Acute baroreflex-mediated hemodynamic instability during thyroid surgery: A case report

Area of Science:

• Endocrinology
• Neurosurgery
• Cardiology

Background:

• Intraoperative hemodynamic instability during thyroid surgery is often linked to thyroid hormone surges.
• Thyroid storms present as emergency situations with hypertension, tachycardia, hyperthermia, and end-organ damage.

Observation:

• A 61-year-old male with a 6-cm thyroid mass, in a euthyroid state, experienced sudden hemodynamic instability after thyroid manipulation during thyroidectomy.
• The patient's presentation suggests a cause beyond typical thyroid storm symptoms.

Findings:

• Baroreflex-mediated neurogenic phenomena, triggered by surgical manipulation near the carotid sinus, are a probable cause of acute hemodynamic changes.
• This contrasts with the commonly assumed etiology of thyroid hormone surges.

Implications:

• Recognizing baroreflex-mediated neurogenic responses is crucial for managing hemodynamic instability during thyroid surgery.
• This understanding may lead to improved patient safety and surgical protocols, differentiating from thyroid storm management.