Hyperthyroid Induced Cardiac Failure Requiring Intra-Aortic Balloon Pump during Thyroidectomy

Hyperthyroid states can negatively impact cardiac function and exacerbate cardiac failure. In cases refractory to medical management, thyroidectomy may be indicated. However, the myocardial depressive effects of inhaled anesthetics in addition to hemodynamic lability of induction, complicate operative planning. While other institutions have published their experience utilizing local anesthesia and sedation during thyroidectomy, this requires agreement with the patient to employ that strategy. We report a case of a patient with refractory hyperthyroidism and exacerbated cardiac failure who underwent thyroidectomy after intra-aortic balloon pump placement given his reluctance to proceed utilizing local anesthesia and monitored anesthesia care.