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Nonthyroid surgery in the patient with thyroid disease

Ellen F Manzullo, MD, FACP
Douglas S Ross, MD
Section Editor
David S Cooper, MD
Deputy Editor
Jean E Mulder, MD


Thyroid disease is common; the prevalence is higher in women and with increasing age [1,2]. In a cross-sectional study of participants in a health fair, the proportion of subjects with an elevated thyroid-stimulating hormone (TSH) level increased with age and ranged from 4 to 21 percent in women and 3 to 16 percent in men [3]. These findings suggest that a significant number of patients who are undergoing surgery may have concomitant thyroid disease.

On the other hand, patients who are seriously ill often have abnormal thyroid function tests that may or may not be clinically significant [4]. These patients need to be distinguished from those who have clinically significant thyroid dysfunction.

The issues surrounding thyroid disease in patients undergoing nonthyroid surgery are discussed here. A brief review of thyroid function in seriously ill patients is presented first, followed by specific issues in patients with hypothyroidism and hyperthyroidism. It should be noted that most patients who have well compensated thyroid disease do not need special consideration prior to surgery. The majority of the discussion applies to patients who have a newly diagnosed thyroid disorder around the time of surgery.

The management of patients with hyperthyroidism undergoing thyroid surgery is reviewed separately. (See "Surgical management of hyperthyroidism", section on 'Preoperative preparation'.)


Assessment of thyroid function in hospitalized or seriously ill patients can be difficult. The majority of hospitalized patients have a low serum triiodothyronine (T3) concentration; from 15 to 20 percent of hospitalized patients and up to 50 percent of patients in intensive care units have low serum thyroxine (T4) concentrations (low T4 syndrome). The serum thyroid-stimulating hormone (TSH) concentration may also be low (figure 1). Abnormalities in the T3 concentration have been noted in patients undergoing elective or emergency surgery, independent of the type of anesthesia.


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Literature review current through: Mar 2017. | This topic last updated: Apr 10, 2015.
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