PMCID: PMC2494229. The site is secure. 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. Lugol's . HHS Vulnerability Disclosure, Help Hundred and five euthyroid patients who underwent surgery without preoperative preparation of patients with Lugol's iodine were enrolled in this study. Preoperative Preparation with Lugol's Iodine in Thyroidectomy of Whilst evaluating the confidence intervals quoted, one notes they are large and cross the initial volume of thyroid tissue considerably. There is no mention within the publication on how refusal to take part in the study was dealt with. This is potentially a source for selection bias. PMID: 7051944 PMCID: PMC2494115 Abstract In a randomised controlled clinical trial of Lugol's iodine against placebo in 44 patients undergoing thyroidectomy we have failed to show any benefit in terms of reduced bleeding or operative facility after using iodide solution. Preparation for thyroid surgery and radioactive iodine diagnosis 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). 2. HHS Vulnerability Disclosure, Help 1983 Jan;65(1):63-4. 2017 Feb;6(1):20-25. doi: 10.1159/000450976. Iodine supplementation can only help hypothyroidism if an iodine deficiency is the cause of your sluggish thyroid. It has also been shown to reduce the risk of intra- and post-operative thyrotoxic storm [9], in addition to acutely inhibiting hormonal secretions [10] and the organification of iodine within the thyroid gland [11]. Disease of the thyroid gland is common. World J Surg. 2017 Dec;58(3):467-473. doi: 10.1007/s12020-017-1461-8. Has anti-biofilm surfactant properties. Two patients required treatment for post-operative hypocalcaemia and 1 sustained recurrent laryngeal nerve injury that persisted beyond 6 months (0.9%). Hope N , Kelly A Eur Thyroid J , 6(1):20-25, 22 Nov 2016 Among these five patients, three patients had (Right RLNP) and two patients had (Left RLNP) palsies. An otorhinolaryngologists view. Emerson CH, Anderson AJ, Howard WJ, Utiger RD. Thyroidectomy: is Lugol's iodine necessary? - PubMed All patients had also been on ATD at the time of the study. Tissue non radioactive iodine aka lugols solution With the advent of iodine in the preoperative treatment of thyrotoxicosis beginning in the early part of the 20th century, some surgeons noted that the iodine treated gland was less vascular and friable than the untreated gland [17]. Bethesda, MD 20894, Web Policies Contemp Clin Trials Commun. National Library of Medicine doi: 10.7860/JCDR/2014/8276.4734. The .gov means its official. Rodier JF, Janser JC, Petit H, Schneegans O, Ott G, Kaissling A, Grob JC, Velten M. Chirurg. Pre-Operative Lugol's Iodine Treatment in the Management - ResearchGate A Shaha, BM Jaffe. It probably decreases both angiogenic stimuli (reduced CD-34 expression) and blood flow in GD. Results: PMC 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. 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. Given that an iatrogenic thyroid storm would have potentially life-threatening consequences, it is important to know the consequences of handling thyroid tissue in patients with known hyperthyroidism at the time of operation. You can't make a hormone without adequate iodine levels. Abstract In a randomised controlled clinical trial of Lugol's iodine against placebo in 44 patients undergoing thyroidectomy we have failed to show any benefit in terms of . The only statistically significant difference in post-operative outcome identified was that those with TMNG suffered from post-operative transient hypocalcaemia more frequently. It is not possible to comment on whether this is an appropriate number as no power calculations were discussed. 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). Fillo JG, Kowalski LP. Iodide has been shown to decrease thyroid hormone levels and reduce blood flow within the thyroid gland. There are numerous critical points to make regarding this publication. Hundred and five euthyroid patients who underwent surgery without preoperative preparation of patients with Lugols iodine were enrolled in this study. Full text is available as a scanned copy of the original print version. Complications of thyroid surgery performed by residents. There is no mention of statistical analysis - if any - of the data presented. The https:// ensures that you are connecting to the A study of complications of thyroidectomy. Vaidya B, Pearce S. Diagnosis and management of thyrotoxicosis. Doppler evaluation of intrathyroid arterial resistances during preoperative treatment with Lugol's iodide solution in patients with diffuse toxic goiter. The American Thyroid Association (ATA) states in their guidelines on the management of hyperthyroidism that Whenever possible, patients undergoing thyroidectomy should be rendered euthyroid with methimazole, and potassium iodide should be given in the immediate preoperative period. The statistical analyses of the groups were clearly outlined, using parametric, non-parametric and correlation calculations to determine significant differences (level set at p < 0.05) between the 2 groups. Although it is hard to draw firm conclusions from this study, it does offer an alternative view on the necessity of pre-operative iodine. FH Lahey. LUGOL's - Uses, Side Effects, and More - WebMD Bethesda, MD 20894, Web Policies The critical appraisal tool CASP was used to help analyse the papers. 