Aim: studying the frequency of tracheal compression and symptoms of chronic hypoxia in the structure of benign thyroid pathology requiring surgical treatment, as well as an assessment of comorbid pathology nature and the results of surgical treatment. Materials and methods. A retrospective analysis of the results of surgical treatment for benign thyroid diseases was carried out in 100 patients. Results. Toxic goiter (74%), tracheal compression (69%) dominated the structure of benign thyroid diseases. Arterial hypertension prevailed in trachea compression cases with statistical significance (2, p0.01). Wheezing inspiration/expiration and the increase in respiration frequency were determined by the trachea stenosis at the level of the thyroid gland to 10 mm or less in 10 patients (10%) with a statistically significant prevalence of pulmonary hypertension (2, p0.01). Thyroidectomy was the most common surgical intervention (80%). There was no statistically significant increase in surgical complications depending on the severity of tracheal compression, age, and concomitant pathology. There were no fatal outcomes. Conclusion. Surgical treatment for benign thyroid pathology complicated by neck compression is necessary and safe regardless of age and associated diseases.

We present a case of a 62-year-old patient with multinodular substernal goiter and tracheal compression (up to 5 mm). The multinodular goiter was initially diagnosed 3 years before by a local endocrinologist. The patient had been suffering from difficulty of breathing and exertional dyspnea for two years. He consulted specialists in therapy, pulmonology, cardiology more than once. However, none of the clinicians was able to identify the cause of labored respiration. Eventually an endocrine surgeon diagnosed a case of the complicated multinodular goiter with the development of cervical compression syndrome and tracheal narrowing.Ultrasound study showed the diffuse enlargement of the thyroid gland mainly due to the large left lobe with a total volume of 132,5 cm3. Computed tomography showed the shift of trachea to the right because of its compression by the left lobe and the luminal narrowing up to 5 mm. The patient needed surgical intervention by life-saving indications. He underwent thyroidectomy. The postoperative period was uneventful, the patient did not complain about labored respiration and reported the improvement of physical activity. It is important to keep in mind that patients with multinodular goiter have the potential risk of developing cervical compression syndrome. Current case demonstrates that such patients should be examined by an endocrine surgeon as early as possible in order to perform timely elective surgery.

Background. Sporadic multiple gland disease in primary hyperparathyroidism occurs in 7 to 33 % of cases. The absence of specific risk factors, low sensitivity of imaging methods, and low efficiency of bilateral neck exploration and intraoperative monitoring of parathyroid hormone indicate the complexity of the diagnosis and treatment of this disease’s form. Aim of the research. To analyze the results of surgical treatment of multiple lesions of the parathyroid gland in primary and secondary hyperparathyroidism. Methods. There was retrospective study, which included 100 observations of surgical treatment for primary and secondary hyperparathyroidism in the thoracic department of Irkutsk Regional Clinical Hospital from May 2018 to September 2019. The main point was to identify the frequency of surgical treatment outcomes in patients with multiple parathyroid lesions. As part of the study, potential predictors of multiple gland disease in primary hyperparathyroidism were analyzed. Results. Multiple gland disease in primary hyperparathyroidism occurs in 29 % of cases and causes persistence of the disease (p ≤ 0.01). Signs of multiple gland disease in primary hyperparathyroidism include the level of ionized calcium, parathyroid hormone (p ≤ 0.05), creatinine level and glomerular filtration rate (p ≤ 0.01). A negative result of intraoperative monitoring correlates with persistence of primary hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05). Selective parathyroidectomy is associated with persistence of hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05), while total parathyroidectomy is associated with remission of the disease (χ2, p ≤ 0.05). We did not find a statistically significant relationship between the results of surgical treatment for morphology of the parathyroid glands (χ2, p > 0.1). Conclusion. Multiple gland disease is the main cause of persistence of primary hyperparathyroidism. This form of the disease corresponds to lower levels of calcium, parathyroid hormone, and kidney function. Persistence factors have been established: removal of less than four parathyroid glands and a negative result of intraoperative monitoring of parathyroid hormone. Bilateral neck exploration does not reduce the incidence of disease persistence.

The analysis of the results of surgical treatment of hyperparathyroidism in 63 patients on dialysis replacement renal therapy is presented. A total of 63 primary and 4 secondary (for recurrence) surgical interventions were performed including 12 (17.9 %)-subtotal parathyroidectomy, 8 (11.9 %)-total parathyroidectomy with autotransplantation

Актуальность. Аортолегочное окно является редкой локализацией эктопии околощитовидных желез. Эта локализация представляет трудности в диагностике и хирургическом лечении, особенно в условиях тяжелой соматической патологии, развивающейся на фоне длительной заместительной почечной терапии. Персистенция третичного почечного гиперпаратиреоза после шейной эксплорации не поддается медикаментозной терапии, сопровождается прогрессированием костных и системных проявлений заболевания, вплоть до летального исхода. Материалы и методы. Представлен случай успешной диагностики и хирургического лечения редкой патологии. Обсуждается лечебно-диагностическая тактика. Больная 66 лет, стаж перитонеального диализа 6 лет. Перенесла шейную паратиреоидэктомию. Эктопированная в средостение паратирома выявлена методом гамма-сцинти графии (с 99m Tc-MIBI). Проведение точной дооперационной топической диагностики оказалось невозможным из-за психического состояния больной. Локализация аденомы установлена на операции после выполнения стернотомии. Результаты. Эффективность операции подтверждена снижением уровня паратиреоидного гормона с 2095 пг/мл (до операции) до 10 пг/мл (через 1,5 мес после операции). Послеоперационный период осложнился развитием медиастинальной гематомы. Больная выписана на 21-е сутки после операции с выздоровлением. Выводы. Использование стернотомии при аортолегочной локализации паратиромы у больных с третичным гиперпаратиреозом позволяет удалить опухоль и целесообразно в условиях отсутствия возможности проведения точной топической диагностики. Этот доступ является вынужденным в условиях тяжелой соматической патологии. Клю че вые сло ва: почечный гиперпаратиреоз, аортолегочное окно, аберрантная около щитовидная железа, стернотомия, паратиреоидэктомия. Background. Aortopulmonary window is a rare localization of ectopic parathyroid glands. This localization is the difficulty in diagnosis and surgical treatment, especially in conditions of the heavy somatic pathology that develops with prolonged of kidney replacement therapy. Persistence of tertiary hyperparathyroidism after cervical revision does not give in medical treatment, accompanied by the progression of bone and systemic symptoms of the disease, including death. Materials and Methods. Illustrates a case successful diagnosis and surgical treatment this rare disease. We discuss the treatment and diagnostic tactics. Female patient (age 66) had the experience of peritoneal dialysis for 6 years. She underwent cervical parathyroidectomy. Ectopic mediastinal paratiroma detected by gamma scintigraphy (from 99m Tc-MIBI). Determination of the exact tumor location proved to be impossible before the surgery due to bad mental condition of the patient. Localization of adenomas was defined on the surgery after a sternotomy.