A-217 Impact of Preoperative Lugol's Iodine on Surgery for Graves Disease. Short-Term Results From Ligradis Multicenter Randomised Clinical Trial

Abstract

Background Many clinical guidelines recommend the preoperative administration of Lugol's solution (LS) for patients undergoing thyroidectomy for Graves’ disease (GD), mainly based on low-quality evidence. Our aim was to assess its influence on intra and postoperative outcomes in patients undergoing total thyroidectomy (TT) for GD. Methods We performed a nationwide multicentre randomised controlled trial including euthyroid patients scheduled for TT due to GD. Patients were randomised for either receiving or not preoperative LS. Surgeons were blinded for treatment assignment. The primary outcome was the overall rate of postoperative complications. Secondary outcomes were intraoperative events and permanent morbidity. Results 136 patients were included (68 in each arm), without preoperative differences among groups. The rate of patients who developed any complication was 51.5% in LS arm vs. 50% in controls (p=1). Postoperative hypocalcaemia appeared in 45.6% vs. 38.2% (p=0.487). The rate of postoperative vocal cord palsy was 6.1% vs. 3.3% (p=0.682). Median Thyroidectomy Difficulty Scale score was slightly higher in the LS group (10 vs. 9; p=0.031). No differences among groups were observed regarding surgical time, intraoperative bleeding, gland weight, or the rate of loss of signal in neuromonitoring. Long-term results have not yet been evaluated. Conclusion Preoperative iodine preparation can be safely obviated facing TT for GD, regarding the intraoperative difficulty and postoperative complications. If long-term results sustain these results, current advice for presurgical preparation in GD could be challenged.