Term
| What is a life-threatening exacerbation of hyperthyroidism that can occur under stress such as infection, surgery, or injury? |
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Definition
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Term
| What are s/s of thyroid storm? |
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Definition
-hyperpyrexia
-tachycardia
-anxiety
-cardiovascular instability
-altered consciousness |
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Term
| With thyroid storm, there is significant morbidity & tx is symptomatic. |
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Definition
| That's all I have to say 'bout that... |
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Term
| What are the MANY ways a pt can become euthyroid before surgery? |
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Definition
*Propylthiourcil & methimazole inhibit synthesis of thyroid hormone
*Propylthiouracil also decreases T4->T3 conversion in periphery
*Inorganic iodide inhibits thyroid hormone release and decreases hyperplasia
*B-blockers impairs conversion of T4 to T3 and decreases symptoms of tachycardia, aniety, heat intolerance
*glucocorticoids (dexamethasone) decreases thyroid hormone production
*radioactive iodine can treat thyroid storm |
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Term
How long does it take to become euthyroid?
What does that mean? Should surgery be delayed? |
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Definition
| 6-8 weeks. Heart rate is <80 with an absence of tremors. Delay surgery if these requirements are not met, unless emergency. |
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Term
| What are the anesthetic complications with hyperthyroidism? |
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Definition
*cont. anti-thyroid meds through morning of surgery
*delay surgery if not euthyroid
*if not euthyroid, prevent sympathetic responses (deep)
*avoid meds that increase SNS (ketamine)
*use direct acting vasopressors for hypotension
*difficult airway if goiter present
*myasthenia gravis incidence higher in hyperthyroidism |
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Term
What is a complication of a thyroidectomy?
How do you evaluate pre and post-op? |
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Definition
*Recurrent laryngeal nerve damage.
-unilateral damage: hoarseness
-bilateral damage: intubation
*Have pt say "EEEE", laryngoscopy, and document hoarse voice pre & post-op! |
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Term
| What is a tx for Hypoparathyroidism? |
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Definition
| Calcium gluconate 10-20cc of a 10% soln. |
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Term
| Name two signs to test for hypoparathyroidism. |
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Definition
Chvostek's sign: facial spasm when face tapped.
Trouseau's sign: spasm of hand or foot w/ BP cuff pressure. |
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Term
| What are some causes of hypothyroidism? Can you have a goiter w/ hypothyroidism? |
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Definition
*radioactive iodine, neck irradation, surgical removal.
*fo shizz! |
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Term
| What are s/s of hypothyroidism? |
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Definition
| lethargy, cold intolerance, slow movements, bradycardia, decreased myocardial contractility, increased pericardial fluid, decreased response to hypoxia. |
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Term
| Is it safe to proceed w/surgery with mild to moderate hypothyroidism? |
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Definition
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