Preoperative Lugol's Solution in Graves' Disease and Toxic Nodular Goiter

NCT ID: NCT04856488

Last Updated: 2024-10-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

182 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-11-18

Study Completion Date

2025-08-31

Brief Summary

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The purpose of this study is to assess if preoperative treatment with Lugol's solution prior to thyroidectomy can reduce the surgical complications hypoparathyroidism and laryngeal nerve palsy

Detailed Description

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Current practice in Sweden before thyroidectomy due to hyperthyroidism is preoperative treatment with antithyroid drugs (ATD) to all patients with Graves' disease and in cases of toxic nodular goiter with pronounced hyperthyroidism. Iodine solution is administered preoperatively in selected cases of Graves' disease where ATD is intolerable. In the cases where iodine is used it is in the form of extemporaneous prepared iodine potassium iodide solution (Lugol 5%). The dose varies in clinical studies. In American and Swedish guidelines the dose is 5-10 drops 3 times per day for 10 days prior to surgery. American guidelines recommend iodine as preoperative treatment i Graves' disease but this is based on sparse evidence. Iodine as preoperative treatment in toxic nodular goiter has yet not been studied.

The purpose of this study is to assess if preoperative treatment with Lugol's solution prior to thyroidectomy due to hyperthyroidism reduce the surgical complications hypoparathyroidism and laryngeal nerve palsy.

Before including toxic nodular goiters accepted for surgery, a pilot study will be performed on 20 patients with toxic nodular goiter. They will receive Lugol solution 3 times per day for ten days and thyroid hormone levels will be measured day 0, day 3-4, day 6-7 and after 10 days of Lugol treatment. Heart rate assessed and ThyPRO39 filled out before and after treatment.

Conditions

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Hyperthyroidism

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Iodine Potassium Iodide solution

Participants receive Iodine Potassium Iodide solution oral drops 3 times per day for 10 Days prior to thyroidectomy in addition to standard preoperative treatment

Group Type EXPERIMENTAL

Iodine-Potassium Iodide 5%-10% Oral and Topical Solution

Intervention Type DRUG

Iodine Potassium Iodide 5% oral solution, administered 3 times per day for 10 days

No intervention

Participants continue with standard preoperative treatment

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Iodine-Potassium Iodide 5%-10% Oral and Topical Solution

Iodine Potassium Iodide 5% oral solution, administered 3 times per day for 10 days

Intervention Type DRUG

Other Intervention Names

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Lugol's solution

Eligibility Criteria

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Inclusion Criteria

* Hyperthyroidism accepted for thyroidectomy due to toxic nodular goiter with free T4 \<30 pmol/L or Graves' disease
* Signed informed consent

Exclusion Criteria

* Unstable coronary artery disease
* Previous thyroid surgery
* Congestive heart failure
* Renal insufficiency
* Hepatic failure
* Current infection
* Treatment with steroids or anticoagulants
* Thyroid associated orbitopathy CAS \> 2
* Diabetes mellitus type 1
* Active cancer
* Severe psychiatric illness
* Amiodarone treatment
* Pregnancy
* Breast feeding
* Women of child bearing potential not using contraceptive
* Inability to comprehend the meaning of the study
* Iodine hypersensitivity
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Jan Calissendorff

OTHER

Sponsor Role lead

Responsible Party

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Jan Calissendorff

MD, Senior Consultant, PhD, Associate Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Jan Calissendorff, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Department of Molecular Medicine and Surgery, Karolinska Institutet

Locations

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Department of Endocrinology, Karolinska University Hospital

Solna, Stockholm County, Sweden

Site Status RECRUITING

Countries

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Sweden

Central Contacts

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Jan Calissendorff, MD, PhD

Role: CONTACT

+46(0)8 51770000

Fredric Hedberg, MD

Role: CONTACT

+46(0)8 51770000

Facility Contacts

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Jan Calissendorff, MD.PhD

Role: primary

0046 (0)8 51770000

Fredric Hedberg, MD

Role: backup

0046 (0)8 51770000

References

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Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-1421. doi: 10.1089/thy.2016.0229.

