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Chapter: Clinical Cases in Anesthesia : Thyroid Disease

What are appropriate preoperative tests for a patient with thyroid disease?

Patients with thyroid disease should have recent evalua-tion of TSH and free T4 levels.

What are appropriate preoperative tests for a patient with thyroid disease?

 

Patients with thyroid disease should have recent evalua-tion of TSH and free T4 levels. These should be nearly normal for elective surgery. Patients who have been on long-term thyroid-hormone replacement do not need recent hormone levels, unless there has been a change in symptoms.

 

Hypothyroidism can cause anemia and thrombo-cytopenia, as well as hyponatremia, hypoglycemia, and cholestasis. Thus, hypothyroid patients should have a complete blood count, platelet count, electrolytes, glucose, and liver function tests evaluated preoperatively.

 

An electrocardiogram should be done looking for the presence of atrial fibrillation, premature complexes, ischemia, or ventricular hypertrophy. Other cardiac testing should be considered for patients with cardiac symptoms.

 

All patients with a goiter or abnormal airway physical examination should have radiological evaluation of the trachea, either by radiography, CT, or MRI. Patients with large or retrosternal goiters should have a CT scan or MRI. These studies will help guide the choice of anesthesia (regional or general), intubation technique, and endo-tracheal tube size.

 

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Clinical Cases in Anesthesia : Thyroid Disease : What are appropriate preoperative tests for a patient with thyroid disease? |


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