From: Heer, Koen de
To: Heer, Koen de
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Date: wo 27 sep 2017 18:08:42 CEST
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euthyroid benign goiters (<80 mL): monitoring 1x/jaar: grootte, TSH
very large goiters (>80 to 100 mL) or goiters that continue to grow
                surgery
                               hypothyreoidie
                               injury to the recurrent laryngeal nerves: 2-9%
                               trachea: 3%
                               parathyroid glands: 7%
                radioiodine therapy alternative: poor surgical candidates, patients wish
                               hypothyreoidie
                               reduction in thyroid volume only moderate: 30-60%
                               recidiefkans groot
                               ca niet uitgesloten
                               tijdelijke toename
                not TSH suppressive therapy: efficacy minimal, potential long-term side effects

hyperthyreoidie
                eerst 1 jaar spontane remissie afwachten: block-and-replace
                               if wish to defer ablative therapy: can be continued for prolonged periods
                               0,1 - 0,5% agranulocytose, meestal eerste maanden
                               1997: analyse, 49 gevallen van hepatotoxiciteit, 1:10.000
                               vasculitis
                               pancreatitis
                               insulinoom
                definitive therapy
                               radioiodine
                                               lower complication rate than surgery
                                               preferred as definitive therapy except in >=moderate orbitopathy
                                                               development or worsening of Graves' orbitopathy
                                               isolatie
                                               herhaling nodig of overdosering
                               thyroidectomy
                                               unpopular being selected by only 1 percent of thyroid specialists                                          indicated
                                                               pregnant women who are allergic to antithyroid drugs
                                                               allergies / poor compliance on drugs but refuse radioiodine
                                                               coexisting suspicious or malignant thyroid nodule
                                                               primary hyperparathyroidism
                                                               obstructive goiter or a very large goiter