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Does Surgery Without Lugol's Solution Pretreatment for Graves' Disease Increase Surgical Morbidity?
Frederic Mercier1, Mathieu Bonal1, Florian Fanget1
1The Department of Digestive and Endocrine Surgery, CHU Lyon Sud, Hospices Civils de Lyon, University of Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.
World Journal of Surgery
|January 6, 2018
Summary
This study found that total thyroidectomy for Graves' disease without iodine pretreatment resulted in low rates of permanent complications. These outcomes suggest iodine pretreatment may not be necessary, warranting further research.
Area of Science:
- Endocrinology
- Surgical Oncology
- Thyroid Surgery
Background:
- Graves' disease often requires total thyroidectomy after achieving a euthyroid state with thioamides.
- Thyroid hypervascularization increases hemorrhage risk and complicates surgical identification of nerves and glands.
- Preoperative Lugol's solution is recommended to reduce vascularity, but may cause thyroid firmness and hypoparathyroidism.
Purpose of the Study:
- To evaluate the complication rates of total thyroidectomy for Graves' disease without preoperative Lugol's solution.
- To compare these complication rates with existing literature data.
Main Methods:
- Retrospective analysis of 380 patients undergoing total thyroidectomy for Graves' disease.
- Data collected between November 2010 and November 2015.
- Complication rates (e.g., cervical hematoma, hypocalcemia, recurrent laryngeal nerve palsy) were analyzed.
Main Results:
- No postoperative deaths occurred.
- Recurrent laryngeal nerve palsy occurred in 7.89% of patients, with permanent injury in 2.37%.
- Hypoparathyroidism occurred in 25.53%, with permanent cases in 3.68%. Cervical hematoma requiring reoperation occurred in 1.05%.
Conclusions:
- Total thyroidectomy without iodine pretreatment showed low rates of permanent nerve injury and hypoparathyroidism.
- These complication rates are comparable to literature findings, even with iodine pretreatment.
- Randomized controlled trials are needed to confirm the necessity of iodine pretreatment for Graves' disease surgery.