Background: Graves' disease requires preoperative preparation before thyroidectomy to reduce perioperative risks. Conventional preparation with antithyroid drugs (ATDs) can last 12-18 months, whereas rapid protocols offer faster readiness but have uncertain efficacy and safety profiles.

Methods: This randomized controlled trial compared rapid versus conventional preoperative preparation in 31 patients planned for thyroidectomy due to Graves' disease from 2019 to 2021. The rapid group (Group B) received carbimazole, propranolol, dexamethasone, and Lugol’s iodine in an accelerated protocol. The conventional group (Group A) underwent standard long-term ATD treatment. Outcomes included biochemical euthyroidism pre-surgery, intraoperative parameters, surgical difficulty, postoperative hypocalcemia, vocal cord palsy, hospital stay, cost-effectiveness, and calcium supplementation needs.

Results: Demographics were comparable. Group B achieved biochemical remission significantly faster (median 1 week) compared to Group A (median 9 weeks) (p<0.0001). Intraoperative physiological parameters (heart rate, BP, temperature) were similar. However, the thyroid gland in Group B was significantly less vascular (p=0.047) and friable (p=0.016), resulting in a lower overall surgical difficulty score (11 vs. 14, p=0.043). There were no significant differences in postoperative hypocalcemia, recurrent laryngeal nerve injury, or hospital stay. The rapid protocol was significantly more cost-effective (Total cost: 9,746 INR vs. 11,661 INR; p=0.045) and required fewer hospital visits (p=0.001).

Conclusions: Rapid preoperative preparation using a multimodal drug regimen is safe and superior to conventional preparation regarding time to surgery and cost-effectiveness. Furthermore, it significantly reduces surgical difficulty by decreasing gland vascularity and friability.

Keywords: Graves’ disease, Thyroidectomy, Rapid preparation, Lugol’s iodine, Thyroid Difficulty Scale.

Upander Kumar has completed his MBBS from Armed Forces medical college in 2015. He has done his Surgery residency for 3 years in PGIMS, Rohtak. Subsequently he has done his senior residency in AIIMS, Delhi in 2019. He has completed his superspecialisation in Breast and Endocrine Surgery in 2022 at the age of 31 years from King Georges Medical University. Subsequently he joined the Breast and Endocrine Surgery department as Assistant Professor in the same college. He has observership at Breast and Endocrine Surgery Unit, Universiti Malaya, Malaysia and Endocrine Surgery unit, National University Health System Singapore. He was awarded BSI Travel scholarship for his presentation in ISW 2024. He has many publications in several reputed national and international journals.