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PubMed1994

Disappearance rate of serum calcitonin after total thyroidectomy for medullary thyroid carcinoma.

We studied the half-life of serum calcitonin (CT) in patients subjected to total thyroidectomy for medullary thyroid carcinoma (MTC). One patient showed a rapid serum CT component with a half-life of 3 hours and a slow component with a half-life of 30 hours; in another case only the 30-hour component was found. By chromatography of tumor extracts, we found that all the immunoreactive CT had a molecular weight of 3,600. After surgery, normalization of serum CT was achieved within 15 days in 4 patients, at 3 months and at 6 months in 2 other patients, while 1 patient never normalized. Normalization of serum CT after surgery is not an index of definitive cure in MTC, as demonstrated by one patient who relapsed 3 months after normalization of serum CT. However, as a general rule, patients who reach undetectable serum CT levels soon after surgery, are those having the best prognosis.

Adult↗
PubMed1981

Diabetes, hypophysectomy, or thyroidectomy reduces nuclear L-triiodothyronine-binding capacity of rat lung.

L-T3 (T3) receptors of the lungs of rats were found to be under hormonal control. The apparent binding capacity of T3 receptors of lungs of diabetic, hypophysectomized, and thyroidectomized rats were 0.224 +/- 0.009, 0.195 +/- 0.007, and 0.102 +/- 0.008 pmol/mg DNA, as compared to 0.0321 +/- 0.014 pmol/mg DNA for normal animals. The binding affinities for T3 in normal, diabetic, hypophysectomized, and thyroidectomized rats were 256 +/- 3.24, 270 +/- 3.81, 249 +/- 4.03, and 260 +/- 8.2 pM, respectively. The magnitude of the maximum binding capacity in these cases was apparently not due to the loss of either T3 receptors or DNA during the incubation. Serum T3 and T4 concentrations in normal rats were 120.0 +/- 7.2 ng/dl and 5.9 +/- 0.5 micrograms/dl, respectively. Diabetes, hypophysectomy, and thyroidectomy lowered these values to 79 +/- 5.4, 60 +/- 5.8, and 30 +/- 1.6 ng/dl for T3 and 3.5 +/- 0.3, 2.7 +/- 0.4, and 1.9 +/- 0.2 micrograms/dl for T4, respectively.

Animals↗
PubMed1982

Thyrotropin-like immunoreactivity in the pituitary and three brain regions of the female rat: diurnal variations and the effect of thyroidectomy.

A method for extracting and assaying TSH-like immunoreactivity (TSH-LI) in regions of the central nervous systems (CNS) of individual rats was developed and validated. Serial dilutions of tissue extracts paralleled dilutions of purified rat TSH standard in the RIA, and tissue TSH-LI comigrated electrophoretically with TSH standard. TSH-LI was measured in the pituitary (PIT), the medial basal hypothalamus (MBH), the remainder of the hypothalamus (HYPO), and the cerebral cortex (CC). Female rats were maintained on a normal 12-h light, 12-h dark cycle (LD; onset of light, 0730 h) or an inverted 12-h light, 12-h dark cycle (DL; onset of light, 1930 h) for 3 weeks and then killed at 4-h intervals throughout the day. Another group of rats on the LD photoperiod were either thyroidectomized or sham thyroidectomized and killed 3 weeks later at 1000 h. Diurnal variations of TSH-LI were present in the PIT, MBH, HYPO, and CC on the LD photoperiod (P less than 0.05). The acrophases of MBH, HYPO, and CC TSH-LI diurnal variations occurred soon after the onset of darkness, whereas the PIT TSH-LI variation peaked soon after the onset of light. Inverting the photoperiod inverted the PIT TSH-LI diurnal variation, but central nervous system TSH-LI variations were not phase shifted after 3 weeks on the inverted photoperiod. Thyroidectomy elevated plasma and MBH TSH-LI levels (P less than 0.05), but PIT, HYPO, and CC TSH-LI levels were not significantly different from those in sham-operated controls. These results indicated that brain TSH concentrations could change under different physiological states independently of changes in PIT or plasma TSH. Although brain TSH exhibited diurnal variations, the data suggested that the phase of these variations was not set by the light-dark cycle.

Animals↗
PubMed1988

Effects of iodine intake on thyroid secondary lysosomes after subtotal thyroidectomy.

