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.
If the patient still has neutropaenia, definitive treatment must be deferred.
Check that renal function remains normal, in case of sepsis, hepatitis or possible vasculitis, to ensure that any side effects of anti thyroid therapy have completely settled prior to giving definitive treatment.
Document the current biochemical thyroid status of the patient before proceeding to any definitive treatment.
Theoretically, thyroid storm may be precipitated by radio active iodine or surgery in the biochemically toxic patient, though this risk will be minimised by adequate preparation.
Surgery (thyroid or otherwise) can be safely performed in patients with a normal thyroxine and liothyronine level despite suppressed thyroid stimulating hormone levels. Mild elevations of thyroid hormones should be discussed on an individual case basis. However, patients with more severe abnormalities of biochemistry e.g. free Thyroxine >28pmol/l or free liothyronine >10pmol/l will require full emergecy preparation.
Similarly, radioactive iodine can usually be given safely with no special precautions although patients with severe abnormalities of biochemistry e.g. free Thyroxine >28pmol/l or free liothyronine >10pmol/l, or with uncontrolled symptoms of thytotoxicosis will require beta blockade for at least 48 hours prior to treatment and should be reviewed on an individual case basis.
This is useful in the patient with a retrosternal goitre, and prior to surgery in high risk patients.