Clinical suspicion of preexisting hypothyroidism presenting with uncommon features in a patient with extra dural hematoma of brain and further management strategy: A surgical challenge in emergency hours

Abstract

Hypothyroidism can be well-diagnosed with classical clinical signs, but not always. Extradural hematomas (EDH) are usually characterized by a rapidly progressing clinical course within few hours necessitating early surgical intervention. Surgical management of EDH with hypothyroidism is really a challenging issue for treating surgeon in the emergency hour, as the ultimate outcome depends on the further consequences of EDH and the ongoing metabolic stress due to hypothyroidism. A 53-year-old woman presented to us with a h/o head injury with dry, coarse, pale skin, and sunken face but without goiter with computed tomography scan of brain suggestive of right temporoparietal EDH. Clinical suspicion to be a case of hypothyroidism from these uncommon features was confirmed upon thyroid function test (TFT). Without delay, we planned for emergency craniotomy and evacuated the extradural blood clots ↓ local anesthesia avoiding the bad impact of regional anesthesia over hypothyroidism. Postoperatively, we supplemented levothyroxine through Ryle's tube, thus surviving the patient of EDH as well as hypothyroidism. Hence, clinical suspicion of some common comorbidity (e.g. hypothyroidism) can enlighten the treating surgeon to plan for further management strategy as reflected in our case.