Reference Type BACKGROUND
PMID: 27521067 (View on PubMed)

Kaur S, Parr JH, Ramsay ID, Hennebry TM, Jarvis KJ, Lester E. Effect of preoperative iodine in patients with Graves' disease controlled with antithyroid drugs and thyroxine. Ann R Coll Surg Engl. 1988 May;70(3):123-7.

Reference Type BACKGROUND
PMID: 2457351 (View on PubMed)

Randle RW, Bates MF, Long KL, Pitt SC, Schneider DF, Sippel RS. Impact of potassium iodide on thyroidectomy for Graves' disease: Implications for safety and operative difficulty. Surgery. 2018 Jan;163(1):68-72. doi: 10.1016/j.surg.2017.03.030. Epub 2017 Nov 3.

Reference Type BACKGROUND
PMID: 29108701 (View on PubMed)

Whalen G, Sullivan M, Maranda L, Quinlan R, Larkin A. Randomized trial of a short course of preoperative potassium iodide in patients undergoing thyroidectomy for Graves' disease. Am J Surg. 2017 Apr;213(4):805-809. doi: 10.1016/j.amjsurg.2016.07.015. Epub 2016 Aug 4.

Reference Type BACKGROUND
PMID: 27769543 (View on PubMed)

Marigold JH, Morgan AK, Earle DJ, Young AE, Croft DN. Lugol's iodine: its effect on thyroid blood flow in patients with thyrotoxicosis. Br J Surg. 1985 Jan;72(1):45-7. doi: 10.1002/bjs.1800720118.

Reference Type BACKGROUND
PMID: 3967130 (View on PubMed)

Yilmaz Y, Kamer KE, Ureyen O, Sari E, Acar T, Karahalli O. The effect of preoperative Lugol's iodine on intraoperative bleeding in patients with hyperthyroidism. Ann Med Surg (Lond). 2016 Jun 16;9:53-7. doi: 10.1016/j.amsu.2016.06.002. eCollection 2016 Aug.

Reference Type BACKGROUND
PMID: 27408715 (View on PubMed)

Huang SM, Liao WT, Lin CF, Sun HS, Chow NH. Effectiveness and Mechanism of Preoperative Lugol Solution for Reducing Thyroid Blood Flow in Patients with Euthyroid Graves' Disease. World J Surg. 2016 Mar;40(3):505-9. doi: 10.1007/s00268-015-3298-8.

Reference Type BACKGROUND
PMID: 26546192 (View on PubMed)

Calissendorff J, Falhammar H. Rescue pre-operative treatment with Lugol's solution in uncontrolled Graves' disease. Endocr Connect. 2017 May;6(4):200-205. doi: 10.1530/EC-17-0025. Epub 2017 Mar 21.

Reference Type BACKGROUND
PMID: 28325735 (View on PubMed)

Calissendorff J, Falhammar H. Lugol's solution and other iodide preparations: perspectives and research directions in Graves' disease. Endocrine. 2017 Dec;58(3):467-473. doi: 10.1007/s12020-017-1461-8. Epub 2017 Oct 26.

Reference Type BACKGROUND
PMID: 29075974 (View on PubMed)

Spallek L, Krille L, Reiners C, Schneider R, Yamashita S, Zeeb H. Adverse effects of iodine thyroid blocking: a systematic review. Radiat Prot Dosimetry. 2012 Jul;150(3):267-77. doi: 10.1093/rpd/ncr400. Epub 2011 Oct 20.

Reference Type BACKGROUND
PMID: 22021061 (View on PubMed)

Nauman J, Wolff J. Iodide prophylaxis in Poland after the Chernobyl reactor accident: benefits and risks. Am J Med. 1993 May;94(5):524-532. doi: 10.1016/0002-9343(93)90089-8. No abstract available.

Reference Type BACKGROUND
PMID: 8498398 (View on PubMed)

Hedberg F, Cramon PK, Branstrom R, Falhammar H, Calissendorff J. Assessing the impact of short-term Lugol's solution on toxic nodular thyroid disease: a pre-post-intervention study. Front Endocrinol (Lausanne). 2024 Jul 25;15:1420154. doi: 10.3389/fendo.2024.1420154. eCollection 2024.

Reference Type DERIVED
PMID: 39119004 (View on PubMed)

Other Identifiers

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LugolProtocol001

Identifier Type: -

Identifier Source: org_study_id

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