Anaes · Head & neck / ENT anaesthesia
Thyroid and parathyroid anaesthesia: goitre, RLN, storm, haematoma
Also known as Retrosternal goitre · Thyroid storm anaesthesia · Post-thyroidectomy haematoma
Exam-exhaustive anaesthesia for thyroidectomy and parathyroidectomy: retrosternal goitre airway planning, DAS-aligned difficult airway behaviour, recurrent laryngeal nerve monitoring and neuromuscular block strategy, thyroid storm pillars, postoperative neck haematoma as an airway emergency, and hypocalcaemia pathways for ANZCA Final and equivalents.
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Red flags
- Post-thyroidectomy haematoma is an airway emergency — open the wound early if needed.
- Elective thyrotoxic patients should be rendered euthyroid when possible.
- Thyroid storm: supportive care, antithyroid drugs, iodine after blockade, beta-blockade, steroids.
- RLN monitoring limits ongoing NMB; tube position matters.
- Symptomatic hypocalcaemia after parathyroid surgery needs prompt calcium.
Meet the patient
A 62-year-old woman with a large retrosternal goitre and mild stridor when supine is listed for total thyroidectomy. TSH is suppressed, free T4 is high despite carbimazole. Later tonight, the PACU nurse will say the neck looks swollen.[10]
The examiner's triple threat: airway, endocrine crisis, and postoperative neck haematoma. Each one can fail the case on its own.[1][8]
References13ShowHide
- [1]Frerk C et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults Br J Anaesth, 2015.PMID 26556848
- [2]Cook TM et al. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia Br J Anaesth, 2011.PMID 21447488
- [3]Randolph GW et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement Laryngoscope, 2011.PMID 21181860
- [4]Schneider R et al. International neural monitoring study group guideline 2018 part I: Staging bilateral thyroid surgery with monitoring loss of signal Laryngoscope, 2018.PMID 30289983
- [5]Satoh T et al. 2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition) Endocr J, 2016.PMID 27746415
- [6]Burch HB, Wartofsky L Life-threatening thyrotoxicosis. Thyroid storm Endocrinol Metab Clin North Am, 1993.PMID 8325286
- [7]Ross DS et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis Thyroid, 2016.PMID 27521067
- [8]Tausanovic K et al. Case Control Study of Risk Factors for Occurrence of Postoperative Hematoma After Thyroid Surgery: Ten Year Analysis of 6938 Operations in a Tertiary Center in Serbia World J Surg, 2022.PMID 35798991
- [9]Adigbli G, King J Airway management of a life-threatening post-thyroidectomy haematoma BMJ Case Rep, 2015.PMID 26670901
- [10]Simo R et al. Surgical management of intrathoracic goitres Eur Arch Otorhinolaryngol, 2019.PMID 30506185
- [11]Santa Ritta Barreira CE et al. Guideline From the Brazilian Society of Surgical Oncology and Brazilian College of Surgeons in Preventing and Managing Acute Hypoparathyroidism After Thyroid Surgery J Surg Oncol, 2024.PMID 39315485
- [12]Wilhelm SM et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism JAMA Surg, 2016.PMID 27532368
- [13]Wells SA Jr et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma Thyroid, 2015.PMID 25810047