**10. Rapid preparation for Graves surgery**

Patients are usually rendered euthyroid by ATD to reduce peri operative complications with thyroid storm being the most dreaded one. However, a subset of patients may require urgent/emergent surgery in view of significant compression, intolerance of drugs or failure of drugs. Such patients may be subjected to a rapid preparation protocol where in two or more of dexamethasone, beta blocker, sodium iopodate, iopanoic acid, collosal/lugols Iodine, cholestyramine, iodinated radiographic contrast agent, lithium and ATD if tolerated are used for 10–12 days prior to anticipated surgery. No significantly increased morbidity has been reported after surgery in the rapidly prepared patients and this strategy is required and is feasible in a subset of patients [44–46]. The occurrence of thyroid storm is rare and biochemically hyperthyroid patients may undergo thyroidectomy safely if the surgeon and anesthetist are comfortable [47]. However, the consensus remains that the outcome is best when surgery is performed on a euthyroid patient.
