Publication:

Subarachnoid anaesthesia for emergency caesarean section in a parturient with thyroid storm: a case report

A 35-year-old multiparous woman, at 36 weeks of singleton gestation with a history of poorly controlled hyperthyroidism, presented in obstructed labour and thyroid storm (Burch-Wartofsky score: 50); she was anxious, agitated, pyrexic, tachycardic, hypertensive, with pedal oedema, atrial fibrillation and bearing live foetus. Following intravenous hydrocortisone and oral digoxin, while on Oxygen supplementation, she had an emergency Caesarean section under subarachnoid block, plus titrations of intravenous labetalol and propofol. Intraoperatively, her haemodynamic parameters remained stable and a live foetus was extracted with APGAR scores of 5 and 7 at 1 and 5 minutes of birth, respectively. Postoperatively, she received multidisciplinary management in the intensive care unit (ICU) culminating in her recovery and discharge. This report highlights the anaesthetic challenges and the critical significance of judicious subarachnoid anaesthetic technique, in the management of a patient with the combination of thyroid storm and obstructed labour in poor-resourced setting.