Peculiarities of operative treatment of goiter on background of autoimmune thyroiditis

Abstract

Objective. To determine the peculiarities of operative technique in surgical treatment of patients with nodular goiter on background of autoimmune thyroiditis.
 Materials and methods. The results of surgical treatment of nodular goiter, basing on data from surgical clinic of the Second Clinical Hospital in City of Poltava through 2003 - 2017 yrs were adduced. There were operated 549 patients, suffering nodular goiter. There were 58 (10.6%) men and 491 (89.4%) women. Unilateral nontoxic nodular goiter was observed in 187 (34.1%) patients, multinodular nontoxic – in 322 (58.7%), multinodular toxic – in 30 (5.5%), thyreotoxic adenoma – in 21 (3.8%) patients. Cervico-retrosternal goiter was in 110 (20.0%) patients. For recurrent goiter 21 (3.8%) patients were operated. Malignant tumors were revealed intraoperatively or after definite histological investigation in 22 (4/0%) patients. Of 108 patients, to whom, basing on the disease clinical signs, laboratory data and preoperative cytological investigation the diagnosis of nodular goiter on background of autoimmune thyroiditis was established, while performing of definite postoperative investigation macromicrofollicular colloidal goiter was revealed in 41 (38%), nodular goiter with the autoimmune thyroiditis – in 51 (47.2%), cancer (papillary, follicular) – in 8 (14.8%) patients. Subtotal resection of thyroid gland was performed in 8 (15.7%) patients, hemithyroidectomy - in 12 (23.5%), extrafascial thyroidectomy – in 23 (45.1%). In patients, suffering thyroidal gland cancer, extrafascial thyroidectomy was performed, while in 3 – with central lymphodissection. Intraoperatively visual macroscopic estimation of thyroid gland and obligatory suboperative cyto- and histological investigations of the specimen obtained were performed. Operative tactics was applied in accordance to actual clinical protocols for treatment of patients, suffering surgical pathology of endocrine system.
 Results. Some technical measures were proposed to minimize the risk of injury of anatomic structures: lower laryngeal nerve, parathyroidal glands, trachea, the neck vessels.
 Conclusion. Extrafascial procedure guarantees a visual control in the risk zones and radicality of operation, minimizes the specific complications rate.