Skip to main content
SpringerLink
Log in

Entfernung von Schilddrüse und Nebenschilddrüsen

Surgical resection of the thyroid and parathyroid glands

  • Schwerpunkt: Postoperative Syndrome und Operationsfolgen
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Hauptindikation für Schilddrüsenoperationen ist die Entfernung von knotigem, potenziell malignem oder hyperfunktionellem Schilddrüsengewebe. Postoperativ ist je nach Restfunktion eine L-Thyroxinsubstitution erforderlich. Gleichzeitig ist bei multinodöser Struma zur Rezidivprophylaxe eine Jodidsupplementation indiziert. Bei Patienten mit differenziertem SD-Karzinom schließen sich im Regelfall eine Radioiodbehandlung und risikoadaptierte Nachsorge an. Trotz unbefriedigender Datenlage ist davon auszugehen, dass Patienten mit niedrigem Rezidivrisiko von einer kompletten Thyreoablation und lebenslangen Thyreosuppression prognostisch nicht profitieren. Werden die Nebenschilddrüsen in ihrer Funktion beeinträchtigt oder bei Hyperparathyreoidismus gezielt entfernt, kann sich eine behandlungsbedürftige Hypokalzämie entwickeln. Bei unzureichender Effektivität einer oralen Kalziumsubstitution müssen additiv Vitamin D-Derivate eingesetzt werden, die aufgrund ihrer geringen therapeutischen Breite regelmäßige Laborkontrollen erfordern.

Abstract

The main indication for surgery of the thyroid gland is the resection of nodular, suspicious or hyperfunctioning tissue. Following thyroidectomy, L-thyroxine therapy is initiated adjusted to the remnant thyroid function. To prevent recurrence of a multinodular goiter, supplementation with iodine is strongly recommended. The management of patients with differentiated thyroid cancer depends on risk stratification. Although large prospective studies are missing, low-risk patients probably do not benefit from total thyroid ablation and lifelong thyroxine suppression therapy. As a result of impaired parathyroid function or resection of the parathyroid glands for hyperparathyroidism, acute or chronic hypocalcaemia can develop. If treatment with oral calcium is insufficient, the addition of a vitamin D analogue is necessary. This requires close monitoring to avoid renal or other hypercalcaemic complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Bilezikian JP, Potts JT Jr, Fuleihan Gel H et al. (2002) Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Bone Miner Res (Suppl 2) 17: N2–N11

    Google Scholar 

  2. Biondi B, Filetti S, Schlumberger M (2005) Thyroid-hormone therapy and thyroid cancer: a reassessment. Nat Clin Pract Endocrinol Metab 1: 32–40

    Article  PubMed  Google Scholar 

  3. Carella C, Mazziotti G, Rotondi M et al. (2002) Iodized salt improves the effectiveness of L-thyroxine therapy after surgery for nontoxic goitre: a prospective and randomized study. Clin Endocrinol 57: 507–513

    Article  Google Scholar 

  4. Chiu B, Sturgeon C, Angelos P (2006) What is the link between nonlocalizing sestamibi scans, multigland disease, and persistent hypercalcemia? A study of 401 consecutive patients undergoing parathyroidectomy. Surgery 140: 418–422

    Article  PubMed  Google Scholar 

  5. Cooper DS, Doherty GM, Haugen BR et al. (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16: 109–142

    PubMed  Google Scholar 

  6. Derwahl M, Broecker M, Kraiem Z (1999) Clinical review 101: Thyrotropin may not be the dominant growth factor in benign and malignant thyroid tumors. J Clin Endocrinol Metab 84: 829–834

    Article  PubMed  Google Scholar 

  7. Di Fabio F, Casella C, Bugari G et al. (2006) Identification of patients at low risk for thyroidectomy-related hypocalcemia by intraoperative quick PTH. World J Surg 30: 1428–1433

    Article  PubMed  Google Scholar 

  8. Gibelin H, Sierra M, Mothes D et al. (2004) Risk factors for recurrent nodular goiter after thyroidectomy for benign disease: case-control study of 244 patients. World J Surg 28: 1079–1082

    Article  PubMed  Google Scholar 

  9. Hegedus L, Nygaard B, Hansen JM (1999) Is routine thyroxine treatment to hinder postoperative recurrence of nontoxic goiter justified? J Clin Endocrinol Metab 84: 756–760

    Article  PubMed  Google Scholar 

  10. Kebebew E, Hwang J, Reiff E et al. (2006) Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model. Arch Surg 141: 777–782; discussion 782

    Article  PubMed  Google Scholar 

  11. Krehan A, Dittmar M, Hoppen A et al. (2002) [Randomized, double-blind crossover study of bioavailability of levothyroxine]. Med Klin 97: 522–527

