Therapy

The three main pillars of treatment for thyroid diseases are

• drug therapy,

• radioiodine therapy and

• surgical therapy.

There are also other forms of treatment, such as thermal ablation, for which there are few indications.

Iodine:
Chronic iodine deficiency is – alongside a familial predisposition – the most common cause of enlargement of the thyroid gland, with or without nodule formation. Iodine is therefore the most important component in the treatment of goitre. However, iodine must not be used if hot nodules are present or if there is already an overactive thyroid, as iodine could intensify this.

Thyroid hormones:
Thyroid hormones can be taken as tablets. There are numerous preparations available for this. Iodine and thyroid hormones are often used as combination tablets. Depending on the metabolic state, this is the method of choice for enlarged thyroid glands; the combination of thyroid hormone and iodine is also used after thyroid surgery or after radioiodine therapy in order to replace missing hormone and to prevent renewed growth of the thyroid.

Pure thyroid hormone is used to treat underactivity in autoimmune diseases of the thyroid (e.g. Hashimoto’s disease) and to compensate for the hormone deficiency. Taking it is usually straightforward and well tolerated. The correct dosage is checked by regular blood tests and adjusted if necessary.

Thyrostatic drugs:
Thyrostatic drugs inhibit the production of thyroid hormones. They are used for overactivity (hyperthyroidism). In Graves’ disease this can lead to a cure, but as a rule they should only be taken for a shorter period, for example to bridge the time until thyroid surgery or radioiodine therapy, as thyrostatic drugs can otherwise cause the thyroid to grow. In addition, many patients react allergically or changes in liver values may occur. Thyrostatic drugs can therefore only be used for long-term therapy in exceptional cases.

Radioiodine therapy is used primarily to treat an overactive thyroid (hyperthyroidism). This may be the case with autonomous nodules or with increased hormone production by the entire thyroid gland (disseminated autonomy or Graves' disease). Radioiodine treatment is also used after surgery for thyroid cancer to eliminate residual thyroid tissue and any secondary tumours (metastases) that may be present.

Radioiodine therapy uses a beta emitter (the radioactive iodine isotope I-131). It is swallowed in the form of a small capsule and finds its way by itself exclusively into the thyroid tissue. The remainder is excreted via the kidneys. The thyroid tissue is thus irradiated "from within" and breaks down over a period of a few weeks to a few months. The overactivity disappears and the thyroid gland becomes smaller.

In Germany, radioiodine therapy may only be carried out in a hospital specially equipped for this purpose. The inpatient stay usually lasts from a few days to one week. During this time, patients may not receive visitors and may not leave their room.

For many thyroid conditions, it makes sense to perform thyroid surgery.

Thanks to the extensive experience and specialisation of our surgeons, thyroid surgery places only a small burden on the patient, with a low risk. Precise anatomical knowledge, improved surgical methods and the use of modern technologies ensure that, for example, blood loss during thyroid surgery amounts to only a few millilitres (usually less than is needed for the blood test required before the operation).

In addition to conventional open surgery, we have for years been one of the few hospitals in Germany to perform minimally invasive thyroid resection using the "ABBA method". Which surgical method can be used in an individual case depends on the thyroid condition and its size, and is carefully weighed up and discussed in detail with the patient beforehand.

The operation is performed through a small incision in the neck, the position of which we choose together with you before the operation at the most cosmetically favourable site. No muscles are cut during the operation, so that you can quickly move your neck freely again after the procedure. After careful dissection of the thyroid gland, diseased tissue is removed. In principle, we follow the philosophy of preserving healthy thyroid tissue whenever possible. The parathyroid glands (responsible for calcium balance) are routinely identified and protected during the operation. Monitoring of the vocal cord nerves by means of neuromonitoring during the operation is mandatory. As a rule, we do not insert drains; the skin wound is closed with a self-dissolving suture – stitches do not need to be removed.

The minimally invasive thyroid surgery technique we use is the so-called “ABBA technique” (axillo-bilateral-breast approach). The thyroid gland is operated on through a skin incision approx. 2 cm long in the area of the front of the armpit and through 2 tiny incisions in the breast area (at the edge of the nipple). With this technique, dissection is carried out strictly within the subcutaneous fatty tissue – nerves, blood vessels and the mammary gland are not affected. Similar to minimally invasive abdominal operations, the surgical area is filled with CO₂ gas to create enough space to insert the fine surgical instruments. The thyroid gland is then operated on under camera vision in the same way as with the conventional surgical technique. The view during this operation is excellent; all nerve and vascular structures can be precisely identified. The vocal cord nerves are also monitored by means of neuromonitoring, and the parathyroid glands are visualised and preserved.

According to current knowledge, malignant thyroid tumours, repeat procedures and greatly enlarged thyroid glands should still be operated on using the conventional technique.