Premedication with Lugol's solution in total thyroidectomy for graves' disease and toxic multinodular goiter: is it still indicated?

Premedication with Lugol’s solution (LS) has traditionally been used to reduce the vascularization and friability of the thyroid gland before total thyroidectomy in patients with Graves’ disease (GD) and toxic multinodular goiter (TMNG) with thyrotoxicosis and/or with undetectable serum TSH. However, the effectiveness and applicability of this treatment remain subjects of debate. This study aims to evaluate the surgical and postoperative outcomes in patients premedicated with LS compared to those who were not premedicated. Data from 100 patients who underwent total thyroidectomy for GD and TMNG at our center from 2014 to 2024 were analyzed. Patients were divided into two groups: Lugol+, premedicated with LS (n = 57), and Lugol−, not premedicated (n = 43). Variables analyzed included thyroid diameter, thyroid weight, operative time, postoperative hemorrhage, hypocalcemia, recurrent laryngeal nerve palsy, length of hospital stay, rate of reintervention for hemorrhage, intraoperative thyroid consistency. No statistically significant differences were found between the groups regarding postoperative hemorrhage (1.7% in Group Lugol+ vs. 2.3% in Group Lugol−), operative time (median: 95 vs. 85 min), immediate postoperative complications such as transient hypoparathyroidism (15.8% vs. 9.3%) and transient recurrent laryngeal nerve (RLN) palsy (3.5% vs. 2.3%), nor the other variables analyzed. Our data suggest that routine preoperative preparation with LS may not be mandatory. This study supports the thesis that patients with GD and TMNG who cannot be premedicated due to inability to obtain LS, insufficient time for preoperative preparation, or lesser compliance by patient, may still be eligible for surgery.