Hypothyroidism

• Hashimoto’s thyroiditis may associated with other autoimmune disease e.g.

SLE, RA, DM, hypoparathyroidism, Addison’s disease.
• May associated with amyloidosis.
A→ goiter → altered A/W anatomy, with possible A/W obstruction
B→ OSA, hypoventilation, ↓ response to ↑PCO2 and ↓PO2, ↑ sensitivity to
narcotics, pul edema
C→ bradycardia, CHF, heart block, hypotension, edema
GI→ ↓ gastric emptying → aspiration
M→ ↓Na, possible SIADH, hypothermia, possible Addison’s disease
• postponed if severe hypothyroid Pt until at least partially treated.
• The management of hypothyroid patients with symptomatic CAD has been
a subject of particular controversy. In symptomatic patients or unstable
patients with cardiac ischemia, thyroid replacement should probably be
delayed until after coronary revascularization.
• Maintain normal body temperature.
• Consider adrenal insufficiency when intra-op hypotension not responding
to fluids and inotrops.
• Risk of amid LA toxicity due to slow metabolism.
Myxedema coma
• a severe form of hypothyroidism →stupor or coma, hypoventilation,
hypothermia, hypotension, and hyponatremia.
• medical emergency with a high mortality rate (50%) and as such requires
aggressive therapy.
• Precipitated by surgery, infection, sedative drugs and trauma.
• Only life-saving surgery should proceed in the face of myxedema coma.
• IV thyroid replacement is initiated as soon as the clinical diagnosis is made.
• An iv loading dose of T4 (sodium levothyroxine, 200–300 ug) is given
initially and followed by a maintenance dose of T4, 50–200 ug·day–1 iv.
• Alternatively, T3 may be used because it has a more rapid onset.
• Improvements in HR, BP, and body temp may occur within 24 hours.
• Replacement therapy with either form may precipitate myocardial ischemia,
• There is also an ↑ likelihood of acute primary adrenal insufficiency in these
patients, and they should receive stress doses of hydrocortisone.
• Steroid replacement continues until normal adrenal function can be
confirmed.