This study tested the effects of different iodine intakes on thyroid ultrastructure and function in thyroid remnants after subtotal thyroidectomy (sub-tx). Removal of most of the thyroid gland causes an elevation of endogenous TSH, which chronically stimulates the residual tissue. Male Sprague-Dawley rats were divided into three groups; Low Iodine Group (LIG), Moderate Iodine Group (MIG), and High Iodine Group (HIG). There was no significant difference among total thyroid weights removed by sub-tx, but thyroid remnant weights and TSH levels were higher at death (6 weeks after sub-tx) in LIG than in MIG and HIG. Total specific activities of cathepsin D and of arylsulfatase A in the sedimentable and nonsedimentable subcellular fractions were at least 38% lower in LIG than in MIG and HIG. The ratio between relative follicular volume and colloid volume determined by morphometry was higher in LIG than in MIG and lower in HIG than in MIG. Ultrastructurally, the relative volume occupied by secondary lysosomes was higher in HIG than in MIG, whereas the number of secondary lysosomes was not higher in LIG than in controls. Autoradiographic studies with 125I revealed that a large part of the radioactivity was in thyroid cell secondary lysosomes in MIG and HIG when radioiodine was injected 3 weeks before death. It is concluded that after sub-tx, iodine 1) regulates the weight of thyroid remnants, perhaps only indirectly through TSH, 2) modulates the number of secondary lysosomes in thyroid cells, and 3) slows down the turnover of secondary lysosomes. An iodine-deficient regimen impedes the secondary lysosomes to increase. Because of these findings, we postulate that chronic TSH stimulation along with a possible toxic role of iodine after sub-tx could induce an accumulation of lysosomal bodies.

Animals↗
PubMed1990

Restoration of thyroid function after total thyroidectomy and quantitative thyroid cell transplantation.

Quantitative thyroid cell transplantation was used to evaluate the reestablishment of thyroid function in surgically thyroidectomized rats. Donor thyroid glands were enzymatically dispersed, and the cells were quantified, serially diluted, and inoculated into the sc fat pads of syngeneic recipient rats 1 day after surgical thyroidectomy. Blood samples were obtained weekly, and serum T3, T4, and TSH levels were determined by RIA. Recipient rats displayed different patterns of restoration of thyroid function depending on 1) the number of thyroid cells inoculated and 2) their dietary iodine intake. We observed cell dose-dependent differences in both the rapidity and extent of thyroid function after cell transplantation. Recipients fed a normal diet and grafted with 6 x 10(4) or more cells reached near-normal levels of all three hormones. In recipients fed a low iodine diet, T4 and TSH levels remained at significantly hypothyroid levels for the duration of the 7-week study. At the highest cell dose examined (3 x 10(5)), however, serum TSH levels began to decline by the sixth to seventh week. In spite of the iodine deficiency, recovery of T3 levels in these recipients paralleled that in recipients fed normal diets. Intact control animals exhibited the anticipated pattern of decreased T4, increased TSH, and essentially unchanged T3. 125I uptake by the grafts was also dependent on the initial number of thyroid cells grafted independent of diet.

Animals↗
PubMed1991

Role of the thyroid gland in seasonal reproduction. III. Thyroidectomy blocks seasonal suppression of gonadotropin-releasing hormone secretion in sheep.

Previous studies demonstrated that the thyroid gland is required for the changes in LH secretion that lead to the end of the breeding season of female sheep, a reproductive transition generated within the ewe by an endogenous annual rhythm. The present study tested the hypothesis that this role of the thyroid is mediated via the GnRH neurosecretory system. The pulsatile secretion of GnRH into hypophyseal portal blood and LH into peripheral blood, as well as the neuroanatomical distribution of GnRH neurons and their light microscopic morphology, were compared among anestrous ewes and thyroidectomized (THX) ewes that failed to make the transition to the anestrous season. The study was conducted under photoperiodic conditions in which the transition to anestrus was generated by the endogenous rhythm. Each animal was ovariectomized and treated sc with a constant release implant of estradiol to normalize gonadal steroid status among thyroid-intact and THX ewes. High frequency pulses of GnRH and LH were evident in THX ewes that failed to make the transition to anestrus, whereas pulsatile secretion of GnRH and LH was generally not observed in thyroid-intact controls that had entered anestrus. This marked effect of thyroidectomy on GnRH secretion was not associated with widespread changes in the total number, distribution, or light microscopic morphology of GnRH neurons in the hypothalamus and preoptic area. Our finding that pulsatile secretion of GnRH is elevated in THX ewes that fail to make the transition to anestrus supports the hypothesis that the thyroid gland is required for the endogenously generated switch in function of the GnRH neurosecretory system that leads to the end of the breeding season of the ewe.

