Anaesthetic Challenges in Thyroidectomy for Graves’ Disease Complicated by Carbimazole-Induced Liver Failure: A Case Report

Carbimazole is a widely used antithyroid drug in the management of Graves’ disease and toxic multinodular goiter. Hepatotoxicity is a rare but potentially life-threatening complication, with an estimated incidence of 0.1-0.2%.1 Anaesthesia in patients with acute liver failure and uncontrolled thyrotoxicosis poses significant perioperative challenges, including an increased risk of thyroid storm, cardiovascular instability, and unpredictable drug pharmacokinetics. We report the successful anesthetic management of a middle-aged woman who underwent thyroidectomy under total intravenous anesthesia (TIVA) in the setting of carbimazole-induced acute liver failure and uncontrolled thyrotoxicosis.