The authors. thankfully proposed in paradigign surgery thyroid nodules, away from total thyroidectomy (TT) to leaving behind residual tissue. The Dunhill procedure is recommended as compromise. The argument could be stated even more courageously. The even more convincing procedure of choice is the resection of the goiter that is appropriate in terms of findings and function. All nodules are resected and as much healthy residual tissue as possible is left behind. This is the resection method that entails the lowest rate of complications, also in terms of potential re-operations (). Their incidence in Germany is about 3% (). It seems questionable whether in all these patients, nodule free tissue residue was left after the first operation. Remaining nodules have key role in recurring goiter development at later stage. The risk of overlooking an occult cancer is also likely to be minimal for this operative technique.
Furthermore, there are initial indications of possible association between quality of life and residual tissue volume (). Where the thyroid residue was> 8 mL, the rates of performance impairment and depressive states were notably lower after surgery. However, more comprehensive clinical studies are required to definitively clarify this observation.
It is easy to understand the theoretical background: TSH secretion is subject to pulsatile rhythm. This is an important regulator in terms of adapting the required hormone to the situation and cannot be imitated by means of medical drugs. This regulatory circuit may function better the more thyroid tissue has been left. This is another aspect under which it is desirable to leave as much healthy thyroid tissue as possible.
In sum, the arguments in favor of resection appropriate for the finding and function are compelling. TT has its place in complete nodular organ restructure. The Dunhill procedure has its place in Graves' disease and disseminated thyroid autonomy. The thyroid is not superfluous organ that should be completely removed without an urgent medical need.
DOI: 10.3238 / arztebl.2014.0435c
Prof. Dr. med. Peter K. Wagner
Rosenheim, chirurgie.rosenheim@ro-med.de
The authors. thankfully proposed in paradigign surgery thyroid nodules, away from total thyroidectomy (TT) to leaving behind residual tissue. The Dunhill procedure is recommended as compromise. The argument could be stated even more courageously. The even more convincing procedure of choice is the resection of the goiter that is appropriate in terms of findings and function. All nodules are resected and as much healthy residual tissue as possible is left behind. This is the resection method that entails the lowest rate of complications, also in terms of potential re-operations (). Their incidence in Germany is about 3% (). It seems questionable whether in all these patients, nodule free tissue residue was left after the first operation. Remaining nodules have key role in recurring goiter development at later stage. The risk of overlooking an occult cancer is also likely to be minimal for this operative technique.
Furthermore, there are initial indications of possible association between quality of life and residual tissue volume (). Where the thyroid residue was> 8 mL, the rates of performance impairment and depressive states were notably lower after surgery. However, more comprehensive clinical studies are required to definitively clarify this observation.
It is easy to understand the theoretical background: TSH secretion is subject to pulsatile rhythm. This is an important regulator in terms of adapting the required hormone to the situation and cannot be imitated by means of medical drugs. This regulatory circuit may function better the more thyroid tissue has been left. This is another aspect under which it is desirable to leave as much healthy thyroid tissue as possible.
In sum, the arguments in favor of resection appropriate for the finding and function are compelling. TT has its place in complete nodular organ restructure. The Dunhill procedure has its place in Graves' disease and disseminated thyroid autonomy. The thyroid is not superfluous organ that should be completely removed without an urgent medical need.
DOI: 10.3238 / arztebl.2014.0435c
Prof. Dr. med. Peter K. Wagner
Rosenheim, chirurgie.rosenheim@ro-med.de
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