Journal of Thyroid Disorders & Therapy
Open Access
ISSN: 2167-7948
+44 1300 500008
ISSN: 2167-7948
+44 1300 500008
Bojan Miletic
Lucerne Cantonal Hospital Wolhusen, Switzerland
Scientific Tracks Abstracts: Thyroid Disorders Ther
Statement of the Problem: Acute dyspnea after knee surgery is a potentially life-threatening complication and is usually caused by an acute cardiovascular or respiratory event. Sometimes, however, the cause is hidden in a completely different organic system and leads diagnostics in the wrong direction, which can have fatal consequences for the patient. Case Presentation: A 81-year-old patient was sent to inpatient rehabilitation five days after the implantation of a total knee endoprosthesis. He has been treated for arterial hypertension and diabetes for a long time. Antithrombotic prophylaxis with rivaroxaban was started perioperatively. Two days later, the patient developed acute dyspnea on minimal exertion. The physical findings were normal, the patient was normotonic, normocardic, afebrile, with normal respiration and oxygen saturation; the auscultatory findings were normal. Blood laboratory findings, including troponin, NT pro BNP and acid-base status were within normal limits, the D-dimer value was slightly elevated – 570 ng/mL (NR <500). Electrocardiographically, first-degree AV-block was registered, and echocardiographically, mild pulmonary hypertension. An emergency CT scan ruled out a pulmonary embolism, but a thyroid goiter with high percentage tracheal stenosis was newly discovered. Hormonal tests revealed hyperthyroidism with TSH values < 0.002 mU/L, fT3 of 22.5 pmol/L, fT4 of 4.6 pmol/L, and thyroglobulin of 141 μg/L. Due to the sudden clinical deterioration, the patient was transferred to the surgical department, where a complete thyroidectomy was immediately performed. Conclusion: Thyroid hormones have numerous effects on the heart, blood vessels and respiratory system, and the pathophysiological mechanisms between hyperthyroidism and pulmonary hypertension are only partially elucidated. For this reason, mildly progressive dyspnea often occurs in patients with thyroid dysfunction. Very rarely, a significantly enlarged thyroid can cause life-threatening airway obstruction. In such cases, rapid diagnosis and urgent surgery is the only solution with the aim of preventing respiratory failure and a possible fatal outcome.
Bojan Miletic is a specialist in internal medicine and cardiology with additional training in physical medicine and rehabilitation and geriatric medicine and many years of experience in rehabilitation medicine. He gained work experience in several hospitals in different European countries - Croatia, Germany, Switzerland and as an associate professor at the University of Rijeka (Croatia).