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Canadian Journal of Anesthesia 51:38-40 (2004)
© Canadian Anesthesiologists' Society, 2004
General Anesthesia

Rapid preparation of severe uncontrolled thyrotoxicosis due to Graves’ disease with Iopanoic acid - a case report

[La préparation rapide, avec de l’acide iopanoïque, pour une thyrotoxicose sévère non contrôlée causée par une maladie de Graves - une étude de cas]

Chandra Kant Pandey, MD, Mehdi Raza, MD, Sanjay Dhiraaj, MD, Anil Agarwal, MD and Prabhat Kumar Singh, MD

From the Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Address correspondence to: Dr. Chandra Kant Pandey, Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India. Phone: 0091-522-2668800, ext. 2490; Fax: 0091-522-2668017; E-mail: ckpandey{at}sgpgi.ac.in

Purpose: To report the rapid preoperative preparation of a case of thyrotoxicosis due to Graves’ disease resistant to medical treatment.

Clinical features: A 14-yr-old boy presented with a history of progressive swelling in the neck. Signs and symptoms were compatible with hyperthyroidism. Thyroid function tests revealed: serum T4 296.5 nmol•L-1, serum T3 6.06 nmol•L-1 and serum thyroid-stimulating hormone < 0.15 mIU•L-1. The diagnosis of thyrotoxicosis due to Graves’ disease was made. Therapy was instituted with carbimazole 30 mg•day-1 and propranolol 80 mg•day-1, which were gradually increased to carbimazole 80 mg•day-1 and propranolol 120 mg•day-1, without response. Preparation was attempted by adding Iopanoic acid 500 mg four times a day and dexamethasone 0.5 mg four times a day in addition to the above drugs for five days. T3 levels declined to 1.8 nmol•L-1, but the serum T4 remained elevated. Symptoms of hyperthyroidism persisted but with decreased intensity. As the patient could not be made euthyroid, surgery was planned to relieve the symptoms. Anesthesia was uneventful except for intraoperative and postoperative tachycardia, which was managed successfully with esmolol.

Conclusion: In life threatening thyrotoxicosis refractory to medical treatment, Iopanoic acid may be used as an adjuvant to antithyroid drugs for rapid preparation of the patient prior to surgery.




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W. Li Pi Shan, R. Hatzakorzian, M. Sherman, and S. B. Backman
Upper airway compromise secondary to edema in Graves' disease: [Atteinte des voies aeriennes superieures secondaire a un oedeme dans la maladie de Graves]
Can J Anesth, February 1, 2006; 53(2): 183 - 187.
[Abstract] [Full Text] [PDF]


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