Does preoperative iodide treatment for thyrotoxicosis bring about involution?

Wilkin, Terence J.; Beck, J. Swanson; Michie, W.

doi:10.1136/jcp.30.2.99

Cited by 11 publications

(7 citation statements)

References 5 publications

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“…On past evidence of visual microscopy, iodine has been believed to induce involution by reducing hyperplasia as judged by the reduction in folficular epithelial cell height [33,34]. Histometry of thyroids from patients pretreated with propranolol alone or with propranolol and iodine showed unexpected variations [35]. Total gland mass increased by one-third in the iodized glands which contained almost twice as much colloid, but epithelial cell mass was similar in both groups.…”

Section: Iodine and Preoperative Involutionmentioning

confidence: 99%

Prevention and management of hypothyroidism after thyroidectomy for thyrotoxicosis

Michie

1978

World j. surg.

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Postoperative hypothyroidism is the most common complication of thyroidectomy for thyrotoxicosis. Its incidence is inversely related to remnant size. Destructive autoimmunity, as measured by the presence of antithyroid antibodies in the serum, may be another of the factors predisposing to postoperative hypothyroidism, but the extent to which such considerations should influence remnant size is a matter for debate. Experience in Iceland suggests that high iodine ingestion is associated with a low incidence of hypothyroidism and a high rate of recurrent thyrotoxicosis; consequently, smaller remnants are obligatory in Iceland. Therefore, it would seem that environmental factors also play a part, and that a remnant “norm” for each locality should be determined empirically to achieve optimum balance between hypothyroidism and recurrent thyrotoxicosis. With the establishment of a “norm,” prediction of hypothyroidism for a group of patients is reasonably accurate. For the individual patient, postoperative status cannot be predicted and it is not possible to select for alternative methods of treatment patients who might be at risk of postoperative hypothyroidism. Irrespective of large remnant size, approximately 15% of patients will develop postoperative hypothyroidism. These may be the patients described at the turn of the century, before effective treatment became available, in whom the natural course of the disease progressed through euthyroidism to hypothyroidism. It would appear, for some patients at least, that surgery merely accelerates the natural course of the disease and compresses into a matter of weeks events which normally take several months and even years. Fortunately, postoperative hypothyroidism declares itself within 12–15 months and, if clinical scrutiny is sufficiently acute, late onset hypothyroidism is rare. The ethical responsibility remains for a prolonged follow‐up of all postthyroidectomy patients.

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Section: Iodine and Preoperative Involutionmentioning

confidence: 99%

Prevention and management of hypothyroidism after thyroidectomy for thyrotoxicosis

Michie

1978

World j. surg.

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“…Quantitative histometry has only recently been introduced to thyroidology ( (Wilkin et al 1977a), and the association between antibody titres and extent of lymphocyte infiltration in thyrotoxic glands (Wilkin et al 1980). In this paper we report on the relationship between the surgical histometry, eventual outcome and type of pretreatment in Graves' disease, and seek explanations for our results.…”

Section: Discussionmentioning

confidence: 78%

“…Indeed, Greene (1953) did not find post-operative hypothyroidism in any patient with diffuse lymphocytic infiltration of the thyroid, even when extreme! Levitt (1951), like Greene (1953), based his study on 'microscopical appearances' but we shave shown that microscopic appearances alone of the thyroid can be very deceptive (Wilkin et al 1977a). The work of Levitt (1951) in any case deals with a functionally heterogeneous group, and 'many of the patients in the lymphoid phases considered hypothyroid required at least temporary post¬ operative boosting with thyroid' -a reference presumably to the temporary post-operative hypo¬ thyroidism described much later by Toft et al (1976), which is a functional phenomenon unrela¬ ted to thyroiditis.…”

Section: Discussionmentioning

confidence: 95%

“…Among those most commonly cited are the extent of infiltration of the thyroid by lymphocytes (Whitesell & Black 1949;Levitt 1951;Greene 1953) and the size of the remnant left by the surgeon Michie 1975). Both associations, however, are based on traditional methods dependent on the subjective impressions of histologist and surgeon, and recent attempts to quantify these impressions place their value in serious doubt (Wilkin et al 1977a;Wilkin et al 1980;Young et al 1976;Hedley étal. 1972).…”

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confidence: 96%

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The relationships between surgical histometry, outcome and pre-treatment in Graves' disease

