How do you prepare toxic goiter for total or subtotal thyroidectomy?

1. B - blocker /inderal .

2. Anti hypertensive .

3. Thionamides : ptu , methimazole .

Thyroxine to restore euthyroid

Treat patient with antithyroid medicines , beta blockers, Lugosi iodine to restore euthyroid status

yes we make patient euthyroid before surgery

bring the patient to euthyroid condition

use of Lugol prior to surgery

The aim of treatment is to make patient euthyroid or even hypothyroid.

- antithyroid  medication : neomercazole the dose is according to the clinical state of the patient & values of TFT and the urgency of the surgery .

- B blokers to treat the tachycardia patient usually has .

- Lugo iodide to decrease the vascularity of the goiter

before going for surgery first treat thyrotoxic state with antithyroid medications, propranolol & lugols iodine, otherwise throtoxic storm could develop

Assess pt clinically and biomedically.if pt have hyperthyroidism as in this case make the pt euthyroid by anti-thyroid drugs and beta blockrers.then assess for anaesthesia fitness and larangioscopy and general fitness.During surgery and post operatively be concious for thyroid storm make all drugs available to handle emergency like anti thyroid drugs ,beta blockers ,lugol iodine ,corticosteroids,cold sponging for hyperpyrexia and intra venous fluids.

Preop.preparation by anti thyoid drug and beta blocker to make clinical and biochemical euthyroid before surgery with preop.laryngeoscope examination. 

We have to guard against a thyroid storm that could happen due to manipulation of the thyroid gland . So the pt must be euthyroid and on suitable beta blockade . Plus standard pre op check ups

first of all tft to make sure the levels of hormones are acceptable with the treatment if not we need to adjust treatment prior to immediate surgery extra dose given to avoid crisis

Restoring U thyroid state in patient prior to opting for thyroidectomy