Authors
Anna Paul, Anuka Alena Abraham, Tina George
Published in
Current opinion in endocrinology, diabetes, and obesity. Aug 13, 2026. Epub Aug 13, 2026.
Abstract
Thyroid dysfunction often delays surgery during preoperative evaluation, though evidence on perioperative risk and biochemical optimization is limited. This review explores recent literature on perioperative outcomes in hypothyroidism and hyperthyroidism, focusing on surgery delays, rapid optimization strategies, and areas of uncertainty.
Observational studies and meta-analyses link subclinical hypothyroidism with adverse cardiovascular outcomes in cardiac surgeries, but evidence for non-cardiac surgeries is limited. Overt hypothyroidism is associated with complications like impaired wound healing, prolonged ventilation, and cardiovascular issues, making euthyroid state preferable before surgery, despite retrospective, heterogeneous data. For hyperthyroid patients undergoing total thyroidectomy, recent literature questions the need for biochemical euthyroid state; evidence for non-thyroid surgeries is sparse and extrapolated from thyroid surgeries. Selective use of liothyronine and therapeutic plasma exchange in severe or urgent cases shows promise, but evidence is limited and low quality.
Current management of thyroid dysfunction is largely consensus-driven and based on limited evidence. Routine elective surgery optimization is advised for overt thyroid disease; however, in urgent cases, surgery after starting appropriate therapy and multidisciplinary planning is often reasonable. Future research should focus on prospective outcome data, rapid correction strategies, and the role of modern care pathways in reducing endocrine-related surgical risks.
PMID:
42590937
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.
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