lugol's iodine thyroidectomy

The controls in this study were therefore patients undergoing thyroidectomy for Graves' disease for whom the only treatment had been anti-thyroid medications (total n = 24). MeSH There was no randomisation or blinding within this retrospective study and there is no comment as to whether patients were assigned to 1 surgeon or a group of surgeons, raising the potential for selection bias. For this reason, the quality of the evidence must be rated as 1-. SBK G, L Shantharam. Full text is available as a scanned copy of the original print version. B. Wolff J, Chaikoff IL. Patients undergoing thyroidectomy to treat Graves' disease are frequently treated with Lugol's iodine (also known as potassium iodide) in the days preceding their operation [ 2 ]. There appears to be little sound clinical evidence that post-operative outcomes are any different following a course of Lugol's iodine. Does Surgery Without Lugol's Solution Pretreatment for Graves' Disease Increase Surgical Morbidity? The study population is clearly identified as patients undergoing thyroidectomy for Graves' disease between 2006 and 2008. Shinall MC Jr, Broome JT, Nookala R, Shinall JB, Kiernan C, Parks L 3rd, Solrzano CC. For example, in endemic areas, the incidence of goitre is 15-30% of the adult population [1]. It probably decreases both angiogenic stimuli (reduced CD-34 expression) and blood flow in GD. Lugol solution (inorganic iodide) has been given preoperatively to patients to limit intraoperative bleeding and related complications resulting from thyroid gland vascularization [6]. Unable to load your collection due to an error, Unable to load your delegates due to an error. Although at first reading the conclusion appears to make sense, there is, in fact, very little justification given based on the evidence provided. The decisions for surgery and the management of the patient with hypertension. doi: 10.7860/JCDR/2014/8276.4734. However, many facets, as already explained, have been overlooked. about navigating our updated article layout. Santosh and Karanam [4] retrospectively analysed operative outcome data from 105 patients undergoing thyroid surgery. The levels of evidence contained within this review are, on the whole, weak. J Clin Diagn Res. As identified whilst critiquing the above literature, the scientific basis for the use of Lugol's iodine may indeed have some merit. Marigold et al., [15] showed that there was reduced blood flow as measured by thyroid uptake of thallium 201 in Graves disease patients treated with Lugols for 10d, though it was not clear if this was an independent effect of iodine on the gland or related to decreased cardiac output because of improvement in thyrotoxicosis. Before Iodide has been shown to decrease thyroid hormone levels and reduce blood flow within the thyroid gland. Pre-Operative Lugol's Iodine Treatment in the Management of Patients Undergoing Thyroidectomy for Graves' Disease: A Review of the Literature Having undertaken an extensive literature review, we are of the opinion that the evidence on which the American Thyroid Association's guidance on the use of preoperative Lugol's iodine is based is tenuous. It is commonly used in the preparation of patients for thyroidectomy [7]. 2002 Jan;112(1):124-33. doi: 10.1097/00005537-200201000-00022. Pre-Operative Lugol's Iodine Treatment in the Management of Patients Undergoing Thyroidectomy for Graves' Disease: A Review of the Literature. . [13] During colposcopy, Lugol's iodine is applied to the vagina and cervix. This site needs JavaScript to work properly. Before There was no difference in recurrent laryngeal nerve palsy, post-operative haematoma or length of hospital stay. By comparing these 2 groups, the authors have attempted to show that there is no difference in outcome when looking at a group that is never treated with iodine versus a group for which iodine treatment has been recommended. It works by shrinking the size of the thyroid gland and by decreasing the amount of thyroid hormones the body makes.This medication may also be used to protect the thyroid gland after radioactive. Whilst evaluating the confidence intervals quoted, one notes they are large and cross the initial volume of thyroid tissue considerably. JW Black, AF Crowther, RG Shanks, et al. The literature available within the public domain regarding the use of iodinated solutions in the pre-operative period for patients about to undergo thyroidectomy for Graves' disease is scant. This said, in those patients who are euthyroid in the pre-operative phase, it would be reasonable to argue that the benefits from pre-operative Lugol's iodine administration, if any, are due to the effects on thyroid vascularity and the minimisation of blood loss. It must be kept in mind that the data in this study was collected retrospectively and this almost certainly introduces bias. 2010 Nov;46(11):811-3. doi: 10.1016/j.oraloncology.2010.07.013. The way in which randomisation was conducted is not iterated within the paper and the blinding of patients is not commented on - a potential source of bias. Hematologic manifestations of thyroid disease. Epub 2010 Aug 21. 