From a practical perspective, incomplete laboratory parameters, no thyroid scintigram, and the decision against fine-needle aspiration biopsy are the hindrances to defining the indication for thyroid nodule surgery. Data from the statutory health insurers confirm this individual clinical experience (1). At this point in time, patients are more prepared to interpret surgery to the wrong side of the thyroid as alleged surgical malpractice (2) than surgery to both thyroid lobes during the same procedure. In this setting, expert witnesses and judges will condemn doctors who operated organ sparingly and thereby unintentionally caused the need for a second operation. The fear of cancer determines the decision about total thyroid resection—in the reported case of surgery to the wrong side of the thyroid as well as in a multitude of operations for benign nodular goiter.
The consequences will have to be:
Individually tailored information about the risks and benefits of surgery for thyroid nodules
Facilitating the observation of nodules in specialized institutions
Preparation of performance data held by the Associations of Statutory Health Insurance Physicians, in order to provide quality enhancing advice to physicians.
The following objectives should be aimed for:
To conduct a complete set of preoperative examinations
To reduce the number of operations for nodular goiter
To increase the proportion of Dunhill procedures
Watchful monitoring of the frequency of thyroid malignancies.
References
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