Top

Published in:

01-06-2011 | Original Article

German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease

Authors: Thomas J. Musholt, Thomas Clerici, Henning Dralle, Andreja Frilling, Peter E. Goretzki, Michael M. Hermann, Jochen Kußmann, Kerstin Lorenz, Christoph Nies, Jochen Schabram, Peter Schabram, Christian Scheuba, Dietmar Simon, Thomas Steinmüller, Arnold W. Trupka, Robert A. Wahl, Andreas Zielke, Andreas Bockisch, Wolfram Karges, Markus Luster, Kurt W. Schmid, The Interdisciplinary Task Force “Guidelines” of the German Association of Endocrine Surgeons

Published in: Langenbeck's Archives of Surgery | Issue 5/2011

Abstract

Introduction

Benign thyroid disorders are among the most common diseases in Germany, affecting around 15 million people and leading to more than 100,000 thyroid surgeries per year. Since the first German guidelines for the surgical treatment of benign goiter were published in 1998, abundant new information has become available, significantly shifting surgical strategy towards more radical interventions. Additionally, minimally invasive techniques have been developed and gained wide usage. These circumstances demanded a revision of the guidelines.

Methods

Based on a review of relevant recent guidelines from other groups and additional literature, unpublished data, and clinical experience, the German Association of Endocrine Surgeons formulated new recommendations on the surgical treatment of benign thyroid diseases. These guidelines were developed through a formal expert consensus process and in collaboration with the German societies of Nuclear Medicine, Endocrinology, Pathology, and Phoniatrics & Pedaudiology as well as two patient organizations. Consensus was achieved through several moderated conferences of surgical experts and representatives of the collaborating medical societies and patient organizations.

Results

The revised guidelines for the surgical treatment of benign thyroid diseases include recommendations regarding the preoperative assessment necessary to determine when surgery is indicated. Recommendations regarding the extent of resection, surgical techniques, and perioperative management are also given in order to optimize patient outcomes.

Conclusions

Evidence-based recommendations for the surgical treatment of benign thyroid diseases have been created to aid the surgeon and to support optimal patient care, based on current knowledge. These recommendations comply with the Association of the Scientific Medical Societies in Germany requirements for S2k guidelines.

Agarwal G, Aggarwal V (2008) Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review. World J Surg 32:1313–1324PubMedCrossRef

Akerstrom G, Malmaeus J, Bergstrom R (1984) Surgical anatomy of human parathyroid glands. Surgery 95:14–21PubMed

Anonymous (1998) Leitlinie zur Therapie der benignen Struma. In: Mitteilungen der Dt. Ges. f. Chirurgie. Stuttgart

Anonymous (2006) American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 12:63–102

Brauckhoff M, Gimm O, Weiss CL et al (2004) Multiple endocrine neoplasia 2B syndrome due to codon 918 mutation: clinical manifestation and course in early and late onset disease. World J Surg 28:1305–1311PubMedCrossRef

Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214PubMedCrossRef

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

Costante G, Meringolo D, Durante C et al (2007) Predictive value of serum calcitonin levels for preoperative diagnosis of medullary thyroid carcinoma in a cohort of 5817 consecutive patients with thyroid nodules. J Clin Endocrinol Metab 92:450–455PubMedCrossRef

Doyle P, Duren C, Nerlich K et al (2009) Potency and tolerance of calcitonin stimulation with high-dose calcium versus pentagastrin in normal adults. J Clin Endocrinol Metab 94:2970–2974PubMedCrossRef

10.

Dralle H (2007) Thyroid incidentaloma. Overdiagnosis and overtreatment of healthy persons with thyroid illness? Chirurg 78:677–686PubMedCrossRef

11.

Dralle H, Pichlamayr R (1991) Decrease of risks in reoperation for benign struma. Chirurg 62:169–175PubMed

12.

Dralle H, Sekulla C (2004) Morbidity after subtotal and total thyroidectomy in patients with Graves’ disease: the basis for decision-making regarding surgical indication and extent of resection. Z Ärztl Fortbild Qualitätssich 98(Suppl 5):45–53PubMed

13.

Dralle H, Sekulla C, Haerting J et al (2004) Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136:1310–1322PubMedCrossRef

14.

Dralle H, Sekulla C, Lorenz K et al (2008) Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 32:1358–1366PubMedCrossRef

15.

Dralle H, Sekulla C, Lorenz K et al (2004) Ambulatory and brief inpatient thyroid gland and parathyroid gland surgery. Chirurg 75:131–143PubMedCrossRef

16.

