BACKGROUND: Hypothyroidism is a common endocrine disorder with a prevalence of 0.4% to 1.7%, affecting predominantly women and older adults. Common anesthetic and surgical complications in patients with hypothyroidism include delayed emergence, myocardial and pulmonary infarction, respiratory arrest, hemorrhage, and fluid or electrolyte imbalance. Severe hypothyroidism can rarely trigger myxedema. This case report describes the case of a patient with hypothyroidism who underwent difficult extubation after thoracoscopic lung surgery.

CASE REPORT: A 62-year-old woman with hypothyroidism developed shortness of breath, stridor, hypoxemia, and decreased muscle strength in the extremities following the removal of a double-lumen endotracheal tube after thoracoscopic resection of the right lung S6 segment. Reintubation revealed marked periglottic edema. Upon admission to the intensive care unit, she presented with lethargy, cold extremities, and edema of the eyelids and dorsum of the feet. A detailed medical history revealed irregular use of levothyroxine sodium and self-discontinuation of the medication for 3 days prior to surgery. Postoperative laryngeal edema was considered the direct cause of extubation difficulty, while inadequately controlled hypothyroidism was identified as a major contributing factor to tissue edema, impaired respiratory muscle function, and delayed postoperative recovery. Following respiratory support and supplementation with levothyroxine sodium, respiratory function and muscle strength gradually improved, and the patient was discharged on the sixth postoperative day.

CONCLUSIONS: This case suggests that in patients with hypothyroidism experiencing difficulty with extubation during the perioperative period, a comprehensive assessment of common causes, such as airway edema and residual neuromuscular blockade, is necessary, and the adverse effects of hypothyroidism on airway edema and recovery from anesthesia should be given due attention.

Keywords: Hypothyroidism, Laryngeal Edema