E-DRUG: Lugol's Solution effectiveness in thyroid treatment (3)
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Hello Kae,
The Martindale's statement is referenced to a Consensus Statement published
in the BMJ in 1996 by a working group of the Research Unit of the Royal
College of Physicians of London, the Endocrinology and Diabetes Committee of the Royal College of Physicians of London, and the Society for
Endocrinology.1 However, in this article, they provide no reference or
explanation as to why they consider iodine to be of little benefit.
Most other drug references seem to suggest that the use of oral potassium
iodide (or strong iodide solution) for pre-operative preparation for
thyroidectomy may be useful.2-5 The iodine is given to decrease gland
vascularity and lower serum thyroid hormone concentrations in patients who
are not euthyroid to facilitate surgical resection.3,6,7 It is important to note that the iodine is given adjunctively after hyperthyroidism is
controlled with other agents such as the thionamides.4,6 Iodide works by
blocking the peripheral conversion of thyroxine (T4) to triiodothionine (T3) and inhibits hormone release and is not typically used for routine treatment because of paradoxical increases in hormonal release from prolonged use.7
When used preoperatively, iodide preparations are typically added to other
anti-thyroid treatment 10-14 days before surgery.2,4,6 One review article
suggests a regimen of one drop of potassium iodide solution (SSKI) two to
three times daily or Lugol's solution 5-10 drops two to three times daily
added to a regimen of antithyroid drug therapy about 10 days before
surgery.6 Another source suggests potassium iodide 15 mg per day up to 250
mg three times daily given 10-14 days preoperatively.2 Lugol's solution may also be of benefit in patients who cannot tolerate standard anti-thyroid therapy.8
Have you spoken to the surgeons who would be performing these types of
surgery in your hospital to find out what their opinion is? It seems that
iodines place in therapy is primarily adjunctive or for patients who cannot
tolerate standard therapy.
Hope this information was helpful!
Regards,
Jenny Albrich, PharmD, BCPS
Amayeza Info Center
South Africa
amayeza@pharmail.co.za
References:
1. Vanderpump MPJ, Ahlquist JAO, Franklyn JA, and Clayton RN. Consensus
statement for good practice and audit measures in the management of
hypothyroidism and hyperthyroidism. BMJ 1996 Aug;313:539-44.
2. Thompson Micromedex. Accessed 12/9/2006.
3. Up to Date. www.uptodate.com
4. McEvoy GK. AHFS Drug Information 2005. Bethesda, MD: American
Society of Health-System Pharmacists
5. Gibbon CJ, ed. South African Medcines Formulary. 7th edition. 2005.
Cape Town: Division of Clinical Pharmacology, Faculty of Health Sciences,
University of Capetown.
6. Schussler-Fiorenza CM, Bruns CM, and Chen H. The surgical management
of Graves' Disease. J Surg Res 2006;133(2):207-14.
7. Reid JR and Wheeler SF. Hyperthyroidism: Diagnosis and Treatment. Am
Fam Physician 2005;72:623-30, 635-6.
8. Jamieson A and Semple CG. Successful treatment of Graves disease in
pregnancy with Lugol's iodine. Scott Med J 2000 Feb;45(1):20-1.
Successful treatment of Graves disease in pregnancy with Lugol's iodine.
Jamieson A, Semple CG.
Centre for Diabetes and Metabolism, Southern General Hospital, Glasgow.
Andrew@jamieson14.freeserve.co.uk
We report a case of Grave's disease in pregnancy complicated by intolerance
of standard antithyroid drug therapy. We describe the success of prolonged use of organic iodine as a primary treatment prior to surgical intervention.
PMID: 10765530 [PubMed - indexed for MEDLINE]
