Preoperative Management Prior to Surgery - Procedure and Importance

Introduction

Thyroid plays an important role in maintaining homeostasis as they have an effect on circulatory, pulmonary, renal, gastrointestinal, hematologic, and central neurological systems. The overall population is well-represented by people who suffer from thyroid dysfunction. According to studies, women are more likely than men to have aberrant thyrotropin readings (21 % versus 3 %). Thyroid malfunction has a wide range of impacts on the body and can make surgery and recovery more difficult. This is because thyroid hormone has so many diverse physiological effects. Identifying, diagnosing, and managing preexisting thyroid disorders in patients undergoing surgery are crucial perioperative considerations, even if systematic screening to detect thyroid disease is not recommended in individuals with no suspicion index. The concerns of the perioperative management of thyroid illness in patients with hypothyroidism and hyperthyroidism who are having non-thyroid surgery will be covered in this article.

What Is Thyroid Disorder?

The thyroid is a small butterfly-shaped gland in the neck that produces hormones that help regulate the body's metabolism, heart rate, and other important functions. A thyroid disorder refers to a condition in which the thyroid gland is either overactive or underactive, leading to an imbalance in hormone levels in the body.

The following are the thyroid disorders:

• Hypothyroidism: This occurs when the thyroid gland does not produce enough thyroid hormones, which can lead to a slower metabolism and a range of symptoms, including fatigue, weight gain, and depression.

• Hyperthyroidism: This occurs when the thyroid gland produces too much thyroid hormone, which can lead to an overactive metabolism and a range of symptoms, including weight loss, anxiety, and an increased heart rate.

• Thyroid Nodules: These are lumps or growths that form in the thyroid gland and may be either benign (non-cancerous) or malignant (cancerous).

• Thyroiditis: This refers to inflammation of the thyroid gland, which can be caused by a viral or bacterial infection or an autoimmune disorder.

• Thyroid Cancer: This is a rare but serious condition in which abnormal cells in the thyroid gland begin to grow and spread.

Why Is Preoperative Management Important Prior to Thyroid Surgery?

Preoperative management is an essential part of preparing for thyroid surgery, and it is critical to ensure the safety and success of the procedure.

Here are a few reasons why preoperative management is important prior to thyroid surgery:

• Assessing the Patient’s Overall Health: Prior to surgery, the patient will undergo a thorough medical evaluation to assess their overall health and identify any medical conditions or risk factors that may increase the risk of complications during surgery. Assessing the patient's evaluation helps the surgical team determine appropriate patients who are suitable candidates for thyroid surgery and develop an appropriate treatment plan.

• Optimizing Thyroid Function: The thyroid gland produces hormones that regulate the body's metabolism and energy levels. Suppose the patient has a thyroid disorder such as hypothyroidism or hyperthyroidism. In that case, optimizing thyroid function before surgery is important to reduce the risk of complications and improve postoperative recovery.

• Managing Medications: Certain medications can increase the risk of bleeding or other complications during surgery, so it is important to manage the patient's medications prior to surgery. For example, blood thinners may need to be temporarily stopped before surgery to reduce the risk of excessive bleeding.

• Educating the Patient: Thyroid surgery can be a complex procedure, and it is important to educate the patient about the risks, benefits, and expected outcomes of the procedure. This education can help the patient feel more confident and informed about their treatment, improving their overall experience and recovery.

What Are the Preoperative Management of Thyroid Patients Before Surgery?

Once a diagnosis is made of thyroid disorder, surgery is the only treatment surgeons decide; the patient is scheduled to undergo surgery. Surgical outcomes can be optimized by careful preoperative management.

The following are the preoperative management of thyroid patients before surgery:

• Preoperative Screening: A total thyroid hormone test (TSH test) should be included in the preoperative assessment to determine the results of treatment and to ensure that thyroid therapy is optimized before surgery in patients with known hypothyroidism or hypothyroidism who have been undergoing treatment. Patients without a history of thyroid disease are not advised to undergo routine preoperative thyroid function tests. If there is a reason to suspect thyroid disease in such patients based on symptoms such as unexplained weight changes, palpitations, tremors, or changes in bowel habits, skin, hair, or eyes that suggest thyroid dysfunction, it would be reasonable to examine the thyrotropin (TSH) level. A TSH test would also be correctly included in a preoperative review when the physical examination or other investigation verifies the existence of exophthalmos, goiter, aberrant reflexes, hair or skin abnormalities, or tachycardia or bradycardia

• Thyroid Function Tests: Before any thyroid surgery, evaluating the patient's thyroid function is important. This is done through thyroid function tests, which include the measurement of thyroid-stimulating hormone (TSH), free thyroxine (T4), and triiodothyronine (T3). These tests help to determine if the patient has an overactive or underactive thyroid, which can impact the management and treatment of the patient.

• Imaging Studies: Imaging studies, such as ultrasound and computed tomography (CT) scans, are also important preoperative tests for thyroid patients. These tests help to identify the size and location of the thyroid nodule or tumor and can guide the surgical approach. Imaging studies can also detect any abnormalities, such as lymph node involvement, which may require additional treatment.

• Cardiovascular Evaluation: Thyroid patients are at an increased risk of cardiovascular complications during and after surgery. Therefore, a thorough cardiovascular evaluation is necessary before surgery. This may include an electrocardiogram (ECG), echocardiogram, and other tests as required. The results of these tests help to determine the patient's cardiovascular fitness and identify any underlying conditions that may need to be managed before surgery.

• Anesthesia Evaluation: Anesthesia is an important aspect of thyroid surgery. Therefore, a detailed evaluation of the patient's medical history and physical examination is necessary before administering anesthesia. This helps to identify any potential risks or complications associated with anesthesia, such as allergies or adverse drug reactions.

• Medication Management: Thyroid patients often take medications, such as thyroid hormone replacement therapy, which may need to be adjusted before surgery. It is important to discuss any medication changes with the patient's physician to ensure that they are appropriately managed before and after surgery.

• Infection Control: Infection control is a critical aspect of preoperative management for all surgical patients. Before surgery, patients should be screened for infections, including human immunodeficiency virus (HIV) and hepatitis B and C. Patients who test positive for these infections may require additional precautions to prevent the spread of infection during surgery.

Conclusion

In summary, preoperative management of thyroid patients before surgery is crucial for optimizing outcomes and reducing the risk of complications. This involves a comprehensive evaluation of the patient's medical history, physical examination, thyroid function tests, imaging studies, cardiovascular and anesthesia evaluation, medication management, and infection control. By following these guidelines, healthcare providers can ensure that thyroid surgery is safe and effective for their patients. Overall, preoperative management plays a critical role in preparing for thyroid surgery and ensuring the safety and success of the procedure.