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. An escape phenomenon has been feared as the iodide effect has been claimed to only be temporary. It is our opinion that the evidence behind the ATA guidance on the use of preoperative Lugol's iodine is tenuous. The study population is clearly identified as patients undergoing thyroidectomy for Graves' disease between 2006 and 2008. However, evidence in support of its claimed benefits, namely a reduction in the vascularity and friability of the toxic thyroid gland, is scanty. Bethesda, MD 20894, Web Policies Calculations of volumes were made using a specific illustrated method. Coyle PJ, Mitchell JE. The incidence of hyperthyroidism in Austria from 1987 to 1995 before and after an increase in salt iodisation in 1990. HS Plummer. Erbil et al. Bookshelf [2], although attempting to answer a specific question compared thyroidectomy outcomes in patients with Graves' disease and toxic multinodular goitre. The primary outcome, microvessel density, was found to be significantly lower in the patients treated with pre-operative Lugol's iodine. The significance level was set at p < 0.05. Preoperative Preparation with Lugol's Iodine in Thyroidectomy of PDF Lugol's Solution in Thyroid Surgery: A Mini-Review - Juniper Publishers Thyroidectomy: is Lugols iodine necessary? You may switch to Article in classic view. NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Lavanya Karanam, Postgraduate, Department of ENT, JJM Medical College, Davangere, India. sharing sensitive information, make sure youre on a federal Please enable it to take advantage of the complete set of features! Yabuta T, Ito Y, Hirokawa M, Fukushima M, Inoue H, Tomoda C, Higashiyama T, Kihara M, Uruno T, Takamura Y, Kobayashi K, Miya A, Matsuzuka F, Miyauchi A. Preoperative administration of excess iodide increases thyroid volume of patients with Graves' disease. There was no randomisation of potassium iodide therapy and the decision to treat with potassium iodide was left to the operating surgeon. Hence, we conclude that it is not of much importance to use Lugol's iodine preoperatively in patients undergoing thyroidectomy. Post-operative complications were recorded and were clearly defined for the purposes of the study. PMC During the postoperative period the following events occurred, five patients (4.7%) had incurred recurrent laryngeal nerve palsy (RLNP) which was confirmed with postoperative indirect laryngoscopic examination and two patients (1.9%) with hypocalcemia (serum calcium less than 8mg/dl) which was managed conservatively and effectively. Aqueous Iodine Oral Solution BP - Summary of Product - medicines 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. 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. Surgery. 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]. No mention is made of post-operative complications. Shinall et al. Get a printable copy (PDF file) of the complete article (528K), or click on a page image below to browse page by page. 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. Muoz de Nova JL, Franch-Arcas G, Meja-Abril GP, Flores-Ruiz ME, Muoz-Prez N, Pintos-Snchez E, Guadarrama Gonzlez FJ, Valds de Anca , Mercader-Cidoncha E, de la Quintana-Basarrate A, Osorio-Silla I, Ros-Lpez S, Gallego-Otaegui L, Santos-Molina E, Martnez-Nieto C, Gamborino-Carams E, Arts-Caselles M, Lorente-Poch L, Garca-Carrillo M, Moreno-Llorente P, Marn-Velarde C, Ortega-Serrano J, Martos-Martnez JM, Vidal-Prez O, Luengo-Pierrard P, Villar-Del-Moral JM. The common complications encountered during thyroidectomy are bleeding, airway compromise due to bleeding, temporary and permanent recurrent laryngeal . Santosh U.P, Prashanth K.B, and Lavanya Karanam. 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. Hypothyroidism results in depression of myocardial function, decreased spontaneous ventilation, abnormal baroreceptor function, reduced plasma volume, anaemia, hypoglycaemia, hyponatremia and impaired hepatic drug metabolism [13,14]. This second article is also considered a level 2- piece of evidence as it is a retrospectively collected dataset of cases and controls. This vital omission is arguably the most important indicator of any intervention that is purported to affect surgical outcomes. Given the lack of robust clinical evidence regarding the clinical need for iodine solution in the pre-operative period, it appears clear 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 operative intervention for Graves' disease. Are there any differences in post-operative outcome following total thyroidectomy in patients who have Graves' disease who do not receive preoperative iodine treatment and in those who undergo total thyroidectomy for a TMNG? This piece of work clearly outlines the population to be studied. To undertake a review of the relevant English literature published on the pre-operative use of Lugol's iodine in the management of patients undergoing thyroidectomy for Graves' disease. Suppression of thyroid hormone production in preparation for subtotal thyroidectomy. Effect of Lugol Solution on Thyroid Gland Blood Flow and Microvessel Density in the patients with Graves Disease. It has been used as a disinfectant, as a reagent for starch detection in organic compounds, in histologic preparations, in Permanent unilateral