Skip to main content
SpringerLink
Log in

Aktualisierung der S2k-Leitlinie

Operative Therapie benigner Schilddrüsenerkrankungen

Update of the S2k guidelines

Surgical treatment of benign thyroid diseases

  • Übersichten
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Resektionen der Schilddrüse stellen mit 76.140 Eingriffen im Jahr 2016 (Quelle Destatis) eine der häufigsten Operationen in Deutschland dar. Überwiegend handelt es sich hierbei um benigne Schilddrüsenerkrankungen. Empfehlungen zur operativen Therapie benigner Schilddrüsenerkrankungen wurden durch die CAEK (Chirurgische Arbeitsgemeinschaft Endokrinologie) vor dem Hintergrund zunehmend radikalerer Resektionsverfahren zuletzt 2010 als S2k-Leitlinie publiziert (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. [AWMF] 003/002). Hemithyreoidektomien bzw. Thyreoidektomien werden in der Praxis routinemäßig zur Behandlung gutartiger Schilddrüsenerkrankungen eingesetzt. Die operationsspezifischen Risiken nehmen mit dem Resektionsausmaß deutlich zu. Darum erfordert die Risiko-Indikations-Abwägung zwischen unilateraler Lobektomie oder Thyreoidektomie eine unabhängige seitengetrennte Indikationsstellung. Insbesondere dieses Prinzip wurde der Aktualisierung der Leitlinien zugrunde gelegt. Darüber hinaus fanden auch die zuvor formulierten Empfehlungen der CAEK zur korrekten Durchführung und Konsequenzen des intraoperativen Neuromonitorings Eingang in die Leitlinien, welche insbesondere der Vermeidung beidseitiger Stimmlippenparesen dienen. Ergänzend wurden die Empfehlungen zur Behandlung postoperativer Komplikationen wie des Hypoparathyreoidismus und postoperativer Infektionen überarbeitet. Die aktualisierten Leitlinien stellen somit den derzeitigen Stand der Wissenschaft bzw. die hieraus resultierende chirurgische Praxis dar.

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

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

    Article  PubMed  Google Scholar 

  2. Alvarado R, Sywak MS, Delbridge L et al (2009) Central lymph node dissection as a secondary procedure for papillary thyroid cancer: is there added morbidity? Surgery 145:514–518

    Article  PubMed  Google Scholar 

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

  4. Gharib H, Papini E, Valcavi R, Baskin HJ, Crescenzi A, Dottorini, ME Duick DS, Guglielmi R, Hamilton CR Jr, Zeiger MA, Zini M; AACE/AME Task Force on Thyroid Nodules (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(1):63–102. Erratum in: Endocr Pract 14(6):802–803 (multiple author names added)

  5. Barbaros U, Erbil Y, Aksakal N et al (2008) Electrocautery for cutaneous flap creation during thyroidectomy: a randomised, controlled study. J Laryngol Otol 122:1343–1348

    Article  PubMed  CAS  Google Scholar 

  6. Bartsch DK, Luster M, Buhr HJ et al (2018) Indications for the surgical management of benign goiter in adults. Dtsch Arztebl Int 115:1–7

    PubMed  Google Scholar 

  7. Bergenfelz A, Jansson S, Kristoffersson A et al (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 393:667–673

    Article  PubMed  CAS  Google Scholar 

  8. Bures C, Klatte T, Gilhofer M et al (2014) A prospective study on surgical-site infections in thyroid operation. Surgery 155:675–681

    Article  PubMed  Google Scholar 

  9. Bures C, Zielinski V, Klatte T et al (2015) Streptococcal mediastinitis after thyroidectomy: a literature review. Chirurg. https://doi.org/10.1007/s00104-014-2972-y

    Article  PubMed  Google Scholar 

  10. Chandrasekhar SS, Randolph GW, Seidman MD et al (2013) Clinical practice guideline: improving voice outcomes after thyroid surgery. Otolaryngol Head Neck Surg 148:S1–S37

