Endocrine Abstracts

Rapid preparation of patients with hyperthyroidism for thyroidectomy

Sinem Kiyici¹, Ozen Oz Gul¹, Soner Cander¹, Turkay Kirdak², Oguz Kaan Unal¹, Canan Ersoy¹, Ercan Tuncel¹, Erdinc Erturk¹ & Sazi Imamoglu¹

¹Department of Endocrinology and Metabolism, Medical Faculty, Uludag University, Bursa, Turkey; ²Department of General Surgery, Medical Faculty, Uludag University, Bursa, Turkey.

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Thyroidectomy is an alternative treatment in the therapy of hyperthyroidism in patients who are non-compliant, drug-resistant or have various side effects to the antithyroid drugs. Preoperative preparation of hyperthyroid patients is extremely important to avoid per operative complications due to severe thyrotoxicosis. We investigated the effects of lugol solution usage with or without thionamides in the rapid preparation of thyroid surgery retrospectively. Twenty-two patients with Basedow-Graves disease, 19 patients with toxic multinodulary goiter and 3 patients with toxic adenoma were enrolled into the study. Mean ages of patients were 46.6±14.7 years and mean duration of hyperthyroidism was 38.2±59.3 months. The indications of surgical treatment were as follows: unresponsiveness to medical treatment (n=19), pancytopenia (n=9), hepatotoxicity (n=6) allergic reactions (n=3) and noncompliance (n=7) with antithyroid drugs. To restore euthyroidism before surgery, 27 patients treated with lugol solution whereas 17 patients treated with lugol solution and thionamides. Mean dose of lugol solution was daily 27.7±5.5 drops and the mean usage of lugol solution was 9.7±2.3 days. Beta-blocking agents were used in 31 patients. After lugol treatment serum free T4 concentration decreased from 2.5±1.6 to 1.37±0.71 ng/dl (normal range=0.7–1.48 ng/dl) while serum free T3 concentrations decreased from 10.0±7.3 to 3.9±3.7 pg/ml (normal range=1.71–3.71 pg/ml). Percentage changes of serum free T4 and free T3 levels were not different in patients treated with lugol solution alone as compared with patients treated lugol solution and thionamides. All patients were clinically in euthyroid status before surgery. Uneventful total and subtotal thyroidectomy performed in 37 patients while hemithyroidectomy was performed in 7 patients.

In conclusion, lugol treatment with and without antithyroid drugs is safe and effective choice in rapid preparation of patients with hyperthyroidism to thyroidectomy when surgery cannot be delayed.

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Endocrine Abstracts (2009) 20 P67