vocal cord paralysis occurs in less than 1% of patients [22] and bilateral vocal cord paralysis is extremely rare. I have been steadily gaining weight ever since. and transmitted securely. The effect of preoperative Lugol's iodine on thyroid blood flow in patients with Graves' hyperthyroidism. It was therefore necessary to extend the search term beyond 5 years to ensure that a comprehensive analysis of the literature was undertaken. By extension, they were sometimes used to treat Graves' disease, but by the end of the century, they were considered to be a dangerous form of therapy. Before The study was reviewed and approved by our institutional ethical committee, and informed consent was obtained for all patients. Generating an ePub file may take a long time, please be patient. eCollection 2017. Before The .gov means its official. Conclusion Treatment of uncontrolled hyperthyroidism with Lugol's solution before definitive treatment is safe and it decreases thyroid hormone levels and heart rate. FOIA However, evidence in support of its claimed benefits, namely a reduction in the vascularity and friability of the toxic thyroid gland, is scanty. Lugol solution (inorganic iodide) has been given preoperatively to patients to limit intraoperative bleeding and related complications resulting from thyroid gland vascularization [6]. 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. PMID: 28620500 Accessibility Demographic variables: birthdate, gender and ethnicity. eCollection 2021 Jun. . The .gov means its official. 2021 Jun 15;22:100806. doi: 10.1016/j.conctc.2021.100806. Lugols iodine: its effect on thyroid blood flow in patients with thyrotoxicosis. DC Chang, MH Wheeler, JP Woodcock, et al. Hematologic manifestations of thyroid disease. Following review of the abstracts, 4 papers were deemed appropriate for analysis. Traditionally, Lugol's solution is taken orally at a dose of 0.5 ml 3 times daily, but clinical practice varies widely [3]. 2017 Feb;6(1):20-25. doi: 10.1159/000450976. PJ Coyle, JE Mitchell. Also highlighted within the guidelines are circumstances where it is not possible to render the patient euthyroid and that there is a need for urgent thyroidectomy. Acts as an anti-histamine at larger dosages. Searches were limited to the English language only. Lugol's solution and other iodide preparations: perspectives and Wolff J, Chaikoff IL. No patient suffered from permanent recurrent laryngeal nerve injury or persisting hypocalcaemia. The histological changes brought about in cases ofexophthalmic goitre by the administration of iodine. The common complications encountered during thyroidectomy are bleeding, airway compromise due to bleeding, temporary and permanent recurrent laryngeal nerve palsy, hypocalcemia, wound infection, scarring and thyrotoxic crisis due to sudden release of hormones. Erbil Y, Ozluk Y, Giris M, Salmaslioglu A, Issever H, Barbaros U, Kapran Y, Ozarmagan S, Tezelman S. Effect of Lugol's solution on thyroid gland blood flow and microvessel density in the patients with Graves' disease. The demographics of the population studied are broadly comparable, thereby minimising the risk that any findings were due to a fundamental difference between the 2 groups. Does Surgery Without Lugol's Solution Pretreatment for Graves - PubMed Epub 2014 Aug 20. Keywords: In cases of dysphonia with vocal cord injury, indirect laryngoscopy was also performed one and six months later. Thyroidectomy: is Lugol's iodine necessary? 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. the display of certain parts of an article in other eReaders. Even if you have had a thyroidectomy, the rest of your body requires and . Despite improvements in operative techniques and antisepsis, thyroid surgery on hyperthyroid patients still had a high mortality rate, ranging from 8% in the hands of experienced surgeons such as the Mayo brothers to 20% at less proficient centers [2]. 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 ]. Objective: To elucidate the necessity of Lugol's iodine in preoperative preparation of patients undergoing thyroidectomy. Preoperative administration of Lugol's solution decreases intraoperative blood loss during thyroidectomy in patients with Graves' disease. 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]. The most common cause of an overactive thyroid gland is the autoimmune condition Graves' disease. Is it necessary? INTRODUCTION. Shinall MC, Jr, Broome JT, Baker A, Solorzano CC. Lugols iodine; Thyroid surgery. This left a study population of 113 patients. 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 . government site. Pre-Operative Lugol's Iodine Treatment in the Management of Patients Undergoing Thyroidectomy for Graves' Disease: A Review of the Literature. Conclusion: Hence, we conclude that it is not of much importance to use Lugols iodine preoperatively in patients undergoing thyroidectomy. In addition, there was no standardised dose of potassium iodide administered and the dose varied according to surgeon preference and TSH level. This site needs JavaScript to work properly. Mercier F, Bonal M, Fanget F, Maillard L, Laplace N, Peix JL, Lifante JC. Why lugol's iodine is given before thyroidectomy? Petruzzi M, Lucchese A, Baldoni E, Grassi FR, Serpico R. Oral Oncol. Name of the medicinal product. Anaesthesia and hypothyroidism: A review of