总结普外科患者合并甲状腺功能亢进症时围手术期诊治中容易忽视的问题，并结合3例患者的实际处理经过分析相应的应对措施。

回顾性分析2023年9月至2025年6月收治的3例围手术期甲状腺功能亢进患者的临床资料，结合术后迟发性甲状腺危象、危象前期表现及术前筛查发现的甲状腺功能亢进病例，分析其围手术期风险及处理过程。

3例患者的临床情况不同。案例1，术后因肠功能恢复延迟持续禁食，抗甲状腺药物（ATD）中断，术后16 d发生甲状腺危象；术后9 d游离四碘甲状腺原氨酸（FT4）为16.11 pmol/L，危象发生时Burch-Wartofsky评分（BWPS）为55分，经丙硫氧嘧啶（PTU）鼻饲、氢化可的松及普萘洛尔治疗后，48 h内心率由145次/min降至110次/min，住院28 d。案例2，术前甲状腺功能亢进控制不佳，FT4为41.6 pmol/L，急诊手术后1 d心率升至125次/min，BWPS为25分，给予PTU、普萘洛尔及泼尼松治疗后，术后2 d症状缓解，术后5 d出院。案例3，术前筛查发现隐匿性甲状腺功能亢进，术后1 d白细胞计数升至17.3×10⁹/L，而降钙素原（PCT）及C反应蛋白（CRP）正常，无明确感染表现；继续抗甲状腺功能亢进治疗后24 h白细胞计数降至10.6×10⁹/L，术后3 d出院。3例患者均顺利完成手术，随访3个月未见严重迟发性外科并发症。

普外科围手术期甲状腺功能亢进患者的风险与甲状腺功能亢进控制情况、手术应激及术后用药是否连续有关。持续禁食时应及时评估ATD的替代给药方式；甲状腺功能亢进控制不佳而需急诊手术者应加强监测；术后出现白细胞升高但缺乏感染依据时，应结合PCT、CRP及临床表现综合判断。

To summarize the issues that are easily overlooked during the perioperative management of patients with thyroid hyperfunction in general surgery, and to analyze the corresponding countermeasures based on the actual handling process of 3 cases.

The clinical data of 3 patients with thyroid hyperfunction during the perioperative period from September 2023 to June 2025 were retrospectively analyzed. The cases of delayed thyroid crisis after surgery, pre-crisis manifestations, and cases of hyperthyroidism detected during preoperative screening were combined to analyze the perioperative risks and handling process.

The clinical conditions of the 3 patients were different. Case 1: Due to delayed recovery of intestinal function and continuous fasting after surgery, the anti-thyroid drugs (ATD) were interrupted. Thyroid crisis occurred 16 days after surgery; the free thyroxine (FT4) level was 16.11 pmol/L on the day of crisis, and the Burch-Wartofsky score (BWPS) was 55 points. After treatment with propylthiouracil (PTU) nasal feeding, hydrocortisone, and propranolol, the heart rate decreased from 145 beats/min to 110 beats/min within 48 hours, and the hospital stay was 28 days. Case 2: The preoperative hyperthyroidism control was poor, with an FT4 level of 41.6 pmol/L. The heart rate increased to 125 beats/min on the 1st day after emergency surgery, and the BWPS was 25 points. After treatment with PTU, propranolol, and prednisone, the symptoms were relieved on the 2nd day after surgery, and the patient was discharged on the 5th day. Case 3: Hidden hyperthyroidism was detected during preoperative screening, and the white blood cell count increased to 17.3×10⁹/L on the 1st day after surgery, while procalcitonin (PCT) and C-reactive protein (CRP) were normal, and there were no clear signs of infection. After continuous anti-thyroid treatment, the white blood cell count decreased to 10.6×10⁹/L 24 hours later, and the patient was discharged on the 3rd day after surgery. All 3 patients successfully completed the surgery, and no serious delayed surgical complications were observed during the 3-month follow-up.

The risks of perioperative hyperthyroidism in general surgery are related to the control of hyperthyroidism, surgical stress, and the continuity of postoperative medication. Timely assessment of the alternative administration method of ATD should be conducted when fasting is continued; patients with poor preoperative hyperthyroidism control and emergency surgery should be closely monitored; when there is an increase in white blood cells but no evidence of infection, a comprehensive judgment should be made based on PCT, CRP, and clinical manifestations.