[Current aspects of surgery of benign struma]

Preoperative procedures, surgical techniques, and postoperative management are discussed in this paper, against the background of latest developments and with reference to 443 struma patients who received surgical treatment in 1984 and 1985. The technique of surgical removal has been modified by the author, as compared to what it used to be back to 1964. Ligature of the inferior thyroid artery has been abandoned. The postoperative rate of unilateral nerve palsy recurrence has been reduced from 4.47 to 2.20 per cent, whereas other complications remained unchanged, such as postoperative bleeding and thyreotoxicosis. Other topical aspects resulted from modification of the regime of prophylaxis to prevent recurrence. The substitution therapy applied by late 1985 had been based on daily thyroxine doses as low as 50 micrograms, with the postoperative hypothyreosis rate reaching a level of more than 50 per cent, as early as three months after surgery. The hypothyreosis rate was lowered to something below ten per cent, after the daily T4-therapy had been increased to 75 micrograms, on January 1st, 1986. General life-long and individually adjusted prophylaxis against recurrence is ensured by regular postoperative clinical and TSH follow-up with adequately adapted thyroxine medication.