thyroxine physiology, pharmacology and anaesthetic implications. Traditionally, Lugol's solution is taken orally at a dose of 0.5 ml 3 times daily, but clinical practice varies widely [ 3 ]. The breakdown of diagnoses for patients is not given, which one would assume is particularly pertinent when addressing the need for Lugol's iodine in patients with Graves' disease who are about to undergo thyroidectomy. We reviewed all relevant papers found through Ovid Medline, PubMed, EMBASE and the American Thyroid Association website. sharing sensitive information, make sure youre on a federal The outcomes of the study were clearly defined. Data is presented for all participants enrolled at the start of the study - thereby minimising the effect of attrition bias. Attempts have been made to provide more objective evidence of iodines effect on vascularity. already built in. "Aqueous solution" simply means that water is the medium for the iodine. Abstract It has been established practice for 60 years to prepare thyrotoxic patients undergoing thyroidectomy with Lugol's iodine. Although major complications such as nerve injury and hypocalcaemia are evaluated, there is no mention of operative time, blood loss or wound infection and seroma rates. The ePub format uses eBook readers, which have several "ease of reading" features [12] However, it appears ineffective in patients who are already euthyroid on anti-thyroid drugs and levothyroxine. Would you like email updates of new search results? An official website of the United States government. Thyroidectomy was performed in 26 patients (96%) and one was treated with radioiodine; all treatments were without serious complications. official website and that any information you provide is encrypted Drugs allergies. and transmitted securely. There does not appear any convincing evidence of advantages of preoperative preparation of patients with lugol's iodine in euthyroid state undergoing surgery. Santosh K, Karanam L. Preoperative preparation with Lugol's iodine in thyroidectomy of euthyroid patients - is it really mandatory? It is a solution of elemental iodine (5%) and potassium iodide (KI, 10%) together with distilled water. Eur Thyroid J. P Abraham, A Avenell, CM Park, WA Watson, JS Bevan. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Although at first reading the conclusion appears to make sense, there is, in fact, very little justification given based on the evidence provided. It is commonly used in the preparation of patients for thyroidectomy [7]. This may be due to the number of patients recruited to the study. Federal government websites often end in .gov or .mil. JM Murkin. Clipboard, Search History, and several other advanced features are temporarily unavailable. Although a potentially divisive topic, the literature in the English language is limited to only a handful of current articles. All patients were operated by the same surgeon where in hemi, total and subtotal thyroidectomies were performed without any usage of Lugols iodine preoperatively. Harbour R, Miller J. A Mostbeck, G Galvan, P Bauer, et al. The effect of preoperative Lugol's iodine on intraoperative bleeding in A new system for grading recommendations in evidence-based guidelines. Ann R Coll Surg Engl. Furthermore, the ATA guideline suggests that most patients with GD should receive KI, SSKI, or Lugol's solution before thyroidectomy because of its beneficial effects including decreases in. The levels of evidence contained within this review are, on the whole, weak. In a randomised controlled clinical trial of Lugol's iodine against placebo in 44 patients undergoing thyroidectomy we have failed to show any benefit in terms of reduced bleeding or operative facility after using iodide solution. Results of administering iodine to patients having exophthalmic goiter. Saturated iodine solution (Lugol's solution) has been recommended to reduce thyroid gland hypervascularization and intraoperative blood loss, although this approach is not used at our center based on our experience that it induces thyroid firmness and potentially hypoparathyroidism. Lugol's iodine: its effect on thyroid blood flow in patients with CH Mayo, CW Mayo. Plummer observed a 75% decrease in mortality associated with thyroidectomy when LS was introduced . Furthermore, the surgical issues surrounding thyroid storms have not been dealt with. Graves disease, Iodine, Thyroid function, Total thyroidectomy, Guidelines. EB Astwood. To this end, this study has an evidence rating level of 2-. 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. 3Post Graduate Student, Department of ENT, JJM Medical College, Davangere, India. Hypocalcemia was defined as a serum calcium level less than 8 mg/dl after the operation. Shinall et al. 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. For this reason, the quality of the evidence must be rated as 1-. Radioactive Iodine ( 131 I) - 614 Adverse Effects Drug Interactions There does not appear any convincing evidence of advantages of preoperative preparation of patients with lugols iodine in euthyroid state undergoing surgery. Since then, the medical management of hyperthyroid patients has advanced considerably, such that patients are now often treated pre-operatively with beta-blockers and thiouracil-containing medications [4].
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