Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

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. Thus, a significant number of patients who are undergoing surgery may have concomitant thyroid disease. Although most patients with well-compensated thyroid disease do not need special consideration prior to surgery, patients who have a newly diagnosed thyroid disorder around the time of surgery require a discussion of the risks and benefits of proceeding with surgery.

The issues surrounding thyroid disease in patients undergoing nonthyroid surgery are discussed here. The management of patients with hyperthyroidism undergoing thyroid surgery is reviewed separately. (See "Surgical management of hyperthyroidism", section on 'Preoperative preparation'.)


Despite the relatively high prevalence of thyroid disease in the general population, we believe there is no need to screen for thyroid disease during the preoperative medical consultation. (See "Preoperative medical evaluation of the adult healthy patient".)

However, if the history and physical examination are suggestive of thyroid disease, it is reasonable to try to make the diagnosis since it can have effects upon perioperative management. (See "Diagnosis of hyperthyroidism" and "Diagnosis of and screening for hypothyroidism in nonpregnant adults".)

For patients with known thyroid disease taking thyroid medication, monitoring of thyroid function on at least an annual basis is part of routine care. Adjustments in dosing are made as needed to maintain euthyroidism. In these patients with well-compensated thyroid disease, we and others believe that additional testing prior to surgery is unnecessary, as long as the patient is on a stable dose of medication and euthyroidism was documented within the past three to six months. (See "Treatment of primary hypothyroidism in adults", section on 'Dose and monitoring'.)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jun 21, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Stathatos N, Wartofsky L. Perioperative management of patients with hypothyroidism. Endocrinol Metab Clin North Am 2003; 32:503.
  2. Weinberg AD, Brennan MD, Gorman CA, et al. Outcome of anesthesia and surgery in hypothyroid patients. Arch Intern Med 1983; 143:893.
  3. Bennett-Guerrero E, Kramer DC, Schwinn DA. Effect of chronic and acute thyroid hormone reduction on perioperative outcome. Anesth Analg 1997; 85:30.
  4. Park YJ, Yoon JW, Kim KI, et al. Subclinical hypothyroidism might increase the risk of transient atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg 2009; 87:1846.
  5. Sherman SI, Ladenson PW. Percutaneous transluminal coronary angioplasty in hypothyroidism. Am J Med 1991; 90:367.
  6. Ladenson PW, Levin AA, Ridgway EC, Daniels GH. Complications of surgery in hypothyroid patients. Am J Med 1984; 77:261.
  7. Drucker DJ, Burrow GN. Cardiovascular surgery in the hypothyroid patient. Arch Intern Med 1985; 145:1585.
  8. Abbott TR. Anaesthesia in untreated myxoedema. Report of two cases. Br J Anaesth 1967; 39:510.
  9. Kim JM, Hackman L. Anesthesia for untreated hypothyroidism: report of three cases. Anesth Analg 1977; 56:299.
  10. Appoo JJ, Morin JF. Severe cerebral and cardiac dysfunction associated with thyroid decompensation after cardiac operations. J Thorac Cardiovasc Surg 1997; 114:496.
  11. CATZ B, RUSSELL S. Myxedema, shock and coma. Seven survival cases. Arch Intern Med 1961; 108:407.
  13. Ragaller M, Quintel M, Bender HJ, Albrecht DM. [Myxedema coma as a rare postoperative complication]. Anaesthesist 1993; 42:179.
  14. Myerowitz PD, Kamienski RW, Swanson DK, et al. Diagnosis and management of the hypothyroid patient with chest pain. J Thorac Cardiovasc Surg 1983; 86:57.
  15. Fliers E, Bianco AC, Langouche L, Boelen A. Thyroid function in critically ill patients. Lancet Diabetes Endocrinol 2015; 3:816.
  16. Chopra IJ. Clinical review 86: Euthyroid sick syndrome: is it a misnomer? J Clin Endocrinol Metab 1997; 82:329.
  17. Frost L, Vestergaard P, Mosekilde L. Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study. Arch Intern Med 2004; 164:1675.
  18. Woeber KA. Thyrotoxicosis and the heart. N Engl J Med 1992; 327:94.
  19. Langley RW, Burch HB. Perioperative management of the thyrotoxic patient. Endocrinol Metab Clin North Am 2003; 32:519.
  20. Geffner DL, Hershman JM. Beta-adrenergic blockade for the treatment of hyperthyroidism. Am J Med 1992; 93:61.
  21. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am 1993; 22:263.
  22. Das G, Krieger M. Treatment of thyrotoxic storm with intravenous administration of propranolol. Ann Intern Med 1969; 70:985.
  23. Fujita Y, Shimizu T, Matsumoto A, Aoki M. [Perioperative and postoperative management of two patients with uncontrolled hyperthyroidism using short acting beta blocker, landiolol]. Masui 2008; 57:1143.
  24. Mizunoya K, Maruyama T, Fujii T, et al. [Anesthetic and perioperative management of a patient with uncontrolled thyrotoxicosis undergoing coronary artery bypass grafting surgery]. Masui 2013; 62:1214.
  25. Adlerberth A, Stenström G, Hasselgren PO. The selective beta 1-blocking agent metoprolol compared with antithyroid drug and thyroxine as preoperative treatment of patients with hyperthyroidism. Results from a prospective, randomized study. Ann Surg 1987; 205:182.
  26. Vickers P, Garg KM, Arya R, et al. The role of selective beta 1-blocker in the preoperative preparation of thyrotoxicosis: a comparative study with propranolol. Int Surg 1990; 75:179.
  27. Feek CM, Sawers JS, Irvine WJ, et al. Combination of potassium iodide and propranolol in preparation of patients with Graves' disease for thyroid surgery. N Engl J Med 1980; 302:883.
  28. Eriksson M, Rubenfeld S, Garber AJ, Kohler PO. Propranolol does not prevent thyroid storm. N Engl J Med 1977; 296:263.