Standard management of Graves’ disease typically allows time for antithyroid drug (ATD) therapy to control thyrotoxicosis before any surgical intervention. A specific subset of patients, however, cannot follow this path: those who need urgent thyroid surgery or those for whom ATDs are contraindicated.
Rapid preoperative preparation is occasionally needed for patients requiring urgent surgery, or in patients with contraindications to antithyroid drugs. Standard ATD-based preparation is not an option in either situation, requiring an alternative approach to achieve rapid thyroid control.
Rapid restoration of euthyroidism — correction of thyrotoxicosis — before the surgical intervention.
A published short-course oral combination protocol — incorporating a β-blocker alongside high-dose glucocorticoid-based therapy, administered over the days immediately preceding thyroidectomy — has demonstrated safe and effective results in patients requiring urgent surgery. The complete regimen, sequencing, and clinical parameters are detailed in the full structured protocol.
Rapid preoperative preparation is occasionally needed for patients requiring urgent surgery (47) or in patients with contraindications to ATDs.
Safe and effective oral therapy with a combination of β-blockers (propranolol 40 mg every 8 hours), high dose glucocorticoids (betamethasone 0.5 mg every 6 hours) and sodium iopanoate (500 mg every 6 hours) has been reported in a small number of patients requiring urgent surgery.
This regimen was given for 5 days with surgery performed on the sixth day.