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      Anesthetic experience in a clinically euthyroid patient with hyperthyroxinemia and suspected impairment of T4 to T3 conversion: a case report

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          Abstract

          We report an anesthetic experience in a clinically euthyroid patient with hyperthyroxinemia (elevated free thyroxine, fT4 and normal 3, 5, 3'-L-triiodothyronine, T3) and suspected impairment of conversion from T4 to T3. Despite marked hyperthyroxinemia, this patient's perioperative hemodynamic profile was suspected to be the result of hypothyroidism, in reference to the presence of T4 to T3 conversion disorder. We suspected that pretreatment with antithyroid medication before surgery, surgical stress and anesthesia may have contributed to the decreased T3 level after surgery. She was treated with liothyronine sodium (T3) after surgery which restored her hemodynamic profile to normal. Anesthesiologists may be aware of potential risk and caveats of inducing hypothyroidism in patients with euthyroid hyperthyroxinemia and T4 to T3 conversion impairment.

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          How to manage perioperative endocrine insufficiency.

          Benjamin A. Kohl, Stanley Schwartz (2010)
          Patients with endocrinopathies frequently present to the operating room. Although many of these disorders are managed on a chronic basis, patients may have acute changes in the perioperative period that, if left unrecognized, can have a negative effect on perioperative morbidity and mortality. It is imperative that anesthesiologists understand the implications of the surgical stress response on hormonal flux. This article focuses on the 4 most commonly encountered endocrinopathies: diabetes mellitus, hyperthyroidism, hypothyroidism, and adrenal insufficiency. Specific challenges pertaining to patients with pheochromocytoma are also discussed.
          Article 0 comments Cited 7 times – based on 0 reviews     Review now
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            Measurement of Serum Free Thyroid Hormone Concentrations: An Essential Tool for the Diagnosis of Thyroid Dysfunction

            Luigi Bartalena, Fausto Bogazzi, Sandra Brogioni … (1996)
            Free thyroid hormones (free thyroxine, FT 4 , and free triiodothyronine, FT 3 ) represent a more useful index of thyroid status than total thyroid hormones, because the latter are influenced by variations of thyroid hormone-binding proteins, especially T 4 -binding globulin (TBG). Thus, increased serum total T 4 (TT 4 ) and, in many instances, T 3 (TT 3 ) concentrations are encountered in euthyroid subjects with TBG excess, familial dysalbuminemic hyperthyroxinemia and transthyretin-associated hyperthyroxinemia, while decreased serum TT 4 and TT 3 levels are associated with TBG deficiency: under these circumstances, measurement of serum FT 4 and FT 3 levels correctly establishes the diagnosis of euthyroidism. In cases of suspected hyperthyroidism, a diagnostic strategy can be suggested based on serum FT 3 (and TSH) measurement, since FT 4 may occasionally be elevated, also in euthyroid subjects, e.g., in patients under chronic amiodarone or L-T 4 treatment. When hypothyroidism is suspected, the most reliable test appears to be FT 4 (together with TSH), because FT 3 may still be normal in patients with subclinical or mild thyroid failure. In any case, it is essential that reliable free thyroid hormone assays be used, which are devoid of methodological limitations responsible for artifactual results under particular circumstances, such as thyroid hormone-binding protein abnormalities, pregnancy and nonthyroidal illness.
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              Euthyroid hyperthyroxinemia.

              G C Borst, C Eil, K D Burman (1983)
              An increasing number of disorders that may cause hyperthyroxinemia without thyrotoxicosis have been recognized in recent years. These include acquired and inherited abnormalities of serum thyroid-hormone-binding proteins, peripheral resistance to thyroid hormones, acute nonthyroidal illness, acute psychiatric illness, and some drug-induced conditions associated with nonthyrotoxic elevations of serum thyroxine. In addition to the laboratory finding of elevated serum thyroxine levels, many of these syndromes are also accompanied by abnormalities in triiodothyronine and free thyroid hormone levels, as well as unresponsiveness of thyroid-stimulating hormone to thyrotropin-releasing hormone, all of which further erroneously indicate a diagnosis of thyrotoxicosis. An awareness of these syndromes and alterations in the results of thyroid function tests that accompany them is important to prevent a misdiagnosis of hyperthyroidism and inappropriate therapy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Anesthesiol
                Journal ID (iso-abbrev): Korean J Anesthesiol
                Journal ID (publisher-id): KJAE
                Title: Korean Journal of Anesthesiology
                Publisher: The Korean Society of Anesthesiologists
                ISSN (Print): 2005-6419
                ISSN (Electronic): 2005-7563
                Publication date (Print): August 2014
                Publication date (Electronic): 26 August 2014
                Volume: 67
                Issue: 2
                Pages: 144-147
                Affiliations
                Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea.
                Author notes
                Corresponding author: Jin Gu Kang, M.D., Ph.D., Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwasung 445-170, Korea. Tel: 82-31-8086-2280, Fax: 82-31-8086-2029, christopher@ 123456hallym.or.kr
                Article
                DOI: 10.4097/kjae.2014.67.2.144
                PMC ID: 4166388
                SO-VID: 332dacd5-7d82-480d-a204-8ffa1ecf4381
                Copyright © Copyright © the Korean Society of Anesthesiologists, 2014
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 09 May 2013
                Date revision received : 21 June 2013
                Date accepted : 23 July 2013
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: anesthesia,euthyroid,hyperthyroxinemia,hyperthyroxinemia due to decreased peripheral conversion of t4
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: anesthesia, euthyroid, hyperthyroxinemia, hyperthyroxinemia due to decreased peripheral conversion of t4

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