Document Detail

Rapid preoperative preparation in hyperthyroidism.
MedLine Citation:
PMID:  1814659     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: We have evaluated an alternative method of preparation of hyperthyroid patients for surgery, using betamethasone, iopanoic acid and propranolol. DESIGN: Betamethasone (0.5 mg every 6 hours), iopanoic acid (500 mg every 6 hours) and propranolol (40 mg every 8 hours) were given orally for 5 days; thyroidectomy was performed on the 6th day. We analysed patient acceptability, clinical and hormonal effects, ease of surgery and final outcome. PATIENTS: Thirteen females and 1 male, aged 16-59 years, ten with diffuse goitre and four with nodular goitre were submitted to subtotal thyroidectomy because antithyroid drugs had failed to control thyrotoxicosis or because hyperthyroidism coexisted with other conditions (pregnancy, hypertensive disease). MEASUREMENTS: Daily clinical assessments were made together with T3, T4 and rT3 serum concentrations before and while on drug treatment, during the surgical procedure and post-operatively. RESULTS: Daily assessment showed progressive clinical improvement so that on day 5 the patients were considered clinically euthyroid. Serum levels of T3 (mean +/- SD) showed significant decrease (by 38.2 +/- 24.9%, P less than 0.01) as early as 24 hours after medication was started, reaching almost euthyroid levels on day 3; on the day of operation T3 had diminished by 64.5 +/- 16.6% (P less than 0.0001). Serum T4 concentration showed a slight but significant decrement only from day 4 on and never reached euthyroid levels. Serum rT3 values exhibited a brisk increment at 24 hours (+333 +/- 194%, P less than 0.0001) and remained elevated between 8 and 10 nmol/l until medication was stopped. Drug tolerance was considered as excellent since no serious side-effects were noted, even in pregnant patients. There were no anaesthetic incidents or postoperative complications and patients were discharged 48-72 hours after operation. The final outcome has been satisfactory and pregnant patients continued their pregnancies without incident, bearing normal children. CONCLUSIONS: Pharmacological combination of betamethasone, iopanoic acid and propranolol has proved to be safe and effective and is of low cost. Provided there is adequate supervision of the patients, it may be used in patients requiring urgent thyroidectomy or in those who for reasons of non-compliance need a short preoperative regime.
A Baeza; J Aguayo; M Barria; G Pineda
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical endocrinology     Volume:  35     ISSN:  0300-0664     ISO Abbreviation:  Clin. Endocrinol. (Oxf)     Publication Date:  1991 Nov 
Date Detail:
Created Date:  1992-06-22     Completed Date:  1992-06-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0346653     Medline TA:  Clin Endocrinol (Oxf)     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  439-42     Citation Subset:  IM    
Department of Oncology, Hospital Salvador, University of Chile (East Division), Santiago.
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MeSH Terms
Betamethasone / administration & dosage*
Drug Administration Schedule
Hyperthyroidism / blood,  surgery*
Iopanoic Acid / administration & dosage*
Middle Aged
Pregnancy Complications / surgery*
Preoperative Care / methods*
Propranolol / administration & dosage*
Thyroxine / blood
Time Factors
Triiodothyronine / blood
Triiodothyronine, Reverse / blood
Reg. No./Substance:
378-44-9/Betamethasone; 525-66-6/Propranolol; 5817-39-0/Triiodothyronine, Reverse; 6893-02-3/Triiodothyronine; 7488-70-2/Thyroxine; 96-83-3/Iopanoic Acid

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