This document discusses the anesthetic considerations for patients with hypothyroidism. Key points include:
- Hypothyroidism can cause difficult airway management, cardiovascular instability, and hypothermia risks intraoperatively.
- Patients require cautious sedation, induction, and hemodynamic monitoring due to effects on circulation and metabolism.
- In pregnancy, hypothyroidism increases risks of complications for both mother and baby, so euthyroid state through levothyroxine is important.
- Myxedema coma is a rare severe form treated with intravenous thyroid replacement and intensive care support.
The tumescent liposuction procedure involves the use of lidocaine (a local anesthetic), epinephrine (a hormone and a neurotransmitter that shrinks blood vessels and minimizes bleeding), and a saline solution that is injected into the treatment area. The fluid causes the fat and skin to swell up, making it easier to suction out excess fatty cells.
Hypothyroidism and hyperthyroidism have significant clinical effects. Both should be optimized. Anesthesia providers should be able to diagnose and manage.
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
A basic overview on the management of intra-operative bronchospasm: the risk factors, triggers, diagnosis, prevention and management. Includes a case scenario – discussion.
presentation regarding investigations and treatment of heart failure in pediatrics, including the management of an emergency , and includes brief description about even drugs used
The tumescent liposuction procedure involves the use of lidocaine (a local anesthetic), epinephrine (a hormone and a neurotransmitter that shrinks blood vessels and minimizes bleeding), and a saline solution that is injected into the treatment area. The fluid causes the fat and skin to swell up, making it easier to suction out excess fatty cells.
Hypothyroidism and hyperthyroidism have significant clinical effects. Both should be optimized. Anesthesia providers should be able to diagnose and manage.
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
A basic overview on the management of intra-operative bronchospasm: the risk factors, triggers, diagnosis, prevention and management. Includes a case scenario – discussion.
presentation regarding investigations and treatment of heart failure in pediatrics, including the management of an emergency , and includes brief description about even drugs used
Myxoedema coma is an extreme state of hypo metabolism
resulting from low levels of thyroid hormone and caused
by a severe and long-standing depletion of thyroid
hormone. lt is characterized by hypothermia, an altered
mental status ranging from slow mentation to coma, and an
identifiable precipitating event.
DEFINITION
• Myxedema coma is a rare life-threatening condition.It is the decompensated state of severe hypothyroidism in whichthe patient is hypothermic and unconscious.The condition occurs most often among elderly women in the winter months and appears to be precipitated by cold.
• Myxedema coma, occasionally called myxedema crisis, is a rare life- threatening clinical condition that represents severe hypothyroidism with physiological decompensation. The condition usually occurs in patients with long-standing, undiagnosed hypothyroidism and is usually precipitated by infection, cerebrovascular disease, heart failure, trauma, or drug therapy.
• Myxedema is also used to describe the dermatologic changes that occur in hypothyroidism which refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
3. THYROID GLAND
• Endocrine gland in the anterior and lateral
aspects of the neck
• Bi-lobed connected by the isthmus
• Upper border of isthmus is below the
cricoid cartilage
• Weighs about 20 grams
• Highly vascular gland-with rich capillary
permeation
• Recurrent laryngeal gland , external
laryngeal nerve are in close proximity to
the gland
4.
5. • Innervated by adrenergic and cholinergic
nervous system
• The gland is made of follicles with
proteinaceous colloid
• Colloid has thyroglobulin-iodinated
glycoprotein-substrate for thyroid hormone
synthesis
• It bears parafollicular C cells-calcitonin
• The hypothalamo-pituitary-thyroid axis
plays an important role in body
metabolism
15. HYPOTHYROIDISM
• Relatively common in adult population
• Could be of two types
primary hypothyroidism
secondary hypothyroidism
euthyroid sick syndrome
16.