Animals↗
PubMed2004

Serum thyroglobulin levels at the time of 131I remnant ablation just after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma.

We investigated whether serum thyroglobulin (Tg) measured at the time of remnant ablation (ablation-Tg) could be a prognostic indicator complementary to serum Tg levels at the time of the first diagnostic whole-body scan (WBS) after thyroid hormone withdrawal (control-Tg; approximately 6-12 months after ablation-Tg) and whether ablation-Tg could predict the persistence or recurrence of disease in low-risk patients with differentiated thyroid carcinoma. Patients with differentiated thyroid carcinoma (n = 268) treated with total or near-total thyroidectomy followed by immediate (131)I remnant ablation were studied. Patients with anti-Tg autoantibodies and those showing evidence of extracervical metastases were excluded. Two patients showing remnant uptake on follow-up diagnostic WBS received a second ablation. We found significant correlation between ablation-Tg and control-Tg levels; 114 of 143 patients (80%) with ablation-Tg greater than 2 microg/liter showed detectable (>/=1 microg/liter) control-Tg, and 70 of 125 (56%) patients with ablation-Tg 2 microg/liter or less showed undetectable (<1 microg/liter) control-Tg [odds ratio 5.1, 95% confidence interval (CI) 3.0-8.9, P < 0.001]. When the 268 patients were followed up for a mean period of 5.7 +/- 1.4 yr (range 2.8-8.3 yr), 35 (13%) had recurrences; 73 (27%) were classified as "Tg positive, no evidence of disease"; and 160 (60%) showed complete remission. Of 143 patients with ablation-Tg greater than 2 microg/liter, recurrence was observed in 33 cases (23%); "Tg positive, no evidence of disease," was observed in 52 cases (36%); and complete remission was observed in 58 cases (41%). Of 125 patients with ablation-Tg 2 microg/liter or less, two patients (2%) showed recurrence during the follow-up; 21 patients (17%) were regarded as "Tg positive, no evidence of disease"; and 102 patients (81%) showed complete remission. The positive predictive value for recurrence in patients having ablation-Tg greater than 2 microg/liter was found to be 23.1% (33 of 143 patients, 95% CI 16.4-30.8%). The negative predictive value for recurrence in patients having ablation-Tg 2 microg/liter or less was found to be 98.4% (123 of 125 patients, 95% CI 94.4-99.8%). These data indicate that serum Tg levels measured at the time of immediate postoperative (131)I remnant ablation correlated well with serum Tg levels at the time of the initial diagnostic WBS and had a complementary role for predicting persistence or recurrence of disease in the earliest postoperative period.

Adolescent↗
PubMed1984

Managing thyroid abnormalities in adults exposed to upper body irradiation in childhood: a decision analysis. Should patients without palpable nodules be scanned and those with scan defects be subjected to subtotal thyroidectomy?

This decision analysis compares two currently recommended management strategies for adults at increased risk for thyroid carcinoma due to childhood upper body irradiation who present without palpable thyroid nodularity: 1) scan-surgery: initially thyroid scan every patient, then perform subtotal thyroidectomy for each patient with single or multiple scan defects; and 2) no scan reexamine: do not scan initially, but reexamine at least every 2 yr, reserving surgery for those in whom palpable nodularity later develops. When surgical morbidity and mortality are taken into account, the expected utility of the no scan reexamine strategy slightly outweighs that of scan-surgery; this preference is maintained in several sensitivity analyses, unless more than 80% of occult cancers progress to palpable size. Moreover, the financial costs of universal scanning coupled with surgery are considerably greater. The no scan-reexamine approach, therefore, deserves serious consideration as the preferred strategy. Since the expected utilities of the two strategies are nearly equal, however, patient attitudes toward risk should be given particular weight in choosing management.

Adult↗
PubMed1988

Hashimoto's thyroiditis with a monoclonal antithyroglobulin autoantibody: disappearance of the monoclonal antibody after thyroidectomy.

