Rapid control of thyrotoxicosis for urgent thyroidectomy

Alexander Kreze, Tomas Podlesak, Jana Roulova, Jiri Koskuba


Surgery for Grave’s disease is one possible option for definitive treatment. Thyroidectomy is performed after achieving a euthyroid state. Pre-operative preparation of the hyperthyroid patient is essential to avoid peri- and post-operative serious complications due to thyrotoxicosis mainly thyrotoxic crisis and death. The mainstay of preparation is the administration of anti-thyroid drugs. Occasionally rapid pre-operative optimization is required for special reasons (intolerance or side effects to anti-thyroid drugs or an aggravated serious disease with thyrotoxicosis). Various regimens for this aim were suggested with protocols composing various combination iodine (as a Lugol’s solution, or iopanoic acid, or ipodat sodium), steroids, usually dexamethasone and beta blockers, alternatively other options are plasmapheresis, lithium and exchange ionic resin. The restoration of hyperthyroid Grave’s disease to euthyroidism in our patient was rapidly accomplished with iodine, dexamethasone and beta blockers (at seventh day without complications). We propose a possible treatment protocol for these cases.


Grave’s disease, Urgent thyroidectomy, Hyperthyroid

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Girgis CM, Champion BL, Wall JR. Current concepts in Grave´s disease. Ther Adv Endocrinol Metab. 2006;2:135-44.

Langley RW, Burch HB. Preoperative management of thyrotoxic patient. Endocrinol Metab Clin North Am. 2003;32:519-34.

Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. American thyroid association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 20016;26:1343-421.

McGill JB, Baranski T, Silverstein JM. Washington manual endocrinology subscpeciality consult, 4th ed. Philadelphia, Lippincott Williams and Wilkins; 2020: 391-9.

Naafs MAB. Lugol’s solution in thyroid surgery: a mini-review. Glob J Otolaryngol. 2017;16:1-4.

Callisendorf J, Falhammar H. Rescue pre-operative treatment with Lugol’s solution in uncontrolled Grave’s disease. Endocrine Connections. 2017;4:200-5.

Gardner DG, Shoback D. Greenspan basic clinical endocrinology, 10th ed., San Francisco, McGraw-Hill; 2018: 44-46.

Pagsisihan D, Silva AA, Roderos PO, Escobin A. Rapid preoperative preparation for thyroidectomy of severely hyperthyroid patient with Grawe’s disease developed agranulocytosis. J ASEAN Fed Endocrin Soc. 2015;30:48-52.

Panzer C, Beazley R, Braverman L. Rapid preoperative preparation for severe hyperthyroid Graves´disease. J Clin Endocrinol Metab. 2004;89:2142-4.

Berghout A, Wiersinga WM, Brummelkamp WH. Sodium ipodate in the preparation of Grave’s hyperthyroid patients for thyroidectomy. Horm Res. 1989;31:256-60.

Bogazzi F, Miccoli P, Berti P, Cosci P, Brogioni S, Lombardi AF, et al. Preparation with iopanoic acid rapidly controls thyrotoxicosis in patients with amiodarone-induced thyrotoxicosis before thyroidectomy. Surgery. 2002;132:1114-7.