Anaesthesia Management of Patient With Hyperthyroidism UnderwentLaparoscopic Cholecystectomy Operation

Background : Hyperthyroidism is a common endocrine disorder that can significantly impact perioperative management, particularly in patients undergoing major surgery. This case report discusses the anaesthetic management of a hyperthyroid patient undergoing laparoscopic cholecystectomy, emphasizing the challenges and strategies employed to optimize perioperative care. Case Illustration : A 53-year-old male presented with progressive jaundice, weight loss, palpitations, and heat intolerance. Clinical evaluation revealed hyperthyroidism with a Wayne Index score of 21 and a Burch and Wartofsky score of 40, indicating an impending thyroid storm. Laboratory findings confirmed suppressed TSH levels and elevated free T4 levels. Additional comorbidities included atrial fibrillation with a normal ventricular response, first- degree atrioventricular block, and obstructive jaundice due to suspected choledocholithiasis. The patient was classified as ASA III and scheduled for laparoscopic cholecystectomy under general anaesthesia. Preoperative optimization included the administration of thiamazole, beta-blockers, Lugol’s solution, and corticosteroids to mitigate the risk of intraoperative thyroid storm. Anesthesia induction was performed using thiopental, fentanyl, and rocuronium, followed by endotracheal intubation and maintenance with inhalational agents. Intraoperatively, hemodynamic stability was maintained with meticulous fluid management and beta-blockade. The procedure was completed successfully with an estimated blood loss of 50 mL, and the patient was transferred to the ICU for postoperative monitoring. Postoperatively, the patient experienced transient delirium and hemodynamic fluctuations, requiring continued sedation and ventilatory support. Thyroid function was closely monitored, and medical therapy was continued. The patient remained hemodynamically stable and was gradually weaned off mechanical ventilation. Conclusion : Anaesthesia management in hyperthyroid patients undergoing surgery requires a multidisciplinary approach, with careful preoperative preparation to prevent thyroid storm, intraoperative hemodynamic control, and vigilant postoperative monitoring. This case highlights the importance of optimizing thyroid function and cardiovascular stability in hyperthyroid patients to improve surgical outcomes.