Studer H
Langenbecks Arch Chir. 1978 Nov;347:119-23. doi: 10.1007/BF01579316.
Surgical cure of hyperthyroidism aims at removing enough functioning follicles to prevent hyperthyroidism while leaving sufficient tissue to maintain euthyroidism. In the case of Graves' disease the surgeon is faced with a goiter consisting of uniformly hyperstimulated follicles that are but one of the multiple targets of an immunologic attack. In contrast, autonomous follicles with an intrinsic functional abnormality are the hallmark of multinodular toxic goiter. These follicles may be clustered (toxic adenoma) or spread in different patterns throughout the gland. Partial thyroidectomy provides definite cure. While operating, the surgeon is unable to appreciate the functional quality of the tissue left behind. Thus, both postoperative hypo- and hyperthyroidism may occur independently of the surgical technique.
甲状腺功能亢进症的手术治疗旨在切除足够数量的有功能的滤泡，以预防甲状腺功能亢进，同时保留足够的组织以维持甲状腺功能正常。对于格雷夫斯病，外科医生面对的是一个由均匀过度刺激的滤泡组成的甲状腺肿，而这些滤泡只是免疫攻击的多个靶点之一。相比之下，具有内在功能异常的自主性滤泡是多结节毒性甲状腺肿的标志。这些滤泡可能聚集在一起（毒性腺瘤），也可能以不同模式散布于整个腺体。甲状腺次全切除术可实现确切治愈。手术过程中，外科医生无法判断残留组织的功能质量。因此，术后甲状腺功能减退和甲状腺功能亢进都可能独立于手术技术而发生。
