Anesth Pain Med.  2020 Jul;15(3):319-324. 10.17085/apm.20009.

Spinal anesthesia for urgent Cesarean section in a patient with uncontrolled hyperthyroidism due to Graves’ disease - A case report -

• Park S
• Choi S
• Jeong J
• Kim J

• KMID: 2504894
• DOI: http://doi.org/10.17085/apm.20009

Abstract

Background
Effective treatment of Graves’ disease during pregnancy is important because uncontrolled hyperthyroidism is associated with increased fetal and maternal morbidity and mortality. While there have been case reports of patients with Graves’ disease who failed to achieve euthyroid state during pregnancy, anesthesiologists rarely encounter patients with uncontrolled hyperthyroidism undergoing urgent Cesarean section. Case: A 31-year-old pregnant patient had uncontrolled hyperthyroidism due to Graves’ disease despite medical treatment. Her signs and symptoms suggested fetal distress and aggravation of the disease, leading to hospitalization. After a failed induction for vaginal delivery, an urgent Cesarean section was performed under spinal anesthesia via an interlaminar approach using 9 mg of 0.5% heavy bupivacaine and 20 μg of fentanyl. It resulted in successful delivery, with no perioperative complications for the mother and neonate.
Conclusions
This case demonstrates that spinal anesthesia may provide clinical stability to patients with uncontrolled hyperthyroidism undergoing urgent Cesarean section.

Keyword

Cesarean section; Emergencies; Hyperthyroidism; Spinal anesthesia

Figure

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  Fig. 1. Perioperative systolic arterial blood pressure (sABP) and heart rate (HR). The patient’s sABP and HR before and after intrathecal injection are shown. Note that the sABP remained stable, and even decreased following the intrathecal injection. HR remained relatively stable throughout the procedure. This figure was prepared using Microsoft PowerPoint and PDF-Xchange Viewer.

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