• Detlef K Bartsch, Markus Luster, Heinz J Buhr, Dietmar Lorenz, Christoph-Thomas Germer, Peter E Goretzki, and German Society for General and Visceral Surgery.
• Department of Visceral, Thoracic and Vascular Surgery, University Hospital of Giessen and Marburg; Marburg; Department of Nuclear Medicine, University Hospital of Giessen and Marburg; Marburg; German Society for General and Visceral Surgery, Berlin; Department of General and Visceral Surgery, Sana Klinikum Offenbach; Offenbach; Department of General, Visceral and Vascular Surgery, University Hospital of Würzburg; Würzburg; Department of General, Visceral and Endocrine Surgery, Lukaskrankenhaus Neuss; Neuss.
• Dtsch Arztebl Int. 2018 Jan 8; 115 (1-02): 171-7.

BackgroundThyroidectomy is still three to six times more common in Germany than in the USA, Great Britain, and the Scandinavian countries. Thus, the question is often asked whether thyroidectomy in Germany is being performed for the correct indications.MethodsThis review is based on studies and guidelines containing information on the indications for surgery in benign goiter and Graves' disease; these publications were retrieved by a systematic literature search in the Medline and Cochrane Library databases (1990-2016). The indications recommended here were determined by vote by the German Society for General and Visceral Surgery (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, DGAV).ResultsOn the basis of the available evidence (levels 2-4), and in the absence of prospective studies, the indications for surgery in goiter include a well-founded suspicion of malignancy, local compressive symptoms, and, rarely, cosmesis. In hyperthyroid goiter and Graves' disease, surgery is a potential alternative to radio - iodine therapy, particularly if the volume of the thyroid gland exceeds 80 mL, in patients with advanced or active orbitopathy, and in female patients who are, or plan to be, pregnant. Large, asymptomatic, euthyroid nodular goiter without any suspicion of malignancy and scintigraphically "cold" nodules without any other evidence of malignancy are not indications for surgery. Thyroid operations of higher levels of difficulty (e.g., recurrent goiter, retrosternal extension, Graves' disease) should be carried out in institutions with special expertise in thyroid surgery.ConclusionThe decision to operate should be made on an interdisciplinary basis and in conformity with the relevant guidelines after all of the appropriate diagnostic studies have been performed. The radicality of any proposed surgical procedure should be weighed against its potential complications.

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