Medication Concerns Before Thyroid Surgery: What Patients Should Know

Issues Regarding Medication Before Thyroid Surgery

Hello Dr.
Hsieh: I am a patient with thyroid nodules (3.8 cm on the left and 2.3 cm on the right) scheduled for surgery next month.
The doctor has prescribed one tablet each of thyroid and jolethin per day, but my levels are normal.
Will taking these medications cause any adverse reactions? Thank you for your assistance.

Ms. Huang, 20~29 year old female. Ask Date: 2009/10/30

Dr. Xie Wenhuai reply Breast and Thyroid

Due to the presence of a sizable tumor on each side of your thyroid, some thyroid tissue will likely be removed during surgery.
The physician may prescribe thyroid hormone replacement therapy beforehand to prevent postoperative thyroid insufficiency.
For further considerations, you may consult the surgeon who will be performing your operation.
Thank you for your inquiry.

Reply Date: 2009/10/30

More Info

When preparing for thyroid surgery, it is essential for patients to understand the implications of any medications they are taking, especially those related to thyroid function. In your case, you have been prescribed thyroid hormone (likely levothyroxine) and jolethin (which may refer to a medication that helps manage thyroid function or related symptoms). Given that your thyroid function tests are normal, the necessity of these medications before surgery can be a point of concern.

Understanding Thyroid Medications Before Surgery
1. Thyroid Hormone Replacement: If you are taking thyroid hormone replacement, the purpose is typically to maintain normal thyroid hormone levels, especially if there is a risk of hypothyroidism post-surgery due to the removal of thyroid tissue. In cases where significant portions of the thyroid are removed, patients may experience a drop in thyroid hormone levels, leading to symptoms of hypothyroidism. Therefore, your physician may have prescribed thyroid hormone to prevent this from occurring.

2. Jolethin: This medication is less commonly discussed, and its specific use can vary. If it is intended to manage symptoms related to thyroid function or to support thyroid health, it is crucial to discuss its necessity with your surgeon. The concern about "引起抗進" (which translates to "causing resistance" or "antibody production") is valid, as some medications can influence the immune response or thyroid function. However, this largely depends on the specific medication and the individual patient's health status.

Preoperative Considerations
- Consult Your Surgeon: It is vital to have a thorough discussion with your surgeon about the medications you are taking. They can provide insights into whether you should continue these medications leading up to the surgery. In many cases, if the thyroid function tests are normal, the surgeon may decide to continue the medications to ensure stable hormone levels.

- Timing of Medication: Some surgeons may recommend stopping certain medications a few days before surgery, particularly if they could interfere with anesthesia or the surgical procedure. However, thyroid hormone is often continued to prevent fluctuations in hormone levels.

- Monitoring Thyroid Function: If you are undergoing surgery for thyroid nodules, it is essential to monitor your thyroid function closely. Postoperative management may include regular blood tests to assess TSH and free T4 levels to ensure that you are not developing hypothyroidism after the surgery.

Risks of Stopping Medications
- Hypothyroidism: If you stop taking thyroid hormone replacement suddenly, especially if a significant portion of the thyroid is removed, you risk developing hypothyroidism, which can lead to fatigue, weight gain, depression, and other health issues.

- Surgical Risks: Inadequate thyroid hormone levels can also increase the risk of complications during and after surgery, including issues with heart rate and metabolism.

Conclusion
In summary, it is crucial to have an open dialogue with your healthcare provider regarding the medications you are taking before your thyroid surgery. They will consider your specific situation, including the size of your nodules, your thyroid function, and any potential risks associated with your medications. Always prioritize clear communication with your medical team to ensure the best outcomes for your surgery and recovery. If you have any concerns about the medications, do not hesitate to ask your doctor for clarification or alternative options. Your health and safety should always come first.

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