Is Potassium Iodide Solution Necessary Before Total Thyroidectomy for Graves Disease?
Abstract
Background Potassium iodide (KI) has traditionally been used to reduce gland vascularity and diminish blood loss in patients undergoing thyroidectomy for Graves disease (GD). Current American Thyroid Association (ATA) guidelines (Recommendation 22) call for its routine administration in GD but avoidance in toxic multinodular goiter (TMNG).Methods A retrospective review (July 2008-May 2012) of perioperative data was performed on 162 patients undergoing total thyroidectomy without preoperative KI and compared to 102 patients with TMNG. Statistical analysis included Student's t test, χ2 test, and multivariate linear regression.Results Compared to TMNG patients, GD patients had a lower mean age (42.7 vs. 49.6 years, p<0.001) and were less likely to be obese (37 vs. 54%, p=0.047). No patients were provided KI in preparation. GD patients did not differ significantly from TMNG patients with respect to mean estimated blood loss (55.4 vs. 51.5 mL, p=0.773) or mean operative time (131.5 vs. 122.6 min, p=0.084). GD patients had a lower rate of transient hypocalcemia (31 vs. 49%, p=0.004), but the two groups did not statistically differ in rates of prolonged hypocalcemia, temporary recurrent laryngeal nerve (RLN) palsy, prolonged RLN paralysis, or hematoma formation.Conclusions Although current ATA recommendations for the management of GD call for routine use of KI before thyroidectomy, this large series demonstrates no appreciable detriment to patient outcomes when this goal is not met.
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The study of omitting preoperative SSKI mitigates concern when thyroidectomy is scheduled and SSKI is not given because of shortages, scheduling issues, patient allergy, or patient intolerance.
“However, this study mitigates concern when thyroidectomy is scheduled and SSKI is not given because of shortages, scheduling issues, patient allergy, or patient intolerance.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [183]
In a series of 162 patients with GD and 102 patients with TMNG, none of whom received SSKI preoperatively, no significant differences were observed in operative times, blood loss, or postoperative complications between the two groups; the authors concluded that omitting preoperative SSKI for GD patients does not impair patient outcomes.
“In a recent series of 162 patients with GD and 102 patients with TMNG, none of whom received SSKI preoperatively, no significant differences were observed in operative times, blood loss, or postoperative complications between the two groups; the authors concluded that omitting preoperative SSKI for GD patients does not impair patient outcomes (183).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [183]
It is unclear whether the study of omitting preoperative SSKI was adequately powered to detect a significant difference, if one existed.
“It is also unclear whether it was adequately powered to detect a significant difference, if one existed.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [183]
The study of omitting preoperative SSKI was performed at a single high-volume institution, compared two different pathologies, and had no comparison group of patients with GD who received SSKI, so its findings may not be generalizable.
“Given that this study was performed at a single high-volume institution, its findings may not be generalizable; comparison was made between two different pathologies, and there was no comparison group of patients with GD who received SSKI.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [183]
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- Authors
- Shinall, M. C., Broome, J. T., Baker, A., & Solorzano, C. C.
- Affiliations
- Vanderbilt University Medical Center (US)
- Corresponding author
- Shinall, Myrick C.
- ORCID
- Shinall, Myrick C.
- Venue
- Annals of Surgical Oncology
- Published
- 2013-07-12
- Volume
- 20
- Issue
- 9
- Pages
- 2964-2967
- ISSN
- 1068-9265 (ISSN-L)
- 1534-4681
- OpenAlex
- W2006358849
- Cited by
- 37
- References
- 23
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 1 · 2019: 5 · 2018: 4 · 2017: 4 · 2016: 6 · 2015: 2 · 2014: 4
- FWCI
- 3.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Annals of Surgical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Keywords
- potassium iodide, total thyroidectomy, Graves' disease, toxic multinodular goiter, perioperative care, blood loss, transient hypocalcemia, recurrent laryngeal nerve palsy, hematoma, American Thyroid Association guidelines
- MeSH terms
- Adult, Combined Modality Therapy, Female, Follow-Up Studies, Goiter, Nodular, Graves Disease, Humans, Male, Middle Aged, Postoperative Complications, Potassium Iodide, Prognosis, Retrospective Studies, Thyroidectomy
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