Pre-operative use of Lugol’s iodine in a case with toxic adenomatous goiter

Abstract

A patient with goiter and a hyperthyroid state can be treated with pharmacotherapy, surgical management or radioiodine. A goiter in hyperthyroid state often has increased vascularity. Intra-operative and immediate postoperative bleeding and a thyrotoxic storm are the most dreaded complications of thyroid surgery. A reduction in bleeding also facilitates a clean dissection and better visualization of important structures like recurrent laryngeal nerves as well as the parathyroid glands. In the early 20th century, it was postulated and later proven that preoperative use of inorganic iodine leads to decreased morbidity and mortality. The histology of adenomatous goiter varies from solid to gelatinous or colloid-rich type. The etiology includes iodine deficiency, dietary goitrogens or inherent dyshormonogenesis. The use of inorganic iodine in pharmacological doses inhibits iodine transport in the thyroid and iodide organification (Wolff-Chaikoff effect) and rapidly inhibits thyroid hormone synthesis and release and thereby negating the thyrotoxicosis. However, after a few weeks, the effect weans off and the thyrotoxicosis recurs. Therefore, short-term use of inorganic iodide is useful in preparing patients with hyperthyroidism for thyroid surgery. Usually, it is given in dosage of three to five drops thrice daily for 10 days.