How should patients with hyperthyroidism be prepared for surgery

How should patients with hyperthyroidism be prepared for surgery?

It is important to render patients euthyroid prior to surgery for hyperthyroidism to avoid perioperative thyroid storm. Antithyroid medications administered for 4 weeks prior to surgery are usually adequate. Because recovery of TSH may lag behind thyroid hormone levels, serum thyroxine (T ) and triiodothyronine (T ) levels should be used to determine adequacy of antithyroid therapy. It is recommended that patients receive saturated solution of potassium iodide (SSKI; or Lugol’s solution, 3–5 drops three times a day) for 10 days prior to surgery to decrease the vascularity of the goiter and reduce the risk of bleeding. Patients who are very symptomatic may benefit from preoperative beta-blockade. For more rapid induction of a euthyroid state, patients may also be given corticosteroids, which can return serum T and T to within the normal range in < 7 days. In cases of severe, refractory hyperthyroidism, plasmapheresis may occasionally be indicated.


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