General anaesthetic

[Portia1974]

Hi All! After some advice. Due to undergo an endometrial ablation under general anaesthetic. (Hopefully to help address chronic iron deficiency anaemia) Aside from having my b12 jab afterwards as opposed to before....anything else I should be aware of in relation to general anaesthetic and hypothyroidism ? Last GA I had was over 20 years ago before I had all these health issues. Mildly anxious. TIA 😊

[SlowDragon Administrator]

Iron deficiency is common hypothyroid issue as are very heavy periods

Getting thyroid levels optimal is likely to improve both

[Portia1974 in reply to SlowDragon]

Classic chicken and egg I know. But since my pleas for an iron infusion have so far gone unanswered...I'm in a catch 22 scenario. Low iron causing heavy periods. Heavy periods causing low iron. Since docs are unphased by the former ...I sought help for the latter. Next step is nailing down exactly what my gut issues are. It was more whether hypothyroidism has any impact in general anaesthetic and vice versa?

[Debsoxford]

Sorry no advice on GA apart from look after yourself afterwards I assume you try and eat/supplement for your iron. One t hi g that might be helpful if you like pate is to get some and freeze in portion size chunks to have on a cracker/toast after surgery , as it's a small nutritious snack will defrost in freezer overnight in fridge

All the best I'm sure you will find GA is improvised from 20 years ago and of course your anxious who wouldn't be? Tell the nurses/famy/freinds so they can support you

Big hug x

[Portia1974 in reply to Debsoxford]

Thank you Debsoxford 😊💙

[ShinyB]

Have you tried having a search through previous posts using the search facility? healthunlocked.com/search/g...

I did read something about GA in one of my thyroid books. Will try to find it and post if it's anything useful.

Good luck

[Portia1974 in reply to ShinyB]

Thanks shinyb! So I found this....

anesthesiaconsiderations.co...

[ShinyB in reply to Portia1974]

I think this is one of those situations where the internet makes you worry more! I've come through two general anaesthetics with no problems (and that was while symptomatic but not on any treatment). I'd make sure you point out to them that you have hypothyroidism and what treatment you're on. Perhaps print off that article and show it to them.

I found which book I was thinking of - it was Dr Skinner's book 'Diagnosis and management of hypothyroidism'. The bit about anaesthetic is as follows (much of which is aimed at untreated patients) (bear in mind also he wrote this book for doctors):

Patients who require surgical procedures need consideration. it is dangerous - although sometimes unavoidable if there is requirement for emergency surgery - to anaesthetise and operate on hypothyroid patients. Firstly, they tend not to tolerate anaesthesia not only in the immediate but also in the long term and many patients postdate the onset or exacerbation of hypothyroidism to a general anaesthetic for a sometime quite minor procedure. A number of patients report a 'bad reaction' to local anaesthetic - most usually for dental procedures - if the anaesthetic contains adrenaline which may parallel the 'bad reaction' to stress reported by a number of patients; in other words, they hypothyroid body system cannot respond physiologically to exogenous or endogenous adrenaline. Secondly, dysfunction of vascular neuromusculature with possibly defective synthesis of blood-clotting factors in severely hypothyroid patients increases the risk of intra-operative or post-operative bleeding which is compounded by poor wound healing in this illness.

There is therefore reason to defer elective procedures until hypothyroidism has been corrected with due cognisance of the nature and extent of the symptomatology of the proposed surgery; it makes no sense for example to charge on with joint replacement or cold cholecystectomy in an untreated hypothyroid patient. It is also crucial that thyroid replacement is not stopped either by the patient's practitioners or (even more daft) the operation is cancelled because the patient is under thyroid replacement - a quite common occurence even in Teaching Hospitals (silly term, isn't it?). Sometimes the patient herself stops the medication under a misconception or just forgets to take her tablets into hospital and omits to tell anyone. It should all come out in the history taking but then a history is only as good as what the patient tells the doctor and what the doctor asks the patient. It is particularly important on account of the number of patients now on thyroid replacement to make specific enquiry on this point.