8600 Rockville Pike Following analysis, the evidence was ranked using the Harbour and Miller [12] classification of hierarchy. There does not appear any convincing evidence of advantages of preoperative preparation of patients with lugol's iodine in euthyroid state undergoing surgery. Two patients required treatment for post-operative hypocalcaemia and 1 sustained recurrent laryngeal nerve injury that persisted beyond 6 months (0.9%). 2017;6:20-25. It is our opinion that the evidence behind the ATA guidance on the use of preoperative Lugol's iodine is tenuous. Careers. There were no statistically significant differences in the demographic composition of the 2 treatment groups. Secondary outcomes such as blood flow and blood loss during surgery were also found to be significantly lower in the patients undergoing treatment (a 9.3-fold decrease). All patients were operated by the same surgeon where in hemi, total and subtotal thyroidectomies were performed without any usage of Lugol's iodine preoperatively. [2], although attempting to answer a specific question compared thyroidectomy outcomes in patients with Graves' disease and toxic multinodular goitre. 2021 Jun 15;22:100806. doi: 10.1016/j.conctc.2021.100806. 8600 Rockville Pike Hope N, Kelly A. Pre-operative Lugol's iodine treatment in the management of patients undergoing thyroidectomy for Graves' disease: a review of the literature. Lugol's solution and other preparations containing iodide have for almost a century been used as an adjuvant treatment in patients with Graves' disease planned for thyroidectomy. It is commonly used in the preparation of patients for thyroidectomy [7]. Rosato Lodovico, Avenia Nicola, Bernante Paolo, Palma M Aurizio De, Gulino Giuseppe, Nasi Pier Giorgio, et al. There are numerous critical points to make regarding this publication. Steurer M, Passler C, Denk DM, Schneider B, Niederle B, Bigenzahn W. Laryngoscope. All patients received anti-thyroid medications. Results of administering iodine to patients having exophthalmic goiter. I can tell, because my hand goes to it and it just feels like it's less there. Lugol's Iodine is an aqueous solution of potassium iodide and iodine. The next major breakthrough in the preoperative preparation of thyrotoxic patients did not come until the 1940s with Astwood and McKenzies description of the use of thiouracil [7]. Preparation to surgery with iodine drops (SSKI or Lugol's solution) for 10-14 days prior to surgery seems, however, to be used by only one-third of respondents to a recent European survey . None of the papers identify whether or not there were any adverse effects of taking iodine in the pre-operative period. It may be used alone, but more frequently is used after the hyperthyroidism is controlled by an antithyroid drug. KR Gardiner, CFJ Russell. An official website of the United States government. Preoperative administration of Lugol's solution decreases intraoperative blood loss during thyroidectomy in patients with Graves' disease. The lack of randomisation and surgeons' hand-picking of cases to receive potassium iodide make it difficult to reach any concrete conclusions. All patients with dual thyroid pathology or who had not undergone ultrasound scan within the previous 6 months were excluded, as were those who received potassium iodide for >1 month. Y Ebril, Y Ozluk, et al. Disclaimer, National Library of Medicine Thyroid volumes were measured at least once within 6 months pre-operatively and again within 3 days prior to surgery. Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN. Lugols iodine; Thyroid surgery. government site. The study was reviewed and approved by our institutional ethical committee, and informed consent was obtained for all patients. Complications of thyroid surgery performed by residents. Side effects were limited. Post-operative complications were recorded and were clearly defined for the purposes of the study. As a randomised controlled trial, this paper ranks higher in the Harbour and Miller classification; however, due to the omission of the randomisation process and the lack of clarity regarding the blinding of the intervention, there is potentially a high risk of bias. From this, the authors state that this reduction in vascularity allows for better visualisation and preservation of the surrounding nerves, vessels and parathyroid glands. Traditionally, Lugol's solution is taken orally at a dose of 0.5 ml 3 times daily, but clinical practice varies widely [ 3 ]. Publication types Clinical Trial Randomized Controlled Trial MeSH terms Adult You may switch to Article in classic view. Keywords: Hyperthyroidism, Thyroidectomy, Iodide, Adjuvant treatment, Escape Go to: Introduction Lugol's solution (LS) was developed 1829 by the French physician Jean Guillaume August Lugol, initially as a cure for tuberculosis. already built in. A study of complications of thyroidectomy. National Library of Medicine Efficacy and safety of preoperative preparation with Lugol's iodine solution in euthyroid patients with Graves' disease (LIGRADIS Trial): Study protocol for a multicenter randomized trial. Ovid Medline, PubMed and the ATA website were used to help identify relevant publications that have aided the answering of this question. C. Block the formation of thyroxine by the thyroid gland. Lugol's solution-induced painless thyroiditis Endocrinol Diabetes Metab Case Rep. 2017 May 30;2017:17-0034. doi: 10.1530/EDM-17-0034. eCollection 2021 Jun. A systematic review of drug therapy for Graves hyperthyroidism. Iodine as preoperative treatment in toxic nodular goiter has yet not been studied. NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Lavanya Karanam, Postgraduate, Department of ENT, JJM Medical College, Davangere, India. Patients undergoing thyroidectomy to treat Graves' disease are frequently treated with Lugol's iodine (also known as potassium iodide) in the days preceding their operation [2]. official website and that any information you provide is encrypted You can't make a hormone without adequate iodine levels. official website and that any information you provide is encrypted See Page 1. tissue Non-radioactive iodine Aka Lugol's solution Mixture of 5% iodine and 10% potassium iodide, converted to iodide in the GI before absorption, decreases Indications: Thyroid storm Preparation for thyroidectomy -Uncommon unless chronically used to cause iodism: Corrosive effects of iodine cause - PO in drops, mix with juice to . government site. Although it is hard to draw firm conclusions from this study, it does offer an alternative view on the necessity of pre-operative iodine. Demographic variables: birthdate, gender and ethnicity. Lugol's iodine reduces the thyroid hormone synthesis and release and also thyroid cellularity and vascularity and hence used in preoperative preparation of patients for thyroidectomy [15,16]. Chang et al., [16] used duplex US of the superior thyroid artery of Graves disease patients before and after 10d of Lugols solution or placebo. Statistical tests were appropriate - non-parametric Mann-Whitney U tests and parametric Student's t tests were adopted. Suppression of thyroid hormone production in preparation for subtotal thyroidectomy. 2013 Nov;154(5):1009-15. doi: 10.1016/j.surg.2013.04.064. JM Murkin. HS Plummer. This retrospective study is set out to elucidate the necessity of preoperative preparation of patients undergoing thyroidectomy with Lugols iodine. Lugol's . The critical appraisal tool CASP was used to help analyse the papers. Journal of Clinical and Diagnostic Research : JCDR. Efficacy and safety of preoperative preparation with Lugol's iodine solution in euthyroid patients with Graves' disease (LIGRADIS Trial): Study protocol for a multicenter randomized trial. Would you like email updates of new search results? Hyperthyroidism is associated with hemodynamic changes, including high output state, increased heart rate and cardiac contractility, and decreased peripheral resistance that are related to both direct cardiostimulatory effects of thyroid hormone and increased peripheral oxygen consumption [9,10]. Following review of the abstracts, 4 papers were deemed appropriate for analysis. The ePub format uses eBook readers, which have several "ease of reading" features already built in. This is arguably due to chance in such a small cohort of patients and would need larger