Suspected Thyroid Storm in a Patient Undergoing Internal Fixation for a Left Mandibular Fracture Under General...

Thyroid storm is a life-threatening condition in which patients with untreated or poorly controlled thyroid disease experience excessive thyroid hormone action triggered by severe stress, resulting in multiple organ dysfunction. We present a case of suspected thyroid storm during surgery for a left mandibular fracture under general anesthesia. The patient was a 23-year-old male, and a preoperative interview revealed no notable medical history. During open reduction and internal fixation under general anesthesia, the patient developed sinus tachycardia, hypertension, elevated end-tidal carbon dioxide, and persistent hyperthermia. Based on these clinical findings, malignant hyperthermia was initially suspected. However, the absence of myoglobinuria led to the exclusion of this diagnosis, and the surgery was continued. After emerging from general anesthesia, the persistent tachycardia, hypertension, and hyperthermia did not improve; therefore, a physical examination was performed, revealing an enlarged thyroid gland. Furthermore, blood tests showed an abnormally high free triiodothyronine level and an abnormally low thyroid-stimulating hormone level. After referral to the endocrinology department, the patient was diagnosed with hyperthyroidism and a suspected thyroid storm triggered by trauma and surgical stress. In conclusion, thyroid storm should be considered as a differential diagnosis in cases of unexplained refractory tachycardia, hyperthermia, or hypercapnia during anesthesia management.