Hypothyroidism

Surgery cancellation - Severe hypothyroid or hyperthyroid conditions, named myxedema and thyroid storm respectively, should always be cancelled in ELECTIVE cases until the patient is brought as close to euthyroid conditions as possible. Difficult airway - Large tongue, goiter, and swollen vocal cords are common in these patients and are risks for a difficult airway. Goiter - Textbooks say that if the patient has a goiter, you should aim for an awake intubation as the best option, and then a spontaneously breathing intubation as the second best. Aspiration risk - metabolic slowing includes slowing of the GI tract Hypotension risk - metabolic slowing includes reduced SVR, contractility, HR, SV.  This implies use of sympathomimetics (ie. ephedrine) to improve the array of symptoms.  Phenylephrine is generally avoided because of the concurrent drop in HR (baroreceptor reflex). Volatile anesthetics onset - FASTER MAC - Hypo/Hyperthyroid issues do NOT affect MAC Higher sensitivity - the more lethargic/slowed/weak the patient is, the more sensitive they will be to anesthetic drugs and neuromuscular blockers Consider D5NS - These patients typically have impaired clearance of free water - so this is good choice when the patient is hyponatremic. Slowed offset of drugs - slower metabolism takes longer to excrete drugs cleared by renal/hepatic systems