Surgery Online

Therapy of goiter

General

Depending on the cause and extent of the thyroid enlargement, surgery is the therapy of choice.

Goiter (enlarged thyroid) is a symptom and not a disease. The therapy therefore depends on the underlying cause of the thyroid enlargement.
There are a number of factors that need to be considered. The subjective complaints, the degree of struma, the result of the examinations, the age, the general condition and the wishes of the patient are essential factors that play an essential role in the choice of treatment. There are situations when therapy is not given. But there are also some treatment options available.

In case of iodine deficiency goiter, taking Iodide tablets a reduction in the size of the thyroid gland can be achieved. In cases in which the iodine deficiency is very pronounced, thyroid hormones are also used.
Drugs that the Thyroid function steam (anti-thyroid drugs) are given in the case of an overactive thyroid.

Medical therapy

Radioiodine therapy

This is one Type of irradiationwhich is specifically aimed at the iodine-storing thyroid tissue. The radioactive one iodine131 is stored in the hormone-producing thyroid cells.
The cells that are particularly active are specifically destroyed. Therefore radioiodine therapy can help 'are called "knots stop the uncontrolled formation of thyroid hormones.
At enlarged thyroid glands, which show no or only insignificant change despite a balanced drug treatment, this treatment is also used successfully. The main focus of radioiodine therapy, however, is tumor treatment, especially as a follow-up treatment for differentiated thyroid cancer / thyroid cancer after the operation.
The radioactive iodine 131 is taken orally in the form of capsules. For reasons of radiation protection, the patients must be admitted as an inpatient - usually for about 5 days. They are not allowed to receive visitors during this time. After their own radioactivity has subsided, they can then be released home.
You can find further information under our topic: radiotherapy.

Operative therapy

The operation of the thyroid is always necessary when the other therapy options are unsuccessful or cannot be applied.
The "cold" lumps are suspicious of cancer unless the ultrasound shows them to be cysts. Such nodes are therefore almost always operated on. Most of the nodules then show up on the tissue examination as benign tumors (Adenomas). However, a malignant tumor is found in about 3% of cases.
Depending on the size of the lump, part of a thyroid lobe, a whole lobe, parts of both thyroid lobes or the whole thyroid gland can be removed during the operation. If thyroid cancer is present, the residual thyroid gland, as well, depending on the tumor stage Lymph nodes away. This can be done as part of a second operation.
Depending on the extent of the remaining thyroid tissue, temporary or lifelong treatment may be required Thyroid hormones necessary.

Risks of thyroid surgery

The risks of Thyroid surgery can - as with all operations - be divided into general and special risks.
Bleeding, secondary bleeding, impaired wound healing and infection are risks that exist in all types of operations.
In the case of thyroid surgery, the special risks are very important as they can sometimes have serious consequences.

In the first place, the injury to the vocal cord nerve (recurrence - paresis) should be mentioned. This nerve runs right along the thyroid gland on the back of the border between the windpipe and thyroid.
The one-sided injury to the nerve leads to hoarseness, but the bilateral injury can also lead to shortness of breath. This is due to the closed, immobile vocal cords in such a case. A lack of mobility or immobility in one or both vocal cords often recovers within one to three months.
A Tracheal incision However, it may be necessary if there is no improvement within this period.
Unilateral injury to the vocal cord nerve is relatively rare, accounting for 2-3% of all thyroid operations. The bilateral injury occurs much less likely (in the alcohol range). Permanent damage can remain in about 1% of the operated patients.

The second specific risk in thyroid surgery concerns the Parathyroid.
These are very small organs that are found in pairs, four in all, on either side of the thyroid gland. Here a hormone (Parathyroid hormone) formed, which is important for that Calcium metabolism is.
The parathyroid glands are difficult to distinguish from the surrounding fatty tissue with the naked eye. Therefore, they can be removed when the thyroid gland, and especially the large thyroid gland with many large nodules, is operated on.
As a rule, only one parathyroid can meet the need for parathyroid hormone.
However, if all four parathyroid glands have been removed, there will be a calcium deficiency, which must be compensated for by regular intake of calcium.
Further information is also available under our topic Parathyroid.

Due to the very fine proportions of thyroid surgery, the Surgeons with magnifying glasses and electronic devices often help themselves to precisely follow the course of the vocal cord nerves.