Head and neck radiotherapy - A risk factor for anaesthesia?

Area of Science:

• Oncology
• Endocrinology
• Anesthesiology

Background:

• Head and neck cancer is common in Indian men, frequently treated with radiation therapy (RT).
• RT can cause airway issues and thyroid dysfunction (hypothyroidism), impacting perioperative care.
• Subclinical hypothyroidism in these patients is often asymptomatic, posing a management challenge.

Purpose of the Study:

• To investigate perioperative management strategies for head and neck cancer patients post-radiation therapy.
• To assess the safety of proceeding with cancer surgery in patients with subclinical hypothyroidism, particularly when parenteral levothyroxine is unavailable.
• To determine an acceptable Thyroid Stimulating Hormone (TSH) level for cancer surgery.

Main Methods:

• A retrospective study of 72 patients undergoing elective surgery at a tertiary cancer center.
• Data collected included thyroid profiles, airway assessments, hypothyroidism treatment, airway access, recovery, and hemodynamic parameters.
• Statistical analysis (Chi-square test) explored correlations between age, sex, RT, chemotherapy, and hypothyroidism.

Main Results:

• Hypothyroidism (subclinical and clinical) was found in 39% of patients, all asymptomatic.
• A significant association was observed between RT and hypothyroidism.
• Difficult airways were encountered in 50% of patients; however, those with subclinical hypothyroidism (TSH < 15) managed with levothyroxine had uneventful anesthesia, extubation, recovery, and postoperative stays.

Conclusions:

• Hypothyroidism and difficult airways are frequent complications following radiation therapy for head and neck cancer.
• Selected cancer patients with subclinical hypothyroidism can undergo surgery with a smooth perioperative course, even with TSH levels up to 15.