Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2010) 21 P379

SFEBES2009 Poster Presentations Thyroid (45 abstracts)

The safety and efficacy of iopanoic acid in the pre-surgical management of thyrotoxicosis

Ravi Sankar Erukulapati , Srikanth Mada & Simon Ashwell


James Cook University Hospital, Middlesbrough, UK.


Background: Iopanoic acid is an iodinated oral cholecystographic contrast agent, which can be used for the rapid blockade of thyroid hormone production in preparation for thyroidectomy, especially in patients who are intolerant of thionamides. However, appropriate timing of thyroid surgery is vital.

Project: In this retrospective audit, we identified all patients with thyrotoxicosis who received pre-operative preparation with iopanoic acid from 2006 to 2009 and evaluated appropriateness of patient selection, administration, monitoring, time to normalisation of fT4 and fT3 levels, timing and complications of thyroid surgery.

Outcomes: We identified five patients. All patients had Graves’ disease. The indication for iopanoic acid- assisted thyroidectomy was neutropaenia on thionamides (n=1), and uncontrolled thyrotoxicosis despite thionamides (n=4). The mean time from commencement of iopanoic acid to thyroidectomy was 13.6 days (range 10–20 days, median 12 days). By the time of thyroid surgery, 100% patients achieved fT3 levels within the reference range and 40% achieved normal or near-normal fT4 levels. Time to normalisation of fT3 levels correlated with baseline fT3. There were no anaesthetic or surgical complications.

Conclusions: Preoperative rapid blockade of thyrotoxicosis with iopanoic acid is safe and efficacious in a supervised environment. The optimum duration of treatment is 12–14 days. However, there is a positive correlation between the pre-iopanoic acid fT4 and fT3 levels and time taken for their normalisation. fT3 levels appear to be a better indicator of safety for surgery than fT4. This audit assists in the planning of the timing of thyroidectomy when iopanoic acid is used.

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