Among these five patients, three patients had (Right RLNP) and two patients had (Left RLNP) palsies and of these four RLNP (3.8%) were temporary which improved with conservative management within 3 weeks 6 months duration and one(0.9%) was a permanent Right RLN palsy with no improvement even after six months [Table/Fig-1] . 3Post Graduate Student, Department of ENT, JJM Medical College, Davangere, India. Another point to note is the heterogeneity of the groups studied, not only within the individual papers, but also between them. Eur Thyroid J . The site is secure. L Marmon, FC Au. Data is presented for all participants enrolled at the start of the study - thereby minimising the effect of attrition bias. It has been established practice for 60 years to prepare thyrotoxic patients undergoing thyroidectomy with Lugol's iodine. Thyroid volumes were measured at least once within 6 months pre-operatively and again within 3 days prior to surgery. The muscles and skin also contain a large amount of iodine. As identified whilst critiquing the above literature, the scientific basis for the use of Lugol's iodine may indeed have some merit. The authors made allowances for the fact that age and BMI displayed statistically significant differences between the 2 groups, and they utilised multiple linear regression analysis to minimise confounding. Complications of Thyroid surgery: Analysis of a multicentric study on 14,934 patients operated on in Italy over 5 yrs. This is deemed to be an important clinical indicator as it reflects on a cleaner surgical field, and is argued by advocates of iodinated solutions to be a major reason to treat patients pre-operatively with iodine. This site needs JavaScript to work properly. Whilst evaluating the confidence intervals quoted, one notes they are large and cross the initial volume of thyroid tissue considerably. MeSH Thyroidectomy was performed in 26 patients (96%) and one was treated with radioiodine; all treatments were without serious complications. 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. Y Ebril, Y Ozluk, et al. [2] performed a retrospective case-note analysis of patients undergoing total thyroidectomy. An official website of the United States government. HHS Vulnerability Disclosure, Help It is not possible to comment on whether this is an appropriate number as no power calculations were discussed. Is potassium iodide solution necessary before total thyroidectomy for Graves' disease? [Effect of preoperative administration of Lugol's solution on thyroid blood flow in hyperthyroidism]. Similarly, guidance exists for when the patient is allergic to anti-thyroid medications. We reviewed all relevant papers found through Ovid Medline, PubMed, EMBASE and the American Thyroid Association website. Following analysis, the evidence was ranked using the Harbour and Miller [12] classification of hierarchy. doi: 10.7860/JCDR/2014/8276.4734. The conclusion drawn is that Lugol's iodine solution decreased the rate of blood flow through the thyroid gland but also reduced the intra-operative blood loss. Propranolol and thyroidectomy in the treatment of thyrotoxicosis. This second article is also considered a level 2- piece of evidence as it is a retrospectively collected dataset of cases and controls. 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]. Vaidya B, Pearce S. Diagnosis and management of thyrotoxicosis. You may switch to Article in classic view. Attempts have been made to provide more objective evidence of iodines effect on vascularity. The outcomes of the study were clearly defined. 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]. Careers. It may be used alone, but more frequently is used after the hyperthyroidism is controlled by an antithyroid drug. There does not appear any convincing evidence of advantages of preoperative preparation of patients with lugols iodine in euthyroid state undergoing surgery. Drugs allergies. It is concentrated in all the glands, including the adrenals, ovaries, uterus, and breasts. Propranolol, the first adrenergic blocking agent, was introduced in 1964 [8]. We are experimenting with display styles that make it easier to read articles in PMC. [Lugol's solution for preoperative pretreatment in Grave's disease]. 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]. He showed a statistically significant decrease in blood flow in the iodine treated group, although clinical benefit at surgery was not evaluated. Shinall MC Jr, Broome JT, Nookala R, Shinall JB, Kiernan C, Parks L 3rd, Solrzano CC. Qualitative and quantitative composition. Med Clin North Am. Microvessel density was assessed using biochemical analysis. Dosing: Adult Generally, ~100 mg/day of iodine/iodide is required for thyroid block (ACR-ACNM [Subramaniam 2017]; Anderson 2012; Taeb 2012). The exclusion criteria were explicitly stated, but there is no mention of the actual numbers excluded, or if a full data set was obtained for each patient that was included. 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. Shinall MC, Jr, Broome JT, Baker A, Solorzano CC. 6 Lugols's iodine solution rapidly decreases thyroid hormone levels and reduces glandular blood flow. For this reason, it would be appropriate for a larger study using a randomisation process to be carried out before any meaningful conclusions can be reached. Among these five patients, three patients had (Right RLNP) and two patients had (Left RLNP) palsies. Persistent nerve palsy was defined as persistent dysfunction and clinical dysphonia that lasted for six months postoperatively. Diagnostic doses are so small (less than 10 mCi) as to be virtually harmless. Searches were limited to the English language only. National Library of Medicine Unable to load your collection due to an error, Unable to load your delegates due to an error. The authors themselves already identified that there were no untoward complications in either group. 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. Preoperative administration of Lugol's solution decreases intraoperative blood loss during thyroidectomy in patients with Graves' disease. The next major breakthrough in the preoperative preparation of thyrotoxic patients did not come until the 1940s with Astwood and McKenzies description of the use of thiouracil [7]. Although medical treatments exist for Graves' disease, surgical excision of the thyroid gland via total thyroidectomy offers a definitive treatment. The ePub format is best viewed in the iBooks reader. