The Thyroid surgery is a sensitive and complex treatment that requires detailed and comprehensive preparations. These preparations include various evaluations including blood tests, imaging studies, and clinical examinations. In the meantime, one of the most important and vital measures before thyroid surgery is the complete and accurate control of the hormonal status of the thyroid gland. This work is done with the aim of restoring the function of the thyroid gland to a normal state and plays a key role in increasing the patient's safety and ensuring the success of the operation. Ignoring this issue creates serious risks during and after the operation.

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Due to the vital role of thyroid hormones in regulating body functions, any disturbance in their production can have serious consequences for the patient's health, especially during and after thyroid surgery. Before thyroid surgery (and any type of surgery in general), doctors try to bring patients with thyroid disorders to a euthyroid state with proper prescriptions. Euthyroid refers to the normal state of the thyroid gland in which the levels of thyroid hormones are within the normal range. In this case, the level of thyroid-stimulating hormone (TSH), free thyroxine (T4) and triiodothyronine (T3) is normal, and as a result, the function of the thyroid gland is normal. This balanced state indicates optimal thyroid function in which the hypothalamus-pituitary-thyroid axis is working properly and the thyroid gland is in a stable state.

This means that the patient must not have untreated hyperthyroidism or hypothyroidism before thyroid surgery. This vital action is performed with the aim of preventing possible complications during and after the operation. If any of these two thyroid disorders are not controlled, the surgery will be canceled; Because in order to avoid acute and dangerous complications, it is better to postpone non-emergency surgeries until the thyroid status (normal level of hormones) is reached. This measure not only minimizes the risk of complications, but also helps the recovery process after the operation.

Required Hypothyroidism control before surgery

Hypothyroidism (too high TSH and low FREE T4) is a condition in which the thyroid gland cannot produce enough thyroid hormone. This issue leads to a decrease in the body's metabolism and causes symptoms such as fatigue, weight gain, slow heart rate and cold intolerance. To control this disorder, doctors use Levothyroxine, which is a synthetic thyroid hormone (T4). In case of hypothyroidism before thyroid surgery, the doctor will bring the patient's TSH and FREE T4 levels to the normal range by prescribing the appropriate dose of levothyroxine on a daily basis to reach euthyroid status.

effects Failure to control hypothyroidism before thyroid surgery

Thyroid surgery without controlling hypothyroidism is not as dangerous as hyperthyroidism; But it still comes with risks and unpleasant side effects. If the patient's hypothyroidism is not diagnosed or controlled before the operation, the possibility of the following problems will be very high:

Effects of anesthesia:

One of the common side effects of surgery without controlling hypothyroidism is that the patient cannot be easily weaned from the ventilator. This happens due to the weakness of the respiratory muscles and the long-term effect of the drugs. The decrease in the body's metabolic rate in hypothyroid patients affects the processing and disposal of anesthetic drugs and causes the patient to regain consciousness late.

Cardiovascular problems:

Deficiency of thyroid hormones directly affects heart function, causing slow heart rate and reducing its pumping power. As a result, the heart becomes vulnerable to the stress caused by surgery and anesthetic drugs, and the risk of serious complications such as heart failure or cardiac arrest increases during the operation.

Delayed recovery:

Thyroid hormones play an important role in tissue repair and proper functioning of the immune system. Lack of thyroid hormones severely reduces the body's ability to repair and recover. Slowing down the healing process of wounds caused by surgery, as well as weakening the immune system in patients with uncontrolled hypothyroidism, increases the risk of infection at the surgical site.

Other possible complications:

The lack of control of hypothyroidism before thyroid surgery causes disturbances in body temperature regulation and may lead to hypothermia (severe decrease in body temperature) during the operation. The lack of thyroid hormones also affects the blood coagulation system and increases the risk of bleeding during and after surgery.

In hyperthyroidism (i.e. too low TSH and high FREE T4), the thyroid gland produces too much hormone. The increase in the levels of thyroid hormones increases the body's metabolic rate and affects the heart, nervous system and other body organs. Doctors use antithyroid drugs such as methimazole or propylthiouracil to control hyperthyroidism before surgery. These drugs inhibit the production of thyroid hormone so that the patient reaches the euthyroid state. Beta-blockers (such as propranolol) may also be prescribed to control symptoms such as palpitations, tremors, and anxiety.

Complications Thyroid surgery without hyperthyroid control

In general, the patient's thyroid should be at rest and in a stable condition before any surgery (including thyroid surgery). This issue is especially important for patients with hyperthyroidism. Thyroid surgery in a person with uncontrolled hyperactivity causes serious and life-threatening complications. These complications occur due to the high level of thyroid hormones and their effect on the body's vital systems.

Thyroid Storm: Thyroid Storm

It is an emergency and very dangerous condition that begins with severe symptoms. These symptoms include an uncontrollable increase in body temperature (hyperthermia), very fast and irregular heartbeat (arrhythmia), high fever, excessive sweating, nausea, and diarrhea. A sharp increase in metabolism and heat production in the body can cause severe dehydration and loss of electrolyte balance, which complicates the patient's condition. In severe cases, this condition can lead to loss of consciousness, shock and even death. Thyroid storm usually occurs during surgery or the first hours after surgery and requires immediate treatment in the intensive care unit.

To read more about thyroid storm click on the link.

Heart problems:

Hyperthyroidism by putting pressure on the heart can lead to increased heart rate (tachycardia) and cardiac arrhythmias (irregular beats), which range from simple to fatal. The stress of surgery and anesthetic drugs also aggravate these problems and greatly increase the risk of heart attack or heart failure.

Disorders of the nervous system:

High levels of hormones directly affect the functioning of the central nervous system and cause symptoms such as severe anxiety, tremors and confusion. These symptoms make it extremely difficult and complicated for the medical team to control the patient's condition during anesthesia as well as during post-operative recovery.

Last word

Before thyroid surgery, it is very important to achieve euthyroid status (normal level of thyroid hormones). This action is done with the aim of minimizing risks during the operation, especially for people with hyperthyroidism. Uncontrolled hyperthyroidism can lead to thyroid storm, a rare and very dangerous complication, as well as serious cardiovascular problems. Likewise, hypothyroidism management also helps to improve anesthesia tolerance, better heart function, and speed up the recovery process after thyroid surgery.

Dr. Seyed Ahmad Fanai is a thyroid and parathyroid surgeon and a member of the American Thyroid Association. He is known as the Golden Paw thyroid surgeon and performs thyroidectomy in a specialized manner. The use of up-to-date equipment such as neurometer, harmony, etc. prevents complications of thyroid surgery after surgery.