Lugol solution in thyroid surgery

Introduction

Lugol solution in thyroid surgery – Lugol solution was first developed in 1829 by the Frenchy physician J.G. August Lugol, as a cure for tuberculosis. It is a solution of elemental iodine (5 %) and potassium iodine (KI, 10 %) together with distilled water. It has been used as a disinfectant, a reagent for starch detection in organic compounds, in histologic preparations, in dental procedures, and in diagnosis of cervical cell alterations. Already in the 1920s, the Lugol solution was used as a pretreatment to thyroid surgery. By that time, Lugol solution became the standard preoperative preparation in patients with Graves’ disease.

Rational for the use of Lugol in thyroid surgery

Thyroid gland in patients with Graves’ disease is very vascular. Thyroidectomy can be associated with higher rates of bleeding compared to thyroids not affected with Graves’ disease. Thus, using methods to reduce thyroid vascularity would be of benefit for the thyroid surgeon. Lugol solution reduces both thyroid hormone release and thyroid blood flow and vascularity. The result is a decrease of blood loss during surgery. Moreover, Lugol solution (LS) reduces friability of the thyroid gland, thereby greatly facilitating surgical maneuvers during thyroidectomy. Reduced thyroid parenchyma friability also means reduced tissue trauma during surgery and therefore less blood loss.

Method of administration

In the past, a short course was used to control patient’s hyperthyroidism (the Wolff-Chaikoff effect) and decrease the likelihood and severity of an intra-operative or post-operative thyroid storm. Nowadays, however, the rational for the use of LS is to decrease the vascularity and friability of the thyroid gland, making thyroidectomy easier and safer.

According to current ATA (American Thyroid Association) guidelines, 5 – 7 drops of LS (8 mg iodine/drop) should be given three times daily mixed in water or juice for 10 days before surgery. About one-third of respondents to a recent European survey prefer the administration of Lugol solution for 10-14 days before surgery.