Farrag TY, Samlan RA, Lin FR et al (2006) The utility of evaluating true vocal fold motion before thyroid surgery. Laryngoscope 116:235–238PubMedCrossRef

17.

Frates MC (2008) Ultrasound in recurrent thyroid disease. Otolaryngol Clin North Am 41:1107–1116PubMedCrossRef

18.

Frates MC, Benson CB, Charboneau JW et al (2006) Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound Consensus Conference statement. Ultrasound Q 22:231–238, discussion 239–240PubMedCrossRef

19.

Gough J, Scott-Coombes D, Fausto Palazzo F (2008) Thyroid incidentaloma: an evidence-based assessment of management strategy. World J Surg 32:1264–1268PubMedCrossRef

20.

Grussendorf M, Vaupel R, Reiners C et al (2005) The LISA trial-a- randomized, double-blind, placebo-controlled four-arm study of 1,000 patients with nodular goiter in Germany. Study design and first results of feasibility. Med Klin (Munch) 100:542–546CrossRef

21.

Hermann M, Hellebart C, Freissmuth M (2004) Neuromonitoring in thyroid surgery: prospective evaluation of intraoperative electrophysiological responses for the prediction of recurrent laryngeal nerve injury. Ann Surg 240:9–17PubMedCrossRef

22.

Hermann M, Ott J, Promberger R et al (2008) Kinetics of serum parathyroid hormone during and after thyroid surgery. Br J Surg 95:1480–1487PubMedCrossRef

23.

Huins CT, Georgalas C, Mehrzad H et al (2008) A new classification system for retrosternal goiter based on a systematic review of its complications and management. Int J Surg 6:71–76PubMedCrossRef

24.

Karges W, Dralle H, Raue F et al (2004) Calcitonin measurement to detect medullary thyroid carcinoma in nodular goiter: German evidence-based consensus recommendation. Exp Clin Endocrinol Diabetes 112:52–58PubMedCrossRef

25.

Kochilas X, Bibas A, Xenellis J et al (2008) Surgical anatomy of the external branch of the superior laryngeal nerve and its clinical significance in head and neck surgery. Clin Anat 21:99–105PubMedCrossRef

26.

Lorenz K, Gimm O, Holzhausen HJ et al (2007) Riedel’s thyroiditis: impact and strategy of a challenging surgery. Langenbecks Arch Surg 392:405–412PubMedCrossRef

27.

Lundgren CI, Zedenius J, Skoog L (2008) Fine-needle aspiration biopsy of benign thyroid nodules: an evidence-based review. World J Surg 32:1247–1252PubMedCrossRef

28.

Machens A, Holzhausen HJ, Thanh PN et al (2003) Malignant progression from C-cell hyperplasia to medullary thyroid carcinoma in 167 carriers of RET germline mutations. Surgery 134:425–431PubMedCrossRef

29.

Mann B, Buhr HJ (1998) Surgical therapy of benign thyroid gland diseases. Zentralbl Chir 123:2–10PubMed

30.

Marongiu F, Cauli C, Mariotti S (2004) Thyroid, hemostasis and thrombosis. J Endocrinol Investig 27:1065–1071

31.

Mazal W (2003) Dissection of the recurrent laryngeal nerve with neuromonitoring—forensic aspects. Eur Surg 35:268–271CrossRef

32.

Miccoli P, Minuto MN, Ugolini C et al (2008) Minimally invasive video-assisted thyroidectomy for benign thyroid disease: an evidence-based review. World J Surg 32:1333–1340PubMedCrossRef

33.

Mishra AK, Temadari H, Singh N et al (2007) The external laryngeal nerve in thyroid surgery: the ‘no more neglected’ nerve. Indian J Med Sci 61:3–8PubMedCrossRef

34.

Moalem J, Suh I, Duh QY (2008) Treatment and prevention of recurrence of multinodular goiter: an evidence-based review of the literature. World J Surg 32:1301–1312PubMedCrossRef

35.

Morris LF, Ragavendra N, Yeh MW (2008) Evidence-based assessment of the role of ultrasonography in the management of benign thyroid nodules. World J Surg 32:1253–1263PubMedCrossRef

36.

Morton RP, Whitfield P, Al-Ali S (2006) Anatomical and surgical considerations of the external branch of the superior laryngeal nerve: a systematic review. Clin Otolaryngol 31:368–374PubMedCrossRef

37.

Paschke R, Reiners C, Fuhrer D et al (2005) Recommendations and unanswered questions in the diagnosis and treatment of thyroid nodules. Opinion of the Thyroid Section of the German Society for Endocrinology. Dtsch Med Wochenschr 130:1831–1836PubMedCrossRef

38.