17. Primary hypothyroidism
• Decreased production of thyroid hormones
inspite of adequate or increased levels of
TSH
seen most commonly
• TRH administration causes exaggerated TSH
elevation
Secondary hypothyroidism
• reduced levels of freeT4,T3,T4 and reduced
TSH level
• TRH stimulation confirms pituitary as cause
which shows absent or blunted reflex
18. Euthyroid sick syndrome
abnormal thyroid function tests in critically
ill patients with significant non thyroid illness
• Low level of T3 T4 and normal TSH level
• With deterioration of the disease,T3 and T4
level decreases further
• Stress induced as a physiological response
during surgery
• No treatment is needed
• Serum TSH
> 10milliunits/L implies hypothyroidism
<5 milliunits/L implies euthyroidism
23. • Deep hoarse voice
• Dry skin
• Intolerance to cold
• Impaired free water clearance-hyponatremia
• Lethargy
• Menorrhagia
• Non pitting edema
• Pleural and pericardial effusion
• Periorbital edema
24. • Sleep apnea
• Slow gastric emptying
• Slow mental functions
• Slow movement
• Weight gain –coarse facial features
-large tongue
25.
26.
27.
28. TREATMENT
• Levothyroxine sodium commonly used
• Response to therapy
sodium and water diuresis
reduction in TSH level
• Patient with cardiomyopathy shows
measurable improvement in myocardial
function with therapy
• Angina if already present may worsen hence
angiogram is needed before hormone
replacement
30. HYPOTHYROIDISM AND ANAESTHSIA
• Mild to moderate thyroid dysfunction has
minimal impact peri-operatively
• Features expressed in hypothyroid state
directs the precautions to be taken peri-
operatively and intra-operatively
• Hypothyroidism reduces anaesthetic
requirement slightly
• Determination of medical treatment is
important
31. • Changes in thyroid function have been
documented in uncomplicated acute
myocardial infarction, congestive heart
failure, cardiopulmonary bypass.
• Significant T3 depression occurs which
may not get corrected with T3
administration
• Patient taking amiodarone are at risk of
hypothyroidism and needs a thyroid
function test before surgery
32. PREOPERATIVE PERIOD
• Euthyroid state is ideal for surgical
procedures
• For chronic thyroid disorder a preoperative
thyroid function test is needed
• Reliable report - if it is less than 6 months
• Thyroid stimulating hormone (TSH) is the
best to evaluate hypothyroidism
• Surgical stress may precipitate myxedema
or thyroid storm in untreated or severe
cases
33. • Elective surgeries must be postponed until
the patient is euthyroid
• Emergency surgeries must be done after
consultation with endocrinologist
• Chest x-ray or CT is used to rule out
tracheal or mediastinal involvement
• Continuation of drug on the day of surgery
is important
34. • In patients with no history of prior thyroid
dysfunction but with present history its
symptoms-TSH alone could be done
• Full replacement dose of levothyroxine-
1.6micrograms/kg/day
-elderly or those with coronary artery
disease the initial dose -25 µg daily
-increase every 2 to 6 weeks until
euthyroid state
• Half life of the drug is 7 days
35. INTRA-OPERATIVE PERIOD
• Increased risk when hypothyroid patient
goes through general or regional
anaesthesia
• Difficult intubation-Swollen oral cavity
-edematous vocal cords
-goitrous enlargement
• Aspiration risk and regurgitation risk-
decreased gastric emptying
37. Hematologic abnormalities
• Anemia 25%-50% of patients
• Platelet dysfunction and coagulation factor
abnormalities (factor viii)
• electrolyte imbalances-hyponatremia
Metabolic demands
• Hypoglycemia is common
• Hypothermia has quicker onset which is
difficult to treat
• decreased neuromuscular excitability
38. PRECAUTIONS
• Extremely sensitive to narcotics and
sedatives
-cautious pre operative sedation is needed
• Hypothyroidism effects on Minimum
Alveolar concentration is negligible
• Due to decreased hepatic metabolism and
renal excretion of drugs- induction agents
and neuromuscular blockers must be used
with caution
39. • Due to cardiovascular instability the
patient may need invasive monitoring and
transesophageal echocardiography
• In noncardiac surgery-intraoperative
hypotension occurs
• In cardiac surgery,heart failure was more
prevalent
40. GENERAL ANESTHESIA
• given through oral endotracheal tube
• Rapid sequence induction or awake
intubation done in case of difficult airway
• Inhalational agents may aggravate
myocardial depression
• Pancuronium is the ideal neuromuscular
blocker from cardiovascular standpoint but
careful dosing is needed due to reduced
skeletal muscle activity and reduced
hepatic metabolism
