The Problems of

Anesthesia in Patients with

Goitre

Thyroid Gland
The thyroid gland secretes thyroid
hormones, thyroxine (T4), and 3,3,5
triiodothyronine (T3), which are the
major regulators of cellular metabolic
activity.
Thyroid hormones exert a variety of
actions by regulating the synthesis
and activity of various proteins.

 They are necessary for proper

cardiac, pulmonary, and neurologic
function during both health and
illness.

Thyroid Metabolism and

Function

Thyroid hormone biosynthesis consists of four stages: (1) organification, (2) binding, (3) coupling,
and (4) release. TSH, thyroid-stimulating hormone; T3, triiodothyronine; T4, thyroxine.

Tests of Thyroid Function

Serum Thyroxine
Serum Triiodothyronine
Tests for Assessing Thyroid Hormone
Binding
Thyroid-Stimulating Hormone
Radioactive Iodine Uptake

Tests of Thyroid Gland

Function

Hyperthyroidism
Hyperthyroidism results from the
exposure of tissues to excessive
amounts of thyroid hormone
The most common cause is the
multinodular diffuse goiter of Graves
disease.
20 and 40 years
predominant in women

 Most patients with this condition

demonstrate a syndrome characterized
by diffuse glandular enlargement,
ophthalmopathy, dermopathy, and
clubbing of the fingers.
A thyroid-stimulating autoantibody
may be present
Thyroid adenoma is the second most
common cause

 Subacute thyroiditis frequently follows a

respiratory illness and is characterized by
a viral-like illness with a firm, painful gland
This type of thyroiditis is frequently treated
with anti-inflammatory agents alone.
Rarely, subacute thyroiditis may occur in a
patient with a normal-size, painless gland.

 Hashimoto's thyroiditis is a chronic

autoimmune disease that usually
produces hypothyroidism but may
occasionally produce
hyperthyroidism

 Hyperthyroidism may also be

associated with pregnancy, 131I
therapy, thyroid carcinoma,
trophoblastic tumors, or TSHsecreting pituitary adenomas

 Iatrogenic hyperthyroidism may follow

thyroid hormone replacement or may
occur after iodide exposure
(angiographic contrast media) in
patients with chronically low iodide
intake (Jod-Basedow phenomenon)
The antiarrhythmic agent amiodarone
is iodine-rich and is another cause of
iodine-induced thyrotoxicosis

Causes of Hyperthyroidism
INTRINSIC THYROID DISEASE
Hyperfunctioning thyroid adenoma
Toxic multinodular goiter

ABNORMAL TSH STIMULATOR

Graves disease
Trophoblastic tumor

DISORDERS OF HORMONE STORAGE OR

RELEASE
Thyroiditis

 EXCESS PRODUCTION OF TSH

Pituitary thyrotropin

EXTRATHYROIDAL SOURCE OF HORMONE

Struma ovarii
Functioning follicular carcinoma

EXOGENOUS THYROID
Iatrogenic
Iodine induced TSH

TSH, thyroid-stimulating hormone.

Clinical Manifestation
The
major
manifestations
of
hyperthyroidism are weight loss, diarrhea,
skeletal muscle weakness and stiffness,
warm and moist skin, heat intolerance,
and nervousness
Cardiovascular
manifestations
include
increased left ventricular contractility and
ejection fraction, tachycardia, elevated
systolic blood pressure, and decreased
diastolic blood pressure

 Hypercalcemia,
thrombocytopenia,
and a mild anemia may be present
Elderly patients may present with
heart failure, atrial fibrillation, or
other cardiac dysrhythmias

Treatment and Anesthetic

Considerations
The most important goal in
managing the hyperthyroid patient is
to make the patient euthyroid before
any surgery, if possible.