I have a young woman who recently presented with thyroid crisis due to graves' disease. She was successfully managed with beta blockade, propylthiouracil, dexamethasone and 10 days of lugol's iodine. She is now controlled on thionamide alone. I would be grateful for your advice as to how long to wait before administering radioiodine, given that she has received lugols iodine. Would a tracer uptake be of benefit?
Hamish Courtney, Royal Victoria Hospital, Belfast
Lugol's iodine is rapidly cleared from the body, especially in a thyrotoxic individual. Probably 2-3 days is enough, but I think you can be confident that after a week the RAIU will be back near the original level. On the other hand, I think you always would want to do an RAIU prior to treatment, anyway. Best regards,
L De Groot,MD