{"id":"https://openalex.org/W7224919773","doi":"https://doi.org/10.7759/cureus.118832","title":"Evaluating an Outpatient Rapid Preoperative Optimization Protocol for Poorly Controlled Graves\u2019 Disease: A Retrospective Cohort Study","display_name":"Evaluating an Outpatient Rapid Preoperative Optimization Protocol for Poorly Controlled Graves\u2019 Disease: A Retrospective Cohort Study","publication_year":2026,"publication_date":"2026-10-30","ids":{"openalex":"https://openalex.org/W7224919773","doi":"https://doi.org/10.7759/cureus.118832","pmid":"https://pubmed.ncbi.nlm.nih.gov/42964670","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13721594"},"language":"en","primary_location":{"id":"doi:10.7759/cureus.118832","doi":"https://doi.org/10.7759/cureus.118832","is_oa":true,"landing_page_url":"https://doi.org/10.7759/cureus.118832","pdf_url":"https://www.cureus.com/articles/524695-evaluating-an-outpatient-rapid-preoperative-optimization-protocol-for-poorly-controlled-graves-disease-a-retrospective-cohort-study.pdf","source":{"id":"https://openalex.org/S2738950867","display_name":"Cureus","issn_l":"2168-8184","issn":["2168-8184"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-20","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310316779","host_organization_name":"Cureus, Inc.","host_organization_lineage":["https://openalex.org/P4310316779"],"host_organization_lineage_names":["Cureus, Inc."],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"diamond","oa_url":"https://www.cureus.com/articles/524695-evaluating-an-outpatient-rapid-preoperative-optimization-protocol-for-poorly-controlled-graves-disease-a-retrospective-cohort-study.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5044815401","display_name":"Hao Wei Tan","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210102902","display_name":"Sheffield Teaching Hospitals NHS Foundation Trust","ror":"https://ror.org/018hjpz25","country_code":"GB","type":"funder","lineage":["https://openalex.org/I4210102902"]}],"countries":["GB"],"is_corresponding":true,"raw_author_name":"Hao Wei Tan","raw_affiliation_strings":["Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR","institution_ids":["https://openalex.org/I4210102902"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5016400033","display_name":"Mohammad Zaid Seegoolam","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I2801759359","display_name":"Northern General Hospital","ror":"https://ror.org/05r409z22","country_code":"GB","type":"healthcare","lineage":["https://openalex.org/I2801759359","https://openalex.org/I4210102902"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Mohammad Zaid Seegoolam","raw_affiliation_strings":["Endocrinology and Diabetes, Northern General Hospital, Sheffield, GBR"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Endocrinology and Diabetes, Northern General Hospital, Sheffield, GBR","institution_ids":["https://openalex.org/I2801759359"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5039393889","display_name":"Mohummad Shaan Goonoo","orcid":"https://orcid.org/0000-0003-2793-309X","observed_orcids":["https://orcid.org/0000-0003-2793-309X"]},"institutions":[{"id":"https://openalex.org/I2801759359","display_name":"Northern General Hospital","ror":"https://ror.org/05r409z22","country_code":"GB","type":"healthcare","lineage":["https://openalex.org/I2801759359","https://openalex.org/I4210102902"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Mohummad Shaan Goonoo","raw_affiliation_strings":["Endocrinology and Diabetes, Northern General Hospital, Sheffield, GBR"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Endocrinology and Diabetes, Northern General Hospital, Sheffield, GBR","institution_ids":["https://openalex.org/I2801759359"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5029236147","display_name":"Sabapathy Prakash Balasubramanian","orcid":"https://orcid.org/0000-0001-5953-2843","observed_orcids":["https://orcid.org/0000-0001-5953-2843"]},"institutions":[{"id":"https://openalex.org/I2801759359","display_name":"Northern General