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[Graves' disease nd toxic nodular goiter--radioiodine therapy].

At the 15th conference on the human thyroid in Heidelberg in 2001 the following aspects of the radioiodine therapy of benign thyroid disorders were presented: General strategies for therapy of benign thyroid diseases, criterions for conservative or definitive treatment of hyperthyroidism as first line therapy and finally preparation, procedural details, results, side effects, costs and follow-up care of radioiodine therapy as well as legal guidelines for hospitalization in Germany. The diagnosis Graves' hyperthyroidism needs the decision, if rather a conservative treatment or if primary radioiodine therapy is the best therapeutic approach. In the USA 70-90% of these patients are treated with radioiodine as first line therapy, whereas in Germany the conservative therapy for 1-1.5 years is recommended for 90%. This review describes subgroups of patients with Graves' disease showing a higher probability to relapse after conservative treatment. Comparing benefits, adverse effects, costs, and conveniences of both treatment strategies the authors conclude that radioiodine therapy should be preferred as first line therapy in 60-70% of the patients with Graves' hyperthyroidism.

Germany↗

[Surgery of euthyroid nodular goiter: special considerations in surgery of recurrent struma].

Indications for surgery need individual risk-analysis. Operative strategy is more conservative with unilateral procedures, more radical with total lobectomy. The crucial risk is recurrent laryngeal nerve paralysis (r.l.n.p.). In 434 operations with 647 nerves at risk (1985-2001) we classified the anatomical situation of the nerve prospectively: X: not identified, A: not in scar and B: within scar (B1, B2 and B3 dorsally, laterally or ventrally). The risk of r.l.n.p. increased from types A to type B to X, and from B1 to B3. Up to now, intraoperative neuromonitoring did not reduce this risk, additionally.

Goiter, Nodular↗

[Basedown disease, thyroid gland autonomy, nodular goiter. When is radiotherapy indicated?].

Treatment options for benign diseases of the thyroid include medication, radioiodine therapy and surgery. Patients with hyperthyroidism initially receive antithyroid drugs, with further treatment determined by the relapse risk. In the case of Graves' disease this is determined by a number of risk factors, including the volume of the thyroid gland or the presence of endocrinal ophthalmopathy. In such cases with a high relapse risk, radioiodine therapy is the recommended first-line treatment. Further indications--if surgery is not necessary--are autonomous goiter, recurrent (autonomous) goiter and latent hyperthyroidism. A single radioiodine treatment suffices to control the situation in more than 90% of the cases, and the goiter clearly diminishes in size. Radiation-induced malignancies or malformations have not been seen, but iodine treatment is contraindicated in pregnancy. In view of the short hospital stay of only four to five days, and the ready availability of treatment units, the authors consider radioiodine therapy a suitable first-line option in patients with Graves' hyperthyroidism.

Antithyroid Agents↗

[Postoperative hypothyroidism in patients with multi-nodular goiter].

Results of surgical treatment of 69 patients with polynodous euthyroid goiter were studied. There was established, that postoperative hypothyrosis is occurring more often in women aged from 41 to 70 years with colloid goiter in combination with adenoma of thyroid gland (in 60% observations) and adenomatous goiter (in 42.8%). Increase of residual tissues volume of thyroid gland do not always provide the decrease of the hypothyrosis frequency occurrence. The physician control absence for the hormonal therapy management worsens the postoperative hypothyrosis course.

Adult↗