Thyroid

YT
Anatomy of Thyroid
Structure of Thyroid
Vascularisation of Thyroid
 Physiology of Thyroid

Dietary iodine absorbed by GI tract converted

to iodide ion actively transported thyroid
gland

In thyroid gland oxidized back into iodine

bound to amino acyd tyrosine resulting 2
hormones T3 ( triiodothyronine ) and T4
thyroxine

More T4 than T3, but T3 more poten and less

protein bound.
Mechanism Controls
Thyroid
Effect of Thyroid
Hyperthyroidism
laboratory
 Drugs

Inhibit thyroid hormone sysnthesis eg. PTU,

methimazole

Prevent hormone release eg. Potassium, sodium

iodida

Mask the sign of adrenergic overactivity eg.

Propanolol

Reduce conversion T4 to T3 B-adrenergic antagonis

Radioactive iodine destroy thyroid cell function

 Anesthetic Consideration

Pre Operative
Elective procedure euthyroid
Not have resting tachycardia
Medication for thyroid continue through morning of
surgery
If emergence control hyperdynamic circulation
with titration of an esmolol infusion
 Intra operative
Monitoring function and body temperature
Exoftalmus greater risk of corneal abrasion
Avoid ketamine
Adequate anesthetic depth avoid stimulation to
tachycardia, hipertension and arrhytmia
 Post operative

Thyroid storm

6-24 h after surgery

Hyperpirexia, tachycardia, altered mental status

and hypotension

No muscle rigidity, elevated creatinin kinase and

respiratory acidosis
 Hydration and cooling

Beta blocker infusion ( esmolol ) maintain HR <

100 bpm

Plug NGT give PTU 250-500mg / 6H

Sodium iodide 1 gr intravena dalam 12 jam

Correction precipitating cause

 Recurrent laryngeal nerve palsy will result in
hoarseness, or aphonia and stridor

Evaluated by laryngoscope immediately, or using

Cuff Leak Test

Failure one or both cords require of intubation and

wound exploration
 Hematoma causing airway compromise from
collapse the trachea, particularly in patient with
tracheomalacia

Immediate treatment opening the neck wound &

evacuating the clot
 Hipoparatiroidism from unintentional removal of
all parathyroid glands acute hypocalcemia 12-72
H

Unusual is pneumothorax
 Sumber

Morgan and Mikail, Anesthesiology.

Pocket Anesthesiology