In patients with hypothyroidism undergoing surgery, what is the correct perioperative management?

• A. Hold thyroid hormone preoperatively
• B. Do not hold thyroid hormone preoperatively unless instructed
• C. Start prednisone preoperatively
• D. Begin insulin therapy preoperatively

Answer: (B)

Continuing thyroid hormone replacement during the perioperative period is essential. Surgery is a physiological stress that increases metabolic demands, and stopping thyroid hormone can push a patient with hypothyroidism toward worsening hypothyroidism or even myxedema coma, with risks like cardiovascular instability, hypothermia, and delayed recovery. Therefore, thyroid hormone therapy should not be held preoperatively unless the surgical team directs otherwise. If the patient cannot take pills due to NPO status, coordinate with anesthesia and endocrinology for a safe alternative (such as IV dosing) and resume oral therapy as soon as possible after surgery. The other measures described aren’t indicated for hypothyroidism in this context and address unrelated conditions.