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

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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Based on a review of relevant recent guidelines from other groups and additional literature, unpublished data, and clinical experience, the German Association of Endocrine Surgeons formulated new recommendations on the surgical treatment of benign thyroid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.

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References

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

    PubMed  CAS  Google Scholar 

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

  4. 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

    Google Scholar 

  5. 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 28:1305–1311

    Article  PubMed  Google Scholar 

  6. 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 

  7. 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 

  8. 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 92:450–455

    Article  PubMed  CAS  Google Scholar 

  9. 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 94:2970–2974

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  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):45–53

    PubMed  Google Scholar 

  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 136:1310–1322

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  16. 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 

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

    Article  PubMed  Google Scholar 

  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 239–240

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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) 100:542–546

    Article  Google Scholar 

  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 240:9–17

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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 6:71–76

    Article  PubMed  Google Scholar 

  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 112:52–58

    Article  PubMed  CAS  Google Scholar 

  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 21:99–105

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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 134:425–431

    Article  PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    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. 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 

  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 32:1301–1312

    Article  PubMed  Google Scholar 

  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 32:1253–1263

    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. 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 130:1831–1836

    Article  PubMed  CAS  Google Scholar 

  38. 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 

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

    Article  PubMed  Google Scholar 

  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 139:357–362

    Article  PubMed  Google Scholar 

  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 28:1282–1286

    Article  PubMed  Google Scholar 

  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 1096

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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 18:721–727

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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 112:124–133

    Article  PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  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 24:1335–1341

    Article  PubMed  CAS  Google Scholar 

  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 74:437–443

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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 127:425–428

    Article  PubMed  CAS  Google Scholar 

  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 75:916–922

    Article  PubMed  CAS  Google Scholar 

  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 127:439–442

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Section of Endocrine Surgery, Clinic of General and Abdominal Surgery, University Medical Center, Gutenberg University—Mainz, Langenbeckstr. 1, 55101, Mainz, Germany

    Thomas J. Musholt

  2. Department of Surgery, Kantonsspital St. Gallen, CH-9007, St. Gallen, Switzerland

    Thomas Clerici

  3. Department for General, Visceral and Vascular Surgery, Martin-Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany

    Henning Dralle & Kerstin Lorenz

  4. Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK

    Andreja Frilling

  5. Surgical Department 1, Lukaskrankenhaus Neuss, Preussenstr. 84, 41456, Neuss, Germany

    Peter E. Goretzki

  6. Department of Surgery, Kaiserin-Elisabeth-Spital, Medical University of Vienna, Huglgasse 1–3, Vienna, Austria

    Michael M. Hermann

  7. Clinic for Endocrine Surgery, Schön Klinik Hamburg–Eilbek, Dehnhaide 120, 22081, Hamburg, Germany

    Jochen Kußmann

  8. Department for General and Visceral Surgery, Niels-Stensen-Kliniken, Marienhospital Osnabrück, Bischofsstr. 1, 49074, Osnabrück, Germany

    Christoph Nies

  9. Department of Surgery, St. Josefs Hospital, Liebigstr. 24, 35338, Giessen, Germany

    Jochen Schabram

  10. Ratajczak & Partners—Solicitors—Berlin•Cologne•Essen•Freiburg•Meissen•Munich•Sindelfingen, Heinrich-von-Stephan-Str. 25, 79100, Freiburg, Germany

    Peter Schabram

  11. Division of General Surgery, Department of Surgery, Medical University, Währinger Gürtel 18–20, 1090, Vienna, Austria

    Christian Scheuba

  12. Department of General and Visceral Surgery, Bethesda Hospital, Heerstrasse 219, 47053, Duisburg, Germany

    Dietmar Simon

  13. Department of Visceral and Endocrine Surgery, DRK-Kliniken Berlin-Westend, Spandauer Damm 130, 14050, Berlin, Germany

    Thomas Steinmüller

  14. Department of Surgery, Kreiskrankenhaus Starnberg GmbH Oßwaldstr. 1, 82319, Starnberg, Germany

    Arnold W. Trupka

  15. Department of Endocrine Surgery, Burgerhospital Frankfurt am Main e.V, Nibelungenallee 37–41, 60318, Frankfurt, Germany

    Robert A. Wahl

  16. Department of Surgery, Klinikum Offenbach GmbH, Starkenburgring 66, 63069, Offenbach, Germany

    Andreas Zielke

  17. Department of Nuclear Medicine, University Hospital of Essen, Hufelandstr. 55, 45122, Essen, Germany

    Andreas Bockisch

  18. Division of Endocrinology and Diabetes, RWTH University Hospital Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany

    Wolfram Karges

  19. Department of Nuclear Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany

    Markus Luster

  20. Department of Pathology, University Hospital of Essen, Hufelandstr. 55, 45122, Essen, Germany

    Kurt W. Schmid

Authors
  1. Thomas J. Musholt
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  2. Thomas Clerici
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  3. Henning Dralle
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  15. Arnold W. Trupka
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  16. Robert A. Wahl
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  19. Wolfram Karges
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  20. Markus Luster
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  21. Kurt W. Schmid
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The Interdisciplinary Task Force “Guidelines” of the German Association of Endocrine Surgeons

Corresponding author

Correspondence to Thomas J. Musholt.

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Author contributions

All of the authors were involved in the conception and design of the guidelines, in data acquisition, analysis, and interpretation, and in drafting and critical revision of the manuscript.

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Musholt, T.J., Clerici, T., Dralle, H. et al. German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease. Langenbecks Arch Surg 396, 639–649 (2011). https://doi.org/10.1007/s00423-011-0774-y

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  • DOI: https://doi.org/10.1007/s00423-011-0774-y

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