Use of laryngeal mask airway in total thyroidectomy in a patient with ocular myasthenia and graves’ disease

Abstract

ABSTRACT: BACKGROUND: The association between Graves’ disease (GD) and ocular myasthenia (OM) is well known. Total thyroidectomy gives a permanent “cure” for GD and the literature reports a varying progression of myasthenia gravis (MG) in such patients after surgery. The main issue in patients with MG is the difficulties with the use of muscle relaxants during anesthesia. In the ensuing case report, a patient with OM and GD who had a total thyroidectomy under general anesthesia (GA) with laryngeal mask airway (LMA) without muscle relaxants is described. CASE REPORT: A 40-year-old man was clinically and biochemically diagnosed to have GD. Subsequently, he developed bilateral ptosis which was diagnosed as OM by a neurologist. Though his OM responded to treatment, his GD was not well controlled. He was admitted, monitored, and made euthyroid by adjusting the carbimazole dose. A decision was made to undertake total thyroidectomy for GD, with total intravenous anesthesia and Proseal® LMA without muscle relaxants following a discussion with the anesthetic team. A conventional total thyroidectomy was performed using nerve encountering, parathyroid preserving, and capsular dissection technique. The patient made an uncomplicated recovery. CONCLUSION: A technique combining total intravenous anesthesia and a LMA without muscle relaxants for thyroid surgery in a patient with MG has advantages over a standard method. The use of LMA in other thyroid surgeries must be further evaluated for future use. CLINICAL SIGNIFICANCE: Coexistence of MG and GD should be in mind when treating the patients with GD. Individualize the use of muscle relaxants in GA and best to avoid whenever possible. © The Author(s). 2019.