[Surgical therapy of carcinoma of the thyroid gland]

Thyroid carcinoma comprises tumours with a wide spectrum of aggressiveness. The method of first choice is surgery, however, views on its extent and technique are frequently controversial. The objective of the present work was to demonstrate and justify the procedure used at the author's department in treatment of this tumour.

During 1988-1992 a total of 919 patients with thyroid disease were operated. The female:male ratio was 4.13:1; a benign finding was confirmed in 76.4% and a malignant one in 23.6%. The female:male ratio in patients with a malignant findings was 3.24:1. Most frequently a papillary carcinoma was confirmed--in 59.9%, followed by follicular carcinoma in 23.11%, medullary carcinoma in 7.0%, Hürtle's carcinoma in 4.25%, anaplastic carcinoma in 1.42% and epidermoid carcinoma in 0.47%. Metastases in the thyroid were present in 0.94% and a myeloma or sarcoma both in 0.47%. In retrosternal goitres papillary carcinoma was most frequent (19 patients) followed by follicular (7 patients). As to surgical operations, total thyroidectomy was performed in 47.6%, total lobectomy in 20.3%, subtotal thyroidectomy in 15.1% and subtotal lobectomy in 2.4% of the operated patients. A palliative resection was made in 11.8% and lymphadenectomy in 2.8% patients with a malignant finding on the thyroid gland. Permanent complications (paresis of the recurrent nerve, hypoparathyroidism) occurred in 0.95% of the patients, temporary complications (abscess in the scar, transient hypoparathyroidism, oedema of the vocal cords) in 8.66% of the operations. None of the patients died.

Surgical results and experience of the clinic for nuclear medicine support a radical approach to all types of thyroid carcinoma in adults as well as in adolescents.