The effect of iodine solution in total thyroidectomy for patients with Graves disease: A meta-analysis

Iodine solution has been used preoperatively in patients with Graves disease undergoing a total thyroidectomy to reduce the vascularization and its associated risk of complications. This meta-analysis aimed to investigate the safety and efficacy of preoperative administration of iodine solution in patients with Graves disease undergoing a total thyroidectomy.

Ovid MEDLINE, CINAHL, Ovid Embase, and the Cochrane Library were searched for articles since its inception to August 2024. The review was registered prospectively on the PROSPERO database (CRD42024585797).

From the 2,243 studies screened, 11 studies met the eligibility criteria, with a total of 2,257 patients with Graves disease undergoing a total thyroidectomy either with iodine solution (n = 760) or control (n = 1,497) groups. Our study demonstrated that the iodine solution group had similar outcomes compared with the control group with regard to intraoperative estimated blood loss (mean difference = -24.6 mL, 95% confidence interval: -56.2, 7.0; I² = 82%), operative time (mean difference = -2.3 minutes, 95% confidence interval: -10.6, 6.0; I² = 68%), endocrine-related complications (odds ratio = 0.85, 95% confidence interval: 0.42, 1.74; I² = 76%), hypocalcemia (odds ratio = 1.11, 95% confidence interval: 0.65, 1.91; I² = 61%), hematoma (odds ratio = 1.44, 95% confidence interval: 0.39, 5.29; I² = 58%) or recurrent laryngeal nerve injury (odds ratio = 0.70, 95% confidence interval: 0.26, 1.93; I² = 53%).

This meta-analysis demonstrates that preoperative iodine solution and control groups had similar clinical outcomes when undergoing total thyroidectomy for Graves disease. Further randomized control trials with larger samples and robust selection criteria are necessary to ascertain the perioperative effects of iodine solution in total thyroidectomy for patients with Graves disease.