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Operatives Therapiekonzept der Immunthyreopathie

Surgical treatment of graves' disease

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Summary

73 patients with Graves' disease, surgically treated from 1975–1986, were investigated retrospectively. 43 patients, treated by subtotal thyroidectomy (Enderlen-Hotz) and a bilateral thyroid remnant of a total of about 8–12 g, were compared with 30 patients, treated by a modified subtotal thyroidectomy leaving a unilateral thyroid remnant of about 4–8 g, with respect to preoperative duration of disease, indications for surgical treatment, weight of resected specimens, operative complications and postoperative thyroid function. Surgical complications were similar in both groups. After subtotal thyroidectomy 14/43 patients (33%) displayed either recurrent hyperthyroidism (9/43, 21%) or local recurrence of Graves' goiter (3/43, 7%) or both (2/43, 5%). The modified subtotal resected group showed no recurrences of the disease. After subtotal thyroidectomy 11 patients were euthyroid without thyroid medication (26%) compared to only two patients (7%) after the modified procedure of subtotal thyroid resection. To prevent recurrences of goiter as well as hyperthyroidism and, on the other hand, to achieve euthyroid function postoperatively without need for thyroid replacement therapy, subtotal thyroidectomy with a small thyroid remnant of about 4–8 g is recommended for all patients with large goiter and a chronic recurrent course of the disease or with iodine induced thyrotoxicosis. Patients with non-recurrent Graves' disease but large goiter probably benefit from subtotal thyroidectomy with a larger thyroid remnant of about 8–12 g.

Zusammenfassung

73 von 1975 bis 1986 operativ behandelte Patienten mit einer Immunthyreopathie und Hyperthyreose wurden retrospektiv untersucht. 43 Patienten, bei denen eine subtotal beidseitige Thyreoidektomie (Enderlen-Rotz) mit einem bilateralen Schilddrüsenrest von insgesamt 8–12 g durchgeführt worden war, wurden mit einer Gruppe von 30 Patienten verglichen, bei denen eine modifizierte subtotale Thyreoidektomie mit einem unilateralen Schilddrüsenrest von 4–8 g erfolgt war. Analysiert wurden die präoperativen anamnestischen Daten, Operationsindikationen, Resektatgewichte, operativen Komplikationen und die postoperative Schilddrüsenfunktion. Die operativ bedingten Komplikationen waren in beiden Gruppen ähnlich. Nach beidseits subtotaler Resektion entwickelten 14/43 Patienten (33%) entweder ein Hyperthyreoserezidiv (9/43, 21 %) oder ein lokales Strumarezidiv (3/43, 7%) oder beides (2/43, 5%). In der modifiziert subtotal thyreoidektomierten Patientengruppe traten keine Rezidive auf. Nach beidseits subtotaler Thyreoidektomie waren 11 Patienten (26%) euthyreot ohne Schilddrüsenhormonsubstitution, nach modifiziert subtotaler Resektion lediglich zwei Patienten (7%). Um postoperativ eine euthyreote Stoffwechsellage ohne Schilddrüsenhormonsubstitution zu erreichen, gleichzeitig aber das Auftreten von Struma-und Hyperthyreoserezidiven zu vermeiden, wird bei allen Patienten mit einer großen Struma und einer primär chronisch-rezidivierenden Verlaufsform der Immunthyreopathie sowie bei jodinduzierter Hyperthyreose als Operationsmethode der Wahl eine subtotale Thyreoidektomie mit einem kleinen Schilddrüsenrest von 4 - 8 g empfohlen, bei Patienten mit großen Strumen und einer nicht-chronisch-rezidivierenden Immunthyreopathie dagegen eine subtotale Thyreoidektomie mit einem Schilddrüsenrest von 8–12 g.

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Authors and Affiliations

  1. Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover, Konstanty-Gutschow-Straße 8, D-3000, Hannover 61

    H. Dralle

  2. Abteilung Nuklearmedizin und spezielle Biophysik, Medizinische Hochschule Hannover, Konstanty-Gutschow-Straße 8, D-3000, Hannover 61

    O. Schober

  3. Abteilung Klinische Endokrinologie, Medizinische Hochschule Hannover, Konstanty-Gutschow-Straße 8, D-3000, Hannover 61

    R. D. Hesch

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Dralle, H., Schober, O. & Hesch, R.D. Operatives Therapiekonzept der Immunthyreopathie. Langenbecks Arch Chiv 371, 217–232 (1987). https://doi.org/10.1007/BF01259433

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