A 50-year-old man with primary hypothyroidism on levothyroxine 100 mcg daily is scheduled for elective inguinal hernia repair. Preoperative TSH is 28 mIU/L (normal 0.4-4.0) and free T4 is low. He has mild fatigue and cold intolerance but no angina or heart failure. Which is the MOST appropriate next step?
- A Proceed with surgery under local anaesthesia only
- B Proceed with surgery under general anaesthesia as scheduled
- C Postpone surgery, optimise thyroid replacement, and reassess in 6-8 weeks ✓
- D Proceed with surgery but give intravenous T3 on the morning of surgery
Correct answer: C. Postpone surgery, optimise thyroid replacement, and reassess in 6-8 weeks
Explanation
Elective surgery should be postponed in symptomatic hypothyroidism because these patients are at increased risk of myocardial depression, hypotension, prolonged ileus, and delayed recovery. The dose of levothyroxine should be increased gradually and TSH re-checked in 6-8 weeks before proceeding with elective surgery.
Reference: Stoelting's Anaesthesia and Co-existing Disease, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.