[Case of thyroid crisis with persistent tachycardia diagnosed postoperatively]

Area of Science:

• Anesthesiology
• Endocrinology
• Emergency Medicine

Background:

• A 35-year-old male patient presented with multiple bone fractures requiring emergency surgery.
• Initial vital signs revealed tachycardia (160 bpm) and hypotension (100/50 mmHg).

Observation:

• Anesthesia was induced using oxygen, sevoflurane, fentanyl, and remifentanil.
• Suspected hypovolemia was treated with crystalloids, red blood cells, and fresh frozen plasma.
• Persistent tachycardia (140 bpm) despite initial resuscitation led to the administration of landiolol (2.5 mg bolus followed by 5-10 mg/hr infusion).

Findings:

• Landiolol effectively controlled heart rate to approximately 120 bpm without causing hypotension during anesthesia.
• Post-operative laboratory data confirmed a diagnosis of thyroid crisis.
• The atypical tachycardia was ultimately attributed to the thyroid crisis.

Implications:

• This case underscores the importance of considering thyroid crisis in patients presenting with unexplained tachycardia during surgical procedures.
• Anesthesiologists and critical care physicians should be vigilant for atypical presentations of thyroid crisis.
• Early recognition and appropriate management of thyroid crisis are crucial for improving patient outcomes in emergency surgical settings.