Hospital","ror":"https://ror.org/05r409z22","country_code":"GB","type":"healthcare","lineage":["https://openalex.org/I2801759359","https://openalex.org/I4210102902"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Sabapathy P Balasubramanian","raw_affiliation_strings":["Diabetes and Endocrinology, Northern General Hospital, Sheffield, GBR"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Diabetes and Endocrinology, Northern General Hospital, Sheffield, GBR","institution_ids":["https://openalex.org/I2801759359"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5112589389","display_name":"Muhammad Fahad Arshad","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210102902","display_name":"Sheffield Teaching Hospitals NHS Foundation Trust","ror":"https://ror.org/018hjpz25","country_code":"GB","type":"funder","lineage":["https://openalex.org/I4210102902"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Muhammad Fahad Arshad","raw_affiliation_strings":["Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR","institution_ids":["https://openalex.org/I4210102902"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5044815401"],"corresponding_institution_ids":["https://openalex.org/I4210102902"],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.86099108,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"18","issue":"10","first_page":"e118832","last_page":"e118832"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10293","display_name":"Thyroid Disorders and Treatments","score":0.6782000064849854,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10293","display_name":"Thyroid Disorders and Treatments","score":0.6782000064849854,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11930","display_name":"Cardiac, Anesthesia and Surgical Outcomes","score":0.15870000422000885,"subfield":{"id":"https://openalex.org/subfields/2705","display_name":"Cardiology and Cardiovascular Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11728","display_name":"Thyroid and Parathyroid Surgery","score":0.10909999907016754,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/graves-disease","display_name":"Graves' disease","score":0.9929999709129333},{"id":"https://openalex.org/keywords/preoperative-optimization","display_name":"preoperative optimization","score":0.8970000147819519},{"id":"https://openalex.org/keywords/hyperthyroidism","display_name":"hyperthyroidism","score":0.8399999737739563},{"id":"https://openalex.org/keywords/hyperthyroidism-management","display_name":"hyperthyroidism management","score":0.5180000066757202}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9789999723434448},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.7649999856948853},{"id":"https://openalex.org/C2780385302","wikidata":"https://www.wikidata.org/wiki/Q367158","display_name":"Protocol (science)","level":3,"score":0.6312999725341797},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.4788999855518341},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.44839999079704285},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.33309999108314514},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.30469998717308044},{"id":"https://openalex.org/C3020110884","wikidata":"https://www.wikidata.org/wiki/Q695416","display_name":"Outpatient clinic","level":2,"score":0.2985000014305115},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.28459998965263367},{"id":"https://openalex.org/C545542383","wikidata":"https://www.wikidata.org/wiki/Q2751242","display_name":"Medical emergency","level":1,"score":0.27549999952316284},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.2628999948501587}],"mesh":[],"locations_count":3,"locations":[{"id":"doi:10.7759/cureus.118832","doi":"https://doi.org/10.7759/cureus.118832","is_oa":true,"landing_page_url":"https://doi.org/10.7759/cureus.118832","pdf_url":"https://www.cureus.com/articles/524695-evaluating-an-outpatient-rapid-preoperative-optimization-protocol-for-poorly-controlled-graves-disease-a-retrospective-cohort-study.pdf","source":{"id":"https://openalex.org/S2738950867","display_name":"Cureus","issn_l":"2168-8184","issn":["2168-8184"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-20","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310316779","host_organization_name":"Cureus, Inc.","host_organization_lineage":["https://openalex.org/P4310316779"],"host_organization_lineage_names":["Cureus, Inc."],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13721594","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13721594/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13721594/pdf/cureus-0018-00000118832.