What is the perioperative management of thyroid medications?

Updated: Jan 09, 2018
  • Author: Nafisa K Kuwajerwala, MD; Chief Editor: William A Schwer, MD  more...
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Advise patients using a replacement thyroxine to take the medication in the perioperative period. Start the drug postoperatively as soon as the patient is on oral liquids. One can withhold this medication for as long as a week because of its long half-life (ie, 7 d).

Monitoring for hypothermia, hypoventilation, hyponatremia, and hypoglycemia is mandatory. Do not defer urgent surgery in a newly diagnosed patient with hypothyroidism. In patients with severe hypothyroidism, intravenous L-thyroxine, with an initial dose of 500 mcg, followed by 50-100 mcg/d, may be given. Elective surgery should be delayed in patients with symptomatic hypothyroidism.

One should also assess for pituitary-adrenal hypofunction, and treat the patient with steroids if needed. Patients with a hypothyroidism or thyrotoxicosis should be under good control prior to surgery. In a case of nonthyroid surgery, patients should receive their antithyroid drug with propranolol on the day of surgery with a sip of water. Resume postoperatively by oral or nasogastric routes within 24 hours after surgery, if possible. Patients with significant hypothyroidism requiring surgery should receive perioperative hydrocortisone for possible adrenal insufficiency.

In the case of a patient undergoing thyroidectomy for thyrotoxicosis, perioperative medication includes iodine for 10 days prior to surgery in addition to the antithyroid drug and propranolol. This reduces intraoperative bleeding from the thyroid gland. Propranolol may be administered for a few days after thyroidectomy and then discontinued.

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