Surgical Treatment of Amiodarone-Induced Thyrotoxicosis in an Adult with Congenital Heart Disease: An Anesthetists Perspective
Challenging differential diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care, Rare disease, Clinical situation which can not be reproduced for ethical reasons
Jose M. El-Asmar, Ahmad Salaheddine Naja, Eliane Al-Halabi
Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
Am J Case Rep 2020; 21:e917350
Available online: 2020-01-24
Amiodarone-induced thyrotoxicosis can be refractory to medical treatment seldom requiring surgical intervention. Herewith, we present the first case to date of amiodarone-induced thyrotoxicosis in a congenital heart disease post-Senning procedure requiring emergent surgical management.
CASE REPORT: A 19-year-old-male patient with a history of a complex congenital heart disease developed severe pulmonary baffle stenosis and atrial fibrillation that was medically treated with amiodarone, upon which he developed. Amiodarone-induced thyrotoxicosis that was refractory to medical treatment. The patient was taken to the operating room for surgical treatment of his refractory disease. An intraoperative transesophageal echocardiography was employed ensuring adequate monitoring of his systemic vascular resistance and pulmonary arterial pressures.
CONCLUSIONS: Because of the high risk of cardiac complications induced by thyroid-induced thyrotoxicosis, patients with complex congenital heart disease require careful intraoperative monitoring in anticipation of tragic events. This is a report of a single case of successful operation on a patient in the thyrotoxic state.
Keywords: amiodarone, Heart Defects, Congenital, Thyroid Crisis