Study on Rapid Control of Thyrotoxicosis for Urgent Thyroidectomy

Abstract

Surgery for Grave’s disease is one possible option for definitive treatment. After establishing euthyroid status, a thyroidectomy is performed. Pre-operative preparation of the hyperthyroid patient is critical to avoid peri- and post-operative serious complications due to thyrotoxicosis, most notably thyrotoxic crisis and death.  The administration of anti-thyroid medications is the cornerstone of preparation. Occasionally, for special reasons, rapid pre-operative optimization is required  (intolerance or side effects to anti-thyroid drugs or an aggravated serious disease with thyrotoxicosis). Several regimens for this goal have been proposed, with protocols containing various combinations of iodine (as a Lugol's solution, or iopanoic acid, or ipodat sodium), steroids, usually dexamethasone, and beta blockers, as well as plasmapheresis, lithium, and exchange ionic resin. The indication for rapid optimization with the target thyroidectomy is poorly-controlled/non-response of disease to thionamides, intolerance or serious side effects to thionamides (allergy, agranulocytosis, hepatitis and vasculitis). 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). For these circumstances, we propose a possible treatment protocol.