Score-basierte Verbesserung der Indikationsstellung der operativen Behandlung von Schilddrüsenläsionen

In Germany a significant amount of thyroid surgeries is performed. About 70.000 patients per year undergo surgery due to complex diagnosis or indication.In most cases the reason for treatment is a goiter. The increased prevalence of benign goiters in Germany due to iodine deficiency results in a considerable prevalence of thyroid autonomies and more or less suspicious nodules. Patients often undergo surgery because a nodule has been found and malignancy cannot be ruled out entirely, even though prevalence of ma-lignancy is rather low. The aim of this thesis is to improve the indication for surgery of thyroid lesions, based on an independently, developed clinical score which is based on results of fine needle aspiration and sonographic examination, as well as the clinical examination on impairments. The patients´ infor-mation and clinical data have been assessed for the years 2013 and 2014. The requirement for patients was to undergo their entire treatment, in-cluding diagnosis, surgery and follow-up at the University Hospital of Marburg. The score is based on the results of the fine needle aspiration (value X), clinical complaints of the patient (Y) and sonographic size of the thyroid prior to surgery (Z). Based on the findings each parameter was scored from 1 to 5, resulting in a cumulative score from 3 to 15. The higher the score, the harder the recommendation for surgery. More than 200 health records of patients have been evaluated according to the above-mentioned parameters. After application of all criteria, a col-lective outcome of 36 candidates for surgery (median age 50,7 years) remained. The average score of all patients was 5,8 points. All Patients with a cumulative score of 7 or higher, which underwent sur-gery, had a good long term result after surgery. That is why we recom-mend an indication for surgery for patients with such cumulative scores. The parameters of fine needle aspiration,clinical complaints of the patient and sonographic dimension of the thyroid can be used generate a score that can assist in the improvement of diagnosis and recommendation of pros and cons of surgery. Our score can be a guide value, to improve diagnosis and treatment and thus help the attending physician to achieve more certainty in the deci-sion-making process. Furthermore, this method does not incur additional medical costs and can be applied easily. In order to confirm the results of this study, our scoring system should be assessed prospectively in a larger cohort.