Optimization of the indications for surgical treatment and choice of surgery volume in patients with nodular endemic goiter and autoimmune thyroiditis

ABSTRACT Hashimoto's thyroiditis is an autoimmune disease that usually requires medical treatment but sometimes benefits from surgical treatment. The reasons why patients with Hashimoto's thyroiditis requires thyroidectomy are (a) malignant lymphoma (b) repeated acute exacerbation of thyroiditis and (c) concern of coexisting thyroid neoplasm from Hashimoto's thyroiditis. We present three patients with Hashimoto's thyroiditis, a 69-year-old woman with MALT lymphoma, a 53-year-old woman with repeated episodes of neckpain and a 67-year-old woman with a coexistent benign thyroid nodule. These three patients with Hashimoto's thyroiditis received surgical treatment and had an excellent outcome and document that some patients with Hashimoto's thyroiditis warrant surgical treatment. How to cite this article Kikuchi S, Matsuzuka F, Aihara T, Yasui C, Yanagi H, Mitsunobu M, Yamanaka N, Kakuno A, Miyauchi A. What should Autoimmune Thyroiditis be considered for? World J Endoc Surg 2012;4(2):54-59.

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Clinical-laboratory and instrument indices of the thyroid gland state after surgical treatment of tumors of the chiasmatic-cellar region

Bulletin of Siberian Medicine ◽

10.20538/1682-0363-2010-4-59-62 ◽

2010 ◽

Vol 9 (4) ◽

pp. 59-62

Author(s):

Ya. A. Kan ◽

M. G. Zhestikova ◽

S. M. Bryzgalina ◽

N. P. Shakhvorost

Keyword(s):

Surgical Treatment ◽

Thyroid Gland ◽

Thyroid Hormones ◽

Operative Treatment ◽

Autoimmune Thyroiditis ◽

Clinical Laboratory ◽

Thyroid Stimulating Hormone ◽

Free Thyroxine ◽

Secondary Hypothyroidism ◽

Cellular Area

Hypopituitarism is often developed in the result of operative treatment of tumours in chiasmal-cellular area. One of frequent indications of hypophysis’ deficit is decreasing of product of thyroid-stimulating hormone (TSH) that leads to deficit of thyroid hormones. Most patients, who had been operated in terms of tumours of chiasmal-cellular area, have normal volume and structure of thyroid gland in the background of decreased level of free thyroxine and absence of increasing of level of TSH on the principle of feedback, it indicates to the secondary character of destruction of thyroid gland. Patients operated in terms of craniopharyngioma and somatoprolactinoma more often have secondary hypothyroidism. A high per cent of fibrotic changes of tissue of thyroid gland in patients operated in terms of prolactinoma is explain by autoimmune thyroiditis in anamnesis.

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Hypothyroidism and Thyroid Substitution: Historical Aspects

Journal of Thyroid Research ◽

10.4061/2011/809341 ◽

2011 ◽

Vol 2011 ◽

pp. 1-10 ◽

Cited By ~ 27

Author(s):

J. Lindholm ◽

P. Laurberg

Keyword(s):

Surgical Treatment ◽

Thyroid Gland ◽

Autoimmune Thyroiditis ◽

Historical Aspects ◽

First Case ◽

Basedow’S Disease ◽

History Of ◽

The One ◽

Theodor Kocher ◽

The 19Th Century

The last part of the 19th century was a period of great achievements in medicine and endocrinology. The thyroid gland evolved from being considered a rudimentary structure to an organ related to specific diseases. The singular importance of iodine became acknowledged. Graves-Basedow's disease was described. Surgical treatment evolved with extraordinary speed. Theodor Kocher observed that the clinical picture in patients after total thyroidectomy was similar to the one seen in cretinism. In 1850, the first case of hypothyroidism or myxedema was described. Less than 50 years later, effective treatment was introduced. Another 50 years later, autoimmune thyroiditis was ascertained as the most frequent cause of hypothyroidism (in areas with no iodine deficiency). This paper gives a short survey of the history of hypothyroidism and its treatment.

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Peculiarities of operative treatment of goiter on background of autoimmune thyroiditis

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2020.1-2.43 ◽

2020 ◽

Vol 87 (1-2) ◽

pp. 43-46

Author(s):

O. P. Kovalov ◽

O. M. Liulka ◽

V. I. Liakhovskyi ◽

I. I. Nemchenko ◽

A. V. Sydorenko

Keyword(s):

Surgical Treatment ◽

Thyroid Gland ◽

Autoimmune Thyroiditis ◽

Malignant Tumors ◽

Laboratory Data ◽

Clinical Signs ◽

Endocrine System ◽

Nodular Goiter ◽

Subtotal Resection ◽

Retrosternal Goiter

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.

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