41. • Controlled ventilation needed as
spontaneous breathing may lead to
hypoventilation
• Intraoperative hypotension is managed by
pharmacological agents like
ephedrine,dopamine,epinephrine if
unresponsive may need supplemental
steroid administration
• Dextrose in normal saline is preferred to
avoid hypoglycemia and hyponatremia
42. POST OPERATIVE PERIOD
• Myxedema coma common in emergency
cases
• Intravenous thyroid replacement therapy
should be started
• intravenous L thyroxine takes 10 to12days
to yield peak basal metabolic rate
• Intravenous tri-iodothyronine effective in 6
hours with peak metabolic rate seen in 36
hours to 72 hours
43. • Levo thyroxine 300 to 500 mcg I.V or Levo tri-
iodothyronine 25 to 50 mcg I.V is the initial
dose
• Hypothyroidism may be associated with
decreased adrenal cortical function,steroid
coverage with hydrocortisone or
dexamethazone could be given
• Milrinone phosphodiesterase inhibitor may be
effective in the treatment of intraoperative
myocardial depression
44. • Post operatively ,if still no ability to administer
the drug enterally after 5 days, intravenous
(IV) levo thyroxine should be administered as
60% to 80% of the oral dose
• the hypothyroid group has a higher rate of
gastrointestinal and neuropsychiatric
complications post surgically
45. MYXEDEMA COMA
• Is a rare severe form of decompensated
hypothyroidism
• Mostly seen in elderly women with chronic
hypothyroidism
• Infection, trauma,cold and central nervous
system depressant predispose
hypothyroidism to myxedema coma
• Patient is not comatose but often needs
mechanical ventilation
46. • Hypothermia of less than 27 degree
centigrade is a cardinal feature with
impaired thermoregulation by
hypothyroidism
• Treatment of choice
Intravenous L-thyroxine or L-triiodothyronine
• Intravenous fluid-glucose containing saline
solution
• Thermoregulation
• Electrolyte imbalance correction
47. • Stabilization of cardiac and pulmonary
function
• Vitals-heart rate ,blood
pressure,temprature improve 24 hours
• Relative euthyroid is achieved in 3 to 5
days
• Hydrocortisone 100-300mcg/day is given
for adrenal insuffiency
48. • management in the intensive care unit
where proper ventilatory, electrolyte, and
hemodynamic support can be given.
• Passive rewarming, broad spectrum
antibiotic coverage and corticosteroids
may be needed.
• The definitive treatment is thyroid hormone
replacement administered as IV T4, 200 to
500 mcg as an initial bolus followed by 50-
100 mcg daily
49. • Few suggest addition of IV T3, 10-25 mcg
every 8 hours if available.
• Rapid thyroid hormone replacement may
precipitate myocardial infarction, hence
caution should be exercised in those with
underlying ischemic heart disease.
• Treatment of the precipitating cause like
an infection is critical for rapid recovery.
52. • Pregnancy is a state of excessive thyroid
stimulation
• increase in thyroid size by 10% in iodide
sufficient areas and 20-40% in iodide deficient
regions
• Due to physiological and hormonal changes
caused by pregnancy and human chorionic
gonadotropin (HCG) the production of
thyroxin (T4) and triiodothyronine (T3)
increase up to 50%
53. • 50% increase in daily iodide need, while
Thyroid-stimulating hormone (TSH) levels
are decreased in first trimester
• In an iodide sufficient area ,thyroid
adaptations during pregnancy are
tolerated, as stored inner iodide is
sufficient
• in iodide deficient areas, due to
physiological adaptations there are
significant changes during pregnancy
56. • severe preeclampsia
• neonatal distress
• diabetes in pregnant women
• thyroid autoimmunity has effects similar to
that of subclinical hypothyroidism
• Subclinical hypothyroidism is the most
common thyroid dysfunction during
pregnancy
57. • hypothyroidism is very common during
pregnancy
• 2-3% of pregnant women suffer from
hypothyroidism
• 0.3-0.5% overt hypothyroidism and 2-2.5%
subclinical hypothyroidism
• main etiology for hypothyroidism in
pregnancy is iodide insufficiency
• in iodide sufficient areas, its main cause is
autoimmune thyroiditis
58. LABOUR COMPLICATION
• Labor – diskinetic,longer due to the
existence of the hypomyotonia and the
simultaneous cardio-respiratory problems;
hypokinesis
• Post-partum hemorrhages occur through
uterus hypotony and through coagulation
disorders
• Post-partum depression, post-partum
thyroiditis, hypogalactia
59. • Vitiated pelvis (limit pelvis) which can be
the reason of various cephalic-pelvis
disproportions
• Thyroid function test in pregnancy includes
free T3 and T4
• The free T4 index (FT4I) is an indirect
measure of FT4 and accounts for increase
in TBG.
