Preparation for thyroid surgery and radioactive iodine

Most patients with well controlled thyrotoxicosis require no special preparation for thyroid surgery or radio active iodine. However, people with uncontrolled thyrotoxicosis or who are intolerant of anti thyroid medications will require specific medical preparation to ensure surgery is safe and to ensure radioactive iodine is safe and effective.

General examination

Thorough general examination is required to assess the patient's thyroid status prior to considering definitive treatment.

Temperature

Pyrexia is a cardinal feature of thyroid storm which requires emergency treatment before definitive treatments can be considered. 

Cardiovascular examination

Full cardiovascular examination is mandatory looking for signs of sepsis and for control of thyrotoxicosis.

Tachycardia, atrial fibrillation and heart failure are cardinal features of thyroid storm which requires emergency treatment before definitive treatments can be considered. 

Respiratory examination

Radio active iodine therapy carries with it the theoretical risk of transient thyroid swelling. Patients with large goitres should therefore be assessed for potential tracheal narrowing prior to radio active iodine therapy.

Gastro-intestinal examination

Abdominal pain and abnormalities of liver funciton may be features of thyroid storm which requires emergency treatment before definitive treatments can be considered. 

Neurological examination

Any neurological dysfunction should raise the possibility of thyroid storm which must be treated prior to considering definitive treatment.