From the Research
For a 50-year-old female with hyperthyroidism and diabetes to be fit for major surgery, her TSH should ideally be within normal range (0.4-4.0 mIU/L), though mild abnormalities may be acceptable depending on clinical stability, as suggested by the most recent guidelines 1. Her HbA1c should be below 8.0% (ideally closer to 7.0%), and her random blood sugar (RBS) should be maintained between 140-180 mg/dL perioperatively. These targets balance surgical risk with realistic glycemic control. Preoperative optimization should begin 2-3 months before elective surgery, with more frequent monitoring of thyroid function and blood glucose. Hyperthyroidism should be controlled with appropriate medications (methimazole, propylthiouracil, or beta-blockers) to prevent thyroid storm during surgery, while diabetes management may require adjustment of oral medications or insulin regimens, as discussed in 2. Poorly controlled hyperthyroidism increases risks of cardiac complications, while uncontrolled diabetes can lead to poor wound healing, increased infection risk, and metabolic derangements. The anesthesiologist and surgeon should be informed of both conditions, and the patient may need endocrinology consultation before surgery for optimal management, as recommended by 3. Key considerations include:
- Monitoring and controlling thyroid function to prevent thyroid storm
- Optimizing blood glucose levels to minimize surgical risks
- Collaborative management between endocrinology, surgery, and anesthesiology teams
- Patient education on the importance of preoperative optimization and postoperative care. The association between thyroid dysfunction and diabetes mellitus is well-established, with several studies documenting the increased prevalence of thyroid disorders in patients with diabetes mellitus and vice versa, as reviewed in 2. Therefore, careful management of both conditions is crucial to ensure the best possible outcomes for the patient. In terms of specific management strategies, the use of antithyroid medications, radioactive iodine, or surgery may be considered for hyperthyroidism, as discussed in 4 and 5. For diabetes management, adjustments to oral medications or insulin regimens may be necessary to achieve optimal glycemic control, as suggested by 2. Ultimately, the goal is to minimize the risks associated with both hyperthyroidism and diabetes, while also ensuring the best possible outcomes for the patient undergoing major surgery.