Impact of Thyroid Function Status on Perioperative Characteristics and Early Postoperative Recovery in Cesarean Section.

Abstract

Aim: Thyroid dysfunction is common in pregnancy, but its effects on perioperative outcomes in cesarean section remain unclear. This study aimed to investigate the effects of thyroid dysfunction in the third trimester on perioperative hemodynamic stability and early postoperative recovery in women undergoing cesarean section.

Methods: Clinical data from women undergoing elective cesarean section at Yuhuan Second People's Hospital between January 2023 and December 2025 were retrospectively collected. Propensity score matching (1:2 nearest neighbor matching, caliper 0.1) was used to balance baseline covariates between groups. After matching, 81 cases were included in the thyroid dysfunction group and 162 cases were categorized in the euthyroid group. Intraoperative hemodynamic parameters (hypotension, hypertension, tachycardia, bradycardia, vasopressor use, and maximum decrease in mean arterial pressure (MAP)), postoperative recovery indicators (pain scores, time to bowel function recovery, onset of lactation, higher Edinburgh Postnatal Depression Scale (EPDS) scores, length of hospital stay, and complications), and neonatal outcomes were compared between the two groups.

Results: After matching, baseline data were well-balanced between the two groups (all standardized differences <0.1). Compared to the euthyroid group, the thyroid dysfunction group had significantly higher rates of intraoperative hypotension, tachycardia, bradycardia, and vasopressor use (all p < 0.01), along with a greater maximum decrease in MAP (p < 0.001). Postoperative pain scores, time to first flatus and defecation, time to onset of lactation, EPDS scores, and length of hospital stay were significantly increased in the thyroid dysfunction group compared with the euthyroid group (all p < 0.001). No significant difference was found between groups in intraoperative hypertension (p > 0.05). Subgroup analysis showed that the hypothyroidism subgroup had higher rates of intraoperative hypotension (p = 0.042), and longer time to first flatus (p = 0.004); the hyperthyroidism subgroup had a higher rate of tachycardia (p = 0.017). Regarding neonatal outcomes, the 5-minute Apgar score was slightly lower in the thyroid dysfunction group (p < 0.05), but all scores were within the normal range. Neonatal hyperthyroidism occurred in one infant born to a mother with hyperthyroidism.

Conclusions: Thyroid dysfunction was associated with intraoperative hemodynamic instability and delayed early postoperative recovery in cesarean section, with distinct clinical characteristics between hypothyroidism and hyperthyroidism. Perioperative monitoring and management should be enhanced for these patients.