Wilkin

Gunn

Moussa

et al. 1981

Acta Endocrinologica

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Quantitative histometric methods were used to established the relationship between the extent of thyroid lymphocytic infiltration at operation, and outcome exactly 18 months later in 50 surgically-treated Graves' disease patients prepared by carbimazole and triiodothyronine. Periods of pre-operative treatment, surgical technique, histometric analysis and diagnostic criteria were all standardised. Controls (107) were ob-

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“…Conseqüentemente, a alteração do fluxo sangüíneo é um importante fator para manter os níveis de HT constantes em condições de variação da ingestão de iodo (4). Altas concentrações de iodo são geralmente administradas durante os 7 a 10 dias anteriores à intervenção cirúrgica na tireóide, com o objetivo de reduzir seu fluxo sangüíneo (5,6). A glândula torna-se mais firme, melhorando as condições cirúrgicas.…”

Section: Introductionunclassified

Atividade colinesterásica em tireóide de ratos: resposta a uma sobrecarga de iodo

Borges¹,

Martins²,

Mathias³

et al. 2000

Arq Bras Endocrinol Metab

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RESUMOA utilização do iodo antes de cirurgias de tireóide visa a redução do fluxo sangüíneo para a glândula e melhora da hemostasia. Para tentar elucidar o mecanismo pelo qual a vasoconstricção se instala, foi determinada a atividade colinesterásica em tireóides de ratos Wistar machos (240-250g de peso corporal), submetidos a uma sobrecarga oral de iodo pela oferta de solução aquosa de iodato de potássio (KIO 3 3mg/ml) como água de beber, por 3 e 7 dias; o grupo controle recebeu água durante o mesmo período. Ao final do tratamento os animais foram sacrificados e suas tireóides retiradas, limpas e pesadas; o rim direito e o lobo direito do fígado foram usados como controles da atividade colinesterásica. Foram preparados homogeneizados em tampão fosfato (pH=8,0), contendo 0,32M de sacarose, na concentração de 40mg de tecido/ml. Os ratos que receberam KIO 3 por 7 dias tiveram diminuição no peso da tireóide quando comparados aos controles (p<0,05), o mesmo não acontecendo aos 3 dias de tratamento. Aos 3 dias de tratamento, a atividade colinesterásica tireóidea foi de 5,38±0,36 nmol/min.mg para o grupo controle (n=12) e de 5,43±0,98 nmol/min.mg para o grupo tratado (n=11) (NS); valores bastante similares foram também encontrados com o tratamento de 7 dias (controles: 5,42±0,27 nmol/min.mg (n=8) e tratados: 5,63±0,88 nmol/min.mg (n=8); NS). Nossos resultados sugerem que, a despeito da vasoconstricção, não há alteração da atividade colinesterásica na tireóide em resposta a sobrecarga oral de iodo. ABSTRACTIodine is given during the 7 to 10 days immediately preceding thyroid operation to decrease the vascularity of the gland, making it less friable and decreasing difficulties for the surgeon. The present work evaluated cholinesterase activity in rat thyroid glands on high iodine intake to establish a possible relationship between high iodineinduced vasoconstriction and parasympathetic activity. Male Wistar rats weighing 240-250g were given KIO 3 (3mg/ml) as drinking water for 3 and 7 days; the control groups received tap water. At the end of the treatment period rats were sacrificed and their thyroid glands taken out, washed and weighed; the liver and the kidney were used as parameters of cholinesterase activity. Rats that received KIO 3 for 7 days had a decreased thyroid gland weight compared to controls (p<0.05). However, no significant decrease in thyroid weight occurred after 3 days of treatment. At 3 days thyroid gland cholinesterase activity (nmol of acetylthiocholine hydrolysed/min.mg of protein) was 5.38±0.36 (mean±SD) in the control group (n=12) and 5.43±0.98 in the treated group (n=11) (NS). After 7 days of treatment cholinesterase activity was 5.42±0.27 in the control group (n=8) and 5.63±0.88 in the treated group (n=8) (NS). Our results suggest that the iodine-induced thyroid gland vasoconstriction is not due to changes in thyroid

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Does preoperative iodide treatment for thyrotoxicosis bring about involution?

Cited by 11 publications

References 5 publications

Prevention and management of hypothyroidism after thyroidectomy for thyrotoxicosis

Prevention and management of hypothyroidism after thyroidectomy for thyrotoxicosis

The relationships between surgical histometry, outcome and pre-treatment in Graves' disease

Atividade colinesterásica em tireóide de ratos: resposta a uma sobrecarga de iodo

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