Question 1

Q: A patient underwent thyroidectomy for hyperthyroidism. Two days later, the patient presented with features of thyroid storm. What is the most likely cause?

Inadequate preoperative preparation. ### Explanation **1. Why "Inadequate Preoperative Preparation" is correct:** The primary goal of preoperative management in hyperthyroidism (especially Graves' disease) is to achieve a **euthyroid state** before surgery. If a patient is not properly prepared with antithyroid drugs (like Carbimazole or Methimazole) and Beta-blockers, the thyroid gland remains hyperactive. Surgical manipulation of an overactive gland triggers a massive release of stored thyroid hormones (T3 and T4) into the circulation. This sudden surge precipitates a **Thyroid Storm**, a life-threatening hypermetabolic state characterized by hyperpyrexia, tachycardia, and cardiac failure. **2. Why other options are incorrect:** * **Poor antibiotic coverage:** While this increases the risk of surgical site infection or sepsis, it does not directly trigger the hormonal surge characteristic of a thyroid storm. * **Rough handling during surgery:** While excessive manipulation can exacerbate hormone release, it rarely causes a storm if the patient was adequately prepared and euthyroid. Preparation is the definitive preventive factor. * **Removal of parathyroid:** This leads to **hypocalcemia** (tetany, Chvostek’s/Trousseau’s signs), not thyroid storm. **3. Clinical Pearls for NEET-PG:** * **Lugol’s Iodine:** Often given 10 days preoperatively to decrease the **vascularity** and friability of the gland (Plummer’s effect). * **Drug of choice for Thyroid Storm:** **Propylthiouracil (PTU)** is preferred over Methimazole because it also inhibits the peripheral conversion of T4 to T3. * **Beta-blockers (Propranolol):** Essential to control adrenergic symptoms and also help inhibit peripheral T4 to T3 conversion. * **Burch-Wartofsky Point Scale:** Used clinically to diagnose and grade the severity of a thyroid storm. [Practice more Surgery PYQs on OnCourse]

Question

A patient underwent thyroidectomy for hyperthyroidism. Two days later, the patient presented with features of thyroid storm. What is the most likely cause?

Accepted Answer

Inadequate preoperative preparation

Answer

Poor antibiotic coverage

Answer

Rough handling during surgery

Answer

Removal of parathyroid

INI-CET 2015 — Surgery