Among the nearly one thousand adult foot and ankle surgeries performed annually at Penn State Hershey Bone and Joint Institute, Paul J. Juliano, M.D., professor of foot and ankle orthopaedics, noticed what seemed to be a higher than average rate of post-surgical wound complications among patients with hypothyroidism. Juliano observed, “Complications in these patients included not only infection, but also wound dehiscence,” a problem not commonly seen following foot and ankle surgery, marked by opening of the wound along natural or surgical suture lines. According to a number of preclinical and clinical findings, hypothyroidism might contribute to poor wound healing. Thyroid hormone (TH) is a key player in the healing of both bony and soft tissue wounds. In vitro and in vivo investigations have shown that TH promotes endochondral ossification, proliferation of keratinocytes, production of keratin, and dermal thickening; it also appears to play a role in the formation and deposition of mature type I collagen. With hypothyroidism, such underlying pathophysiologic changes could lead to non-union of bony fractures, delayed wound closure, and decreased density and strength of scar tissue. Clinical studies indicate that preoperative hypothyroidism is associated with wound complications after head and neck surgery, body contouring, and vascular surgery. In patients with head and neck cancer, those with hypothyroidism (versus euthyroid patients) experienced higher rates of flap edema, flap necrosis, and fistula development.