Endocrine Abstracts

JOINT2009

Introduction: Graves’ disease is a predominantly female autoimmune disorder of the thyroid gland. It is characterized by a diffuse goiter and biological hyperthyroidism, often accompanied by exophthalmos. Although medical treatments exist for Graves’ disease, surgical excision of the thyroid gland offers a definitive treatment. Preoperative preparation with Lugol’s iodine is still controversial. The aim of our study is to highlight the benefits of preoperative treatment with Lugol’s iodine in the management of patients undergoing thyroidectomy for Graves’ disease.

Patients and methods: This is a retrospective study that collected records of patients hospitalized for surgical management of Graves’ disease over an eleven-year period.

Results: Our series included 51 patients, 38 women (75%) and 13 men (25%) with a mean age of 39.41 years and extremes of 14 to 69 years. The goiter was multi-nodular in 23 patients (45%), homogeneous in 22 cases (43%) and nodular only in 12% of patients. Surgery was indicated in cases of resistance to medical treatment (84%), poor compliance (8%) and associated thyroid carcinoma (6%). Forty-nine patients (96.1%) underwent preoperative preparation with potassium iodide (Lugol’s solution 2%) at a dose of 07-10 drops*3/day (over a period of 07 to 10 days). All our patients underwent total thyroidectomy. The operative difficulties were mainly the dissection of the recurrent nerves and the parathyroid glands made difficult by the hypervascularization of the gland and the bleeding during the procedure. Postoperative complications included transient hypocalcemia in 21 patients (41.17%), transient dysphonia in 3 patients (5.88%), and hematoma in 2 patients (3.92%).

Conclusion: Total thyroidectomy is the procedure of choice for the definitive cure of Graves’ disease. Postoperative complications are frequent and not negligible, hence the need for preoperative medical preparation. Both the American Thyroid Association and the European Thyroid Association recommend the use of Lugol’s solution in the preparation of patients undergoing surgery, but their recommendations are based on low-quality evidence.