Preoperative Use of Lugol's Iodine in Graves' Disease- Clearer Surgical Field but No Effect on Outcomes: A Meta-analysis of Controlled Studies

Abstract

Background: Recently, the American Thyroid Association (ATA) assessed their guidelines regarding the treatment of the Graves’ disease and its compliance. These guidelines emphasized on preoperative treatment with Lugol’s Iodine before surgery, but said guidelines are based on historical practice rather than on evidence to the benefit of Lugol’s Iodine in the preoperative period. We conducted a meta-analysis to analyse the effect of Lugol's Iodine in the preoperative patient with Graves' disease.

Data Source: Studies were identified using the Medical Subject heading and free-text words: “Graves'’ disease” “Thyroidectomy” “Preoperative Treatment” “Lugol's Iodine” “Potassium Iodine” “Hyperthyroidism” in Pubmed Central, Pubmed, Cochrane, Embase, ICTRP, CINAHL and Google Scholar.

Methods: Randomized and controlled studies which compared the Lugol's Iodine therapy with non Lugol's Iodine or placebo therapy prior to thyroidectomy for Graves'’ disease were included in the study. Single arm study, non-comparative study, euthyroid and non-toxic thyroid nodules were excluded from the study. Meta-analysis data was assessed using random effect with pooled results using mean difference and Odd’s ratio where applicable. Outcomes assessed were intraoperative and postoperative parameters.

Results: We found 4 randomised control trial and 6 comparative studies which compared the effect Lugol's Iodine with non-Lugol's Iodine in the preoperative period in a patient of Graves' disease. A total of 977 patients were identified with 372 administered Lugol's Iodine and 605 not administered Lugol's Iodine in the preoperative phase. Mean blood flow, vascular density and estimated blood loss was significant in patients who were administered preoperative Lugol's Iodine solution, while there was no significant difference in difficult thyroidectomy scale, thyroid volume, and post-operative outcomes such as mean-operative time, hypocalcaemia, vocal cord paresis, hematoma formation in both the groups.

Conclusion: Administration of Lugol's Iodine decreases the vascularity and estimate blood loss intraoperatively, but has no effect on difficult thyroidectomy scale, its volume and weight and on postoperative parameters. We found no clinical evidence that Lugol’s Iodine improves patient outcomes.