Can I go under anesthesia for a thyroidectomy with allergies?

Question

Hello doctor,

I am scheduled to have a total thyroidectomy in a month. I have Graves' disease and initially started treatment with Methimazole, but after three weeks, I developed hives and red, swollen rashes on my skin. My endocrinologist then prescribed PTU (Propylthiouracil), but I experienced the same side effects. To keep my thyroid levels controlled and safe for surgery, I need to continue taking a thyroid blocker. Currently, I am on PTU along with prednisone and Allegra. However, despite taking the allergy medication and steroids, I still have intermittent skin breakouts characterized by red rashes and occasional welts. These flare-ups come and go. Will the anesthesiologist postpone or decline my surgery because of these breakouts? Should I consider stopping the PTU before surgery and increasing the steroid dose to minimize skin reactions?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Cutaneous allergic reactions (hives, rashes, urticaria) alone—if not associated with systemic symptoms (such as difficulty breathing, hypotension, facial, laryngeal swelling, or signs of anaphylaxis)—are not absolute contraindications to anesthesia or surgery.

The anesthesiologist's key concern is the risk of progression to a more severe reaction, especially under the stress of surgery or from exposure to other medications or agents used in the perioperative period. Your situation involves ongoing hypersensitivity reactions to both Methimazole and PTU (Propylthiouracil). This is a red flag that requires close preoperative assessment by anesthesia, endocrinology, and possibly immunology or allergy teams.

Stopping PTU abruptly before a total thyroidectomy can lead to thyroid hormone rebound and increase the risk of thyroid storm, a rare but life-threatening emergency under anesthesia. So, do not stop PTU on your own without guidance from your endocrinologist and surgeon. Your current regimen (PTU, Prednisone, and Allegra) appears to be an attempt to suppress the hypersensitivity reaction while keeping your thyroid levels controlled. This is a common bridging strategy when patients are allergic to both Methimazole and PTU.

Adjusting the Prednisone dose to better control the immune-mediated skin reactions might be considered, but this must be done under supervision. Increasing steroids without addressing thyroid control could suppress your immune system without solving the underlying issue.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.