Comprehensive Nursing Pharmacology Q 55
Ms.Clark has hyperthyroidism and is scheduled for a thyroidectomy. The physician has ordered Lugol’s solution for the client. The nurse understands that the primary reason for giving Lugol’s solution preoperatively is to:
A. Decrease the risk of agranulocytosis postoperatively.
B. Prevent tetany while the client is under general anesthesia.
C. Reduce the size and vascularity of the thyroid and prevent hemorrhage.
D. Potentiate the effect of the other preoperative medication so less medicine can be given while the client is under anesthesia.
Correct Answer: C. Reduce the size and vascularity of the thyroid and prevent hemorrhage.
The client may receive an iodine solution (Lugol’s solution) for 10 to 14 days before surgery to decrease vascularity of the thyroid and thus prevent excess bleeding. Plummer observed a 75% decrease in mortality associated with thyroidectomy when Lugol’s solution was introduced. At that time metabolic rate decreased as well as symptoms.
Option A: Doses of over 30 mg/day may increase the risk of agranulocytosis. In a recent randomized control trial in patients receiving Lugol’s solution median blood losses (50 vs. 140?mL), and operative times (138 vs. 150?min), were also significantly less compared to controls. The reduced blood loss is associated with both a 60% reduction in systemic angiogenic factor (VEGF) and with 50% of interleukin-16. If other angiogenic mediators also are involved is unknown.
Option B: Lugol’s solution does not act to prevent tetany. Calcium is used to treat tetany. Lugol’s solution is used both in combination with antithyroid drugs preoperatively in planned thyroidectomies in certain centers routinely, and alone as rescue therapy if severe side effects to antithyroid drugs have occurred.
Option D: Lugol’s solution does not potentiate any other preoperative medication. Lugol’s solution and other iodide preparations seem to have a low frequency of adverse effects. In doses of 1000 times the normal nutritional need, side effects may include acne, loss of appetite, or upset stomach. More severe side effects are fever, weakness, unusual tiredness, swelling in the neck or throat, mouth sores, skin rash, nausea, vomiting, stomach pains, irregular heartbeat, numbness or tingling of the hands or feet, or a metallic taste in the mouth.