Assessment and management of thyroid disease

Thyroid emergencies are rare but are important to recognise because of the high mortality associated with them. Thyroid storm is a clinical syndrome associated with fever, central nervous effects, gastrointestinal-hepatic dysfunction, tachycardia and congestive cardiac failure. Myxoedema coma is typically associated with hypothermia, hypoventilation, hyponatraemia, hypoglycaemia and decreased mental function. Surgical and anaesthetic aspects of thyroid disease include the assessment of patients with thyroid dysfunction before non-thyroidal surgery, recognising post-thyroidectomy complications, and the management of acute upper airway obstruction due to goitre. Factors including systemic illness, medication and pregnancy may affect thyroid function, and it is important to consider these before deciding on the appropriate management strategy.