Beta-blockers and the thyrotoxic patient for thyroid and non-thyroid surgery: a clinical review

Introduction: Thyrotoxic patients presenting for surgery should ideally be biochemically and clinically euthyroid. This is conventionally achieved through the use of anti-thyroid drugs, beta-blocker therapy and iodine. However, there are some circumstances where anti-thyroid drugs may not be a viable option. The implications of this scenario are not widely reported in the literature. This clinical review looks at the evidence on the safety of beta-blocker therapy without the use of anti-thyroid drugs in the preparation of the thyrotoxic patient for surgery. We also highlight key points in the pathophysiology of thyrotoxicosis and the management goals of these patients.

Conclusion: In circumstances where the use of anti-thyroid drugs is not possible in the preoperative management of patients for thyroid or non-thyroid surgery, the use of beta-blockers has been shown to be safe and effective. Safety can be increased by using iodine with or without corticosteroids up to the day of surgery in the rapid preoperative preparation of a severely thyrotoxic patient.