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Abstract
Background and aims Hyperthyroidism occurs in about 0.1% -0.4% of pregnancies1, and Graves’ disease accounts for 95% of all cases of hyperthyroid parturients.2 Pregnancy aggravates Graves’ hyperthyroidism in early trimester, remission during late pregnancy and increase in post-partum period.3 To represent anesthesia management for caesarean section in pregnant patients with hyperthyroidism.
Methods Case 1: a 28-year-old parturient, Gravida 5, Para 3, 32–34 weeks gestation, experienced contraction and PROM. She was known for uncontrolled hyperthyroidism, had struma and exoftalmus eyes, T3/TSH level was 2,49 (Normal 0,8–2,0)/<0,01(Normal 0,27–4,2). BP 130/80 mmHg, HR 95 bpm, BW score 0 (minimal risk of thyroid storm). Emergency caesarean section was scheduled with spinal anesthesia (Bupivacain heavy 0,5% 10 mg).
Case 2: a 23-year-old parturient, Primigravida, 39–40 weeks gestation, experienced contraction and PROM. She was known for unmedicated hyperthyroidism, struma, T4/TSH level was 20,24 (Normal 0,93–1,7)/3,48 (Normal 0,27–4,2). BP 102/71 mmHg, HR 108 bpm, BW score 10 (minimal risk of thyroid storm). Emergency caesarean section was scheduled with spinal anesthesia (Bupivacain heavy 0,5% 10 mg).
Results We had successful caesarean section in both cases with no episode of thyroid storm or other adverse event throughout surgery and afterwards. Preterm (case 1) and a term baby (case 2) were delivered with apgar score 7/9.
Conclusions Regional technique using spinal anesthesia for caesarean section in hyperthyroid parturients was revealed maternal and neonatal safe outcomes. Spinal anesthesia in hyperthyroid parturient was preferable due to its sympathetic block, non-tocolytic effect, and good post-operative analgesia which is beneficial to avoid excitement of thyroid storm.