Anesthetic management of a pregnant woman undergoing thyroidectomy following propylthiouracil-induced hepatotoxicity: a case report
Bruna Carvalho Oliveira, Camila Borges Ferreira, Katharina Lanza Japolini, Marina Ayres Delgado
Abstract
This case report describes the anesthetic management of a pregnant woman with severe hyperthyroidism treated with propylthiouracil, who developed hepatotoxicity, leading to the suspension of the medication and the need for thyroidectomy as the only therapeutic option. The patient, at 24 weeks of gestation, presented with jaundice and drug-induced hepatitis, associated with uncontrolled hyperthyroidism. The surgery was performed under balanced anesthesia, with strict hemodynamic monitoring and precautions to diagnose complications such as thyroid storm. This case highlights the complexity of managing hyperthyroidism during pregnancy and the importance of careful anesthetic planning in high-risk situations.
Keywords
References
1. Chestnut DH, Wong CA, Tsen LC, Kee WDN, Beilin Y, Mhyre JM, et al. Chestnut’s obstetric anesthesia: principles and practice. 6th ed. Philadelphia: Elsevier; 2019. p.1066-71.
2. Glinoer D, Cooper DS. The propylthiouracil dilemma. Curr Opin Endocrinol Diabetes Obes. 2012;19(5):402-7. https://doi.org/10.1097/MED.0b013e3283565b49. PMid:22820213.
3. Lee SY, Pearce EN. Assessment and treatment of thyroid disorders in pregnancy and the postpartum period. Nat Rev Endocrinol. 2022;18(3):158-71. https://doi.org/10.1038/s41574-021-00604-z. PMid:34983968.
4. Akmal A, Kung J. Propylthiouracil, and methimazole, and carbimazole-related hepatotoxicity. Expert Opin Drug Saf. 2014;13(10):1397-406. https://doi.org/10.1517/14740338.2014.953796. PMid:25156887.
5. Tonacchera M, Chiovato L, Bartalena L, Cavaliere AF, Vitti P. Treatment of Graves’ hyperthyroidism with thionamides: a position paper on indications and safety in pregnancy. J Endocrinol Invest. 2020;43(2):257-65. https://doi.org/10.1007/s40618-019-01148-w. PMid:31784912.
6. Lao TT. Drug-induced liver injury in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2020;68:32-43. https://doi.org/10.1016/j.bpobgyn.2020.03.005. PMid:32312690.
7. Maganha CA, Mattar R, Mesa CO Jr, Marui S, Solha ST, Teixeira PF, et al. Rastreio, diagnóstico e manejo do hipertireoidismo na gestação. Febrasgo Posit Statement [Internet]. 2022 [cited 2024 Dec 26];8:1-11. Available from: https://www.febrasgo.org.br/images/pec/posicionamentos-febrasgo/FPS---N8---Agosto-2022---portugues.pdf
8. Vadini V, Vasistha P, Shalit A, Maraka S. Thyroid storm in pregnancy: a review. Thyroid Res. 2024;17(1):2. https://doi.org/10.1186/s13044-024-00190-y. PMid:38229163.
9. Ma Y, Li H, Liu J, Lin X, Liu H. Impending thyroid storm in a pregnant woman with undiagnosed hyperthyroidism: a case report and literature review. Medicine. 2018;97(3):e9606. https://doi.org/10.1097/MD.0000000000009606. PMid:29504986.
10. Brakke BD, Sviggum HP. Anaesthesia for non-obstetric surgery during pregnancy. BJA Educ. 2023;23(3):78-83. https://doi.org/10.1016/j.bjae.2022.12.001. PMid:36844444.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email