Perioperative Management of Patients with Hypothyroidism

Abstract

Hypothyroidism is an endocrine disorder characterized by reduced thyroid hormone production and may increase the risk of perioperative complications due to cardiovascular, respiratory, metabolic, and altered anesthetic responses. Perioperative management should therefore be tailored to the severity of hypothyroidism and the urgency of surgery. In elective surgery, optimization of thyroid function with levothyroxine and achievement of a euthyroid state are generally recommended before surgery, particularly in patients with overt or severe hypothyroidism. Anesthetic management requires careful selection and dosing of anesthetic agents, adequate hemodynamic and respiratory monitoring, maintenance of body temperature, and prevention of factors that may precipitate cardiovascular or respiratory compromise. Postoperative care should include close monitoring for cardiovascular, respiratory, metabolic, and neurological complications, including myxedema coma. In emergency surgery, the need for timely surgical intervention should be balanced against the severity of hypothyroidism. Surgery may proceed when clinically necessary, with appropriate perioperative thyroid hormone replacement and supportive management; intravenous levothyroxine may be considered in severe hypothyroidism when oral administration is not feasible. A structured approach based on the severity of thyroid dysfunction and surgical urgency is essential to reduce perioperative morbidity and mortality. Achieving a euthyroid state remains the preferred goal before elective surgery whenever clinically feasible.