[Radicality principles in operations on malignant thyroid tumors]

[Problems of tracheotomy in locally invasive anaplastic thyroid cancer]

Between 1955-1985 515 patients with carcinoma of the thyroid have been operated. Among 170 cases with a local infiltration 69 tracheostomies were performed in 55% for lesions of both laryngeal nerves or intratracheal bleeding (absolute indication), in 45% as a prophylactic intraoperative procedure to avoid later death from asphyxiation (relative indication). In a retrospective study clinical results were analysed with special reference to the question whether patients profit by the tracheostomy. Follow-up examinations showed that tracheostomy did not influence the outcome of patients with a differentiated thyroid carcinoma while there was a remarkable difference in survival of patients with anaplastic tumors where those with a tracheostomy had a worse survival. In this group postoperative external radiotherapy often could not be administered or was delayed due to local complications of the tracheostoma.

[Surgery of metastases of differentiated thyroid cancers]

84 (19.5%) of 431 patients with differentiated thyroid cancer developed distant metastases in bone and parenchymal organs. 78% of primary bone metastases and only 21% of primary lung metastases were treated operatively. High survival rates of 33-60% at 5 years supported the necessity of surgical interventions primarily in bone metastases to prevent early morbidity due to pathological fractures. Even in case of questionable increase in survival rate surgery of metastases from differentiated thyroid carcinomas doubtlessly improves the quality of life in these patients.

Management of goiter and thyroid nodules in an area of endemic goiter

This article discusses the diagnostic and therapeutic measures we have used during the past five years to treat 861 patients from an edemic goiter area with various thyroid disorders. The similarities and differences between these patients, with nontoxic goiter, toxic goiter, and thyroid cancer, were compared with those seen in patients with thyroid problems who live in iodine-rich areas.