• FT4I= TT4 ×RT3U
• The reported reference value for FT4I is
4.5-12.5mcg/dl.
60. • The values associated with hypothyroidism
increase in TSH
low FT4
low FT4I and
• variable presence of thyroperoxidase
antibodies (TPO)
• TSH and FT4/FT3 are used to assess and
follow thyroid diseases in pregnancy.
• limit of TSH should be
0.1 mIU/L -2.5 mIU/L in 1st trimester and
0.2 mIU/L -3mIU/L in 2nd and 3rd trimesters
61. • If the serum TSH is ≥3 mIU/L, tests are
repeated along with FT4 and TPO.
• Start levothyroxine meanwhile
• If declared euthyroid stop levothyroxine
• If TSH is >3mIU/L and FT4 is normal, then
patient should be tested throughout the
pregnancy
• If TSH >3mIU/L along with low FT4, then
levothyroxin is continued and the dose is
titrated to maintain TSH level in the range
of 0.5-2.5 mIU/ L
62.
63. MEDICAL MANAGEMENT
• pre-existing hypothyroidism, there is 30-
50% increase in requirement of
levothyroxine during the first trimester.
• due to increased T4 metabolism, elevated
TBG as well as inhibition of thyroid
hormone (TH) absorption from the gut by
prenatal iron supplements.
• Could be treated by iron supplements and
TH four hours apart.
64. • hypothyroidism during pregnancy,
levothyroxine should be started at a dose
of 1-2 mcg/kg/day
• TSH levels should be reassessed 4-6
weeks following the dose change
• Treatment goal of TSH in the range of 0.5-
2.5 mIU/L.
• overt hypothyroidism diagnosed in
pregnancy, T4 should be normalised as
rapidly as possible by using two to three
times the estimated final daily dose.
65. ANESTHETIC MANAGEMENT
• During pre operative preparation, anxiolytics
and sedatives should be avoided
• administration of antihistamines like
ranitidine and oral sodium citrate solution
along with metoclopramide are considered
safe.
• Severe hypothyroidism should be managed
with IV T3/T4
66. • Hypothermia should be prevented in the
operation room as well as in the post
operative period
• hypothyroidism is associated with
qualitative platelet dysfunction-
dysfunction-arrangement of fresh frozen
plasma or platelets is needed
• epidural hematoma is a risk and presence
of normal coagulation should be confirmed
before regional anesthesia
67. • Vasopressor response is normal for
epinephrine but, decreased for
phenylephrine.
• During surgical stress, hydrocortisone
should be given
• Regional anesthesia should be favoured
over general anesthesia
• Nerve stimulators may not be useful
clinically due to abnormal response to the
peripheral nerve stimulator, due to
depression of neuromuscular junction
activities
68. REFERENCES
• Miller’s ANESTHESIA-volume1-eighth edition
• Stoelting’s anesthesia and co-existing disease-
second south asian edition
• MAEdiCA-a journal of clinical medicine-2010-
Maternal and fetal complications of the
hypothyroidism-related pregnancy
• Iran J Reprod Med-review article-2015-Thyroid
dysfunction and pregnancy outcomes
• Schwartz’s principles of surgery-10th edition
• https://www.apicareonline.com/thyroid-
disorders-during-pregnancy-and-anesthetic-
considerations/