Part of “CHAPTER 44 – SURGERY OF THE THYROID GLAND“

A number of different regimens are available for the preoperative preparation of patients with thyrotoxicosis; for example, iodine alone; propylthiouracil (PTU) plus iodine; PTU or methimazole (Tapazole) plus thyroxine plus iodine; PTU plus propranolol plus iodine; propranolol plus iodine; and propranolol alone. The author’s patients are typically prepared for operation by the use of PTU or methimazole, plus iodine, with or without the addition of propranolol. Each treatment has advantages and disadvantages; however, the preoperative restoration of euthyroidism is recommended.5 Most patients are treated initially with an antithyroid drug, PTU or methimazole, until they approach a normal thyroid state. Many surgeons then prefer to administer several drops of iodine (saturated solution of potassium iodide, or SSKI), two to three times a day, for 8 to 10 days or longer before surgery. The iodine decreases the vascuarity and increases the firmness of the gland.