A 46-yr-old man had typical Hashimoto's thyroiditis (HT) and a serum monoclonal immunoglobulin (MIgG kappa). There was no evidence of disseminated lymphoid malignancy. Because of rapid enlargement of the goiter with pressure symptoms, a total thyroidectomy was performed. The surgery was followed by the complete disappearance of the MIgG kappa paralleled by the disappearance of serum antithyroglobulin autoantibodies. Thyroid sections demonstrated HT. Direct immunofluorescence assay showed diffuse infiltration by lymphocytes and plasma cells that were mainly IgG kappa positive. Moreover, the serum MIgG kappa had antithyroglobulin activity, as demonstrated by two different methods, namely labeling of focused serum proteins with radioiodinated human thyroglobulin and immunoadsorption of the monoclonal IgG on a human thyroglobulin affinity column. These results demonstrate that a monoclonal antithyroglobulin autoantibody was produced within the thyroid in a patient with HT. As the production of a MIg is regarded as the last stage preceding the malignant transformation of normal B lymphocytes, this report strongly suggests that a B lymphoma can directly emerge from the intrathyroidal lymphocytes involved in the pathogenesis of Hashimoto's thyroiditis.

Antibodies, Monoclonal↗
PubMed1992

Male soprano voice: a rare complication of thyroidectomy.

A soprano voice from cricothyroid fusion is a rare complication following thyroidectomy. Thyroid surgeons should be aware of this possibility and recognize it early if voice pitch rises following thyroid surgery. This patient's unfortunate complication may prove fortuitous for phonosurgeons and their patients. Cricothyroid fusion may provide a better long-term retention of frequency elevation than traditional cricothyroid approximation. It is also a reversible procedure. Cricothyroid fusion should be investigated as an alternative to cricothyroid approximation for pitch modification.

Cicatrix↗
PubMed1998

Effects of thyroidectomy or thiouracil treatment on copulatory behavior in adult male rats.

Male copulatory behavior and the function of the hypothalamo-hypophysial-gonadal axis in hypothyroid male rats were investigated in the present study. Hypothyroidism was induced by thyroidectomy or thiouracil. In male copulatory behavior test, intromission latencies in hypothyroid rats were significantly longer than those in euthyroid rats and ejaculation frequencies were reduced in hypothyroid male rats compared to control rats without reduction of plasma concentrations of testosterone. These changes in copulatory behavior in hypothyroid male rats were restored to control levels by administration of T4 (5 micrograms/rat). Hypothyroidism decreased adrenal weights, and basal and peak concentrations of corticosterone during diurnal variation, whereas it increased peak concentrations of ACTH in adult male rats. These results indicate that hypothyroidism causes adrenal dysfunction directly and results in hypersecretion of ACTH. The adrenal disturbance observed in hypothyroid rats may affect male copulatory behavior.

Adrenal Glands↗
PubMed2005

Severe hypocalcemia following total thyroidectomy after biliopancreatic diversion.

Patients undergoing malabsoprtive operations for bariatric surgery are prone to disturbances of bone metabolism, but this does not commonly lead to clinical symptoms. We present a morbidly obese patient who had undergone the biliopancreatic diversion of Larrad, and presented clinical symptoms of severe hypocalcemia and tetany after total thyroidectomy. Very high doses of i.v. calcium and calcitriol and 10 days of hospitalization were required to control the symptoms and correct plasma levels. The physiological aspects that contribute to this situation are discussed.

Adult↗
PubMed2002

Thyroxine vs thyroxine plus triiodothyronine in treatment of hypothyroidism after thyroidectomy for Graves' disease.

It was recently demonstrated that treatment with levorotatory thyroxine (T4) plus triiodothyronine (T3) compared with treatment with T4 alone improves psychologic functioning in hypothyroid patients with thyroid cancer or autoimmune thyroiditis. In the present double-blind crossover study, we again compared the effects of combined thyroid replacement vs monotherapy on psychologic function, endocrine function, cardiovascular function, and body composition. The patients were women who were hypothyroid after thyroidectomy for Graves' disease. The substitution of 10 microg of T3 for 50 microg of T4 caused a statistically significant decrease in free T4 concentration but no significant change in T3 or thyroid-stimulating hormone concentration. Symptoms of hypothyroidism and of hyperthyroidism tended to decrease on a standard symptom scale after combined treatment. With combined hormone replacement, mental state tended to improve on some mood scales but not on cognitive tests. We found alterations in left ventricular diastolic function but no change in body composition after the combined treatment regimen. These preliminary findings in a small group of patients with Graves' disease are consistent with earlier findings that thyroid replacement with T4-T3 combination improves mental functioning.

