Is potassium iodide solution necessary before total thyroidectomy for Graves disease?

Potassium iodide (KI) has traditionally been used to reduce gland vascularity and diminish blood loss in patients undergoing thyroidectomy for Graves disease (GD). Current American Thyroid Association (ATA) guidelines (Recommendation 22) call for its routine administration in GD but avoidance in toxic multinodular goiter (TMNG). A retrospective review (July 2008-May 2012) of perioperative data was performed on 162 patients undergoing total thyroidectomy without preoperative KI and compared to 102 patients with TMNG. Statistical analysis included Student's t test, χ2 test, and multivariate linear regression. Compared to TMNG patients, GD patients had a lower mean age (42.7 vs. 49.6 years, p<0.001) and were less likely to be obese (37 vs. 54%, p=0.047). No patients were provided KI in preparation. GD patients did not differ significantly from TMNG patients with respect to mean estimated blood loss (55.4 vs. 51.5 mL, p=0.773) or mean operative time (131.5 vs. 122.6 min, p=0.084). GD patients had a lower rate of transient hypocalcemia (31 vs. 49%, p=0.004), but the two groups did not statistically differ in rates of prolonged hypocalcemia, temporary recurrent laryngeal nerve (RLN) palsy, prolonged RLN paralysis, or hematoma formation. Although current ATA recommendations for the management of GD call for routine use of KI before thyroidectomy, this large series demonstrates no appreciable detriment to patient outcomes when this goal is not met.