[Portia1974 in reply to ShinyB]

Ah that's interesting! Thank you! I've collapsed after any sedation I've ever had (wisdom teeth particularly bad experience). I'm only recently diagnosed hypo (also hinder going tests for adrenal insufficiency) but not currently treated as wanted to get other nutrient levels optimal before beginning Levo. May have to have a chat with them about the best order to do things in 🤔

[humanbean]

I think you should have the B12 jab before the surgery rather than afterwords. If you are low in B12, then have an anaesthetic, you can end up very severely deficient. It may only be for a short while, but since extreme deficiency can cause life-long damage to the spinal cord, in your shoes I would have the B12 jab first. I would ask for an additional jab after surgery too.

b12-vitamin.com/anesthesia/

I'm surprised that you would go for endometrial ablation rather than trying to find ways of improving your absorption of iron first. And there are a number of pharmacological options that can be tried before surgery. In your shoes I would move Heaven and Earth to sort out the iron deficiency and your failure to absorb iron before I let a surgeon anywhere near my pelvis.

sci-hub.tw/10.1016/j.jmig.2...

Does your condition have a name? Is it this one or something else?

hersfoundation.com/docs/End...

There may be other options :

patient.info/doctor/menorrh...

.

I realise I'm probably intruding where I'm not wanted, and you've done all this research yourself already.

One thing you might not be aware of is that eating a low carb diet can reduce the heaviness and frequency of periods. It also helps PCOS (I don't know if this is relevant to you). I realise that going very low carb isn't necessarily compatible with being hypothyroid, so you would need to experiment with the amount of carbs you were eating to see what effect it had on you.

I've interfered enough, so I'll stop now, you'll be pleased to hear. I hope I haven't upset you with the above. But having the inside of your uterus deliberately scarred seems like such a drastic step to take when other less invasive methods might achieve the same end without surgery.

[Portia1974 in reply to humanbean]

Ah bless you! No I'm not offended or annoyed and I don't see it as interference. Yes I agree it sounds drastic. But I have tried and tried and tried to a) get my Iron levels up and b) get docs to find out why my Iron levels remain so low/deficient. They seem to care not one jot about low nutrients or the causes of them. I cannot function like this any longer. Iron deficiency anaemia, now hypothyroid, b12 deficiency, low folate, vit d deficiency. Honestly cannot cope any longer. Since this is the only avenue I've been given access to, I have to take it. This hasn't been pushed on me. I asked to be referred and for once they agreed. Classic example of nhs being happy to treat symptoms rather than find causes. (Heavy periods are a symptom in my case, not a cause. I'm fairly sure of that.) I have no sentimental attachment to my uterus. I am grateful for my gorgeous son but do not want more children. In fact I think I have developed a hate hate relationship with my uterus and the periods that ground me for two weeks out of four and add to my issues with iron even if they are not the cause of them . But the cycle has to be broken somehow. I have a haematology appointment prior to the ablation. If I can convince them to give me an iron infusion and test for low stomach acid and that turns out to be an issue, then I may well defer the ablation. But I am not hopeful. So covering all bases. Perhaps telling the haematologist that I am prepared to have the inside of my womb burned away will convince him of the impact low iron is having on me. We'll see.

[humanbean]

I post these links about low stomach acid and how it arises quite often. They may interest you.

Low stomach acid can affect absorption of any and all nutrients.

scdlifestyle.com/2012/06/hy...

scdlifestyle.com/2012/03/3-...

scdlifestyle.com/2012/03/ho...

scdlifestyle.com/2013/10/4-...

And for a through explanation of how reflux starts, what causes it, and all the other effects of it :

1) chriskresser.com/what-every...

2) chriskresser.com/the-hidden...

3) chriskresser.com/more-evide...

4) chriskresser.com/how-your-a...

5) chriskresser.com/how-your-a...

6) chriskresser.com/get-rid-of...

[Portia1974]

Thanks humanbean. Think I've probably read all of those. Hence my requesting serum gastrin and pepsinogen test. Yet to be agreed. But have a strong suspicion this is one of my issues.