A 45-year-old woman with poorly controlled Graves disease presents for thyroidectomy with a massive goiter, positional dyspnea, and subtle stridor. The question isn’t just how you’re going to secure the airway—it’s what could happen if you take away the things currently keeping it open.
In this episode of The Anesthesia Playbook, we work through the case from pre-op evaluation to the PACU. We’ll reason through the difficult airway, awake intubation, anesthetic planning, thyroid physiology, and the recognition and treatment of thyroid storm. Then, just when the case seems finished, new postoperative problems force us to rethink the differential: hoarseness, neck swelling, and stridor.
Along the way, we’ll tackle the kinds of questions that matter both in the OR and on oral boards:
Would you sedate this patient? Would you induce general anesthesia before securing the airway? How would you recognize thyroid storm—and distinguish it from malignant hyperthermia? What would you do if she developed an expanding neck hematoma after surgery?
This isn’t about memorizing a list of answers. It’s about understanding the physiology, anticipating what could happen next, and making a defensible clinical decision.
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The Anesthesia Playbook is intended for education only and does not replace clinical judgment, institutional protocols, or appropriate supervision.
