From the Research
A TSH level <0.01, indicating hyperthyroidism, does not automatically preclude someone from undergoing elective surgery, but it does require careful evaluation and management before proceeding. According to the most recent study 1, hyperthyroid patients can undergo surgery safely during the hyperthyroid phase if they are cardiovascularly stable, without an increased risk of thyroid storm or perioperative complications. However, uncontrolled hyperthyroidism increases surgical risks, including cardiac complications, hemodynamic instability, and potentially life-threatening thyroid storm.
Ideally, surgery should be postponed until the patient is biochemically euthyroid. Treatment typically involves antithyroid medications like methimazole or propylthiouracil, along with beta-blockers such as propranolol to control sympathetic symptoms. For urgent surgeries where postponement isn't possible, aggressive preoperative preparation with beta-blockers, antithyroid drugs, and possibly iodine solutions may be implemented.
Key considerations in the management of hyperthyroid patients undergoing elective surgery include:
- Evaluation of the patient's overall condition and comorbidities by a multidisciplinary team including anesthesiologists, surgeons, and endocrinologists
- Stabilization of the cardiovascular system
- Determination of the underlying cause of hyperthyroidism, which may influence management decisions
- Consultation with an endocrinologist for optimal management
- Informing the anesthesiologist about the patient's thyroid status to prepare for potential perioperative complications. As noted in 1, recent studies suggest that thyroidectomy can be safely performed during the hyperthyroid phase by experienced anesthesiologists and surgeons without precipitating thyroid storm or increasing intraoperative and postoperative complications.