Case Report of an Autism Patient Who was Diagnosed as Having Basedow’s Disease Because of Tachycardia during General Anesthesia

Abstract

  A 7-year-old girl with autism was scheduled to undergo dental treatment under general anesthesia. A preoperative electrocardiogram showed sinus tachycardia (143 beats/min). The patient was underweight (BMI : 13.9), and she did not have goiter or exophthalmos. Anesthesia was induced with oxygen, nitrous oxide and sevoflurane, and nasotracheal intubation was facilitated with intravenous rocuronium bromide. Although a sufficient anesthesia depth was maintained with nitrous oxide and sevoflurane, hyperthyroidism was suspected because of ongoing tachycardia (around 140 beats/min). Blood samples were thus obtained to measure the serum thyroid hormone level. Her heart rate was controlled at 110 beats/min using 0.2 mg of propranolol hydrochloride administered twice during the operation. Except for the tachycardia, both the dental treatment and the general anesthesia were completed uneventfully. Blood tests performed during the operation showed a T₃ level of 510 μg/dl (standard value : 70-176 μg/dl), a T₄ level of 27.8 ng/dl (standard value ; 4.8-10.5 ng/dl), and a TSH level of less than 0.1 μU/ml (0.53-5.16 μU/ml), confirming a diagnosis of hyperthyroidism. The patient was diagnosed as having Basedow’s Disease based on a TSH-TSAb (thyroid stimulating hormone-thyrotropin receptor antibody) level of 2,292% (less than 120%), a euthyroid status has since been maintained using thiamazole (20 mg/day).