Anesthetic management of a patient with hyperthyroidism due to hydatidiform mole.
Secondary hyperthyroidism can often complicate gestational trophoblastic disease, a malignant uterine cancer. We report here the perioperative management of hyperthyroidism due to hydatidiform mole. A 53-year-old woman underwent emergency surgery due to suspicion of hydatidiform mole. Tachycardiac atrial fibrillation was detected by electrocardiography at the preoperative examination. No abnormalities were found in blood count, coagulation, biochemical tests, chest radiographs, or respiratory function. General anesthesia with nitrous oxide, oxygen, and sevoflurane, combined with fentanyl and 1% mepivacaine, was administered intermittently from an epidural catheter. Intraoperative events included hypotension and tachycardia, although in general, tachycardia was prevented with antiarrhythmic agents and transfusion with a plasma expander and crystalloid fluid. Hyperthyroidism was highly suspected from the patient's clinical course and was confirmed by high levels of preoperative serum free triiodothyronine (T3) and thyroxine (T4). The patient became euthyroid within a few days after mole evacuation and did not require an antiarrhythmic agent after her return to the inpatient ward.
Matsumoto
Shigekiyo
S
Department of Anesthesiology and Intensive Care Medicine, Yufu, Oita, Japan.
Shingu
Chihiro
C
Hidaka
Seigo
S
Goto
Koji
K
Hagiwara
Satoshi
S
Iwasaka
Hideo
H
Noguchi
Takayuki
T
D000758:Anesthesia; D001281:Atrial Fibrillation / Q000209:etiology / Q000628:therapy; D006063:Chorionic Gonadotropin / Q000097:blood; D004562:Electrocardiography; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D006828:Hydatidiform Mole / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006980:Hyperthyroidism / Q000209:etiology* / Q000628:therapy*; D007044:Hysterectomy; D007431:Intraoperative Complications / Q000628:therapy*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010052:Ovariectomy; D011247:Pregnancy; D013963:Thyroid Hormones / Q000097:blood; D014057:Tomography, X-Ray Computed
D006063:Chorionic Gonadotropin; D013963:Thyroid Hormones