Penatalaksanaan Intensif Badai Thyroid pada Wanita Hamil

Anesthesia management was conducted in a case of female 33 years old with G4P2A1, 35 weeks of pregnancy, type I respiratory failure, suggestive Thyroid Storm, CAP, anemia, and hypoalbuminemia. In emergency admission, patient was found dyspneic, agitated, measured BP is 117/60 mmHg, HR 153 x/min, RR 35 x/ min, temperature 37,8oC, no wheezing or rales in physical examination. From ECG evaluation was STC 148 x/min, AF RVR. According to Burch and Wartofsky scoring, obtained score is 60, from temperature (score 5), tachycardia ≥140 (score 25), AF (score 10), agitated (score 10), and pregnancy as a precipitating factor (score 10). Thyroid crisis can be diagnosed if scoring more than 45 points. The patient was intubated, and connected to mechanical ventilation, and admitted to HCU. In HCU, the patient was given supportive therapy, invasive monitoring such as CVC and parenteral nutrition. Causative therapy such as antibiotic administration, lugol, PTU, corticosteroid and propanolol were also given. During HCU admission, patient’s condition had not improved because of gravis anemia, after 3 days in HCU, patient was moved to ICU admission for 5 days, in 4th day of ICU admission, pregnancy was terminated, and in 5th day, patient was moved to maternal ward.

Dilaporkan seorang wanita 33 thn, G4P2A1, hamil 35 minggu, gagal napas tipe I, suggestive Thyroid Storm, CAP, Presbo, G4P2A1, hamil 34 minggu 5 hari, anemia, hIpoalbuminemia. Di UGD RSUP Dr. Sardjito pasien tampak sesak, kesadaran agitasi, tensi 117/60 mmHg, HR 153 kali/mnt, RR 35 kali/mnt, suhu. 37,8oC. RBK -/-, wheezing -/-, vesikuler +/+. Gambaran EKG: STC 148 kali/menit, AFRVR. berdasarkan Sistem skoring Burch dan Wartofsky didapatkan suhu 37,8oC (skor 5) adanya takikardi ≥140 kali/menit (skor 25), adanya atrial fibrilasi (skor 10), adanya kelainan system saraf yang dimulai dengan adanya agitasi (skor 10) serta adanya faktor pencetus berupa kehamilan (skor 10) sehingga jumlah skor adalah 60. Dimana skor ≥45 maka krisis tiroid dapat ditegakkan. Pasien dilakukan intubasi, nafas kendali dan ditransport ke HCU. Di HCU pasien diberikan terapi suportif berupa ventilasi mekanik, pemasangan monitor invasif berupa CVC dan nutrisi. Terapi kausatif diberikan berupa pemberian antibiotic, lugol, PTU, kortikosteroid, dan propanolol. Selama perawatan HCU kondisi pasien relatif sama, diperberat kondisi anemia gravis yang diderita pasien, 3 hari perawatan di HCU pasien dipindahkan ke ICU, perawatan di ICU kurang lebih 5 hari, pada hari ke 4 di ICU pasien dilakukan terminasi, hari ke-5 pasien pindah ke IMP.