Does preoperative administration of Lugol's solution in patients undergoing thyroidectomy for Graves' disease really improve surgical outcomes? A propensity score matching analysis from six high-volume centers (StELLinA study)

In patients with Graves’ disease, the 2016 American Thyroid Association guidelines and 2018 European Thyroid Association guidelines recommend the administration of Lugol’s solution prior to surgery. The objective of this study was to evaluate whether preoperative administration of this solution in patients undergoing thyroidectomy for Graves’ disease really improves surgical outcomes. Patients who underwent total thyroidectomy for Graves’ disease, performed by high-volume surgeons, in six European centers, between 2019 and 2023, were retrospectively evaluated. Based on preoperative administration of Lugol’s solution, two groups were identified: LS Group, including patients who received this solution, and NoLS Group, including those who did not receive it. Surgical outcomes were assessed after performing propensity score matching (1:1). According to the inclusion criteria, 1380 patients were enrolled: 622 in LS Group and 758 in NoLS Group. After propensity score matching, the study population consisted of 494 patients: 247 in LS Group and 247 in NoLS Group. Regarding complications, neck hematomas managed conservatively were significantly greater in NoLS Group (P = 0.016); while unilateral recurrent laryngeal nerve injury, overall postoperative hypoparathyroidism, and temporary hypoparathyroidism were significantly greater in LS Group (P = 0.026, P < 0.001, P < 0.001; respectively). The duration of surgery and postoperative hospital stay were significantly longer in LS Group (P < 0.001, P < 0.001; respectively). Based on our findings and those of other authors, we believe that the recommendations of existing guidelines should be revised.