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Surgery for Benign Goiter

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The Thyroid and Its Diseases

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Abstract

Surgery for benign goiter is an infrequent surgical procedure. Country and regional variations in surgical treatment of benign goiter are influenced by disease-specific differences as well as by health system-related factors. Thyroid surgery is therefore performed with regional variations by specialized endocrine, general, and ENT surgeons.

Surgery for benign euthyroid conditions is selected according to the underlying disease; however, corresponding or prevalent thyroid functional status and response to previous therapy may further influence the surgical concept for the individual patient. For nodular goiter, extent of resection is directed by number, localization, and distribution of affected areas within each thyroid lobe. Preoperative work-up generally includes laboratory assessment and thyroid ultrasonography at minimum. Functional status and organ volume in large goiter with possible retrosternal extension may be further investigated with nuclear medicine or radiological imaging. Assessment of preoperative vocal cord function is regarded as obligatory.

Key issues of thyroid surgery are preservation of the recurrent laryngeal nerves (RLN) and parathyroid glands (PG) as well as cautionary measures to prevent postoperative hemorrhage and recurrent goiter. Intraoperative neuromonitoring (IONM) is an established technique that may assist in limiting injury of the RLN, while intraoperative functional assessment of the PG with fluorescent techniques awaits further investigations regarding their value for PG preservation in thyroid surgery. Postoperative management focuses on observation of the typical complications of thyroid surgery, namely, airway management (recurrent laryngeal nerve palsy (RLNP)), hypocalcemic symptoms (hypoparathyroidism), and any signs of bleeding in the early postoperative phase. Follow-up after thyroid surgery assesses remaining thyroid function or adequate thyroid hormone substitution and possible signs of goiter recurrence. Surgery for recurrent goiter may be very challenging and is associated with significantly elevated complication rates; however, in specialized experienced centers, good surgical results at low complications rates are achieved.

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  1. Department of Visceral, Vascular, and Endocrine Surgery, Martin-Luther-University of Halle-Wittenberg, Halle (Saale), Germany

    Kerstin Lorenz

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  1. Kerstin Lorenz
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Correspondence to Kerstin Lorenz .

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Editors and Affiliations

  1. Department of Nuclear Medicine, Philipps University Marburg, Marburg, Germany

    Markus Luster

  2. Unit of Endocrinology Diabetes and Metabolism, Evgenidion Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Leonidas H. Duntas

  3. Georgetown University School of Medicine, Washington, DC, USA

    Leonard Wartofsky

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Lorenz, K. (2019). Surgery for Benign Goiter. In: Luster, M., Duntas, L., Wartofsky, L. (eds) The Thyroid and Its Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-72102-6_14

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