Anesthesia and thyroid surgery: The never ending challenges

Abstract

Thyroidectomy is the most common endocrine surgical procedure being carried out throughout the world. Besides, many patients who have deranged thyroid physiology, namely hyperthyroidism and hypothyroidism, have to undergo various elective and emergency surgical procedures at some stage of their life. The attending anesthesiologist has to face numerous daunting tasks while administering anesthesia to such patients. The challenging scenarios can be encountered at any stage, be it preoperative, intra-op or postoperative period. Preoperatively, deranged thyroid physiology warrants optimal preparation, while anticipated difficult airway due to enlarged thyroid gland further adds to the anesthetic challenges. Cardiac complications are equally challenging as also the presence of various co-morbidities which make the task of anesthesiologist extremely difficult. Thyroid storm can occur during intra-op and post-op period in inadequately prepared surgical patients. Postoperatively, numerous complications can develop that include hemorrhage, laryngeal edema, nerve palsies, tracheomalacia, hypocalcemic tetany, pneumothorax, etc., The present review aims at an in-depth analysis of potential risk factors and challenges during administration of anesthesia and possible complications in patients with thyroid disease.

Keywords: Airway management; carbimazole; propanolol; thyroid; thyroidectomy; thyroxin; tracheomalacia.

Figure 1

Lateral view of neck X-ray showing the compression of trachea from a longstanding enlarged goiter (thyroid gland)

Figure 2

Lateral view of the neck showing the enlarged thyroid gland

Figure 3

Frontal view of the neck showing enlarged thyroid gland (goiter)