Indication for operation of patients with autonomously functioning thyroid tissue in endemic goiter areas

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Abstract
Four hundred thirty‐nine patients with autonomously functioning thyroid tissue (AFTT), 26% of all patients with AFTT diagnosed at the University of Marburg between 1970 and 1982, underwent thyroidectomy. One hundred ninety (43.3%) of these patients with AFTT were operated on for clinical hyperthyroidism, compared to only 62 patients with Graves' disease during this same time period. The remaining 249 patients with AFTT underwent surgery because of nonsuppressible uptake of technetium (TcTU) (3.5% or greater) by the thyroid.AFTT was 5 times more common in women than men. Hyperthyroidism was more common in older patients (p< 0.001) and in patients with numerous autonomous nodules. Many patients had no obvious signs of hyperthyroidism, but 42.4% had cardiac disorders. A preceding history of goiter (mean 15.3 years) was present in patients with AFTT and hyperthyroidism. Serum T3and T4levels were elevated in 88.5% and 74.6% of AFTT patients with clinical hyperthyroidism, while in clinically euthyroid AFTT patients, T3and T4values were in the upper normal range, i.e., 53.7% and 15.2%, respectively.Hyperthyroid patients were prepared for operation with antithyroid drugs. Additionally, propranolol was used in the perioperative period. Patients were operated on selectively after 1979, either by enucleation or unilateral thyroidectomy for unifocal AFTT, and subtotal thyroidectomy for bilateral disease. The results of treatment were most satisfactory and only 11 patients with AFTT (2.5%) developed recurrent hyperthyroidism. Surgical treatment of patients with hyperthyroidism and AFTT is a safe and effective therapeutic modality.

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