You are here

  • Home
  • Archive
  • Volume 15, Issue 12
  • Anaesthesiology perspective on a multidisciplinary approach to optimal perioperative management of a patient with giant peptic ulcer perforation caused by the physiological stress of a thyroid storm necessitating emergent laparotomy

Article Text

Article menu
Download PDFPDF
Case Reports: Unusual association of diseases/symptoms
Anaesthesiology perspective on a multidisciplinary approach to optimal perioperative management of a patient with giant peptic ulcer perforation caused by the physiological stress of a thyroid storm necessitating emergent laparotomy
  1. Sujani Wijeratne1,
  2. Claudia Chong1 and
  3. Dinoo Suran Kirthinanda2
  1. 1Department of Anaesthesia, Intensive Care and Pain Medicine, Khoo Teck Puat Hospital, Singapore
  2. 2Jurong Health Campus, Anaesthesiology, National University Health System, Singapore
  1. Correspondence to Dr Dinoo Suran Kirthinanda; dinoo.sn{at}live.com

Abstract

Thyroid storm is a rare, fatal complication of thyrotoxicosis that necessitates aggressive medical treatment. We present a case of a patient who developed duodenal ulcer perforation as a result of a thyroid storm caused by Graves’ thyrotoxicosis. In addition to life-threatening intra-abdominal sepsis complicated by high anion-gap metabolic acidosis, he was found to have severely deranged thyroid hormone levels and clinical features compatible with thyroid storm based on the Burch-Wartofsky Score. Diagnosis and management of such patients with compromised gastrointestinal (GI) tract present a remarkable clinical challenge to the anaesthetist and the intensivists. Multidisciplinary care with rapid preoperative optimisation, careful intraoperative anaesthetic techniques and postoperative care resulted in excellent outcomes. This case report sheds light on how to tailor general anaesthesia to minimise physiological derangement associated with thyroid storm and re-establish homeostasis in patients presenting for emergent surgery, particularly those with GI dysfunction.

  • Anaesthesia
  • Thyroid disease
  • Gastrointestinal surgery

https://doi.org/10.1136/bcr-2022-250816

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors We would like to state that all persons who are listed as authors below certify that they have participated sufficiently in the submitted work to take public responsibility for the content. SW conceived the idea of the case report and participated in the design, data collection, analysis, drafting of the manuscript, revision of the manuscript and approval of the final manuscript. DSK participated in the design, analysis, drafting of the manuscript, revision of the manuscript and approval of the final manuscript. CC participated in data collection, analysis, drafting of the manuscript, revision of the manuscript and approval of the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.