ABSTRACT
Hyperthyroid disease is a hypermetabolic state, and patient should be rendered euthyroid if it is not an emergency procedure, to avoid any catastrophic event like toxic crisis. Hyperthyroidism patients are highly sensitive to sympathomimetic drugs so these drugs should be avoided, and for correction of hypotension, indirectly acting sympathomimetic drugs should be used. Uncorrected hypothyroidism is characterized by bradycardia and reduced cardiac output that result in slow metabolism of drugs and delayed recovery from anesthesia. Furthermore, hypoxic and ventilatory drive is also depressed in hypothyroidism so sedative drugs should be judiciously used. Patients with huge long-standing goiter can have a difficult intubation and tracheostomy so the plan for airway management should be discussed preoperatively with surgeon to avoid any airway-related complications. Patients with long-standing goiter may also have tracheomalacia so extubation in this scenario may be very difficult and tricky. Sometimes patients may require reintubation. While using nerve integrity monitor, long-acting muscle relaxants should be avoided. Postoperatively, patient should be monitored for at least 24 hours to detect and timely mange the complications like hematoma and hypocalcemia (because of inadvertent removal of parathyroid gland). Hyperparathyroidism patients for elective surgery will require thorough cardiovascular examination and calcium levels preoperatively, which should be within normal range. Postoperative pain management should include multimodal analgesia regime.