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"Text"},{"id":"pmid:42964670","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42964670","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"Journal Article"}],"best_oa_location":{"id":"doi:10.7759/cureus.118832","doi":"https://doi.org/10.7759/cureus.118832","is_oa":true,"landing_page_url":"https://doi.org/10.7759/cureus.118832","pdf_url":"https://www.cureus.com/articles/524695-evaluating-an-outpatient-rapid-preoperative-optimization-protocol-for-poorly-controlled-graves-disease-a-retrospective-cohort-study.pdf","source":{"id":"https://openalex.org/S2738950867","display_name":"Cureus","issn_l":"2168-8184","issn":["2168-8184"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-20","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310316779","host_organization_name":"Cureus, Inc.","host_organization_lineage":["https://openalex.org/P4310316779"],"host_organization_lineage_names":["Cureus, Inc."],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":1.0}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7224919773.pdf","grobid_xml":"https://content.openalex.org/works/W7224919773.grobid-xml"},"referenced_works_count":22,"referenced_works":["https://openalex.org/W1764073923","https://openalex.org/W1981565562","https://openalex.org/W1983562605","https://openalex.org/W2034746294","https://openalex.org/W2041536357","https://openalex.org/W2057915382","https://openalex.org/W2089212170","https://openalex.org/W2130246688","https://openalex.org/W2141326175","https://openalex.org/W2413815091","https://openalex.org/W2510464317","https://openalex.org/W2517330109","https://openalex.org/W2521229585","https://openalex.org/W2609756780","https://openalex.org/W2610534492","https://openalex.org/W2884675353","https://openalex.org/W2884779255","https://openalex.org/W2968708637","https://openalex.org/W3013190317","https://openalex.org/W3022564440","https://openalex.org/W4246035014","https://openalex.org/W4408498576"],"related_works":["https://openalex.org/W4307884557","https://openalex.org/W4401151473","https://openalex.org/W7082630750","https://openalex.org/W2411123457","https://openalex.org/W2288463332","https://openalex.org/W1492466757","https://openalex.org/W3087190009","https://openalex.org/W3130449746","https://openalex.org/W7217491511","https://openalex.org/W4248945167"],"abstract_inverted_index":{"BACKGROUND:":[0],"Thyroidectomy":[1],"is":[2,451],"indicated":[3],"in":[4,86,110,280,335,341,347,355,361,368,393,414],"relapsed":[5],"or":[6,59,170,224,380,442],"poorly":[7,145],"controlled":[8,146],"Graves'":[9,87,147],"disease,":[10,13],"thyroid":[11,37,203,241,318,420],"eye":[12],"pregnancy,":[14],"suspected":[15],"malignancy,":[16],"and":[17,26,63,99,121,158,190,193,198,266,302,350,365,417,427],"large":[18],"goiter.":[19],"Guidelines":[20],"recommend":[21],"rendering":[22],"patients":[23,245,284,343,363,395,416],"biochemically":[24],"euthyroid":[25],"adequately":[27],"beta-blocked":[28],"before":[29,453],"surgery":[30,64,141],"to":[31,45,48,72,94,112,295,309,328,445],"reduce":[32],"the":[33,107,231,235,276,435,438],"risk":[34],"of":[35,215,255,282,322,375,437],"perioperative":[36,240,317,419],"storm,":[38],"but":[39],"thionamide":[40],"therapy":[41,181,332],"commonly":[42],"requires":[43],"four":[44],"eight":[46],"weeks":[47],"achieve":[49,95],"this.":[50],"Rapid":[51,84],"multimodal":[52],"preparation,":[53],"used":[54],"where":[55],"antithyroid":[56],"drugs":[57],"fail":[58],"are":[60],"not":[61],"tolerated,":[62],"cannot