Role of Lugol solution before total thyroidectomy for Graves' disease: randomized clinical trial.

IF 8.6 1区 医学 Q1 SURGERY British Journal of Surgery Pub Date : 2024-08-02 DOI:10.1093/bjs/znae196
Donatella Schiavone, Filippo Crimì, Giulio Cabrelle, Gianmaria Pennelli, Diana Sacchi, Caterina Mian, Francesca Torresan, Maurizio Iacobone
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Abstract

Background: Lugol solution is often administered to patients with Graves' disease before surgery. The aim is to reduce thyroid vascularization and surgical morbidity, but its real effectiveness remains controversial. The present study was designed to evaluate the effects of preoperative Lugol solution on thyroid vascularization and surgical morbidity in patients with Graves' disease undergoing total thyroidectomy.

Methods: Fifty-six patients undergoing total thyroidectomy for Graves' disease were randomly assigned to receive 7 days of Lugol treatment (Lugol+ group, 29) or no Lugol treatment (LS- group, 27) before surgery in this single-centre and single-blinded trial. Preoperative hormone and colour Doppler ultrasonographic data for assessing thyroid vascularization were collected 8 days before surgery (T0) and on the day of surgery (T1). The primary outcome was intraoperative and postoperative blood loss. Secondary outcomes included duration of surgery, thyroid function, morbidity, vascularization, and microvessel density at final pathology.

Results: No differences in demographic, preoperative hormone or ultrasonographic data were found between LS+ and LS- groups at T0. At T1, free tri-iodothyronine (FT3) and free thyroxine (FT4) levels were significantly reduced compared with T0 values in the LS+ group, whereas no such variation was observed in the LS- group. No differences between T0 and T1 were found for ultrasonographic vascularization in either group, nor did the histological findings differ. There were no significant differences between the LS+ and LS- groups concerning intraoperative/postoperative blood loss (median 80.5 versus 94 ml respectively), duration of surgery (75 min in both groups) or postoperative morbidity.

Conclusion: Lugol solution significantly reduces FT3 and FT4 levels in patients undergoing surgery for Graves' disease, but does not decrease intraoperative/postoperative blood loss, thyroid vascularization, duration of surgery or postoperative morbidity.

Registration number: NCT05784792 (https://www.clinicaltrials.gov).

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巴塞杜氏病甲状腺全切除术前使用鲁戈尔溶液的作用:随机临床试验。
背景:巴塞杜氏病患者在手术前通常会使用卢戈溶液。其目的是减少甲状腺血管扩张和手术发病率,但其实际效果仍存在争议。本研究旨在评估术前使用卢戈溶液对接受全甲状腺切除术的巴塞杜氏病患者甲状腺血管化和手术发病率的影响:在这项单中心、单盲试验中,56名接受甲状腺全切除术的巴塞杜氏病患者被随机分配到术前接受7天鲁戈尔治疗(鲁戈尔+组,29人)或不接受鲁戈尔治疗(LS-组,27人)。手术前 8 天(T0)和手术当天(T1)收集术前激素和用于评估甲状腺血管的彩色多普勒超声数据。主要结果是术中和术后失血量。次要结果包括手术时间、甲状腺功能、发病率、血管化程度以及最终病理检查时的微血管密度:结果:LS+组和LS-组在T0时的人口统计学、术前激素或超声数据均无差异。T1时,与T0值相比,LS+组游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)水平明显降低,而LS-组无此变化。两组患者在 T0 和 T1 期间的超声血管造影结果均无差异,组织学结果也无差异。LS+组和LS-组在术中/术后失血量(中位数分别为80.5毫升和94毫升)、手术时间(两组均为75分钟)或术后发病率方面均无明显差异:结论:卢戈溶液可明显降低接受手术治疗巴塞杜氏病患者的FT3和FT4水平,但不会减少术中/术后失血量、甲状腺血管形成、手术持续时间或术后发病率:NCT05784792 (https://www.clinicaltrials.gov)。
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来源期刊
CiteScore
12.70
自引率
7.30%
发文量
1102
审稿时长
1.5 months
期刊介绍: The British Journal of Surgery (BJS), incorporating the European Journal of Surgery, stands as Europe's leading peer-reviewed surgical journal. It serves as an invaluable platform for presenting high-quality clinical and laboratory-based research across a wide range of surgical topics. In addition to providing a comprehensive coverage of traditional surgical practices, BJS also showcases emerging areas in the field, such as minimally invasive therapy and interventional radiology. While the journal appeals to general surgeons, it also holds relevance for specialty surgeons and professionals working in closely related fields. By presenting cutting-edge research and advancements, BJS aims to revolutionize the way surgical knowledge is shared and contribute to the ongoing progress of the surgical community.
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