A woman who was scheduled to have surgery for Graves’ disease must now wait for her endocrinologist to clear her. Her most recent thyroid studies are thyroid-stimulating hormone (TSH) <0.03 mU/L, free triiodothyronine (T3) 2.8 nmol/L, and free thyroxine (T4) 0.88 nmol/L. The patient has been hyperthyroid for years and has had prior surgeries without problems (e.g., thyroid storm). Why is this suddenly an issue?
—Constance Lepper, RN, FNP-C, Fruita, Colo.

I can only assume that the surgeon and the type of procedure are the reasons for this requirement. Since her TSH is obviously suppressed, she may be considered clinically stable, but that does not predict her performance under anesthesia and the other rigors of surgery.
—Sherril Sego, MSN, FNP (110-4)

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