A 38-year-old woman presents for elective thyroidectomy for a benign goitre. Preoperative workup shows TSH 9.8 mIU/L with normal free T4. She is clinically euthyroid and asymptomatic. What is the most appropriate course?
- A Postpone surgery until TSH is fully normalised
- B Start high-dose beta blockers and proceed
- C Proceed with surgery; mild subclinical hypothyroidism is not a contraindication ✓
- D Cancel surgery and start thyroid hormone replacement for six months before reconsidering
Correct answer: C. Proceed with surgery; mild subclinical hypothyroidism is not a contraindication
Explanation
Elective surgery can safely proceed in asymptomatic patients with mild hypothyroidism or subclinical disease; the risks of significant myocardial depression, impaired ventilatory response to hypercapnia, and delayed drug clearance become relevant mainly in overt, symptomatic hypothyroidism or myxoedema coma, which demand postponement. Beta-blocker loading is the preparation for thyrotoxicosis, not hypothyroidism, making option B inappropriate. Indefinite cancellation is unjustified for an asymptomatic biochemical abnormality of this degree.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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