Table 4 Summary of ETD for Recommendation # 24

Original Recommendation

If surgery is chosen as treatment for GD, patients should be rendered euthyroid prior to the procedure with ATD pretreatment, with or without beta-adrenergic blockade. A potassium iodide containing preparation should be given in the immediate preoperative period (Strong Recommendation; Low Quality Evidence).

Modified Recommendation

If surgery is chosen to manage thyrotoxicosis, patients should be rendered euthyroid prior to the procedure with ATD pre-treatment and/or beta-adrenergic blockade. A KI-containing preparation should be given in the immediate preoperative period.

Overall Conclusion

☐Strong recommendation for Modified Recommendation

☐Conditional recommendation for Modified Recommendation

☐Conditional recommendation for either Original Recommendation or Modified Recommendation

☐Conditional recommendation for Original Recommendation

☒Strong recommendation for Original Recommendation

Additional Suggestions:

• Potassium iodide should be administered one hour after ATD to prevent iodine being used as substrate for further thyroid hormone synthesis

Justification:

• Rendering a patient euthyroid prior to surgery is essential. Potassium iodide helps achieve euthyroid status while also providing additional potential benefits such as decreasing thyroid vascularity and limiting intraoperative bleeding.