The case for thyroid surgery

Although the case for thyroid surgery is based on morphologic and physiolog ic criteria, it is mainly based on individual therapeutic goals. The goals are influenced by various biographic, medical and personal facts and by man y environmental conditions. Thus, there is no rationale for cataloguing ind ications. With the euthyroid goitre the indication for surgery is usually g iven by the size of the thyroid gland, especially since it has become clear in various studies that with drug therapy the achievable size reduction is rather small. With Graves' disease the pros and cons of the three main met hods, surgery, medical treatment or radioiodine, have to be considered in e ach case. Surgery is mainly indicated when the goal is a rapid and reliable normalization of the hormonal status. Thyroid autonomy is a clear-cut case for radioiodine. Only isolated autonomous nodules can equally well be trea ted by surgery. In addition, a case for surgery is given when besides the a utonomy a large goitre is present. A special indication is iodine-induced t hyrotoxicosis that cannot be normalized by medical treatment. All kinds of thyroid carcinoma, with very few exceptions, usually have to be operated on as the first choice.