Disorders of the thyroid gland are frequently unrecognized and untreated by the attending physician and present the anesthesiologist with a diagnostic and therapeutic challenge. Very large goiters distort and compress the larynx and require an experienced anesthesiologist for safe intubation. If surgery is elective and can be postponed in patients suspected of being hypo- or hyperthyroid, there is sufficient time to permit the anesthesiologist and the attending physician to obtain appropriate tests of thyroid function and institute appropriate therapeutic measures to restore the metabolic rate to normal. When there is insufficient time to confirm a clinical diagnosis of thyroid disease, the anesthesiologist is faced with important therapeutic decisions. It is the author's opinion that therapeutic intervention is, in most instances, preferable to therapeutic nihilism. In the case of a patient suspected of hypothyroidism, it is usually safe to administer a physiologic replacement dose of thyroxine to support the patient intraoperatively or postoperatively. If hypothyroidism is associated with cardiovascular disease, other debilitating illness, or advanced age, thyroxine must be given with extreme caution in order to avoid dangerous tachyarrhythmias or too rapid acceleration of the metabolic rate. The hyperthyroid patient facing nonelective surgery represents a very serious challenge to the anesthesiologist, since marked accentuation of clinical hyperthyroidism (thyroid storm) is a major risk of such surgery. In such a situation, intravenous propranolol and intravenous iodine are the optimal drugs for a safe and uncomplicated clinical course during and following surgery. In both instances, the anesthesiologist must use skillful clinical judgment in making the appropriate diagnosis and selecting appropriate therapy. Careful and continuous supervision of the patient is necessary during and following surgery and appropriate treatment and support of the patient should be provided until it is safe to discontinue therapy, if necessary, to confirm the diagnosis of thyroid disease. Careful clinical judgment and judicious use of appropriate medication should provide the patient with a smooth and safe intraoperative course and a rapid and uncomplicated postoperative recovery.
甲状腺疾病常常未被主治医生识别和治疗，给麻醉医生带来诊断和治疗方面的挑战。非常大的甲状腺肿会使喉部变形并受到压迫，需要经验丰富的麻醉医生进行安全插管。如果手术是选择性的，对于疑似甲状腺功能减退或亢进的患者可以推迟手术，那么就有足够的时间让麻醉医生和主治医生进行适当的甲状腺功能检查，并采取适当的治疗措施使代谢率恢复正常。当没有足够时间确诊甲状腺疾病的临床诊断时，麻醉医生面临重要的治疗决策。作者认为，在大多数情况下，治疗性干预优于治疗虚无主义。对于疑似甲状腺功能减退的患者，术中或术后给予生理替代剂量的甲状腺素通常是安全的，可以支持患者。如果甲状腺功能减退与心血管疾病、其他虚弱疾病或高龄相关，必须极其谨慎地给予甲状腺素，以避免危险的快速心律失常或代谢率过快加速。面临非选择性手术的甲状腺功能亢进患者对麻醉医生来说是一个非常严峻的挑战，因为手术中临床甲状腺功能亢进（甲状腺危象）的明显加重是此类手术的主要风险。在这种情况下，静脉注射普萘洛尔和静脉注射碘是手术期间及术后安全、顺利临床过程的最佳药物。在这两种情况下，麻醉医生必须运用熟练的临床判断力做出适当的诊断并选择适当的治疗方法。手术期间及术后必须对患者进行仔细持续的监测，如有必要，应给予患者适当的治疗和支持，直到可以安全停止治疗以确诊甲状腺疾病。谨慎的临床判断力和明智地使用适当药物应能为患者提供平稳、安全的术中过程以及快速、顺利的术后恢复。
Zotero 插件