studies to confirm that the use of Lugol's iodine was directly related to a reduction in complications. This is deemed to be an important clinical indicator as it reflects on a cleaner surgical field, and is argued by advocates of iodinated solutions to be a major reason to treat patients pre-operatively with iodine. sharing sensitive information, make sure youre on a federal [Lugol's solution for preoperative pretreatment in Grave's disease]. Following this, the evidence was ranked using the Harbour and Miller classification of hierarchy. Thyroidectomy was performed in 26 patients (96%) and one was treated with radioiodine; all treatments were without serious complications. An interesting retrospective article by Yabuta et al. There does not appear any convincing evidence of. You may switch to Article in classic view. [2] have clearly defined the cases and comparison group. Indication of surgery was ranging from suspected malignancy to cosmetic reasons and compressive features like dysphagia , dyspnoea and hoarseness of voice. It causes lowering of basal metabolic rate and heart rate and an increase in body weight[5]. Surgery. Contemp Clin Trials Commun. It is not possible to comment on whether this is an appropriate number as no power calculations were discussed. This information is intended for use by health professionals. Effect of Lugol Solution on Thyroid Gland Blood Flow and Microvessel Density in the patients with Graves Disease. Shinall MC, Jr, Broome JT, Baker A, Solorzano CC. Disease of the thyroid gland is common. The nurse is aware that this medication is given to: A. The authors confirm there are no conflicts of interest to declare. FOIA Variables: Preoperative variables. Study population: 270 patients (135 patients in each arms) undergoing total thyroidectomy (TT) due to GD in Spanish hospitals, which perform a minimum of 100 thyroidectomies a year, at least 10 of them for GD. Lugol's iodine 5 drops qds given in milk or orange juice for one week prior to surgery will block hormone production and release of preformed hormone. Bethesda, MD 20894, Web Policies government site. Lugol's solution and other iodide preparations: perspectives and research directions in Graves' disease. 8600 Rockville Pike Before He showed a statistically significant decrease in blood flow in the iodine treated group, although clinical benefit at surgery was not evaluated. Propranolol, the first adrenergic blocking agent, was introduced in 1964 [8]. Acts as an anti-histamine at larger dosages. FH Lahey. Among these five patients, three patients had (Right RLNP) and two patients had (Left RLNP) palsies. Phone :+91 8197727354 , E-mail: Received 2013 Dec 23; Revisions requested 2014 Mar 29; Accepted 2014 Jul 3. HHS Vulnerability Disclosure, Help Ebril et al., [20] hypothesized that Lugol solution might act through two mechanisms. Erbil et al. It is very important to realize that today's Lugol's is not universally the same as it was because of new federal legal requirements about concentration levels. On closer analysis of the above literature, however, it would appear that the clinical relevance of such attributes are somewhat lacking. Anaesthesia and hypothyroidism: A review of thyroxine physiology, pharmacology and anaesthetic implications. from . There appears to be little in the way of sound clinical evidence that post-operative outcomes are any different following a course of Lugol's iodine. Learn more A Mostbeck, G Galvan, P Bauer, et al. Thyrotoxicosis is a relatively common endocrine disease with an annual incidence of approximately 1 in 2,000 in Europe [1]. Conclusion Treatment of uncontrolled hyperthyroidism with Lugol's solution before definitive treatment is safe and it decreases thyroid hormone levels and heart rate. Additionally, there is no mention of how blood loss was quantified; given that this is one of the most important clinical parameters under study, it is imperative to know this information. I have been taking 0.137 mg of Synthroid daily and have just added cytomel 5 mg daily. Microvessel density was assessed using biochemical analysis. Propranolol and thyroidectomy in the treatment of thyrotoxicosis. This vital omission is arguably the most important indicator of any intervention that is purported to affect surgical outcomes. Iodine deficiency can cause hypothyroidism, but it's very rare in the United States. Unable to load your collection due to an error, Unable to load your delegates due to an error. Efficient anti-pathogen-kills most forms of bacteria, viruses, and fungi quickly. 