Abstract
Lugol’s solution and other preparations containing iodide have for almost a century been used as an adjuvant treatment in patients with Graves’ disease planned for thyroidectomy. Iodide has been shown to decrease thyroid hormone levels and reduce blood flow within the thyroid gland. An escape phenomenon has been feared as the iodide effect has been claimed to only be temporary. Lugol’s solution has many additional effects and is used in other settings beside the thyroid. Still, there are questions of its mode of action, which doses should be deployed, if it should be used preoperative in all thyroidectomies or only in a few selected ones if at all, what is its use in other forms of thyrotoxicosis besides Graves’ disease, and what is the mechanism acting on the vasculature and if these effects are confined only to arterial vessels supporting the thyroid or not. This review aims to collate current available data about Lugol’s solution and other iodide preparations in the management of Graves’ disease and give some suggestions where more research is needed.
Highlights
Lugol’s solution (LS) was developed 1829 by the French physician Jean Guillaume August Lugol, initially as a cure for tuberculosis
We recently demonstrated that LS in this setting was effective and decreased both thyroid hormone levels and heart rate with few side effects [4]
LS has been advocated for almost 100 years in the treatment of Graves’ disease (GD)
Summary
Lugol’s solution (LS) was developed 1829 by the French physician Jean Guillaume August Lugol, initially as a cure for tuberculosis. In another Japanese study the combination resulted in a higher propotion of normalized thyroid hormones at 30 and 60 days compared to antithyroid drugs alone [50] In both these investigations iodide was stopped when free T4 had normalized. In a Swiss investigation, patients with high free T4 and free T3 were pretreated before surgery with betablockers, 2 mg dexamethasone (to inhibit peripheral conversion to T3) and 13 drops LS thrice daily (243.75 mg of iodide daily) for 10–14 days, and acquired almost normalization of thyroid hormones [52]. In the study by Sato et al adverse effects with a combination of methimazole 15 mg and inorganic iodine (KI tablets) at dose of 38.2 mg per day were less common than in a group of patients treated with methimazole alone with 30 mg daily [50]. We do not know if the vasculature effects in GD are present in other thyroidal diseases such as goiter or multinodular diseases, or in other vascular beds in the body
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