    Article  PubMed  Google Scholar 

  11. Chi SY, Lammers B, Boehner H et al (2008) Is it meaningful to preserve a palsied recurrent laryngeal nerve? Thyroid 18:363–366

    Article  PubMed  Google Scholar 

  12. 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 19:1167–1214

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  14. Darr EA, Tufano RP, Ozdemir S et al (2014) Superior laryngeal nerve quantitative intraoperative monitoring is possible in all thyroid surgeries. Laryngoscope 124:1035–1041

    Article  PubMed  Google Scholar 

  15. Dionigi G, Rovera F, Boni L et al (2006) Surgical site infections after thyroidectomy. Surg Infect (Larchmt) 7(Suppl 2):S117–S120

    Article  Google Scholar 

  16. Dionigi G, Rovera F, Boni L et al (2008) Surveillance of surgical site infections after thyroidectomy in a one-day surgery setting. Int J Surg 6(Suppl 1):S13–S15

    Article  PubMed  Google Scholar 

  17. Dralle H, Lorenz K, Schabram P et al (2013) Intraoperative neuromonitoring in thyroid surgery. Recommendations of the Surgical Working Group for Endocrinology. Chirurg 84:1049–1056

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. Feldkamp J, Fuhrer D, Luster M et al (2016) Fine needle aspiration in the investigation of thyroid nodules. Dtsch Arztebl Int 113:353–359

    PubMed  PubMed Central  Google Scholar 

  21. Francis G, Waguespack SG, Bauer AJ et al (2015) Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid. https://doi.org/10.1089/thy.2014.0460

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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 240:9–17

    Article  PubMed  PubMed Central  Google Scholar 

  23. http://www.awmf.org/leitlinien/detail/ll/088-007.html

  24. http://www.awmf-leitlinien.de

  25. http://www.delbi.de

  26. Kamani D, Darr EA, Randolph GW (2013) Electrophysiologic monitoring characteristics of the recurrent laryngeal nerve preoperatively paralyzed or invaded with malignancy. Otolaryngol Head Neck Surg 149:682–688

    Article  PubMed  Google Scholar 

  27. 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 21:99–105

    Article  PubMed  Google Scholar 

  28. Lloyd RV, Osamura RY, Klöppel GN et al (2017) WHO classification of tumours of endocrine organs. International Agency for Research on Cancer (IARC), Lyon

    Google Scholar 

  29. Lorenz K, Abuazab M, Sekulla C et al (2014) Results of intraoperative neuromonitoring in thyroid surgery and preoperative vocal cord paralysis. World J Surg 38:582–591

    Article  PubMed  Google Scholar 

  30. Lorenz K, Sekulla C, Kern J et al (2015) Management of postoperative hemorrhage following thyroid surgery. Chirurg 86:17–23

    Article  PubMed  CAS  Google Scholar 

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

    Article  Google Scholar 

  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 32:1333–1340

    Article  PubMed  Google Scholar 

  33. Mintziori G, Goulis DG (2015) European Thyroid Association guidelines in comparison with the American Thyroid Association and Endocrine Society practice guidelines for the screening and treatment of hypothyroidism during pregnancy. Hormones (Athens) 14:174–175

    Google Scholar 

  34. 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 61:3–8

    Article  PubMed  Google Scholar 

  35. 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 32:1301–1312

    Article  PubMed  Google Scholar 

  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 31:368–374

    Article  PubMed  CAS  Google Scholar 

  37. Musholt TJ, Clerici T, Dralle H et al (2011) German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease. Langenbecks Arch Surg 396:639–649

    Article  PubMed  Google Scholar 

  38. Pacini F, Schlumberger M, Dralle H et al (2006) European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 154:787–803

    Article  PubMed  CAS  Google Scholar 

  39. Pei YC, Fang TJ, Li HY et al (2014) Cricothyroid muscle dysfunction impairs vocal fold vibration in unilateral vocal fold paralysis. Laryngoscope 124:201–206

