Preoperative assessment: thyrotoxicosis preparation: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Preoperative assessment: thyrotoxicosis preparation

Sample item

A patient with Graves disease is scheduled for elective thyroidectomy. Which preoperative preparation is standard?

AThyroxine supplementationBAntithyroid drug and propranolol, with Lugol's iodine for 7 to 10 days before surgeryCRadioactive iodine on the morning of surgeryDImmediate surgery without preparation

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Antithyroid drug and propranolol, with Lugol's iodine for 7 to 10 days before surgery

The patient should be rendered euthyroid with an antithyroid drug, and a beta blocker controls adrenergic symptoms. Lugol's iodine for 7 to 10 days reduces gland vascularity and hormone release. Antithyroid drugs are continued up to the day of surgery.

Option by option

A. Thyroxine supplementation
Thyroxine would worsen thyrotoxicosis.
B. Antithyroid drug and propranolol, with Lugol's iodine for 7 to 10 days before surgery (correct)
Correct. This combination makes the patient euthyroid and the gland less vascular.
C. Radioactive iodine on the morning of surgery
Radioactive iodine is an alternative therapy and is not a perioperative measure.
D. Immediate surgery without preparation
An unprepared thyrotoxic patient risks thyroid storm.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is B, Antithyroid drug and propranolol, with Lugol's iodine for 7 to 10 days before surgery. The patient should be rendered euthyroid with an antithyroid drug, and a beta blocker controls adrenergic symptoms.

Why is "Thyroxine supplementation" not the answer?

Thyroxine would worsen thyrotoxicosis.

Why is "Radioactive iodine on the morning of surgery" not the answer?

Radioactive iodine is an alternative therapy and is not a perioperative measure.

Why is "Immediate surgery without preparation" not the answer?

An unprepared thyrotoxic patient risks thyroid storm.

What concept does this question test?

It tests Preoperative assessment: thyrotoxicosis preparation in Anaesthesia. Lugol's iodine for 7 to 10 days reduces gland vascularity and hormone release. Antithyroid drugs are continued up to the day of surgery.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Preoperative assessment: thyrotoxicosis preparation?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.