Thyrotoxic patients

Antithyroid drugs and occasionally thyroxine should be continued until the day before surgery. In addition a thyroid storm may be prevented by pre-operative prophylaxis with - Lugol's iodine (10 drops TDS x 7-10 days) or propranolol (Inderal) 40-160 millegrammes QDS or a combination of both.

Aim to achieve a resting pulse of $<$ 80/min - give propranolol (Inderal) 40 millegrammes orally the morning of surgery and continue for 5 days post-op.

Postoperatively

• Observe for neck haematoma / airway compromise

• Check serum calcium daily for 3 days in cases where parathyroids have been compromised

• Patients may be placed on tri-iodothyronine (T3) 40 microgrammes immediately post-op for 4 months.