Rapid preoperative preparation for severe hyperthyroid Graves’ disease

Thyroidectomy (TX) is no longer the preferred choice for the therapy of hyperthyroid Graves ’ disease but is an alternative in patients who are noncompliant with or have reactions to antithyroid drugs, have moderate to severe ophthalmopathy, have large goiters, orwho refuse 131I therapyand/or long-term antithyroid drug therapy. Seventeen clinically and biochem-ically severely thyrotoxic patients (16 female, mean age of 35 yr), all but one with large goiters, underwent TX after rapid preparation. The potent inhibitors of the deiodination of T4 to T3, iopanoic acid (IOP) (500 mg twice a day) and dexametha-sone (DEX) (1 mg twice a day), were given with propylthio-uracil or methimazole, when possible, and -blockers. Thy-roid function tests were obtained before treatment and at TX. All patients were thyrotoxic (mean SE: T4, 21.6 1.2 g/dl; free T4 index (FTI), 10.3 0.8; total T3, 510 48 ng/dl). IOP an