{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T01:10:21Z","timestamp":1742865021097,"version":"3.40.2"},"reference-count":18,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>General anesthesia in patients with undiagnosed hypothyroidism can lead to neurological, pulmonary, and cardiovascular complications. We report a case of hypothyroidism in a patient with treatment-resistant depression detected intraoperatively based on multiple clinical findings. A 49-year-old woman was scheduled for orthognathic surgery for mandibular prognathism. She had depression since the age of 36 and was taking multiple psychotropic medications. After induction, she had persistent hypotension, bradycardia, low bispectral index, and hypothermia that were resistant to treatment. After ruling out common causes and reducing the anesthetic agents, blood tests were performed intraoperatively to examine thyroid function which revealed hypothyroidism. No delayed recovery or postoperative abnormalities were observed. Lithium carbonate was identified as the most likely cause of hypothyroidism by an endocrinologist. Given the overlap in signs and symptoms, hypothyroidism may be overlooked in a patient with depression. The possibility of hypothyroidism should be considered especially noted in patients taking lithium carbonate. Furthermore, suspicion of hypothyroidism based on clinical findings during anesthesia may prompt the need for further evaluation.<\/jats:p>","DOI":"10.2344\/23-0031","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:02:28Z","timestamp":1742860948000},"page":"28-32","source":"Crossref","is-referenced-by-count":0,"title":["Hypothyroidism Revealed During General Anesthesia in a Patient With Treatment-Resistant Depression: A Case Report"],"prefix":"10.2344","volume":"72","author":[{"given":"Makiko","family":"Shibuya","sequence":"first","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuya","family":"Sakurai","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukifumi","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takayuki","family":"Hojo","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saori","family":"Tada","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiaki","family":"Fujisawa","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanta","family":"Kido","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1191","reference":[{"key":"i1878-7177-72-1-28-b01","series-title":"Korean J Anesthesiol","first-page":"398","article-title":"Respiratory insufficiency in a patient with preeclamsia and hypothyroidism developed after general anesthesia for emergency cesarean section: a case report","volume":"57","author":"Kim SS,","year":"2009","unstructured":"Kim SS,\nKang MS,\nJung HS. Respiratory insufficiency in a patient with preeclamsia and hypothyroidism developed after general anesthesia for emergency cesarean section: a case report. Korean J Anesthesiol. 2009;57:398\u2013402."},{"key":"i1878-7177-72-1-28-b02","series-title":"Depress Res Treat","first-page":"4176825","article-title":"A review of the conceptualisation and risk factors associated with treatment-resistant depression","volume":"2017","author":"Murphy JA,","year":"2017","unstructured":"Murphy JA,\nSarris J,\nByrne GJ. A review of the conceptualisation and risk factors associated with treatment-resistant depression. Depress Res Treat. 2017;2017:4176825."},{"key":"i1878-7177-72-1-28-b03","series-title":"Br J Anaesth","first-page":"i95","article-title":"Response of bispectral index to neuromuscular block in awake volunteers","volume":"115","author":"Schuller P,","year":"2015","unstructured":"Schuller P,\nNewell S,\nStrickland P,\nBarry J. Response of bispectral index to neuromuscular block in awake volunteers. Br J Anaesth. 2015;115:i95\u2013i103."},{"key":"i1878-7177-72-1-28-b04","series-title":"J Clin Anesth","first-page":"301","article-title":"Bispectral analysis during cardiopulmonary bypass: the effect of hypothermia on the hypnotic state","volume":"13","author":"Mathew JP,","year":"2001","unstructured":"Mathew JP,\nWeatherwax KJ,\nEast CJ,\nWhite WD,\nReves J. Bispectral analysis during cardiopulmonary bypass: the effect of hypothermia on the hypnotic state. J Clin Anesth. 2001;13:301\u2013305."},{"key":"i1878-7177-72-1-28-b05","series-title":"J Clin Anesth","first-page":"340","article-title":"Impact of deep hypothermic circulatory arrest on the BIS index","volume":"22","author":"Ziegeler S,","year":"2010","unstructured":"Ziegeler S,\nBuchinger H,\nWilhelm W,\nLarsen R,\nKreuer S. Impact of deep hypothermic circulatory arrest on the BIS index. J Clin Anesth. 2010;22:340\u2013345. 20650380"},{"key":"i1878-7177-72-1-28-b06","series-title":"J Anaesthesiol Clin Pharmacol","first-page":"306","article-title":"Temperature management under general anesthesia: compulsion or option","volume":"33","author":"Bindu B,","year":"2017","unstructured":"Bindu B,\nBindra A,\nRath G. Temperature management under general anesthesia: compulsion or option. J Anaesthesiol Clin Pharmacol. 2017;33:306."