5 Clinical problems_PASTA.qxp_-

The Ehlers-Danlos syndrome (EDS) is a genetic disorder with autosomal dominant transmission that gives laxity in the ligaments, heart valve defects and impaired muscle contractility (1). To further complicate the picture there is a dysregulation of the autonomic nervous system (2). We report a case of a patient of 57 years old affected by EDS associated with a serious drug intolerance (Multiple Chemical Sensitivity MSC), candidate to total thyroidectomy for multinodular goiter disease, partially immersed in the upper left anterior mediastinum, with deviation and compression of the laryngotracheal axis. We found several problems, and we tried to find effective solutions for the management of the patient during the whole peri-operative process, from a clinical, pharmacological and also from a surgical point of view.