Thyroid problems, surgery before anesthesia to adjust thyroid hormone levels

Thyroid problems, surgery before anesthesia to adjust thyroid hormone levels – New Express by Chen Sitao, Zhang Qiuxia and Wang Si on August 28, 2018

New Express News reporter Chen Sitao correspondents Zhang Qiuxia and Wang Si reported: before the operation, anesthesiologists routinely visit patients. Some patients seem to be indifferent and slightly swollen. They usually don’t like activities. If the patient’s thyroid hormone is significantly reduced, the general anesthesiologist will advise the patient to ask the endocrinologist to adjust the thyroid hormone level before surgery. Some patients wonder why they can’t have an operation immediately. Professor Ma Wuhua, director of Anesthesiology Department of the First Affiliated Hospital of Guangzhou University of traditional Chinese medicine, points out that too much or too little thyroid hormone in the body is a disease. Whether hyperthyroidism or hypothyroidism, it will increase the risk of operation and anesthesia.

Hyperthyroidism and surgical risk

The thyroid gland is located about 2-3cm below the “laryngeal knot” and can move up and down with it when swallowing. The hormone it secretes is called thyroid hormone. Its main function is to promote metabolism, promote growth and development, improve the excitability of the central nervous system, strengthen and regulate the role of other hormones and speed up heart rate, strengthen cardiac contractility and increase cardiac output.

When the synthesis of thyroid gland releases too much thyroid hormone, resulting in hyperthyroidism and sympathetic excitement, it is hyperthyroidism, which we usually call “hyperthyroidism”. Patients may eat more, but do not gain weight, especially afraid of heat, heart beat fast, flustered, irritable, insomnia and anxiety, some people may have eye-catching symptoms.

If the patients with severe hyperthyroidism are not treated or treated insufficiently, and encounter some stimulating factors, such as surgery, anesthesia, infection and mental stimulation, they may have thyroid crisis, also known as hyperthyroidism crisis. The symptoms include high fever, sweating, tachycardia, irritability, anxiety, delirium, nausea, vomiting and diarrhea. Severe patients may have heart failure, shock and coma. The mortality is more than 20%.

Hypothyroidism and surgical risk

Hypothyroidism refers to the decrease of thyroid hormone synthesis and secretion, or the decrease of body metabolism caused by insufficient physiological effect after thyroid surgery. The patient is particularly afraid of cold, pale, indifferent to everything, anorexia but weight gain, swollen cheeks, slow heartbeat, sleepiness.

Severe hypothyroidism patients, after the application of anesthetics, may induce hypothyroidism crisis, also known as mucinous water coma. The symptoms included lethargy, coma, hypothermia, bradycardia, hypotension, hypoglycemia and hypoxemia. In the past, the mortality rate was as high as 85%. Recently, due to early detection and active treatment, the mortality rate has decreased, but it is still as high as 25%.

Therefore, patients with thyroid diseases need to review thyroid function before anesthesia, regulate thyroid hormone levels, and reduce the risk of surgery and anesthesia.

Editor: Nancy


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