Aktualisierung der S2k-Leitlinie

Abstract

Thyroid resections represent one of the most common operations with 76,140 interventions in the year 2016 in Germany (source Destatis). These are predominantly benign thyroid gland diseases. Recommendations for the operative treatment of benign thyroid diseases were last published by the CAEK in 2010 as S2k guidelines (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. [AWMF] 003/002) against the background of increasingly more radical resection procedures. Hemithyroidectomy and thyroidectomy are routinely performed for benign thyroid disease in practice. The operation-specific risks show a clear increase with the extent of the resection. Therefore, weighing-up of the risk-indications ratio between unilateral lobectomy or thyroidectomy necessitates an independent evaluation of the indications for both sides. This principle in particular has been used to update the guidelines. In addition, the previously published recommendations of the CAEK for correct execution and consequences of intraoperative neuromonitoring were included into the guidelines, which in particular serve the aim to avoid bilateral recurrent laryngeal nerve paralysis. Moreover, the recommendations for the treatment of postoperative complications, such as hypoparathyroidism and postoperative infections were revised. The updated guidelines therefore represent the current state of the science as well as the resulting surgical practice.

Thyroid surgery in children and young adults: potential overtreatment and complications

“…Intraoperative frozen section was routinely used in cases with pre-or intraoperative suspected malignancy. Indications for surgery for nonmalignant thyroid disease in children were established according to the CAEK guidelines for the surgical treatment of benign thyroid diseases [28]. Lymph node dissection was performed according to the CAEK practice guidelines for the management of malignant thyroid disease in adults [27] as well as the ATA management guidelines for children with thyroid nodules and differentiated thyroid cancer [7]: lateral lymph node dissection was carried out in case of histologically proven lateral lymph node metastases and central lymph node dissection was performed either in therapeutic or in prophylactic intention, carefully weighing risk of postoperative morbidity with oncological advantages in the individual patient.…”

Moderne Schilddrüsenchirurgie – das endokrin-chirurgische Verständnis des Operateurs und seine Verantwortung für Resektionsausmaß und Komplikationsrate

“…Besteht bei einem solitären Schilddrüsenknoten histologische Abklärungspflicht, so wird vielfach unkritisch als erster Schritt eine Hemithyreoidektomie gefordert, um eine primäre Sanierung des knotentragenden Schilddrüsenlappens zu erzielen [1,19]. In vielen Fällen ist allerdings mit dem verbleibenden gesunden kontralateralen Schilddrüsenlappen keine sichere Euthyreose zu erzielen und der Patient wird substitutionspflichtig.…”

“…Die Verwendung des kontinuierlichen Neuromonitorings ist bei der Rezidivstruma empfohlen und hat sich gut bewährt. Die Operationszeit bei der Rezidivstruma kann durch die review Anwendung des kontinuierlichen Neuromonitorings deutlich verkürzt werden [1,19]. keiner intraoperativen Ausschüttung freier Schilddrüsenhormone kommt [25].…”

“…Hingegen ist eine Hemithyreoidektomie mit zentraler Lymphadenektomie bei vorangegangener eingeschränkter Knotenresektion unkompliziert. Somit ist eine primäre Hemithyreoidektomie bei gutartigem Solitärknoten nur notwendig, wenn der Knoten im dorsalen Lappenbereich liegt, einen Großteil des Lappens ausfüllt oder eine sehr suspekte Zytologie vorliegt [ 1 , 3 , 19 ].

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Medullary Thyroid Carcinoma: Why Is Specialization Mandatory?

“…During the last years, biochemical cure rates of patients with sporadic MTC improved constantly in the era of calcitonin screening [17]. Therefore, the German Association of Endocrine Surgeons recommends routine calcitonin screening before every thyroid operation to exclude or detect MTC [18,19]. The interpretation of calcitonin levels, however, can be challenging because of a variety of falsely high levels caused by medication such as proton pump inhibitors or lithium, alcohol abuse, renal insufficiency, or children under 3 years of age.…”