Therapy
When treating goiter, the exact cause and origin must first be clarified. Thus, for example, a therapy of diffuse goiter and nodosa goiter differs significantly. In principle, there are 3 main therapy options known today: 1) Drug therapy Iodine deficiency is known as the most important cause (over 90%) for the development of the diffuse goiter.
But also with thyroid nodules (Struma nodosa colloides) it is assumed that insufficient iodine supply plays an important role! For an adult person, the daily iodine requirement is 150 micrograms. During pregnancy and breastfeeding, women even need 250 micrograms.
If those affected now suffer from goiter, they should usually take 100-150 micrograms of iodine in the form of tablets once a day (iodine substitution therapy). In most cases, the doctor will add a thyroid hormone, L-thyroxine (levothyroxine), to the drug therapy. This is called a “combination therapy” and it is hoped that the goiter will be reduced in size within one to one and a half years.
For some time, however, there has been a great deal of discussion among experts about the long-term success of such combined therapies. Nevertheless, over the years, it has gained acceptance and is used in many places! In order to check the function and condition of the thyroid gland, regular check-ups are arranged with your doctor.
For this purpose, he will check the thyroid hormones in the blood and, using an ultrasound machine, the reduction of the goiter. Under no circumstances should you change the dosage of your medication yourself. The impression is deceptive: although the thyroid tablets are very small, the amount of hormones they contain is considerable!
2.) Radioiodine therapy For 50 years radioiodine therapy has been a gentle alternative to surgery. It is particularly suitable for patients suffering from struma caused by Graves’ disease (autoimmune thyroid disease) and patients with many nodes in the thyroid gland, especially if these cause hyperactivity.
The treatment may also be suitable for elderly people whose overall condition no longer permits surgery under general anesthesia. In order to be able to produce its hormones, the thyroid gland needs the iodine naturally found in food. For this purpose, it is stored by specialized cells of the gland.
This principle is used in radioiodine therapy. After some preliminary examinations, you will be given a capsule with radioactive iodide in the hospital. Externally it does not differ from a conventional tablet, but in its effect it does!By absorbing the radioactive iodide, the substance naturally accumulates in the thyroid cells.
Now the iodide irradiates the thyroid gland from within. The tissue is weakened and eventually shrinks, so that the goiter is very effectively reduced. Since the radioactive iodide only radiates about half a millimeter, there is no danger that healthy organs or other parts of your body will also be damaged.
Nevertheless, the treatment is subject to the Radiation Protection Act. You may therefore only leave the hospital as soon as the measured radiation from your thyroid gland reaches a sufficiently low level. In order not to endanger your surroundings, you must remain in your hospital room strictly shielded until then.
Unfortunately, it is not possible to predict the exact time period. Daily measurements, however, guarantee the fastest possible course of action. Many patients are very insecure at the beginning of the therapy.
However, the safety of the therapy has been proven in many long-term studies. There are no risks of unintended organ damage or late effects. Comparable overall radiation exposure levels are also achieved, for example, during an X-ray examination.
It is important to mention that the full effect only occurs after a few months. After complete scarring, a doctor regularly checks the metabolic state of the thyroid gland. In this way, any medication, such as thyroid hormones, can be administered in good time.
3.) Surgery Particularly large goiter, but also individual nodes can be removed surgically. The operation is performed under general anesthesia and is now routine in many hospitals.
A distinction is made between complete removal of the thyroid gland (thyroidectomy) or removal of the enlarged parts (strum resection). In the past, there was often a risk of accidental damage to the vocal cord nerves (“recurrens paresis”). However, modern procedures such as neuromonitoring have reduced such complications.
Every year, about 100,000 patients are operated on the thyroid gland in Germany. Either the entire thyroid gland (thyroidectomy), a thyroid lobe (hemithyroidectomy) or individual nodes (strum resection) can be removed. The size, location, type and function of the goiter determine the extent of the operation.
For example, if there is malignant enlargement, total thyroidectomy is indicated. Even in the case of goiter in Graves’ disease, a large part of the thyroid gland is usually removed. Individual benign nodules, on the other hand, can often be removed without significant loss of thyroid tissue.
Every struma operation is performed under general anesthesia. During the procedure, the patient lies on his or her back with an overstretched neck. The surgeon opens the front of the neck with a small incision about two cm above the pit of the neck (“collar incision”).
In order to achieve an ideal cosmetic result and to avoid scarring later on, the surgeon places the incision in a natural neck crease. After cutting through fatty tissue and thin neck muscles (platysma), the thyroid gland is exposed. Special attention is now paid to the two vocal cord nerves (laryngeal recurrens nerve).
They run on the left and right side of the thyroid gland and are responsible for the movement of the vocal cords. If they are accidentally injured, long-term damage to the voice, speech and breathing can result! To minimize this risk, a so-called “neuromonitoring” is used during the operation.
Modern technology makes it possible to monitor the position and function of the nerve precisely through electrical stimulation! In addition to the protection of the vocal cord nerves, the four parathyroid glands, also called epithelial corpuscles, must be protected. Usually they are located in close proximity to the upper and lower pole of the two thyroid lobes.
They regulate the calcium level in the human body. If they are inadvertently removed or damaged, considerable, life-long disturbances of the calcium balance can occur. In any case, a pathologist examines the removed thyroid preparations.
He examines the exact structure under a fine microscope (histologically) and can thus conclusively assess which type of goiter was present. The complication rate for goiter operations has decreased considerably, especially due to the use of neuromonitoring. As a rule, patients can leave the hospital just a few days after surgery.
