(1)   A 32 years old woman who is a known hyperthyroid on Carbimazole for control of her symptoms is scheduled for an elective lumpectomy from her left breast. Which of the following preoperative considerations is essential in this woman?

 (a)    She should continue her Carbimazole on the day of the surgery

(b)   She needs to be started on a calcium channel blocker for her blood pressure control

(c)    She should discontinue her Carbimazole one day prior to surgery and restart 3 days after surgery

(d)   She should be started on levothyroxine, as she is likely to be hypothyroid by now.

 Answer: The answer is (a). The oral agent should be continued till the day of surgery and even on the day of the surgery to avoid any thyrotoxic crisis on the table. Calcium channel blockers may be started for control of blood pressures but a better choice would be beta-blockers. There is no role for levothyroxine in this patient.