Perioperative Management of Hyperthyroidism Patient undergoing Appendectomy

Background: Hyperthyroidism is a condition where the hormone levels of T4, T3 or both are high and result in various systemic symptoms. The worst complication in patients with hyperthyroidism is thyroid storm. Case: A 49-year-old female patient was diagnosed with atrial fibrillation and abdominal pain when she was admitted to emergency department of hospital with complaints of chest pain and palpitation. In ward patient also complain with fine tremor, abdominal pain, warm skin, firm, enlarged and palpable thyroid, and weight loss in 3 month, and later patient was diagnosed with hyperthyroidism from internist and appendicitis from surgeon, patient was scheduled for appendectomy. Aims: The aims of management in this case were to resolve the symptoms presented and get the thyroid hormone levels restored to euthyroid or subclinical hyperthyroidism state to prevent thyroid storm after the surgery. Results: PTU with high dose and propranolol were given after diagnosis for symptomatic reliever and rate control. After five days patient was going to appendectomy, and thyroid storm no occurs after the procedures. Conclusion: In patients with hyperthyroidism who will undergo emergency surgical procedures such as appendectomy, the levels of FT4 and TSHs should be close to euthyroid or subclinical hyperthyroidism to prevent thyroid storms.