Document Detail

Herbal intake: undiagnosed hypothyroidism leading to postoperative refractory circulatory collapse--a case report.
MedLine Citation:
PMID:  18637616     Owner:  NLM     Status:  MEDLINE    
There is a high probability of missing out on the preoperative diagnosis of hypothyroidism in elderly females, as most of the symptoms are attributed to old age. We report a patient with undiagnosed hypothyroidism, operated for excisional biopsy of carcinoma of tongue, who postoperatively developed septicemia refractory to maximum ionotropic support and antibiotic coverage and succumbed within 40 hours. Her symptoms of constipation, sedentary life style, and joint pains were attributed to old age by the family and thus were not communicated to us in the preoperative assessment. Her long-standing hypothyroidism probably was associated with adrenocortical suppression exaggerated with intermittent and chronic ingestion of herbal powder, which generally contains steroids. We recommend that a more careful preoperative evaluation and history pertaining to hypothyroidism in obese female patients more than 45 years with joint pains should be sought for. Ingestion of herbal powders should alert us as these contain steroids If there is a suspicion of hypothyroidism, then elective surgery should be deferred to rule out the same due to possibility of progression to myxedema coma under stress of anesthesia and surgery. We also recommend that in these cases preoperative blood cortisol level should be evaluated to rule out adrenocortical suppression and direct its management, if present.
Jyotsna Punj; M K Arora
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Middle East journal of anaesthesiology     Volume:  19     ISSN:  0544-0440     ISO Abbreviation:  Middle East J Anaesthesiol     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-07-21     Completed Date:  2008-11-17     Revised Date:  2014-10-10    
Medline Journal Info:
Nlm Unique ID:  8604187     Medline TA:  Middle East J Anaesthesiol     Country:  Lebanon    
Other Details:
Languages:  eng     Pagination:  1169-77     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Anesthesia / adverse effects*
Fatal Outcome
Hypothyroidism / chemically induced*,  complications
Phytotherapy / adverse effects*
Shock / etiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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