Which statement is most accurate regarding hyperthyroid perioperative management and epinephrine use?

Which statement is most accurate regarding hyperthyroid perioperative management and epinephrine use?

• A. Epinephrine is beneficial in thyroid storm, and anesthetics with epinephrine should be given
• B. Epinephrine should be avoided in thyroid storm
• C. No special considerations
• D. Hyperthyroid patients require preoperative thyroid hormone suppression

Answer: (A)

In thyroid storm the body is in a highly adrenergic state, and maintaining stable blood pressure and perfusion during anesthesia is a priority. Epinephrine can be beneficial because it provides the necessary alpha-adrenergic vasoconstriction to support blood pressure and systemic vascular resistance, while its beta-adrenergic effects help maintain cardiac output. When used judiciously and with careful monitoring (often alongside beta-blockade to blunt excessive tachycardia and with ongoing thyroid-storm treatment like antithyroid drugs, iodides, and steroids), epinephrine supports hemodynamics without completely abandoning the need to control sympathetic overactivity. It isn’t a blanket contraindication in thyroid storm; instead, it’s a tool for hemodynamic management when hypotension or poor perfusion occurs during anesthesia or during crisis care. Preoperative thyroid suppression is important for planned elective cases, but in an acute thyroid storm, immediate stabilization takes precedence, so relying on preoperative suppression alone isn’t the approach.