Longnecker's Anesthesiology > Part 2. Preparing for Anesthesia > Section B. Preoperative Evaluation of the Anesthesia Patient > Chapter 12. Evaluation of the Patient with Endocrine Disease or Diabetes Mellitus A.D. John, MD, and F.E. Sieber, MD

Key Points

"1. Thyroid disorders are the second most common endocrine disease after diabetes. The range of presentation is vast, ranging from subclinical hyperthyroidism to life-threatening thyroid storm, and from subclinical hypothyroidism to myxedema coma with high mortality if not appropriately treated.

2. The current thyroid-stimulating hormone (TSH) assays, along with the free thyroxine (FT₄) level, will often lead to the correct diagnosis of the thyroid disorder. Although the signs and symptoms of hypo- and hyperthyroidism are quite distinct, with aging, the clinical picture may not be quite as clear. A high level of suspicion, the appropriate use of tests, and clarity in appropriately differentiating coexisting conditions will lead to increased patient safety.

3. Patients with mild hypo- and hyperthyroidism may safely undergo elective surgery if proper care is exercised; but, patients with thyroid storm or myxedema coma may have significant morbidity with elective surgery.

4. Hypercalcemia places a patient at increased risk for hypovolemia and cardiac dysrhythmias. Hypocalcemia may present with decreased myocardial contractibility, tetany, cardiac dysrhythmias, and altered response to muscle relaxants leading to increased perioperative patient risk. Prompt recognition and successful treatment can be lifesaving.

5. The complex interplay between the thyroid, adrenal, and pituitary glands..."