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.