Korean J Anesthesiol.  1995 Feb;28(2):318-322. 10.4097/kjae.1995.28.2.318.

Development of Thyrotoxic Crisis during the Treatment of Postherpetic Neuralgia

• Choi MK
• Moon DE
• Suh JH

• KMID: 2239181
• DOI: http://doi.org/10.4097/kjae.1995.28.2.318

Abstract

Thyrotoxic crisis is a life-threatening exacerbation of hyperthyroidism seen during periods of stress, which requires early recognition and adequate treatment. A 52-year-old female who suffered from severe right thoracic pain due to postherpetic neuralgia with hyperthyroidism, has been initially treated with antiviral agent and anticonvulsant in the department of neurology. She was transfered to our pain clinic because of uncontrolled severe pain. In our pain clinic, continuous thoracic epidural administration of bupivacaine and clonidine and oral analgesic medications produce visual analog scale from 8-9 to 5-6. She was admitted because of partially controlled pain and she was performed intercostal neurolysis with 10% phenol. As a result, visual analog scale was decreased from 5-6 to 2-3. After 3 days admission, extreme irritability, delirium, tachypnea, mild fever and tachycardia(heart rate: 160-180/min) were developed suddenly. Three hours later of proper treatment with oxygen inhalation, rapid fluid administration, diazepam 10 mg injection and antithyroid drug medication, heart rate and consciousness were returned to normal. Thoracic sympathetic ganglion neurolysis with absolute alcohol was performed without any sequelaes for the treatment of remnant visceral pain. And then, she was discharged with the relief of pain. The purpose of the present report is to review our experience with the clinical manifestations and management of thyrotoxic crisis developed during the treatment of postherpetic neuralgia, and to review of the treatment of thyrotoxic crisis and postherpetic neuralgia.

Keyword

Thyrotoxic crisis; Postherpetic neuralgia

MeSH Terms

Bupivacaine
Clonidine
Consciousness
Delirium
Diazepam
Ethanol
Female
Fever
Ganglia, Sympathetic
Heart Rate
Humans
Hyperthyroidism
Inhalation
Middle Aged
Neuralgia, Postherpetic*
Neurology
Oxygen
Pain Clinics
Phenol
Tachypnea
Thyroid Crisis*
Visceral Pain
Visual Analog Scale
Bupivacaine
Clonidine
Diazepam
Ethanol
Oxygen
Phenol