Indications for surgical intervention in thyropathies

Overview

On the basis of many-year surgical experience with thyropathies, in collaboration with endocrinologists and other participating experts the authors present their own nine-year series (1995–2003). During that period the opinion on radical intervention in the separate types of thyropathy has been changing. Gradually, subtotal resections of the thyroid gland have been abandoned, so that at present, in agreement with endocrinologists, most frequently there are performed more radical surgeries – TTE, nTTE, TL, and nTL. Valid is the principle that all patients with thyropathies operated on, have to be under life-long dispensary care and endocrinological treatment, namely under substitution therapy that has been previously a prevention of recurring thyropathies in subtotal resection. Endocrinologists carry out dispensary examinations once to twice a year, in the meanwhile the patients are in the care of family physicians who prescribe medication. There have also been changing the surgical procedure in the sense that in more radical interventions there is now being carried out the identification of n. recurrens and the para-thyroid glands. In as it is well known that there is almost zero mortality in thyroid surgery, there has also been gradually shortened post-operation hospitalization. Although in the USA thyropathy surgery has been included in the group treated under the regimen of „one day surgery”, on the basis of our own experience we are of the opinion that in our conditions that would threaten the patients operated on, and that has been confirmed by reports from other central European facilities. The grounds for that may be delayed hemorrhage in the matrix at the site of thyroidectomy with compression of the trachea.

Key words:
indication for surgery of thyropathies – radicalness of surgical intervention – shortening of postoperation hospitalization