# Preoperative Lugol's solution and surgical outcomes in Graves’ disease: a single-center retrospective study

## TL;DR

This study found no significant difference in surgical outcomes between patients with Graves' disease who received preoperative Lugol's solution and those who did not.

## Contribution

The study provides new evidence that preoperative Lugol's solution does not reduce surgical complications in Graves' disease.

## Key findings

- No significant difference in preoperative calcium, alkaline phosphatase, or parathyroid hormone levels between groups.
- Operative times and thyroid specimen weights were similar between the groups.
- Rates of hypoparathyroidism and vocal cord paralysis were comparable, with no protective effect of Lugol's solution observed.

## Abstract

Basedow Graves disease (BG) is the most common cause of hyperthyroidism. Lugol's solution (LS) is used preoperatively to inhibit thyroid hormone production, decrease thyroid gland vascularity and ensure a safer surgical field. This study aims to evaluate efficacy of the LS and its association with surgical complications in patients with BG.

Patients with total thyroidectomy for BG between 2019 and 2024 were retrospectively included. Preoperative calcium (Ca), alkaline phosphatase (ALP), parathyroid hormone (PTH) levels, operative time, resected thyroid specimen weights, postoperative complications were analyzed.

Among 128 patients, 38(29.6%) received LS (Group1), while 90 (70.3%) did not (Group2). No significant difference was found between groups regarding preoperative Ca, ALP, PTH (p = 0.780, p = 1.000, p = 1.000, respectively). Mean operative times were 147.79 ± 64.66 min in Group1, 146.19 ± 35.69 min in Group2 (p = 0.225). Mean thyroid specimen weights were 36.83 ± 26.47 g in Group1, 43.16 ± 30.81 g in Group2 (p = 0.246). The rates of incidental parathyroidectomy were 21.1% (n = 8) in Group1 and 15.6% (n = 14) in Group2 (p = 0.456). Transient hypoparathyroidism rate was slightly higher in Group1 (34.2%, n = 13) than in Group2 (23.3%, n = 21) (p = 0.292). Permanent hypoparathyroidism occurred in 2.63% of Group1 and 8.89% of Group2 patients (p = 0.375). The rates of postoperative vocal cord paralysis, adjusted for the number of nerves at risk, were comparable between the groups (9.21%, 8.89%; p = 1.000).

The primary endpoint of postoperative hypocalcemia/hypoparathyroidism did not differ significantly between groups. Although the incidence of transient hypoparathyroidism was slightly higher in the LS group, no statistically significant difference was observed. Additionally, no significant difference was found regarding intraoperative or long-term outcomes. Present study did not demonstrate a protective effect of preoperative LS on surgical complications in patients with BG.