Adult↗
PubMed1989

[Two cases of Graves' disease with anti-thyroid hormone autoantibodies: the effect of subtotal thyroidectomy on the titers of anti-thyroid hormone autoantibodies and anti-Tg antibodies].

We experienced two cases of Graves' disease associated with anti-thyroid hormone autoantibodies (Case 1: anti-T4, Case 2: anti-T3). Both cases underwent subtotal thyroidectomy, and titers of anti-thyroid hormone antibodies and anti-Tg antibodies were compared before and after operation. In case 1, titers of both anti-T4 and anti-Tg antibodies decreased after operation, whereas in Case 2, titers of both anti-T3 and anti-Tg were unchanged before and after operation. There was a significant positive correlation between titers of anti-T4 and anti-Tg antibodies in Case 1 (r = 0.90, P less than 0.01), and anti-T3 and anti-Tg antibodies in Case 2 (r = 0.64, P less than 0.01). These results strengthen the possibility that the antigen of anti-thyroid hormone autoantibodies in both cases is the Tg molecule.

Autoantibodies↗
PubMed1990

[Changes in TSH-receptor antibody (TR-AB) and thyroid stimulating antibody (TS-AB) after thyroidectomy in thyrotoxic patients].

Changes in TSH-receptor antibody (TR-Ab) and thyroid stimulating antibody (TS-Ab) after thyroidectomy were examined in seventeen thyrotoxic patients (3 males and 14 females, 40.0 +/- 3.4 yr) with positive TR-Ab and TS-Ab. They were subjected to thyroid surgery because of suspected malignancy, methymazol induced agranulocytosis, cardiac failure, recurrent gastric ulcer or emotional instability. Of these patients, 3 were totally thyroidectomized, 11 were subtotally thyroidectomized and 3 were unilaterally lobectomized. Histological findings in these patients showed diffuse hyperplasia in 8 cases, an adenomatous goiter in 3, diffuse hyperplasia plus follicular adenomas in 5, and Hashitoxicosis in one. Their thyroid function before surgery was as follows: T3 level, 3.9 +/- 0.7 ng/ml; T4, 19.5 +/- 3.3 micrograms/dl; free T3, 11.9 +/- 1.2 pg/ml; free T4, 4.9 +/- 1.0 ng/dl; and TSH, 0.9 +/- 0.1 microU/ml. Mean levels of TR-Ab and TS-Ab before surgery were 56.8 +/- 4.6% and 1,218.6 +/- 262.4%, respectively. Positive anti-thyroid antibody (TGHA) was 47.0%, positive anti-microsomal antibody (MCHA) was 88.2% in these thyrotoxic patients, and mean levels of TGHA and MCHA were 1,688 +/- 715 and 89,280 +/- 34,717 times, respectively. After the operation, these parameters were decreased and their thyroid functions became an euthyroid or a hypothyroid state one month later. The incidence of post-operative hypothyroidism was 45.5% in subtotally thyroidectomized patients, 33.3% in unilaterally lobectomized patients and 100% in totally thyroidectomized patients. TR-Ab levels decreased from 56.2 +/- 6.5% before surgery to 24.5 +/- 12.2% 12 months after surgery, but increased again to 35.0 +/- 15.7% 24 months after surgery in subtotally thyroidectomized patients. These levels also decreased from 50.4 +/- 11.0% before surgery to 37.8 +/- 11.4% 12 months after surgery, and remained unchanged to 38.2 +/- 10.4% 24 months after surgery in unilaterally lobectomized patients. On the other hand, in totally thyroidectomized patients, TR-Ab levels decreased and normalized 12 months after surgery. One of subtotally thyroidectomized or unilaterally lobectomized patients developed recurrent thyrotoxicosis with an increased positive TR-Ab. Mean levels of TS-Ab decreased to 28.3 +/- 181.3% and 152.5 +/- 47.9% 12 and 24 months after surgery, respectively, in subtotally thyroidectomized patients. These levels decreased 12 months after surgery and then increased again to 303.6 +/- 130.6% in unilaterally lobectomized patients. On the other hand, TS-Ab levels decreased and normalized to 94.3 +/- 3.9% 6 months after surgery in totally thyroidectomized patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1996

Effects of thyroidectomy on thyrotropin-releasing hormone (TRH) and somatotropin release-inhibiting factor (SRIF) patterns in intrahypophysial microdialysates in rats.

