Treating bilateral benign nodular goiter surgicaly
About 100,000 thyroid operations are performed in Germany each year, a large percentage of them for the treatment of benign thyroid disease (euthyroid nodular goiter). In the current issue of Deutsches Arzteblatt International (Dtsch Arztebl Int 2014; 111 (10): 161-8), Nada Rayes and colleagues suggest a paradigm shift in the treatment of such lesions. The article is accompanied by an editorial by Roland Gartner.
Radical surgery has become much more common in the past few years and has been motivated by a desire to prevent recurrences. From 2006 to 2008, the percentage of total thyroidectomies rose from 27% to 37%, while the rate of partial thyroid resections dropped from 53% to 40%.
The complication rate of total thyroidectomy, which can be as high as 10%, exceeds that of less invasive methods such as the Dunhill procedure, in which only part of the thyroid is removed. The authors contend that the Dunhill procedure is radical enough in most cases and still has an important role to play in the surgical treatment of thyroid disease. Moreover factors such as age, occupation, and accompanying illnesses should be taken more strongly into account when it comes to deciding which surgical option is most appropriate for the individual patient.