Rapid preparation of severe uncontrolled thyrotoxicosis due to Graves' disease with Iopanoic acid--a case report.
OBJECTIVE
To report the rapid preoperative preparation of a case of thyrotoxicosis due to Graves' disease resistant to medical treatment.


METHODS
A 14-yr-old boy presented with a history of progressive swelling in the neck. Signs and symptoms were compatible with hyperthyroidism. Thyroid function tests revealed: serum T4 296.5 nmol.L(-1), serum T3 6.06 nmol.L(-1) and serum thyroid-stimulating hormone < 0.15 mIU.L(-1). The diagnosis of thyrotoxicosis due to Graves' disease was made. Therapy was instituted with carbimazole 30 mg.day(-1) and propranolol 80 mg.day(-1), which were gradually increased to carbimazole 80 mg.day(-1) and propranolol 120 mg.day(-1), without response. Preparation was attempted by adding Iopanoic acid 500 mg four times a day and dexamethasone 0.5 mg four times a day in addition to the above drugs for five days. T3 levels declined to 1.8 nmol.L(-1), but the serum T4 remained elevated. Symptoms of hyperthyroidism persisted but with decreased intensity. As the patient could not be made euthyroid, surgery was planned to relieve the symptoms. Anesthesia was uneventful except for intraoperative and postoperative tachycardia, which was managed successfully with esmolol.


CONCLUSIONS
In life threatening thyrotoxicosis refractory to medical treatment, Iopanoic acid may be used as an adjuvant to antithyroid drugs for rapid preparation of the patient prior to surgery.
Pandey
Chandra Kant
CK
Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. ckpandey@sgpgi.ac.in
Raza
Mehdi
M
Dhiraaj
Sanjay
S
Agarwal
Anil
A
Singh
Prabhat Kumar
PK
D000293:Adolescent; D000758:Anesthesia; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D006111:Graves Disease / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007480:Iopanoic Acid / Q000627:therapeutic use*; D008297:Male; D011300:Preoperative Care; D013958:Thyroid Crisis / Q000150:complications* / Q000188:drug therapy; D013965:Thyroidectomy; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood
D000893:Anti-Inflammatory Agents; D014284:Triiodothyronine; D003907:Dexamethasone; D007480:Iopanoic Acid; D013974:Thyroxine