We
report an
anesthetic experience in a clinically euthyroid
patient with
hyperthyroxinemia (elevated free
thyroxine , fT4 and normal 3, 5, 3'-L-
triiodothyronine , T3) and suspected impairment of conversion from T4 to T3. Despite marked
hyperthyroxinemia , this
patient 's perioperative
hemodynamic profile was suspected to be the result of
hypothyroidism , in reference to the presence of T4 to T3
conversion disorder . We suspected that pretreatment with antithyroid medication before
surgery , surgical stress and
anesthesia may have contributed to the decreased T3 level after
surgery . She was treated with
liothyronine sodium (T3) after
surgery which restored her
hemodynamic profile to normal.
Anesthesiologists may be aware of potential
risk and caveats of inducing
hypothyroidism in
patients with euthyroid
hyperthyroxinemia and T4 to T3 conversion impairment.