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Is Potassium Iodide Solution Necessary Before Total Thyroidectomy for Graves Disease?

Abstract

Background

Potassium iodide (KI) has traditionally been used to reduce gland vascularity and diminish blood loss in patients undergoing thyroidectomy for Graves disease (GD). Current American Thyroid Association (ATA) guidelines (Recommendation 22) call for its routine administration in GD but avoidance in toxic multinodular goiter (TMNG).

Methods

A retrospective review (July 2008–May 2012) of perioperative data was performed on 162 patients undergoing total thyroidectomy without preoperative KI and compared to 102 patients with TMNG. Statistical analysis included Student’s t test, χ 2 test, and multivariate linear regression.

Results

Compared to TMNG patients, GD patients had a lower mean age (42.7 vs. 49.6 years, p < 0.001) and were less likely to be obese (37 vs. 54 %, p = 0.047). No patients were provided KI in preparation. GD patients did not differ significantly from TMNG patients with respect to mean estimated blood loss (55.4 vs. 51.5 mL, p = 0.773) or mean operative time (131.5 vs. 122.6 min, p = 0.084). GD patients had a lower rate of transient hypocalcemia (31 vs. 49 %, p = 0.004), but the two groups did not statistically differ in rates of prolonged hypocalcemia, temporary recurrent laryngeal nerve (RLN) palsy, prolonged RLN paralysis, or hematoma formation.

Conclusions

Although current ATA recommendations for the management of GD call for routine use of KI before thyroidectomy, this large series demonstrates no appreciable detriment to patient outcomes when this goal is not met.

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References

  1. Plummer HS. Results of administering iodine to patients having exophthalmic goiter. JAMA. 1923;80:1955.

    Google Scholar 

  2. Bahn Chair RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21:593–646.

    PubMed  Article  Google Scholar 

  3. Werga-Kjellman P, Zedenius J, Tallstedt L, Traisk F, Lundell G, Wallin G. Surgical treatment of hyperthyroidism: a ten-year experience. Thyroid. 2001;11:187–92.

    PubMed  Article  CAS  Google Scholar 

  4. Barakate MS, Agarwal G, Reeve TS, Barraclough B, Robinson B, Delbridge LW. Total thyroidectomy is now the preferred option for the surgical management of Graves’ disease. ANZ J Surg. 2002;72:321–4.

    PubMed  Article  Google Scholar 

  5. Chiang FY, Wang LF, Huang YF, Lee KW, Kuo WR. Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery. 2005;137:342–7.

    PubMed  Article  Google Scholar 

  6. Lal G, Ituarte P, Kebebew E, Siperstein A, Duh QY, Clark OH. Should total thyroidectomy become the preferred procedure for surgical management of Graves’ disease? Thyroid. 2005;15:569–74.

    PubMed  Article  Google Scholar 

  7. Ku CF, Lo CY, Chan WF, Kung AW, Lam KS. Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves’ disease. ANZ J Surg. 2005;75:528–31.

    PubMed  Article  Google Scholar 

  8. Weber KJ, Solorzano CC, Lee JK, Gaffud MJ, Prinz RA. Thyroidectomy remains an effective treatment option for Graves’ disease. Am J Surg. 2006;191:400–5.

    PubMed  Article  Google Scholar 

  9. Gaujoux S, Leenhardt L, Tresallet C, et al. Extensive thyroidectomy in Graves’ disease. J Am Coll Surg. 2006;202:868–73.

    PubMed  Article  Google Scholar 

  10. Feliciano DV, Lyons JD. Thyroidectomy is optimal treatment for Graves’ disease. J Am Coll Surg. 2011;212:714–20.

    PubMed  Article  Google Scholar 

  11. Hallgrimsson P, Nordenstrom E, Almquist M, Bergenfelz AO. Risk factors for medically treated hypocalcemia after surgery for Graves’ disease: a Swedish multicenter study of 1,157 patients. World J Surg. 2012;36:1933–42.

    PubMed  Article  CAS  Google Scholar 

  12. Zambudio AR, Rodriguez J, Riquelme J, Soria T, Canteras M, Parrilla P. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg. 2004;240:18–25.

    PubMed  Article  Google Scholar 

  13. Agarwal G, Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review. World J Surg. 2008;32:1313–24.

    PubMed  Article  Google Scholar 

  14. Rienhoff WF. The histological changes brought about in cases of exophthalmic goiter by the administration of iodine. Bull Johns Hopkins Hosp. 1925;37:285–306.

    Google Scholar 

  15. Langley RW, Burch HB. Perioperative management of the thyrotoxic patient. Endocrinol Metab Clin N Am. 2003;32:519–34.

    Article  Google Scholar 

  16. Ansaldo GL, Pretolesi F, Varaldo E, et al. Doppler evaluation of intrathyroid arterial resistances during preoperative treatment with Lugol’s iodide solution in patients with diffuse toxic goiter. J Am Coll Surg. 2000;191:607–12.

    PubMed  Article  CAS  Google Scholar 

  17. Marigold JH, Morgan AK, Earle DJ, Young AE, Croft DN. Lugol’s iodine: its effect on thyroid blood flow in patients with thyrotoxicosis. Br J Surg. 1985;72:45–7.

    PubMed  Article  CAS  Google Scholar 

  18. Chang DC, Wheeler MH, Woodcock JP, et al. The effect of preoperative Lugol’s iodine on thyroid blood flow in patients with Graves’ hyperthyroidism. Surgery. 1987;102:1055–61.

    PubMed  CAS  Google Scholar 

  19. Coyle PJ, Mitchell JE. Thyroidectomy: is Lugol’s iodine necessary? Ann R Coll Surg Engl. 1982;64:334–5.

    PubMed  CAS  Google Scholar 

  20. Marmon L, Au FC. The preoperative use of iodine solution in thyrotoxic patients prepared with propranolol. Is it necessary? Am Surg. 1989;55:629–31.

    PubMed  CAS  Google Scholar 

  21. Yabuta T, Ito Y, Hirokawa M, et al. Preoperative administration of excess iodide increases thyroid volume of patients with Graves’ disease. Endocr J. 2009;56:371–5.

    PubMed  Article  CAS  Google Scholar 

  22. Erbil Y, Ozluk Y, Giris M, et al. Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves’ disease. J Clin Endocrinol Metab. 2007;92:2182–9.

    PubMed  Article  CAS  Google Scholar 

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Disclosures

The authors declare no conflict of interest.

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Correspondence to Myrick C. Shinall Jr. MD.

Additional information

Myrick C. Shinall Jr. and James T. Broome contributed equally to this article, and both should be considered first author.

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Shinall, M.C., Broome, J.T., Baker, A. et al. Is Potassium Iodide Solution Necessary Before Total Thyroidectomy for Graves Disease?. Ann Surg Oncol 20, 2964–2967 (2013). https://doi.org/10.1245/s10434-013-3126-z

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  • DOI: https://doi.org/10.1245/s10434-013-3126-z

Keywords

  • Recurrent Laryngeal Nerve
  • Total Thyroidectomy
  • Estimate Blood Loss
  • Grave Disease
  • Recurrent Laryngeal Nerve Palsy