Document Type
Poster
Original Publication Date
2025
Journal/Book/Conference Title
Society for Perioperative Assessment and Quality Improvement
Date of Submission
March 2025
Abstract
CASE PRESENTATION: J.W. was seen by the PACE (Preoperative Assessment, Communication and Education) Center prior to a mediastinal mass resection. Medical history includes well-controlled rheumatoid arthritis, anxiety and a recent diagnosis of hyperthyroidism. Labs were significant for TSH DISCUSSION: Untreated GD is rarely correlated with thymic hyperplasia; however the pathogenesis is not well understood. Regardless of the association, contextualization of this patient's history and lab values prompted the provider to seek specialized management. This finding was then communicated with the surgical team, who often rely on PACE providers to screen patients with the ultimate goal of risk reduction and optimization of clinical outcomes. Unfortunately, there is minimal literature documenting evidence of patients who are poorly optimized prior to surgery.
CONCLUSIONS: Preoperative screening from a provider with high clinical acumen and a high index of suspicion resulted in appropriate referral and timely intervention for this patient with an unoptimized comorbidity. An appointment with PACE prevented this patient from undergoing surgery and developing a life threatening complication (Thyroid Storm) from an elective procedure. Despite a recent shift against preoperative screening, this case report highlights the importance of a comprehensive evaluation and multidisciplinary approach ensuring appropriate standard of care and patient safety.
Recommended Citation
De Mul, N., Damstra, J., Van Dijkum, E. J. N., Fischli, S., Kalkman, C. J., Schellekens, W. M., & Immink, R. V. (2021). Risk of perioperative thyroid storm in hyperthyroid patients: a systematic review. British Journal of Anaesthesia, 127(6), 879–889. https://doi.org/10.1016/j.bja.2021.06.043 Peris, B. P., Galiana, P. A., Royo, F. J. M., & Alfaro, A. Á. M. (2023). Thymic Hyperplasia and Graves Disease: a nonincidental association. JCEM Case Reports, 1(5). https://doi.org/10.1210/jcemcr/luad083 Ogawa, N., Yomota, M., Notsu, M., & Kanasaki, K. (2023). Progressive thymic hyperplasia with Graves’ Disease: a case report. Cureus. https://doi.org/10.7759/cureus.43950 Wan, W. Y., & Colburn, J. A. (2020). Massive thymic hyperplasia secondary to graves disease. AACE Clinical Case Reports, 6(3), e144–e146. https://doi.org/10.4158/accr-2019-0423 Haider, U., Richards, P., & Gianoukakis, A. G. (2017). Thymic Hyperplasia Associated with Graves’ Disease: Pathophysiology and Proposed Management Algorithm. Thyroid, 27(8), 994–1000. https://doi.org/10.1089/thy.2017.0086 Hori, Y., Nakayama, A., & Sakamoto, A. (2016). Surgery cancellations after entering the operating room. JA Clinical Reports, 2(1). https://doi.org/10.1186/s40981-016-0066-1
Is Part Of
VCU Anesthesiology Publications