    Article  PubMed  Google Scholar 

  40. Perros P, Boelaert K, Colley S et al (2014) Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 81(Suppl 1):1–122

    Article  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  42. Randolph GW (2010) The importance of pre- and postoperative laryngeal examination for thyroid surgery. Thyroid 20:453–458

    Article  PubMed  Google Scholar 

  43. 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 139:357–362

    Article  PubMed  Google Scholar 

  44. Russo M, Scollo C, Padova G et al (2014) Cardiac arrest after intravenous calcium administration for calcitonin stimulation test. Thyroid 24:606–607

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  46. Serpell JW, Phan D (2007) Safety of total thyroidectomy. ANZ J Surg 77:15–19

    Article  PubMed  Google Scholar 

  47. 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 18:721–727

    Article  PubMed  Google Scholar 

  48. Statistisches Bundesamt, DRG Statistik. https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Krankenhaeuser/FallpauschalenKrankenhaus2120640167004.html

  49. 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 112:124–133

    Article  PubMed  Google Scholar 

  50. Suslu N, Vural S, Oncel M et al (2006) Is the insertion of drains after uncomplicated thyroid surgery always necessary? Surg Today 36:215–218

    Article  PubMed  Google Scholar 

  51. Timmermann W, Hamelmann WH, Thomusch O et al (2004) Zuverlässigkeit und Konsequenzen des intraoperativen Neuromonitorings in der Schilddrüsenchirurgie. Stellungnahme der „Interdisziplinären Studiengruppe Intraoperatives Neuromonitoring Schilddrüsenchirurgie“. Chirurg 75:916–922

    Article  PubMed  CAS  Google Scholar 

  52. Tuggle CT, Roman SA, Wang TS et al (2008) Pediatric endocrine surgery: who is operating on our children? Surgery 144:869–877 (discussion 877)

    Article  PubMed  Google Scholar 

  53. Ubl P, Gincu T, Keilani M et al (2014) Comparison of side effects of pentagastrin test and calcium stimulation test in patients with increased basal calcitonin concentration: the gender-specific differences. Endocrine 46:549–553

    Article  PubMed  CAS  Google Scholar 

  54. Zambudio AR, Rodriguez J, Riquelme J et al (2004) Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg 240:18–25

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sektion Endokrine Chirurgie der Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Langenbeckstr. 1, 55101, Mainz, Deutschland

    T. J. Musholt FEBS

  2. Klinik für Nuklearmedizin, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    A. Bockisch

  3. Klinik für Chirurgie, Kantonsspital St. Gallen, 9007, St. Gallen, Schweiz

    T. Clerici

  4. Klinik für endokrine Chirurgie, Helios Universitätsklinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Deutschland

    C. Dotzenrath

  5. Sektion Endokrine Chirurgie, Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    H. Dralle

  6. Chirurgische Klinik, Campus Charite Mitte/Campus Virchow Klinikum, Endokrine Chirurgie, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    P. E. Goretzki

  7. 2. Chirurgische Abteilung, Krankenanstalt Rudolfstiftung, Märzstr. 80, 1150, Wien, Österreich

    M. Hermann

  8. Sektion Endokrine Chirurgie der Viszeral‑, Thorax- u. Gefäßchirurgie, Universitätsklinikum Marburg, Baldingerstr., 35043, Marburg, Deutschland

    K. Holzer

  9. Sektion Endokrinologie und Diabetologie – Medizinische Klinik III, Universitätsklinikum Aachen, RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    W. Karges

  10. Klinik für Pädiatrie mit Schwerpunkt Endokrinologie und Diabetologie, Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    H. Krude

  11. Klinik für Endokrine Chirurgie, Schön Klinik Hamburg-Eilbeck, Dehnhaide 120, 22081, Hamburg, Deutschland

    J. Kussmann

  12. Klinik u. Poliklinik f. Allgem.-, Viszeral- u. Gefäßchirurgie, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06120, Halle, Deutschland