},{"key":"i1878-7177-72-1-28-b07","article-title":"Surveillance of chronic disease risk factors: country level data and comparable estimates","author":"World Health Organization.","year":"2005","unstructured":"World Health Organization. Surveillance of chronic disease risk factors: country level data and comparable estimates. 2005."},{"key":"i1878-7177-72-1-28-b08","series-title":"J Epidemiol","first-page":"117","article-title":"Clinical characteristics and outcomes of myxedema coma: analysis of a national inpatient database in Japan","volume":"27","author":"Ono Y,","year":"2017","unstructured":"Ono Y,\nOno S,\nYasunaga H,\nMatsui H,\nFushimi K,\nTanaka Y. Clinical characteristics and outcomes of myxedema coma: analysis of a national inpatient database in Japan. J Epidemiol. 2017;27:117\u2013122. 28142035"},{"key":"i1878-7177-72-1-28-b09","series-title":"Auris Nasus Larynx","first-page":"605","article-title":"Postoperative myxedema coma in patients undergoing major surgery: case series","volume":"46","author":"Yafit D,","year":"2019","unstructured":"Yafit D,\nCarmel-Neiderman NN,\nLevy N, et al. Postoperative myxedema coma in patients undergoing major surgery: case series. Auris Nasus Larynx. 2019;46:605\u2013608."},{"key":"i1878-7177-72-1-28-b10","series-title":"Drug Saf","first-page":"215","article-title":"Drug-induced endocrine and metabolic disorders","volume":"30","author":"Ma RC,","year":"2007","unstructured":"Ma RC,\nKong AP,\nChan N,\nTong PC,\nChan JC. Drug-induced endocrine and metabolic disorders. Drug Saf. 2007;30:215\u2013245. 17343430"},{"key":"i1878-7177-72-1-28-b11","series-title":"Best Pract Res Clin Endocrinol Metab","first-page":"793","article-title":"Drugs that suppress TSH or cause central hypothyroidism","volume":"23","author":"Haugen BR.","year":"2009","unstructured":"Haugen BR. Drugs that suppress TSH or cause central hypothyroidism. Best Pract Res Clin Endocrinol Metab. 2009;23:793\u2013800. 19942154"},{"key":"i1878-7177-72-1-28-b12","series-title":"Int J Mol Sci","first-page":"13070","article-title":"Augmentative pharmacological strategies in treatment-resistant major depression: a comprehensive review","volume":"22","author":"Caldiroli A,","year":"2021","unstructured":"Caldiroli A,\nCapuzzi E,\nTagliabue I, et al. Augmentative pharmacological strategies in treatment-resistant major depression: a comprehensive review. Int J Mol Sci. 2021;22:13070."},{"key":"i1878-7177-72-1-28-b13","series-title":"J Affect Disord","first-page":"385","article-title":"Augmentation strategies for treatment resistant major depression: a systematic review and network meta-analysis","volume":"302","author":"Nu\u00f1ez NA,","year":"2022","unstructured":"Nu\u00f1ez NA,\nJoseph B,\nPahwa M, et al. Augmentation strategies for treatment resistant major depression: a systematic review and network meta-analysis. J Affect Disord. 2022;302:385\u2013400. 34986373"},{"key":"i1878-7177-72-1-28-b14","series-title":"Lancet","first-page":"461","article-title":"Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory data","volume":"386","author":"Shine B,","year":"2015","unstructured":"Shine B,\nMcKnight RF,\nLeaver L,\nGeddes JR. Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory data. Lancet. 2015;386:461\u2013468. 26003379"},{"key":"i1878-7177-72-1-28-b15","series-title":"Revista Colombiana de Psiquiatr\u00eda (English ed)","first-page":"35","article-title":"Endocrinological disorders related to the medical use of lithium. A narrative review","volume":"48","author":"Garc\u00eda-Maldonado G,","year":"2019","unstructured":"Garc\u00eda-Maldonado G,\nde Jes\u00fas,\nCastro-Garc\u00eda R. Endocrinological disorders related to the medical use of lithium. A narrative review. 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Br J Psychiatry. 1999;175:336\u2013339."},{"key":"i1878-7177-72-1-28-b18","series-title":"Brain Sci","first-page":"133","article-title":"Long-term lithium therapy and thyroid disorders in bipolar disorder: a historical cohort study","volume":"13","author":"Joseph B,","year":"2023","unstructured":"Joseph B,\nNunez NA,\nPazdernik V, et al. Long-term lithium therapy and thyroid disorders in bipolar disorder: a historical cohort study. Brain Sci. 2023;13:133."}],"container-title":["Anesthesia Progress"],"original-title":[],"link":[{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/view\/journals\/anpr\/72\/1\/article-p28.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/downloadpdf\/journals\/anpr\/72\/1\/article-p28.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/downloadpdf\/journals\/anpr\/72\/1\/article-p28.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:03:52Z","timestamp":1742861032000},"score":1,"resource":{"primary":{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/view\/journals\/anpr\/72\/1\/article-p28.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":18,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.2344\/23-0031","relation":{},"ISSN":["1878-7177","0003-3006"],"issn-type":[{"value":"1878-7177","type":"electronic"},{"value":"0003-3006","type":"print"}],"subject":[],"published":{"date-parts":[[2025,3]]}}}