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Operationsindikation und chirurgisches Vorgehen bei jodinduzierten Hyperthyreosen

Surgical treatment of iodine induced thyrotoxicosis

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Summary

Clinical course, indications for surgical treatment, and results of treatment in 8 female patients with iodine induced thyrotoxicosis (IIT) are reported. The diagnosis of IIT could be established in all patients by a) clinical hyperthyroidism, b) increased T3 and T4 serum concentrations, and c) previous iodine contamination. Sources of iodine were radiographic contrast agents for urography (n = 4), oral cholecystography (n = 3), intravenous cholangiography (n = 1), phlebography (n = 1), and cranial computer tomography (n = 1). The onset of hyperthyroidism occurred 1– 8 weeks after iodine exposure. Indications for surgical treatment of IIT were: 1. autonomous nodular goiter (n = 6), and 2. iodine exacerbation of preexisting thyrotoxicosis in patients with Graves' disease (n = 2). Corresponding to the different pathogenesis of autonomous and immunogenetic goiter the following surgical treatment is recommended: a) Enucleation of solitary autonomous adenomas or unilateral lobectomy in case of large adenomas, b) subtotal bilateral lobectomy in toxic multinodular goiter or, preferentially, unilateral lobectomy combined with subtotal resection of the contralateral thyroid lobe; c) “Near-total” thyroidectomy in Graves' immunopathy.

Zusammenfassung

Klinischer Verlauf, Operationsindikation and Behandlungsergebnisse bei 8 Patientinnen mit jodinduzierter Hyperthyreose (IIT) werden vorgestellt. Die Diagnose einer IIT konnte bei allen 8 Patientinnen gesichert werden durch den Nachweis a) der klinischen Hyperthyreose, b) einer Erhöhung des Serum T3 und T4 und c) der vorangegangenen Jodbelastung. Die Hyperthyreose-auslösenden Jodbelastungen waren Röntgenkontrastmittel zur i. v.-Pyelographie (n = 4), oralen Cholecystographie (n = 3), i. v.-Cholangiographie (n = 1), Phlebographie (n = 1) und zur Schädel-Computertomographie. Die Latenzphase bis zum Auftreten der Hyperthyreose betrug 1 bis 8 Wochen. Die Indikationen zur Operation waren: 1. IIT bei autonomer Knotenstruma (n = 6) und 2. IIT bei Immunthyreopathie (n = 2). Entsprechend der unterschiedlichen Pathogenese jodinduzierter Hyperthyreosen bei autonomen und immunogenen Strumen wird folgendes operatives Vorgehen empfohlen: a) Enukleation beim solitären autonomen Adenom oder Hemithyreoidektomie bei großen autonomen Adenomen, b) bilateral subtotale Schilddrüsenresektion oder, wenn möglich, Hemithyreoidektomie kombiniert mit einer subtotalen Resektion kontralateral bei autonomen Knotenstrumen; c) „near total”-Thyreoidektomie bei Immunthyreopathien.

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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 & R. Pichlmayr

  2. Institut für Pathologie, Medizinische Hochschule Hannover, Konstanty-Gutschow-Straße 8, D-3000, Hannover 61

    W. Lang

  3. Institut für Nuklearmedizin und spezielle Biophysik, Medizinische Hochschule Hannover, Konstanty-Gutschow-Straße 8, D-3000, Hannover 61

    D. P. Pretschner

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

    R. D. Hesch

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  1. H. Dralle
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Meinem Vater, Herrn Dr. A. Dralle, zum 65. Geburtstag gewidment

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Dralle, H., Pichlmayr, R., Lang, W. et al. Operationsindikation und chirurgisches Vorgehen bei jodinduzierten Hyperthyreosen. Langenbecks Arch Chiv 365, 79–89 (1985). https://doi.org/10.1007/BF01261135

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