Iodide with iodine (Lugol's solution)

How it works

Pharmacological doses of iodine transiently inhibit thyroid hormone release and reduce the vascularity and friability of the gland (Wolff-Chaikoff effect), making surgery technically easier.

Prescribing in practice

• Use only short-term, as the antithyroid effect escapes after a couple of weeks and prolonged use can paradoxically worsen thyrotoxicosis or induce iodism.
• Give after antithyroid drug therapy has rendered the patient euthyroid, generally in the days immediately before planned surgery.
• Avoid in iodine hypersensitivity and use cautiously where there is a risk of precipitating thyroid dysfunction.

Monitoring

Monitor clinical thyroid status and watch for features of iodism such as a metallic taste, sore mouth, coryza and rash.

Counselling the patient

• Dilute the drops in water, milk or juice and take with or after food to reduce gastric irritation.
• This is a short course given before your operation, not a long-term treatment.
• Report rash, mouth soreness or a persistent metallic taste.

Evidence & guidelines

Preoperative iodine to reduce thyroid vascularity before thyroidectomy is long-established surgical practice supported by endocrine and surgical guidelines.