THE HYPOFUNCTIONAL THYROID-NODULE - SURGICAL THERAPY

In contrast to autonomously functioning nodules, where surgery may be indicated to treat hyperthyroidism, the patient with hypofunctional no dules undergoes surgery mainly to exclude malignancy. Ultrasonography as a screening method may describe the lesion as a cyst, an adenoma or regressive nodule. Only fine needle aspiration cytology (FNC) is sens itive enough to diagnose a thyroid carcinoma preoperatively. The paper deals with 770 patients, who underwent subtotal thyroid resection for hypofunctional thyroid nodules over a period of 51/2 years. The preop erative work-up consisted of sonography, scintiscan and FNC - as the m ost sensitive method to exclude malignancy. In 568 patients the FNC wa s unsuspicious (group I/II) in 99% (= 1 % false positive). The share o f atypical adenomas and carcinomas in 159 patients with FNC "III" was 26% and reached 80 % when FNC described group IV/V (n = 43). This retr ospective analysis induced us to investigate a new surgical concept fo r the "high risk" group FNC "III" in a prospective fashion. In patient s with hypofunctional thyroid nodules with FNC "III" we performed a he mithyroidectomy with intraoperative frozen section. In cases of post-o perative proven malignancy (follicular carcinomas may be verified by i nvasion of atypical cells to vessels, or the capsule), a thyroidectomy has to follow. The advantage of this concept is, that in cases of a r eoperation only the contralateral side has to be resected. From Novemb er 1989-July 1991 we performed a primary hemithyroidectomy in 85 patie nts with FNC "III". The share of atypical adenomas and highly differen tiated carcinomas revealed 21, respectively 12 %. The rate of recurren t nerve palsy (2.4 %) was comparable to the rate after subtotal resect ions, on the premises of a general identification of the recurrent lar yngeal nerve.