Anesthesia for patients with thyroid disease
- William R Furman, MD
William R Furman, MD
- Professor of Anesthesiology
- Geisel School of Medicine, Dartmouth
- Amy C Robertson, MD
Amy C Robertson, MD
- Assistant Professor of Anesthesiology
- Vanderbilt University School of Medicine
Thyroid disease and thyroid surgery present specific challenges for anesthesiologists.
This topic reviews the preanesthetic evaluation, intraoperative management, and immediate postoperative care of patients with thyroid disease, including those having thyroid surgery. Preoperative medical management of patients with thyroid disease, perioperative surgical management of patients undergoing thyroid surgery, and urgent management of severe and life-threatening overt thyroid storm are reviewed separately. (See "Nonthyroid surgery in the patient with thyroid disease" and "Surgical management of hyperthyroidism" and "Initial thyroidectomy" and "Thyroid storm".)
Patients with either hyper- or hypothyroidism have associated physiologic changes that influence anesthetic care. Mechanical thyroid-related airway problems are generally limited to patients with large substernal or invasive goiters or thyroid tumors, or postoperative surgical complications that impact the airway.
Hyperthyroidism — As the degree of hyperthyroidism increases, clinical manifestations are more prominent and have a greater potential impact on anesthetic care. These physiologic changes resolve with treatment, as the patient becomes euthyroid. (See "Overview of the clinical manifestations of hyperthyroidism in adults".)
●Cardiovascular changes may lead to perioperative hemodynamic instability. Hyperthyroid patients have increased heart rate, circulating blood volume, cardiac contractility, and myocardial oxygen consumption, as well as enhanced diastolic relaxation and reduced systemic vascular resistance. Patients are also prone to arrhythmias (sinus tachycardia and atrial fibrillation), coronary spasm and ischemia, and may have cardiomyopathy in the late stages [1-9]. (See "Cardiovascular effects of hyperthyroidism".)
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- ANESTHETIC CONCERNS
- Airway problems
- PREOPERATIVE EVALUATION
- Thyroid function
- Airway evaluation
- ANESTHETIC MANAGEMENT
- Choice of anesthetic technique
- - General anesthesia
- - Local or regional anesthesia
- Intraoperative anesthetic management
- - Monitoring
- - Induction and intubation
- - Maintenance of anesthesia
- Hyperthyroid patients
- Hypothyroid patients
- - Emergence and extubation
- POSTOPERATIVE COMPLICATIONS
- Airway complications
- - Nerve injury
- - Cervical hematoma
- - Tracheomalacia
- Other complications
- - Thyroid storm
- - Hypocalcemia
- - Complications of parathyroidectomy
- SUMMARY AND RECOMMENDATIONS