2021 Jun 15;22:100806. doi: 10.1016/j.conctc.2021.100806. PMCID: PMC2494229. The 36 consecutive patients awaiting surgery for Graves' disease were randomly allocated to either receive 10 days of Lugol's solution pre-operatively or not to receive any. Iodine solutions, such as saturated solutions of potassium iodide (SSKI) or potassium iodide-iodine (Lugol's solution), replaced burnt sponge extract in the 19 th century as treatment for endemic goiter. Eur Thyroid J. Name of the medicinal product. eCollection 2017. Traditionally, Lugol's solution is taken orally at a dose of 0.5 ml 3 times daily, but clinical practice varies widely.I had a total thyroidectomy 6 years ago for cancer. Thyroid volume measurements were made using a specific ultrasound scanning machine and model. Indication of surgery was ranging from suspected malignancy to cosmetic reasons and compressive features like dysphagia , dyspnoea and hoarseness of voice. In cases of dysphonia with vocal cord injury, indirect laryngoscopy was also performed one and six months later. 2Professor, Department of ENT, JJM Medical College, Davangere, India. Although it is mentioned that all patients were clinically euthyroid, there is no further information as to whether this was physiological or was brought about by medical intervention. Authors Ji Wei Yang 1 , Jacques How 1 Affiliation 1 Division of Endocrinology and Metabolism, Department of Medicine, McGill University Health Centre, Montreal, QuebecCanada. Given the lack of robust clinical evidence regarding the clinical need for iodine solution in the pre-operative period, it appears clear to us that a larger, prospective, randomised controlled trial of all relevant outcomes - clinical and scientific - is required to answer whether or not patient preparation with Lugol's iodine is in fact necessary prior to surgical intervention for Graves' disease. Diagnostic doses are so small (less than 10 mCi) as to be virtually harmless. The authors themselves already identified that there were no untoward complications in either group. No patient suffered from permanent recurrent laryngeal nerve injury or persisting hypocalcaemia. Hypocalcemia was defined as a serum calcium level less than 8 mg/dl after the operation. The preoperative use of iodine solution in thyrotoxic patients prepared with propranolol. The ePub format is best viewed in the iBooks reader. The site is secure. Accessibility Persistent nerve palsy was defined as persistent dysfunction and clinical dysphonia that lasted for six months postoperatively. PMC legacy view Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. FOIA Total thyroidectomy for Graves' disease: compliance with American Thyroid Association guidelines may not always be necessary. Fillo JG, Kowalski LP. We are experimenting with display styles that make it easier to read articles in PMC. Strict exclusion criteria were identified including which patients were on anti-coagulants or who had had previous thyroid surgery, thereby attempting to control for potential confounding factors. The https:// ensures that you are connecting to the Thyroidectomy: is Lugols iodine necessary? Complications of thyroidectomy present study, The complications incurred in our study were compared as follows, Preoperative Preparation with Lugols Iodine in Thyroidectomy of Euthyroid Patients-Is it Really Mandatory?-An Otorhinolaryngologists View, JCDR Research & Publications Private Limited. Chang DC, Wheeler MH, Woodcock JP, Curley I, Lazarus JR, Fung H, John R, Hall R, McGregor AM. Keywords: There does not appear any convincing evidence of advantages of preoperative preparation of patients with lugols iodine in euthyroid state undergoing surgery. It wasnt until Plummers idea in 1923[3] to use inorganic iodine preoperatively that the mortality rate was substantially reduced (to less than 1%) in the hands of the most experienced surgeons [2,4]. This dose can be achieved with ~16 drops/day of Lugol's 5% solution (eg, 16 drops x 6.25 mg iodine/iodide per drop = 100 mg iodine/iodide). The purpose of this study is to assess if preoperative treatment with Lugol's solution prior to thyroidectomy due to hyperthyroidism reduce the surgical complications hypoparathyroidism and laryngeal nerve palsy. The largest amount of iodine in the body is in the fat cells. Complications of Thyroid surgery: Analysis of a multicentric study on 14,934 patients operated on in Italy over 5 yrs. 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