Manejo perioperatorio de pacientes con patología tiroidea y tratamiento crónico con corticoids

Abstract

Thyroid disorders and chronic use of corticosteroids are common in the surgical population, so is necessary an appropriate perioperative management of these patients. There is no contraindication for elective surgery in patients with asymptomatic hypothyroidism and good control, it is not necessary to maintain the levothyroxine dose the day of surgery, due to the pharmacokinetic properties of the drug. If hypothyroid patients are symptomatic and/or have not reached the euthyroid phase, should be treated and compensated prior to the elective surgical procedure. Patients with hyperthyroidism should keep their antithyroid treatment including the day of surgery. The symptomatic and/or decompensated hyperthyroidism have an increased risk of developing a thyroid storm, so no elective surgery is recommended in these patients, which should be conducted once achieved an euthyroid state. A strict monitoring in the postoperative period is key to prevent complications. Chronic glucocorticoid use is common. In these patients there is risk of developing acute adrenal insufficiency by surgical stress, so before surgery (elective or emergency) it is necessary to supplement with exogenous corticosteroid dose dependent on the type of surgical procedure performed.