Phitayakorn R, Mchenry CR (2008) Follow-up after surgery for benign nodular thyroid disease: evidence-based approach. World J Surg 32:1374–1384PubMedCrossRef

39.

Porterfield JR Jr, Thompson GB, Farley DR et al (2008) Evidence-based management of toxic multinodular goiter (Plummer’s disease). World J Surg 32:1278–1284PubMedCrossRef

40.

Randolph GW, Kamani D (2006) The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy. Surgery 139:357–362PubMedCrossRef

41.

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

42.

Scheuba C, Kaserer K, Weinhausl A et al (1999) Is medullary thyroid cancer predictable? A prospective study of 86 patients with abnormal pentagastrin tests. Surgery 126:1089–1095, discussion 1096PubMedCrossRef

43.

Schmid KW, Ladurner D (1997) Intraoperative diagnostic frozen section of the thyroid gland. Pathologe 18:98–101PubMedCrossRef

44.

Sgourakis G, Sotiropoulos GC, Neuhauser M et al (2008) Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: is there any evidence-based information? Thyroid 18:721–727PubMedCrossRef

45.

Sheu S-Y, Frilling A, Betzler M et al (2005) Der intraoperative Gefrierschnitt der Schilddrüse - Indikation, Verlässlichkeit, Limitierungen. Viszeralchirurgie 40:174–179CrossRef

46.

Stalberg P, Svensson A, Hessman O et al (2008) Surgical treatment of Graves’ disease: evidence-based approach. World J Surg 32:1269–1277PubMedCrossRef

47.

Steurer M, Passler C, Denk DM et al (2002) Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 112:124–133PubMedCrossRef

48.

Thompson NW, Eckhauser FE, Harness JK (1982) The anatomy of primary hyperparathyroidism. Surgery 92:814–821PubMed

49.

Thomusch O, Machens A, Sekulla C et al (2000) Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 24:1335–1341PubMedCrossRef

50.

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 74:437–443PubMedCrossRef

51.

Thomusch O, Sekulla C, Machens A et al (2004) Validity of intra-operative neuromonitoring signals in thyroid surgery. Langenbecks Arch Surg 389:499–503PubMedCrossRef

52.

Timmermann W, Hamelmann WH, Meyer T et al (2002) Identification and surgical anatomy of the external branch of the superior laryngeal nerve. Zentralbl Chir 127:425–428PubMedCrossRef

53.

Timmermann W, Hamelmann WH, Thomusch O et al (2004) Effectiveness and results of intraoperative neuromonitoring in thyroid surgery. Statement of the Interdisciplinary Study Group on Intraoperative Neuromonitoring of Thyroid Surgery. Chirurg 75:916–922PubMedCrossRef

54.

Trupka A, Sienel W (2002) Autotransplantation of at least one parathyroid gland during thyroidectomy in benign thyroid disease minimizes the risk of permanent hypoparathyroidism. Zentralbl Chir 127:439–442PubMedCrossRef

55.

Wang C (1976) The anatomic basis of parathyroid surgery. Ann Surg 183:271–275PubMedCrossRef

56.

White ML, Doherty GM, Gauger PG (2008) Evidence-based surgical management of substernal goiter. World J Surg 32:1285–1300PubMedCrossRef

Title: German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease
Authors: Thomas J. Musholt
Thomas Clerici
Henning Dralle
Andreja Frilling
Peter E. Goretzki
Michael M. Hermann
Jochen Kußmann
Kerstin Lorenz
Christoph Nies
Jochen Schabram
Peter Schabram
Christian Scheuba
Dietmar Simon
Thomas Steinmüller
Arnold W. Trupka
Robert A. Wahl
Andreas Zielke
Andreas Bockisch
Wolfram Karges
Markus Luster
Kurt W. Schmid
The Interdisciplinary Task Force “Guidelines” of the German Association of Endocrine Surgeons
Publication date: 01-06-2011
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 5/2011
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-011-0774-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2011

Splenectomy for non-haematological metastatic malignant disease

Hepatic resection for liver metastases from carcinomas of the distal bile duct and of the papilla of Vater

ESES Workshop 2011: Potentially Malignant Adrenal Tumors

Workload and quality of life of surgeons. Results and implications of a large-scale survey by the German Society of Surgery

Fast-track surgery—an update on physiological care principles to enhance recovery

Which surgical procedure offers the best treatment for pilonidal disease?