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Occasionally, rapid pre\u2010operative optimization is required. The primary objective was to compare the outcomes of patients undergoing elective surgery for well\u2010controlled GD with those undergoing rapid pre\u2010operative treatment. We also propose a formal treatment protocol for future use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study in a tertiary referral centre included 247 patients with well\u2010controlled GD undergoing elective surgery and 19 patients with poorly controlled disease undergoing surgery after rapid optimization. The latter group did not respond well to thionamides (carbimazole and\/or propylthiouracil) or had intolerance or side effects to thionamides and were treated with a range of non\u2010thionamide drugs, including Lugol's iodine, cholestyramine, beta blockers and steroids (with or without thionamides), and closely monitored for 1\u20132 weeks before surgery. Outcome measures included thyroid storm, hypoparathyroidism and recurrent laryngeal nerve palsy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 266 patients with male\u2010to\u2010female ratio of 1:6 and median (interquartile range) age of 39 (31\u201351) were included. Overall, long\u2010term recurrent laryngeal palsy and hypoparathyroidism occurred in 1 (0.38%) and 13 (4.9%) patients, respectively. No patient had thyroid storm. There was no significant difference in hypoparathyroidism (<jats:italic>p<\/jats:italic>\u2009=\u20091), vocal cord palsy (<jats:italic>p<\/jats:italic>\u2009=\u20090.803) and post\u2010operative bleeding (<jats:italic>p<\/jats:italic>\u2009=\u20090.362), between elective surgery and rapid optimization groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Rapid pre\u2010operative treatment is effective, safe and is associated with similar outcomes compared to usual treatment. A rapid pre\u2010operative optimization protocol is proposed.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-019-05125-5","type":"journal-article","created":{"date-parts":[[2019,8,12]],"date-time":"2019-08-12T16:07:51Z","timestamp":1565626071000},"page":"3051-3058","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Outcomes After Urgent Thyroidectomy Following Rapid Control of Thyrotoxicosis in Graves\u2019 Disease are Similar to Those After Elective Surgery in Well\u2010Controlled Disease"],"prefix":"10.1002","volume":"43","author":[{"given":"Adibah","family":"Ali","sequence":"first","affiliation":[{"name":"Endocrine Surgery Unit Sheffield Teaching Hospitals NHS Foundation Trust F8, Ward F2, Royal Hallamshire Hospital, Beech Hill Road S10 2JF Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Debono","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabapathy P.","family":"Balasubramanian","sequence":"additional","affiliation":[{"name":"Endocrine Surgery Unit Sheffield Teaching Hospitals NHS Foundation Trust F8, Ward F2, Royal Hallamshire Hospital, Beech Hill Road S10 2JF Sheffield UK"},{"name":"Department of Oncology and Metabolism University of Sheffield Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp0801880"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020\u2010017\u20101306\u20105"},{"key":"e_1_2_8_4_1","first-page":"CD003420","article-title":"Antithyroid drug regimen for treating Graves\u2019 hyperthyroidism","volume":"1","author":"Abraham P","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/2042018811408488"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000129357.58265.3c"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0889\u20108529(03)00010\u20100"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000181127"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1067\/msy.2002.128561"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102265.1991.tb03562.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003\u2010031981"},{"key":"e_1_2_8_12_1","first-page":"w14243","article-title":"Rapid preoperative blockage of thyroid hormone production\/secretion in patients with Graves\u2019 disease","volume":"146","author":"Fischli S","year":"2016","journal-title":"Swiss Med Wkly"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2016.0500"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2010.0047"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1607\u2010551X(09)70352\u20103"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020\u2010008\u20109076\u20108"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199902000\u201000012"},{"key":"e_1_2_8_18_1","first-page":"1","article-title":"Modification, validation and implementation of a protocol for post\u2010thyroidectomy hypocalcaemia","volume":"100","author":"Stedman T","year":"2017","journal-title":"Ann R Coll Surg Engl"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0243"},{"key":"e_1_2_8_20_1","first-page":"3","article-title":"The management of hyperthyroidism due to Graves\u2019 disease in Europe in 1986. 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