    Article  Google Scholar 

  12. Lombardi CP, Raffaelli M, Princi P et al. (2006) Parathyroid hormone levels 4 hours after surgery do not accurately predict post-thyroidectomy hypocalcemia. Surgery 140: 1016–1023; discussion 1023–1015

    Article  PubMed  Google Scholar 

  13. McLeod IK, Arciero C, Noordzij JP et al. (2006) The use of rapid parathyroid hormone assay in predicting postoperative hypocalcemia after total or completion thyroidectomy. Thyroid 16: 259–265

    Article  PubMed  Google Scholar 

  14. Miccoli P (2005) Parathyroid surgery: we only need a minimal surgical approach. J Endocrinol Invest 28: 570–573

    PubMed  Google Scholar 

  15. Miccoli P, Berti P, Frustaci GL et al. (2006) Video-assisted thyroidectomy: indications and results. Langenbecks Arch Surg 391: 68–71

    Article  PubMed  Google Scholar 

  16. Ogilvie JB, Clark OH (2005) Parathyroid surgery: we still need traditional and selective approaches. J Endocrinol Invest 28: 566–569

    PubMed  Google Scholar 

  17. Olubowale O, Chadwick DR (2006) Optimization of thyroxine replacement therapy after total or near-total thyroidectomy for benign thyroid disease. Br J Surg 93: 57–60

    Article  PubMed  Google Scholar 

  18. Pacini F, Schlumberger M, Dralle H et al. (2006) European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 154: 787–803

    Article  PubMed  Google Scholar 

  19. Quack I, Zwernemann C, Weiner SM et al. (2005) Dihydrotachysterol therapy for hypoparathyroidism: consequences of inadequate monitoring. Five cases and a review. Exp Clin Endocrinol Diabetes 113: 376–380

    Article  PubMed  Google Scholar 

  20. Quiros RM, Alioto J, Wilhelm SM et al. (2004) An algorithm to maximize use of minimally invasive parathyroidectomy. Arch Surg 139: 501–506; discussion 506–507

    Article  PubMed  Google Scholar 

  21. Roher HD, Goretzki PE, Hellmann P et al. (1999) [Complications in thyroid surgery. Incidence and therapy]. Chirurg 70: 999–1010

    Article  PubMed  Google Scholar 

  22. Rojdmark J, Jarhult J (1995) High long term recurrence rate after subtotal thyroidectomy for nodular goitre. Eur J Surg 161: 725–727

    PubMed  Google Scholar 

  23. Rotondi M, Amato G, Del Buono A et al. (2000) Postintervention serum TSH levels may be useful to differentiate patients who should undergo levothyroxine suppressive therapy after thyroid surgery for multinodular goiter in a region with moderate iodine deficiency. Thyroid 10: 1081–1085

    PubMed  Google Scholar 

  24. Schabram J, Vorlander C, Wahl RA (2004) Differentiated operative strategy in minimally invasive, video-assisted thyroid surgery results in 196 patients. World J Surg 28: 1282–1286

    PubMed  Google Scholar 

  25. Schumm-Draeger PM, Encke A, Usadel KH (2003) [Optimal recurrence prevention of iodine deficiency related goiter after thyroid gland operation. A prospective clinical study]. Internist 44: 420–426; 429–432

    PubMed  Google Scholar 

  26. Silverberg SJ, Bilezikian JP (2006) The diagnosis and management of asymptomatic primary hyperparathyroidism. Nat Clin Pract Endocrinol Metab 2: 494–503

    Article  PubMed  Google Scholar 

  27. Stratmann SL, Kuhn JA, Bell MS et al. (2002) Comparison of quick parathyroid assay for uniglandular and multiglandular parathyroid disease. Am J Surg 184: 578–581; discussion 581

    Article  PubMed  Google Scholar 

  28. Thomusch O, Sekulla C, Dralle H (2003) [Is primary total thyroidectomy justified in benign multinodular goiter? Results of a prospective quality assurance study of 45 hospitals offering different levels of care]. Chirurg 74: 437–443

    PubMed  Google Scholar 

Download references

Danksagung

Für die kritische Durchsicht und Diskussion des Manuskripts danken wir ganz herzlich Herrn Dr. Johann Schönberger, Abteilung für Nuklearmedizin, und Herrn Dr. Ayman Agha, Klinik und Poliklinik für Chirurgie der Universität Regensburg.

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität Regensburg, 93042, Regensburg, Deutschland

    U. Woenckhaus, R. Büttner & L. C. Bollheimer

Authors
  1. U. Woenckhaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Büttner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. C. Bollheimer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U. Woenckhaus.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Woenckhaus, U., Büttner, R. & Bollheimer, L. Entfernung von Schilddrüse und Nebenschilddrüsen. Internist 48, 569–577 (2007). https://doi.org/10.1007/s00108-007-1834-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-007-1834-9

Schlüsselwörter

Keywords

Search

Navigation