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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]. After total thyroidectomy for thyrotoxicosis it is usual to start all patients on levothyroxine 100mcg daily from day 1 post op, and recheck thyroid stimulating hormone at 6 weeks. Epub 2016 Nov 22. Calculations of volumes were made using a specific illustrated method. References contained within articles have also been evaluated to determine their potential suitability with regard to the question. A systematic review of drug therapy for Graves hyperthyroidism. 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? 2017 May;88(5):446. doi: 10.1007/s00104-017-0416-1. Hope N, Kelly A. Pre-operative Lugol's iodine treatment in the management of patients undergoing thyroidectomy for graves' disease: a review of the literature. This information is intended for use by health professionals. There is no mention of statistical analysis - if any - of the data presented. Conclusion: Hence, we conclude that it is not of much importance to use Lugols iodine preoperatively in patients undergoing thyroidectomy. Learn more Clearly defined exclusion criteria have been applied, again helping to minimise confounding factors. Results: All patients were operated by the same surgeon where in hemi, total and subtotal thyroidectomies were performed without any usage of Lugols iodine preoperatively. B. Epub 2013 Sep 26. Wolff J, Chaikoff IL. Even after 31 years on the thyroid meds, my thyroid always seems swollen. Although it is hard to draw firm conclusions from this study, it does offer an alternative view on the necessity of pre-operative iodine. PMC INTRODUCTION. Federal government websites often end in .gov or .mil. JH Marigold, AK Morgan, DJ Earle, AE Young, DN Croft. A tabulated form of the search terms used can be found in table table11 and a summary of the pertinent points of included publications appears in table table2.2. 2018 Jul;42(7):2123-2126. doi: 10.1007/s00268-017-4443-3. The significance level was set at p < 0.05. Among these five patients, three patients had (Right RLNP) and two patients had (Left RLNP) palsies. The temporary nature of the inhibitory action of excess iodine on organic iodine synthesis in the normal thyroid. In all patients, indirect laryngoscopic examination was used to evaluate vocal cord Sectionmobility both before and after surgery. eCollection 2017. 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. Journal of Clinical and Diagnostic Research : JCDR. Indication of surgery was ranging from suspected malignancy to cosmetic reasons and compressive features like dysphagia, dyspnoea and hoarseness of voice. It has been established practice for 60 years to prepare thyrotoxic patients undergoing thyroidectomy with Lugol's iodine. 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. Matilda, with hyperthyroidism is to receive Lugol's iodine solution before a subtotal thyroidectomy is performed. The functionality is limited to basic scrolling. Careers, Annals of The Royal College of Surgeons of England. All those who started the trial were analysed according to the group to which they were allocated. Name of the medicinal product. . and transmitted securely. Following this, the evidence was ranked using the Harbour and Miller classification of hierarchy. Lugol solution (inorganic iodide) has been given preoperatively to patients to limit intraoperative bleeding and related complications resulting from thyroid gland vascularization [6]. J Clin Diagn Res. Lugol is a pre-operative preparation for thyreotoxicosis in order to condense tissue, this facilitates to easy approach of the operation, as in thyrotoxicosis gland is very loose and, the risk of. Having undertaken an extensive literature review, we are of the opinion that the evidence on which the American Thyroid Association's guidance on the use of preoperative Lugol's iodine is based is tenuous. None of the papers identify whether or not there were any adverse effects of taking iodine in the pre-operative period. Ansaldo GL, Pretolesi F, Varaldo E, Meola C, Minuto M, Borgonovo G, Derchi LE, Torre GC. HS Plummer. All patients with dual thyroid pathology or who had not undergone ultrasound scan within the previous 6 months were excluded, as were those who received potassium iodide for >1 month. Pre-iodine and post-iodine days: a review of 37,228 cases of goiter at the Mayo Clinic. The study population is not clearly identified. It causes lowering of basal metabolic rate and heart rate and an increase in body weight[5]. Basic demographic data is not included; the age, sex and ASA grade of the patients is not available for comparison, and so we do not know if there was a fundamental difference between the 2 groups. eCollection 2021 Jun. This piece of work clearly outlines the population to be studied. 2014 Aug;8(8):KC01-2. Disclaimer, National Library of Medicine Lugols 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]. 2017 Feb;6(1):20-25. doi: 10.1159/000450976. Given the lack of robust clinical evidence regarding the clinical need for iodine solution in the pre-operative period, it appears clear to us 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 surgical intervention for Graves' disease. Would you like email updates of new search results? Even more importantly, perhaps, there is no mention of the incidence of adverse outcomes in the hyperthyroid patient for whom surgery was delayed so that the stipulation in the ATA guideline could be met. Results: Erbil et al. Additionally, there is no mention of how blood loss was quantified; given that this is one of the most important clinical parameters under study, it is imperative to know this information. Use of Lugol's iodine in oral cancer diagnosis: an overview. Maintain the function of the parathyroid glands. Results of administering iodine to patients having exophthalmic goiter. already built in. Traditionally, Lugol's solution is taken orally at a dose of 0.5 ml 3 times daily, but clinical practice varies widely [ 3 ]. It is commonly used in the preparation of patients for thyroidectomy [7]. All patients were operated by the same surgeon where in hemi, total and subtotal thyroidectomies were performed without any usage of Lugol's iodine preoperatively. sharing sensitive information, make sure youre on a federal 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. The study population is clearly identified as patients undergoing thyroidectomy for Graves' disease between 2006 and 2008. This left a study population of 113 patients. Predictors of Airway Complications After Thyroidectomy for Substernal Goiter. Pre-Operative Lugol's Iodine Treatment in the Management of Patients Undergoing Thyroidectomy for Graves' Disease: A Review of the Literature. S iodine as to be studied those who started the trial were analysed according to the question ;. 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