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

Sharang Kulkarni, Sheetal Murchite, Saurabh Parab, Vikash Tiwari, Archa Rajagopal


Euthyroid state is considered a requisite before planning a thyroid surgery. Before such a surgery, pharmacotherapy can be used for managing a hyperthyroid state. It warrants a long-term treatment with pharmacotherapy agents like imidazole class (carbimazole, methimazole) or propylthiouracil. In cases with large goiters, with pressure symptoms like dyspnoea, dysphagia, dysphonia; a surgeon would prefer a pharmacotherapy with a quicker action than the established agents. Lugol’s iodine was used pre-operatively before the advent of newer agents. In rural areas, where patients present with large goiters, hyperthyroid states due to lack of awareness and availability of the modern pharmacotherapy, Lugol’s iodine can be a rescue pre-operative therapy to make such a patient euthyroid and to decrease the vascularity of the goiter, which facilitates a safer thyroid surgery.


Thyroid surgery, Euthyroid, Lugol’s iodine

Full Text:



Calissendorff J, Falhammar H. Rescue pre-operative treatment with Lugol’s solution in uncontrolled Graves’ disease. Endocr Connect. 2017;6(4):200-5.

Yilmaz Y, Kamer KE, Ureyen O, Sari E, Acar T, Karahalli O. The effect of preoperative Lugol's iodine on intraoperative bleeding in patients with hyperthyroidism. Ann Med Surg (Lond). 2016;9:53-7.

Santosh UP, Prashanth KB, Karanam L. Preoperative preparation with Lugol’s Iodine in thyroidectomy of euthyroid patients-is it really mandatory?-an otorhinolaryngologist’s view. J Clin Diagn Res. 2014;8(8):1.

Yoshida SH, Takamatsu JU, Kuma KA, Murakami YA, Sakane SA, Katayama SH, et al. A variant of adenomatous goiter with characteristic histology and possible hereditary thyroglobulin abnormality. J Clinic Endocrinol Metabol. 1996;81(5):1961-6.

Farling PA. Thyroid disease. Br J Anaesth. 2000;85:15-28.

HS Plummer. Results of administering iodine to patients having exophthalmic goiter. JAMA. 1923;80:155-6.

Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American thyroid association and american association of clinical endocrinologists. Endocr Pract. 2011;17(3):456-520.

Ansaldo GL, Pretolesi F, Varaldo E, Meola C, Minuto M, Borgonovo G, et al. Doppler evaluation of intrathyroid arterial resistances during preoperative treatment with Lugol’s iodide solution in patients with diffuse toxic goiter. J Am Coll Surg. 2000;191(6):607-12.

Erbil Y, Ozluk Y, Giris M, Salmaslıoglu A, Issever H, et al. Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves’ disease. J Clin Endocrinol Metab. 2007;92(6):2182-9.

Carroll R, Matfin G. Endocrine and metabolic emergencies: thyroid storm. Ther Adv Endocrinol Metab. 2010;1(3):139-45.

Hope N, Kelly A. Pre-operative lugol's iodine treatment in the management of patients undergoing thyroidectomy for Graves' disease: a review of the literature. European Thyr J. 2017;6(1):20-5.