Pagán-Rappo María José, Jurado-Fernández de Lara Claudia Estephania, Castro-Sánchez Olga, Carpio-Vargas Karen Yarivani, Gutiérrez-Riveroll Karla Itzel
Secretaría de Salud, Hospital Para el Niño Poblano, Servicio de Anestesiología Pediátrica. Puebla, Puebla, México.
Secretaría de Salud, Hospital de Alta Especialidad de Veracruz, Servicio de Anestesiología. Veracruz, Veracruz, México.
Rev Med Inst Mex Seguro Soc. 2022 Aug 31;60(5):584-590.
Hyperthyroidism is the increase in the synthesis and secretion of thyroid hormones. It is rare but serious in children and constitutes approximately 5% of all cases; 15% manifests before 10 years of age. The peak of presentation and the majority of cases (80%) are diagnosed around 10-15 years of age. Adolescence is usually the stage with the highest incidence and it is more frequent in women (5:1). Acute thyrotoxic crisis or thyroid storm is rare and only occurs in a poorly controlled hyperthyroid patient or in a hyperthyroid patient undergoing emergency surgery. It is manifested by fever, extreme tachycardia, tachyarrhythmia with atrial fibrillation, vomiting, diarrhea, agitation and mental confusion.
17-year-old adolescent with Graves' disease with uncontrolled clinical manifestations that did not respond to medical treatment and was scheduled for radical thyroidectomy. 35 points were obtained on the Burch and Wartofsky Scale. It was managed with general anesthesia, reducing stimuli for airway and regional control to reduce surgical stimuli. Adjuvant medications such as magnesium sulfate for intraoperative stability were used.
Multimodal anesthesia managed to avoid thyroid storm, postoperative pain, as well as other complications.
甲状腺功能亢进是甲状腺激素合成和分泌增加。在儿童中较为罕见但严重，约占所有病例的5%；15%在10岁前出现。发病高峰以及大多数病例（80%）在10至15岁左右被诊断出来。青春期通常是发病率最高的阶段，女性更为常见（5∶1）。急性甲状腺毒症危机或甲状腺危象罕见，仅发生在甲状腺功能亢进控制不佳的患者或接受急诊手术的甲状腺功能亢进患者中。其表现为发热、极度心动过速、伴有心房颤动的快速心律失常、呕吐、腹泻、躁动和精神错乱。
一名17岁患有格雷夫斯病的青少年，临床表现未得到控制且对药物治疗无反应，计划进行根治性甲状腺切除术。在伯奇和瓦尔托夫斯基量表上得分为35分。采用全身麻醉进行处理，减少气道刺激和区域控制以减少手术刺激。使用了辅助药物如硫酸镁以维持术中稳定。
多模式麻醉成功避免了甲状腺危象、术后疼痛以及其他并发症。
