Department of Visceral, Thoracic and Vascular Surgery, University Hospital of Giessen and Marburg; Marburg; Department of Nuclear Medicine, University Hospital of Giessen and Marburg; Marburg; German Society for General and Visceral Surgery, Berlin; Department of General and Visceral Surgery, Sana Klinikum Offenbach; Offenbach; Department of General, Visceral and Vascular Surgery, University Hospital of Würzburg; Würzburg; Department of General, Visceral and Endocrine Surgery, Lukaskrankenhaus Neuss; Neuss.
Dtsch Arztebl Int. 2018 Jan 8;115(1-02):1-7. doi: 10.3238/arztebl.2018.0001.
Thyroidectomy is still three to six times more common in Germany than in the USA, Great Britain, and the Scandinavian countries. Thus, the question is often asked whether thyroidectomy in Germany is being performed for the correct indications.
This review is based on studies and guidelines containing information on the indications for surgery in benign goiter and Graves' disease; these publications were retrieved by a systematic literature search in the Medline and Cochrane Library databases (1990-2016). The indications recommended here were determined by vote by the German Society for General and Visceral Surgery (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, DGAV).
On the basis of the available evidence (levels 2-4), and in the absence of prospective studies, the indications for surgery in goiter include a well-founded suspicion of malignancy, local compressive symptoms, and, rarely, cosmesis. In hyperthyroid goiter and Graves' disease, surgery is a potential alternative to radio - iodine therapy, particularly if the volume of the thyroid gland exceeds 80 mL, in patients with advanced or active orbitopathy, and in female patients who are, or plan to be, pregnant. Large, asymptomatic, euthyroid nodular goiter without any suspicion of malignancy and scintigraphically "cold" nodules without any other evidence of malignancy are not indications for surgery. Thyroid operations of higher levels of difficulty (e.g., recurrent goiter, retrosternal extension, Graves' disease) should be carried out in institutions with special expertise in thyroid surgery.
The decision to operate should be made on an interdisciplinary basis and in conformity with the relevant guidelines after all of the appropriate diagnostic studies have been performed. The radicality of any proposed surgical procedure should be weighed against its potential complications.
甲状腺切除术在德国的实施频率仍比美国、英国和斯堪的纳维亚国家高 3 至 6 倍。因此，人们经常会问德国的甲状腺切除术是否针对正确的适应证。
本综述基于包含甲状腺良性结节和格雷夫斯病手术适应证信息的研究和指南；这些出版物是通过在 Medline 和 Cochrane Library 数据库中进行系统文献检索获得的（1990-2016 年）。这里推荐的适应证是由德国普通和内脏外科学会（Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie，DGAV）投票决定的。
根据现有证据（2-4 级），在缺乏前瞻性研究的情况下，甲状腺切除术的适应证包括对恶性肿瘤有充分依据的怀疑、局部压迫症状，以及罕见的美容原因。在甲状腺功能亢进性结节和格雷夫斯病中，手术是放射性碘治疗的潜在替代方法，尤其是当甲状腺体积超过 80 mL 时，或当存在晚期或活动性眼眶病，或当女性患者计划怀孕时。对于没有恶性肿瘤可疑迹象且放射性碘扫描表现为“冷”结节的大的、无症状、甲状腺功能正常的结节性甲状腺肿，以及没有其他恶性肿瘤证据的大的、无症状、甲状腺功能正常的结节性甲状腺肿，不建议手术。更具难度的甲状腺手术（如复发性甲状腺肿、胸骨后延伸、格雷夫斯病）应在具有甲状腺手术专业知识的机构中进行。
在进行所有适当的诊断研究后，应基于多学科的基础并符合相关指南来决定是否进行手术。任何拟议手术的根治性应与其潜在并发症进行权衡。
