Reactions Weekly | 2021
Multiple drugs
Abstract
Various toxicities: case report A 65-year-old man developed supraventricular tachycardia during treatment with ephedrine for hypotension, and iatrogenic hypothyroidism during treatment with thiamazole for arterial hypertension and Graves disease. Additionally, he developed hypotension secondary to interaction of remifentanil and propofol with iatrogenic hypothyroidism, and exhibited no response with ephedrine while being treated for hypotension [not all routes, dosages and outcomes stated; durations of treatments to reactions onset not stated]. The man, who had thyroid cartilage chondrosarcoma, was planned for partial excision of the thyroid cartilage. He had a history of arterial hypertension and Graves disease treated with thiamazole [methimazole]. The most-latest laboratory data revealed slightly low thyroid stimulating hormone (TSH). Prior to the induction of anaesthesia, non-invasive blood pressure (NIBP) was 169/100mm Hg, oxygen saturation was 100% and heart rate (HR) was 65/min. Thereafter, anaesthesia was started with a target controlled propofol 4mug/ml infusion at effect-site, remifentanil 0.25 mug/kg/min infusion and concomitant administration of rocuronium bromide [rocuronium]. Orotracheal intubation was completed by direct laryngoscopy and propofol was decreased. After 3 minutes of intubation, HR was 90/min and NIBP was 79/45. After 2 minutes, NIBP reduced to 45/23. The man received ephedrine 10mg and developed increasing tachycardia with no response on NIBP. During this time, because of supraventricular tachycardia and haemodynamic instability secondary to thiamazole induced hypothyroidism, synchronised cardioversion was carried out. Afterwards, NIBP increased and HR decreased. Subsequently, he received esmolol and the HR reduced further to normality. After this, there had been a current upsurge in dosage of methimazole. New blood tests revealed moderate hypothyroidism with TSH of 72.61 muUI/mL, T3 of 71 ng/dL and free T4 of 0.59 ng/dL.