":[65,433],"wait,":[66],"has":[67],"conventionally":[68],"required":[69,164,268,334,452],"a":[70,138,252],"10-":[71],"14-day":[73],"admission,":[74],"with":[75,144,188,202,251,409,440],"no":[76,373,418],"standardized":[77],"outpatient":[78,104,125,153,407],"alternative":[79],"described.":[80],"The":[81,178,209,423],"Sheffield":[82],"Perioperative":[83],"Optimization":[85],"Disease":[88],"(SPROG)":[89],"protocol":[90,179],"was":[91,100,135,213,239,333,345,366,385,391,402],"developed":[92],"locally":[93],"rapid":[96,399],"biochemical":[97,411],"control":[98],"adapted":[101],"for":[102],"entirely":[103,404],"delivery":[105],"during":[106],"COVID-19":[108],"pandemic":[109],"response":[111],"hospital":[113],"bed":[114],"pressures.":[115],"This":[116],"study":[117,134,432],"evaluated":[118],"its":[119],"safety":[120,237,436],"effectiveness":[122],"as":[123,200],"an":[124,406],"regimen.":[126],"MATERIALS":[127],"AND":[128],"METHODS:":[129],"A":[130],"single-center":[131],"retrospective":[132],"observational":[133],"conducted":[136],"at":[137,176,230,275,293],"tertiary":[139],"endocrine":[140],"unit.":[142],"Patients":[143],"disease":[148],"who":[149],"underwent":[150,263],"thyroidectomy":[151],"after":[152],"optimization":[154,401],"between":[155],"December":[156,159],"2020":[157],"2025":[160],"were":[161,246,273,372],"included.":[162],"Eligibility":[163],"free":[165,171,219,225,287,304],"thyroxine":[166,220,288],"above":[167,173],"30":[168,222],"pmol/L":[169,175,223,292,297,308,311],"triiodothyronine":[172,226,305],"10":[174,228],"baseline.":[177],"escalates":[180],"stepwise":[182],"over":[183],"approximately":[184],"14":[185],"days,":[186],"beginning":[187],"propranolol":[189,196],"Lugol's":[191],"iodine":[192],"adding":[194],"cholestyramine,":[195],"titration,":[197],"dexamethasone":[199],"required,":[201],"function":[204],"measured":[205],"on":[206,405],"alternate":[207],"weekdays.":[208],"primary":[210,236],"efficacy":[211],"outcome":[212,238],"achievement":[214],"either":[216],"predefined":[217,410],"targets,":[218],"below":[221,227],"pmol/L,":[229],"final":[232,277],"preoperative":[233,269,278,400],"assessment;":[234],"storm.":[242],"RESULTS:":[243],"Twenty-three":[244],"included,":[247],"20":[248],"(87%)":[249],"female,":[250],"median":[253,303],"age":[254],"41":[256],"years":[257],"(interquartile":[258,298,312],"range":[259,299,313],"31-47":[260],"years).":[261],"All":[262],"total":[264],"thyroidectomy,":[265],"none":[267],"admission.":[270],"Both":[271],"targets":[272,412],"achieved":[274,413],"assessment":[279],"23":[281,283],"(100%).":[285],"Median":[286,382],"decreased":[289],"from":[290,306],"78.6":[291],"baseline":[294],"24.1":[296],"18.25-35.05":[300],"pmol/L),":[301],"38.5":[307],"6.5":[310],"5.32-7.58":[314],"pmol/L).":[315],"No":[316],"storm":[319,421],"occurred":[320,340,360],"(0":[321],"23;":[323],"95%":[324],"confidence":[325,441],"interval":[326],"0":[327],"14.8%).":[329],"Off-protocol":[330],"rescue":[331],"one":[336,369,386],"patient":[337],"(4.3%).":[338,370],"Hypocalcemia":[339],"nine":[342],"(39.1%),":[344],"transient":[346],"seven":[348],"(30.4%),":[349],"persisted":[351],"beyond":[352],"six":[353],"months":[354],"two":[356,362],"(8.7%).":[357],"Voice":[358],"change":[359],"(8.7%)":[364],"long-term":[367],"There":[371],"cases":[374],"bleeding,":[376],"infection,":[377],"reoperation,":[378],"readmission,":[379],"death.":[381],"postoperative":[383],"stay":[384],"day.":[387],"Incidental":[388],"papillary":[389],"microcarcinoma":[390],"found":[392],"five":[394],"(21.7%).":[396],"CONCLUSIONS:":[397],"Structured":[398],"delivered":[403],"basis,":[408],"most":[415],"observed.":[422],"retrospective,":[424],"uncontrolled":[425],"design":[426],"small":[428],"cohort":[429],"mean":[430],"this":[431],"establish":[434],"approach":[439],"demonstrate":[443],"equivalence":[444],"inpatient":[446],"optimization.":[447],"Prospective":[448],"comparative":[449],"evaluation":[450],"wider":[454],"adoption.":[455]},"counts_by_year":[],"updated_date":"2026-11-05T12:25:35.769452","created_date":"2026-10-31T00:00:00"}