[Surgery for hyperthyroidism].

Abstract

The concept of therapy for hyperthyroidism combines endocrinology, nuclear medicine and surgery. For selection of the treatment of choice, pathophysiology as well as individual aspects are considered. Surgical therapy is mainly concerned with treatment of functional autonomy, Grave's disease and iodine-excess-related hyperthyroidism based on either autonomous or Grave's disease. For each of these three main groups of hyperthyroidism exist differentiated surgical concepts based on the underlying thyroid disease and its course: The various forms of functional autonomy, solitary autonomous nodules, multifocal autonomy or disseminated autonomy are dealt with selective enucleation-resection, functionally and morphologically oriented resection and extensive resection with little remaining thyroid tissue of about 5-6 ml, respectively. For Grave's disease extensive resections with thyroid-tissue remainders of about 2-4 ml or tatal thyroidectomy are established; the latter demonstrating in cases of concomittant endocrine ophthalmopathy the most convincing results. In cases of iodine-related hyperthyroidism the concept of early and radical surgical treatment, following stabilization of the patient in a reasonably short amount of time shows best results and is thus favored. In these cases, contrary to all other forms of hyperthyroidism, establishment of preoperative euthyroid metabolism is not mandatory.