For several years I used to give preoperative Lugol Solution to patients undergoing thyroidectomy for Graves’ disease. The objective of such preoperative treatment is to reduce vascularization and morbidity, and control thyroid function. However, this preoperative administration is not consensual and it is tough to find the Lugol Solution in Portuguese pharmacies.
A recent paper from my friends Francesca Torresan and Maurizio Iacobone from Padua, Italy, intend to clarify its utility. They studied 57 patients with Graves’ disease who were randomly assigned to receive 7 days of Lugol Solution (LS+) or no Lugol Solution (LS-) before undergoing total thyroidectomy. Blood loss was the primary outcome, but thyroid function, vascularization, and operation time were also analyzed and compared between the two groups. For studying thyroid function and vascularization, data were collected 8 days before surgery (T0) and on the day of surgery (T1).
Both groups were identical. The authors found that thyroid function (fT3 and fT4 levels) was significantly decreased in the LS+ group on the T1, but not in the LS- group. On the contrary, the authors found no significant difference in vascularization between T0 and T1 in both groups. Additionally, there was no difference in blood loss or in operation time. These data support the idea that Lugol Solution has no effect in decreasing thyroid vascularization and blood loss. However, Lugol Solution significantly reduced thyroid function in Graves’ disease. Is this effect truly important in patients also doing anti-thyroid drugs?
Was the duration of preoperative Lugol Solution treatment enough? The authors only promoted one week-long treatment. I usually advise for a two-week-long preoperative Lugol Solution treatment. Would one more week of treatment change the vascularization and blood loss findings?
Nowadays it seems that Lugol Solution has no impact on thyroid vascularization and blood loss. This paper is another one supporting that idea. Since this was the main reason to justify its preoperative administration, in the present day I am operating patients with Graves’ disease without doing the Lugol Solution. For now, I am not seeing any difference in blood loss. It is getting clear that there is no sense in postpone a curative surgery because the patient did not complete a preoperative Lugol Solution treatment.
What are your thoughts on this? Do you still use Lugol Solution? Are you going to keep using it? Are you going to change your practice? Will you use it only for patients whose thyroid function is difficult to control?
Link to article:
Dr. Carlos Eduardo Costa Almeida
General Surgeon
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