org/0000-0002-1360-1708
Received March 25, 2019; Revised May 13, 2019; Accepted May 14, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Hyperthyroidism is one of the most common endocrinologic disorders. When patients with hyperthyroidism undergo general anesthesia, potential perioperative complications such as atrial fibrillation, congestive heart failure, ischemic heart disease, thrombocytopenia may occur. Hyperthyroidism treatment is mainly divided into three parts: Medical treatment, radioactive iodine therapy, and surgical removal of the thyroid. However, the previous two treatments may not have a significant effect on patients with liver failure. In this report, we present a case where a patient with an underlying disease of uncontrolled hyperthyroidism and liver failure undergoing liver transplantation, where preoperative thyroid levels couldn’t be managed aggressively due to liver failure. We managed hyperthyroidism using conservative management before and during surgery; perioperative use of steroids, beta-blockers, calcium channel-blockers, IV (Intravenous) fluids, body temperature regulation, opioid use such as remifentanil and fentanyl, sufficient sedation are all key in ensuring the hemodynamic stability of such a patient.
Keywords : Hyperthyroidism; Liver failure; Management
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