Basedow disease, which presents with hyperthyroidism, is an autoimmune disease induced by an autoantibody against the thyroid stimulating hormone (TSH) receptor. We report the case of a patient with Basedow disease found on thyroid crisis during mandibular osteotomy.
An 18-year-old man with skeletal mandibular protrusion was scheduled to undergo mandibular osteotomy.There was no sign of Basedow disease on preoperative examination, and we could not find any particular risks associated with the surgical procedure. Immediately after the operation began, he had hypertension, tachycardia, and hyperthermia, reaching 39℃.
Although we suspected malignant hyperthermia, characteristic findings were lacking. We therefore considered the possibility of thyroid crisis. Postoperative laboratory data showed hyperthyroidism (FT3 15.0 pg/mL, FT4 3.85 ng/dL, TSH 0.007μU/mL). Both thyroid stimulating antibody and anti-TSH receptor antibody were also positive. Therefore, Basedow disease was finally diagnosed. He was immediately treated with a β -blocker, potassium iodide preparation, and antithyroid agent. His thyroid function improved, and no further episode of thyroid crisis subsequently.
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