Delayed recovery from general anaesthesia following thyroidectomy: a "near miss"

Thyroid storm is an endocrine emergency which carries a high mortality. The spectrum of emergencies can vary from an impending storm to a thyroid crisis depending upon the degree of systemic decompensation. It is a clinical diagnosis which can be supported by biochemical investigations. In the perioperative setting a multitude of factors can act as potential triggers for a patient to develop a thyroid storm. However subtle signs of an “impending storm” can be masked by other co-morbid factors which befits the phrase “calm before a storm”. There are a number of case reports in the literature on delayed recovery in hypothyroid patients undergoing general anaesthesia for various procedures. However, there were no reported cases of delayed recovery among patients with hyperthyroidism following surgery secondary to an impending storm. We report a case of a 48- year old man who underwent a total thyroidectomy combined with a herniorrhaphy and a hydrocelectomy and had a delayed recovery from general anaesthesia due to an impending thyroid storm, which could have resulted in a catastrophic postoperative period.