Grave's disease surgery is one option for a definite treatment. A thyroidectomy is performed once euthyroid status has been established. Pre-operative hyperthyroid patient preparation is crucial to avoid catastrophic thyrotoxicosis-related peri- and post-operative consequences, most notably thyrotoxic crisis and mortality. The cornerstone of preparation is the use of anti-thyroid medicines. Rapid pre-operative optimization is occasionally required for unique reasons (intolerance or side effects to anti-thyroid drugs or an aggravated serious disease with thyrotoxicosis). Several procedures involving various combinations of iodine (as a Lugol's solution, iopanoic acid, or ipodat sodium), steroids, generally dexamethasone, and beta blockers, as well as plasmapheresis, lithium, and exchange ionic resin have been proposed to achieve this purpose. Poorly controlled/non-responsive disease to thionamides, intolerance, or substantial adverse effects to thionamides are indications for quick optimization with the target thyroidectomy (allergy, agranulocytosis, hepatitis and vasculitis). With iodine, dexamethasone, and beta blockers, our patient's hyperthyroid Grave's disease was quickly restored to euthyroidism (at seventh day without complications). We present a viable therapy plan for these scenarios.
Author(S) Details
Alexander Kreze
Department of Internal Medicine, Hospital of Bulovka Prague, Czech Republic.
Tomas Podlesak
Department Otorhinolaryngology, Hospital of Bulovka Prague, Czech Republic.
Jana Roulova
Department of Internal Medicine, Hospital of Bulovka Prague, Czech Republic.
Jiri Koskuba
Department of Internal Medicine, Hospital of Bulovka Prague, Czech Republic.
View Book:- https://stm.bookpi.org/RDMMR-V9/article/view/4592
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