    K. Lorenz

  13. Nuklearmedizin, Universitätsklinikum Gießen und Marburg, GmbH, Standort Marburg, Baldingerstrass, 35041, Marburg, Deutschland

    M. Luster

  14. Sektion Endokrine Chirurgie, Franziskus Spital, Nikolsdorfergasse 32, 1050, Wien, Österreich

    B. Niederle

  15. Klinik für Allg.- u. Viszeralchirurgie, Marienhospital Osnabrück, Bischofsstr. 1, 49074, Osnabrück, Deutschland

    C. Nies

  16. Chirurgische Universitätsklinik, Währinger Gürtel 18–20, 1090, Wien, Österreich

    P. Riss

  17. Klinik für Endokrine Chirurgie, Asklepios Klinik Lich, Goethestr. 4, 35423, Lich, Deutschland

    J. Schabram

  18. Anwaltskanzlei Ratajczak & Partner, Heinrich-von-Stephan-Str. 25, 79100, Freiburg im Breisgau, Deutschland

    P. Schabram

  19. Pathologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    K. W. Schmid

  20. Klinik f. Allg.- u. Viszeralchirurgie, Ev. Bethesda Krankenhaus Duisburg GmbH, Heerstr. 219, 47053, Duisburg, Deutschland

    D. Simon

  21. Medizinische Klinik und Poliklinik II, LMU Klinikum der Universität München – Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    Ch. Spitzweg

  22. Chirurgische Abteilung, Zentrum f. Allg.- u. Viszeralchirurgie, DRK-Kliniken Westend, Spandauer Damm 130, 14050, Berlin, Deutschland

    Th. Steinmüller

  23. Chirurgische Klinik, Klinikum Starnberg GmbH, Oßwaldstr. 1, 82319, Starnberg, Deutschland

    A. Trupka

  24. Endokrine Chirurgie, Bürgerhospital Frankfurt am Main, Nibelungenallee 37–41, 60318, Frankfurt am Main, Deutschland

    C. Vorländer

  25. Klinik für Endokrine Chirurgie, Katholisches Klinikum Mainz, An der Goldgrube 11, 55131, Mainz, Deutschland

    T. Weber

  26. Klinik für Visceral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen und Marburg, GmbH, Standort Marburg, Baldingerstrass, 35041, Marburg, Deutschland

    D. K. Bartsch

Authors
  1. T. J. Musholt FEBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Bockisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Clerici
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Dotzenrath
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Dralle
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. E. Goretzki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Hermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. K. Holzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. W. Karges
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. H. Krude
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. J. Kussmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. K. Lorenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. M. Luster
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. B. Niederle
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. C. Nies
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. P. Riss
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. J. Schabram
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. P. Schabram
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. K. W. Schmid
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. D. Simon
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Ch. Spitzweg
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Th. Steinmüller
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. A. Trupka
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. C. Vorländer
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. T. Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. D. K. Bartsch
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Leitliniengruppe der CAEK

Corresponding author

Correspondence to T. J. Musholt FEBS.

Ethics declarations

Interessenkonflikt

T.J. Musholt, A. Bockisch, T. Clerici, C. Dotzenrath, H. Dralle, P.E. Goretzki, M. Hermann, K. Holzer, W. Karges, H. Krude, J. Kussmann, K. Lorenz, M. Luster, B. Niederle, C. Nies, P. Riss, J. Schabram, P. Schabram, K.W. Schmid, D. Simon, C. Spitzweg, T. Steinmüller, A. Trupka, C. Vorländer, T. Weber und D.K. Bartsch geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Musholt, T.J., Bockisch, A., Clerici, T. et al. Aktualisierung der S2k-Leitlinie. Chirurg 89, 699–709 (2018). https://doi.org/10.1007/s00104-018-0653-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-018-0653-y

Schlüsselwörter

Keywords

Search

Navigation