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. 2010 May;54(3):255-8.
doi: 10.4103/0019-5049.65374.

Fatal thyrocardiac event

Samit Kumar Khutia  1 , Bhaskar Roy, Mohan Chandra Mandal, Sabyasachi Das
Affiliations

Fatal thyrocardiac event

Samit Kumar Khutia et al. Indian J Anaesth. 2010 May.

Abstract

Atrial fibrillation occurs frequently (2-20%) in chronic hyperthyroidism patients. Poorly treated thyrotoxic patients may present with a life-threatening cerebrovascular accident giving little scope to revert the situation. At times, it is difficult to make a patient euthyroid with conventional management. The definitive treatment of choice is (131)I, radioiodine. An adjusted dose of an oral anticoagulant is highly efficacious for the prevention of all types of strokes. Timely intervention by a skilled airway manager with right instruments is the key to success in airway management. A 50-year-old thyrotoxic, semiconscious male presented with a sudden onset of haemiplegia. He had chronic AF, a huge thyroid swelling with gross tracheal deviation and dilated cardiomyopathy. A CT scan showed infarction in the left middle cerebral artery territory. After initial improvement with conservative management, patient's condition deteriorated in the next 48 h. Repeat CT scan showed increase in the infarct size with haemorrhage and midline shift. Finally, he died despite all resuscitative measures.

Keywords: Atrial fibrillation; airway management; anticoagulant; hyperthyroidism; ischaemic stroke.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Patient with a huge multinodular thyroid swelling which progressively increased to the present size over the last 20 years
Figure 2
Figure 2
Right-sided deviated trachea with an increased cardiothoracic ratio
Figure 3
Figure 3
Computed tomography of brain (plain) showed (a) left MCA territory infarction having no midline shift (on admission); (b) large haemorrhagic infarction in the left MCA territory with a gross midline shift after 36 h
See this image and copyright information in PMC

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