make a model case sheet of 45 yr old female with hypothyroidism planne

make a model case sheet of 45 yr old female with hypothyroidism planned for lap assisted vaginal hysterectomy in MD anaesthesia with viva questions

Reading File

Finding Sources

Searching PubMed

hypothyroidism perioperative anaesthesia management

Reading File

This is a comprehensive MD anaesthesia model case sheet. Here's what's included and why it was constructed this way:

What's Covered and Key Teaching Points

45F with Hashimoto's thyroiditis (autoimmune hypothyroidism), currently euthyroid on levothyroxine 75 mcg - this is the most common and realistic scenario
Fibroid uterus with menorrhagia (logical indication for LAVH)
Mild anaemia (Hb 10.2), trace oedema, borderline dyslipidaemia, goitre Grade I - all authentic hypothyroid features
Trivial pericardial effusion on echo - a classic, often-missed finding in hypothyroid patients

Feature	Principle
Euthyroid state confirmed	Elective surgery can proceed; per Miller's 10e, TFT within 6 months on stable dose is sufficient
Ketamine as preferred induction	Sympathomimetic - offsets reduced cardiac output
Continue levothyroxine on day of surgery	6-7 day half-life but standard practice to not interrupt
RSI / modified RSI	Delayed gastric emptying in hypothyroidism = aspiration risk
Mandatory temperature monitoring	Hypothyroid patients at high risk of perioperative hypothermia
TOF-guided NMB reversal	Hypothyroid myopathy may prolong NMB
Apfel score 3 = high PONV risk	Multimodal prophylaxis / TIVA consideration

Basic sciences (thyroid physiology, pharmacokinetics)
Clinical management (when to postpone surgery, myxoedema coma)
Procedure-specific (pneumoperitoneum physiology, Trendelenburg, LAVH positioning)
Higher-order integration (combined risk hypothyroid + LAVH, Schmidt's syndrome, PONV, difficult airway)

This is a shared conversation. Sign in to Orris to start your own chat.