Total Thyroidectomy for Refractory Amiodarone-Induced Thyroid Storm in a High-Risk Cardiac Patient: A Perioperative Management Strategy
DOI:
https://doi.org/10.25751/rspa.47039Keywords:
Amiodarone, Anesthesia, Thyroid Storm, Thyroidectomy, ThyrotoxicosisAbstract
Thyroid storm is a life-threatening endocrine emergency in which clinical decompensation, rather than hormone concentration alone, determines severity. Amiodarone-induced thyrotoxicosis is particularly challenging because iodine load, prolonged tissue persistence, and mixed pathogenic mechanisms may delay or limit response to conventional therapy. We report the perioperative management of a 49-year-old ASA IV male with ischemic cardiomyopathy, left ventricular ejection fraction of 36%, an implantable cardioverter-defibrillator, and amiodarone-induced thyroid storm complicated by sustained ventricular tachycardia. Severe thyrotoxicosis persisted despite high-dose thionamide therapy, corticosteroids, amiodarone withdrawal, and six sessions of therapeutic plasma exchange. Following multidisciplinary discussion, urgent total thyroidectomy was performed. The anaesthetic strategy focused on attenuating sympathetic response and reducing myocardial oxygen demand, together with strict temperature control, invasive monitoring, preservation of cardiac electrical stability, and careful vasopressor selection. The postoperative course was favourable. This case highlights thyroidectomy as a definitive rescue strategy when refractory thyrotoxicosis perpetuates cardiovascular instability.
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Copyright (c) 2026 Michele Paes Tomazini Coutinho, Daniel Rodrigues Alves, Miguel Morgado
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