Lugol's Solution

Introduction

Iodine solutions, such as saturated solutions of potassium iodide (SSKI) or potassium iodide-iodine (Lugol's solution), replaced burnt sponge extract in the 19th century as treatment for endemic goiter.

  • By extension, they were sometimes used to treat Graves' disease, but by the end of the century, they were considered to be a dangerous form of therapy.

They returned to favor in the 1920s as preoperative treatment for hyperthyroidism and were used in the 1930s as the sole therapy for mild hyperthyroidism prior to the introduction of the thionamides.

Today, iodine continues to have a minor role in the treatment of hyperthyroidism.



Formulation

According to British Pharmacopoeia 2020, the formulation is as shown below:

  • Iodine 50 g
  • Potassium Iodide 100 g
  • Purified Water, freshly boiled and cooled - sufficient to produce 1000 ml.

1 ml of aqueous Lugol's iodine oral solution contains 50 mg of iodine and about 130 mg of total iodine, free and combined.



Dosage

Dosing in Lexicomp for thyrotoxic storm.

  • Adult, 4 to 10 drops (0.2 to 0.5 ml) every 6 to 8 hours. May discontinue after evidence of clinical improvement (e.g. defervescence, resolution of CNS and cardiovascular manifestations); for patients undergoing thyroidectomy within 10 to 14 days of initiating iodine therapy, may continue day of surgery.
  • Administer at least 1 hour after antithyroid drug therapy (e.g. propylthiouracil, methimazole).

In thyroid storm management, Sarawak Handbook of Medical Emergencies 3rd edition suggested a dosing of 10-20 drops 8 hourly. However, the dosing of oral Lugol's iodine is then updated in 4th edition to 5 to 10 drops 6-8 hourly.



Administration

Since aqueous iodine oral solution can be irritating, it should be diluted in 240 ml or more of beverage (water or juices) and taken with food.



Storage

It should be kept in a well-closed container, the materials of which are resistant to iodine.



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