Substitution therapy after surgery for autonomous adenomas.

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A substitution therapy with L-thyroxine subsequent to surgery on the thyroid gland due to autonomous dysfunction depends in particular on the extent of resection. A specific postoperative therapy is not necessary in areas with sufficient iodine supply if the remaining part of the thyroid gland guarantees a euthyroid metabolic state. The radicalness of the intervention is dependent on the existence of an unifocal, multifocal or disseminated autonomy. Surgery due to disseminated autonomy always necessitates a substitutive therapy with thyroid hormones and in most cases surgery due to multifocal autonomies require the same treatment. The therapy is initiated with a dose of 1.5 microg L-thyroxine per kg body weight. Suppression of the TSH level is not necessary. Due to the greater risk of recurrence the L-thyroxine administration should be complemented in areas of iodine deficiency with approximately 100-200 mg iodide. After operations with functionally adequate thyroid remnants (8-10 ml), an exclusive prophylaxis with 200 mg iodide can be implemented. The result of surgery should be sonographically documented three months after the intervention.