Perioperative management of the thyrotoxic patient

Endocrinology and Metabolism Clinics of North America
Roy W Langley, Henry B Burch


Preoperative thyrotoxicosis is a potentially life-threatening condition that requires medical intervention before surgery. Most patients are undergoing thyroidectomy for persistent thyrotoxicosis, usually Graves' disease, either having contraindications to or failing medical therapy. Fewer patients are undergoing nonthyroidal surgery that is likely urgent or emergent. The choice of treatment depends on the time available for preoperative preparation, the severity of the thyrotoxicosis, and the impact of any current or previous therapies. Generally treatment is directed at a combination of targets in the thyroid hormone synthetic, secretory, and peripheral pathway with concurrent treatment to correct any decompensation of normal homeostatic mechanisms. Thionamides are the preferred initial treatment unless contraindicated, but do require several weeks to render a patient euthyroid. beta-Blockers should always be used unless absolutely contraindicated because they improve thyrotoxic symptoms especially of the cardiovascular system. Other agents including iodine and steroids can be used if rapid preparation is required or more severe thyrotoxicosis is present. The goal of therapy is to render the patient as close as possible to cl...Continue Reading


Dec 1, 1976·The Journal of Clinical Endocrinology and Metabolism·A D ToftG P Lidgard
Feb 3, 1977·The New England Journal of Medicine·M ErikssonP O Kohler
Jun 1, 1977·The Journal of Clinical Endocrinology and Metabolism·P CoulombeP Walker
Jan 1, 1991·Thyroid : Official Journal of the American Thyroid Association·L WartofskyM Izumi
Jun 1, 1990·The Journal of Clinical Endocrinology and Metabolism·B SolomonL Wartofsky
Nov 1, 1991·Clinical Endocrinology·A BaezaG Pineda
May 1, 1989·Anaesthesia·H R VijayakumarJ J Ferrara
Aug 1, 1989·Anesthesiology·A C Thorne, R F Bedford
Jan 1, 1985·The British Journal of Surgery·J H MarigoldD N Croft
Nov 16, 1974·Lancet·J H LazarusG M Owen
May 17, 1969·Lancet·R G ShanksD A Montgomery
Jun 1, 1973·Annals of Surgery·T C LeeJ J Canary
Jan 1, 1970·The Journal of Clinical Investigation·L WartofskyS H Ingbar
Mar 1, 1967·Archives of Surgery·T S HarrisonW J Weber
Dec 1, 1982·The American Journal of Medicine·D S CooperE C Ridgway
Jan 1, 1982·The Journal of Clinical Endocrinology and Metabolism·N NabilJ M Amatruda
Jun 1, 1982·Annals of Surgery·T C LeeJ J Canary
Apr 1, 1981·Annals of Internal Medicine·J FeelyJ Crooks
Oct 1, 1995·Thyroid : Official Journal of the American Thyroid Association·S C YeungA Balasubramanyam
Nov 25, 1998·Thyroid : Official Journal of the American Thyroid Association·H B BurchC D Shriver
Jun 24, 2000·World Journal of Surgery·T OkamotoT Obara
Jun 30, 2000·Endocrinology and Metabolism Clinics of North America·O Alsanea, O H Clark
Dec 29, 1960·The New England Journal of Medicine·D G FRIEND

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