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Hypothyroidism
Tue, 12/25/2007 - 11:11 — oxygen
Hypothyroidism Listen to Audio Clinical causes Clinical manifestations Diagnosis Treatment
Preoperative management Intraoperative
management Postoperative management Clinical
causes: -Hashimotos thyroiditis -iodine deficiency
-radioactive iodine -antithyroid medications
-thyroidectomy -secondary hypothyroidism Clinical
manifestations -weight gain -cold intolerance
-muscle fatigue -lethargy -constipation -reflex
decreased (hyporeflexia) -depression Diagnosis:
Primary hypothyroidism: -decreased T3 -decreased
T4 -increased TSH Secondary hypothyroidism:
-decreased T3 -decreased T4 -decreased TSH Treatment: Oral replacement: -physiological effect
within few days -clinical improvement within several weeks Myxedema/emergency: -loading dose:
levothyroxine 300 - 500mg -maintenence doses: ex. levothyroxine 50 mg q day Preoperative
management: Elective surgery: -thyroid hormone level should be therapeutic Emergency surgery:
give thyroid hormone prior to procedure in patients with: -uncorrected severe hypothyroidism T4<
1mg/dL -myxedema coma Premedication: -may not be required due to the sedative nature of the
disease (lethargy, depression) -may be more prone to opiod induced respiratory depression
Intraoperative management: induction: ketamine may be considered induction agent of choice
Airway: may be difficult intubation due to large tongue CNS: same MAC requirements CVS:
senstive to cardiodepressant effects of volatile anesthetics due to: -decreased intravascular volume
therefore decreased preload -blunted baroreceptor response theferefore decreased HR -overall
decreased cardiac output Other possible intraoperative complications: -hypoglycemia
-hyponatremia -hypothermia -large tongue for difficult ventilation/intubation Postoperative
management May have delayed emergence/recovery from GA due to: -hypothermia -respiratory
depression -delayed/slowed drug biotransformation *therefore may require prolonged mechanical
ventilation *ketorolac may be preferred to opiod analgesia due to less risk of drug induced
respiratory depression