The effects of thyroidectomy on patterns of TRH and somatotropin release-inhibiting factor (SRIF) release from the hypothalamus were investigated by using a microdialysis technique. Thyroidectomized and sham-operated rats underwent placement of a guide cannula into the anterior pituitary gland to obtain dialysates, or implantation of an intravenous cannula into the right atrium for blood sampling. Seven days postoperatively dialysates were collected at a flow rate of 2 microliters/min every 1 h. TRH concentrations in dialysates from thyroidectomized rats (0.43 +/- 0.2 pg/h) were significantly higher than those from control rats (0.17 +/- 0.02 pg/h). In contrast, SRIF concentrations in dialysates from thyroidectomized rats (2.45 +/- 0.05 pg/h) were significantly lower than those from control rats (3.80 +/- 0.22 pg/h). In addition, plasma TSH concentrations in thyroidectomized rats (24.8 +/- 0.5 ng/ml) were increased compared with those in control rats (2.5 +/- 0.1 ng/ml), and plasma GH concentrations were decreased from 68.6 +/- 6.4 ng/ml in control rats to 21.2 +/- 0.6 ng/ml in thyroidectomized rats. These findings indicate that TRH and SRIF releases from the hypothalamus are detectable by microdialysis method, and directly show the increase in TRH secretion and the decrease in SRIF secretion from hypothalamus in the hypothyroid state.

Animals↗
PubMed1997

Appearance of TSH receptor antibody and hyperthyroidism associated with metastatic thyroid cancer after total thyroidectomy.

We report here on a patient who was diagnosed with follicular carcinoma in 1985, and who was treated with total thyroidectomy. Two years later, when metastasis was found in his neck lesion, lung, pelvis and right femur, the patient received 131I treatment. Six years after receiving 131I treatment, the patient presented with hyperthyroidism. Whole-body scan with 131I revealed functioning metastasis in his right femur and pelvis. There was no hot spot in the neck region, confirming that no thyroid tissue remained. Blood panels revealed an increase in both TSH binding inhibitory immunoglobulin (TBII. 36.2%; normal. -10 approximately 10%) and thyroid stimulating antibody (TSAb, 176%; normal, less than 145%). Treatment with antithyroid drugs, dexamethasone and radioisotope therapy rapidly resolved his hyperthyroidism. Thyrotoxicosis and positive TRAb occurred in the absence of thyroid tissue, and many years after the completion of R1 therapy. The overproduction of thyroid hormone can therefore only be attributed to some mechanism of activity in the metastatic tumor tissue.

Adenocarcinoma, Follicular↗
PubMed2001

Malignant hyperthermia in a patient with Graves' disease during subtotal thyroidectomy.

We report the case of a 31-year-old man with Graves' disease who manifested malignant hyperthermia during subtotal thyroidectomy. His past medical history and family history were unremarkable. Before surgery, his condition was well controlled with propylthiouracil, beta-adrenergic blocker and iodine. During the operation, anesthesia was induced by intravenous injection of vecuronium and thiopental, followed by suxamethonium for endotracheal intubation. Anesthesia was maintained with nitrous oxide and sevoflurane. One hour after induction of anesthesia, his end tidal carbon dioxide concentration (ET(CO2)) increased from 40 to 50 mmHg, heart rate increased from 90 to 100 beats per min and body temperature began to rise at a rate of 0.3 degrees C per 15 min. Suspecting thyroid storm, propranolol 0.4 mg and methylprednisolone 1,500 mg were administered, which, however, had little effect. Despite the lack of muscular rigidity, the diagnosis of malignant hyperthermia was made based on respiratory acidosis. Sevoflurane was discontinued and dantrolene was given by intravenous bolus. Soon after the treatment, ET(CO2), heart rate and body temperature started to fall to normal levels. His laboratory findings showed abnormally elevated serum creatine phosphokinase and myoglobin but normal thyroid hormone levels. Since dantrolene is efficacious in thyrotoxic crisis and malignant hyperthermia, an immediate intravenous administration of dantrolene should be considered when a hypermetabolic state occurs during anesthesia in surgical treatment for a patient with Graves' disease.

Acidosis, Respiratory↗