How should patients with hyperthyroidism be prepared for surgery?
It is important to render patients euthyroid prior to surgery for hyperthyroidism to avoid perioperative thyroid storm. Antithyroid medications administered for 4 weeks prior to surgery are usually adequate. Because recovery of TSH may lag behind thyroid hormone levels, serum thyroxine (T 4 ) and triiodothyronine (T 3 ) levels should be used to determine adequacy of antithyroid therapy. It is recommended that patients receive saturated solution of potassium iodide (SSKI; or Lugol’s solution, 3–5 drops three times a day) for 10 days prior to surgery to decrease the vascularity of the goiter and reduce the risk of bleeding. Patients who are very symptomatic may benefit from preoperative beta-blockade. For more rapid induction of a euthyroid state, patients may also be given corticosteroids, which can return serum T 4 and T 3 to within the normal range in < 7 days. In cases of severe, refractory hyperthyroidism, plasmapheresis may occasionally be indicated.