Korean J Anesthesiol.  2014 Aug;67(2):144-147. 10.4097/kjae.2014.67.2.144.

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

• Lee SH
• Kang JG
• Hahm MC
• Park JH
• Kim KM
• Lim TW
• Kim YR

• KMID: 2227418
• DOI: http://doi.org/10.4097/kjae.2014.67.2.144

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.

Keyword

Anesthesia; Euthyroid; Hyperthyroxinemia; Hyperthyroxinemia due to decreased peripheral conversion of T4

MeSH Terms

Anesthesia
Conversion Disorder
Hemodynamics
Humans
Hyperthyroxinemia*
Hypothyroidism
Sodium
Thyroxine
Triiodothyronine
Sodium
Thyroxine
Triiodothyronine