Thyroid and Liver Problems- Can I Have BA and TT?

Question

Can you have surgery if your liver AST and ALT are high?And also if you have Thyroid just found this out today and my TT and BA is Nov 2011 Please help.

Ronald Schuster, MD · Answer

Find out why your tests are abnormal and get yourself treated before doing any surgery. You will heal better and reduce the chances of getting complications. Let your surgeon know that you might have to delay your surgery.

Aaron Stone, MD · Answer

In general patients can have cosmetic surgery with elevated liver AST and ALT as well as abnormal thyroid hormone levels depending on how abnormal they are, whether the condition - levels have been stable over time and whether or not the corresponding medical condition has been normalized by appropriate medical care. Without more details it is impossible to say whether you specifically can safely have the surgery. I just did an abdominoplasty on a patient last week with elevated AST and ALT but those values had been stable for over a year and multiple hepatitis B and C screens had been negative.

	No one with uncontrolled hyperthyroidism should be undergoing surgery because of the life threatening risk of thyroid storm. On the other end of the scale uncontrolled hypothyroidism can delay the healing process and ruin the results of a cosmetic surgery.

	Before any surgery you need to be medically evaluated and your physical condition optimized. During and after surgery your medications should be adjusted as needed. That would be the safest path for you to take.

	I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Richard H. Tholen, MD, FACS · Answer

Of course, regardless of your liver or thyroid status, if you were in a car wreck and needed surgery to save your life, then there is no question about the appropriateness of proceeding with necessary surgery. The risks are higher than NOT proceeding.

	But with elective cosmetic surgery, taking on unnecessary risks becomes another thing entirely!

	Your internist or family practitioner should evaluate WHY your liver enzymes are elevated (how much is another issue), as well as identify the cause and proper treatment for your thyroid issues. More testing may be needed, and the driving force here should not be the timetable of your scheduled elective surgery, but your overall health and suitability for anesthesia and elective cosmetic surgery. THIS is why patients are required to have a complete medical history, physical examination, and lab tests PRIOR to undergoing surgery (especially elective)--we want to ensure as much safety as possible.

	Anything less is foolish. Follow up with your own physician, and reschedule with your plastic surgeon if necessary--he or she will certainly want what's best for your overall health. (We prefer our patients to be out walking around and showing off our good work and results, rather than just looking good in the casket!)

	Elevated liver enzymes may simply be related to the party you were over-served at last weekend, or medications you take, or could be a sign of other more serious issues. Don't ignore this; don't seek reassurance on-line; go see your doctor! Best wishes!

Steve Laverson, MD, FACS · Answer

Your surgeon and anesthesiologist should know about these findings.  Your elevated AST and ALT are merely indicators.  The degree of elevation is important, and whether or not other lab abnormalities are present (alkaline phospatase and bilirubin, hepatitis screen, etc.) is germane.  If these are new findings, they should be pursued to know exactly why they are elevated.  While the lab studies themselves are no contraindication to your procedure, an understanding about why they are elevated should probably be developed before cosmetic surgery.  

	Regarding your thyroid function abnormality, this too should be investigated prior to cosmetic surgery.  Get clearance from your medical doctor(s) before proceeding.  Let your plastic surgeon know what is going on.

Tom J. Pousti, MD · Answer

Thank you for the question.

	The medical issues and laboratory findings that you have described do not necessarily  make you a poor candidate for the scheduled procedure. However, it would be in your  best interest to be seen by your family doctor or internist (before surgery) to determine and/or treat the causes of the abnormal laboratory findings.

	This medical evaluation may provide useful information to your plastic surgeon and anesthesiologist.

	I hope this helps

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