Surgical treatment of recurrent goiter

The causes of postoperative goiter recurrence and the tactics of their treatment have not yet been sufficiently studied. The frequency of relapses of diffuse toxic goiter varies widely (O. V. Nikolaev and F. A. Agafonov, 1957 - 0.2%; E. S. Drachinskaya, 1954 - 2%; N. I. Truten, 1956 - 1, 5%), According to the combined statistics of 60 authors, concerning 43818 operations for goiter (F.A.Agafonov, 1948), the recurrence rate is 6.4.

Results of sclerotherapy for recurrent and non-recurrent nodular goiter

Background. The problems of treating recurrent nodular goiter are still relevant. The technical difficulties of the intervention on the neck tissues altered by the scarring process and the comorbid background of patients cause an unacceptably high risk of complications of traditional surgical treatment and, as a result, a long and difficult rehabilitation period and high costs for the treatment of patients who have undergone surgery for recurrent goiter. Alternative methods, such as sclerotherapy, which reduce the risk of complications, have been successfully used in patients with non-operated thyroid, but the possibilities of minimally invasive destruction of recurrent nodules have not been studied enough, and it is not known whether it is as safe and effective as sclerotherapy of non-recurrent nodules. The aim of the study was to compare the efficacy and safety of treatment of recurrent and non-recurrent nodular goiter using sclerotherapy. Materials and methods. The study included 30 previously not operated patients with nodular goiter and 30 patients with recurrent nodular goiter. All of them underwent 4 courses of sclerotherapy, each of which included 5 sessions with a frequency of 1 session per week; polidocanol was used as a sclerosant. Results. The analysis showed that the efficiency of reduction of nodules did not decrease in patients with recurrent goiter, despite severe sclerotic changes in the tissues. The size of the nodules and the volume of thyroid tissue were reduced during sclerotherapy, regardless of the presence of a history of thyroid surgery, as well as the cure of functional autonomy and relief of symptoms of neck compression. The tolerability of sclerotherapy also did not depend on the presence of recurrent goiter, and the rate of complications was the same (0.8%). Complications of sclerotherapy were not serious in any case. Conclusions. Thus, sclerotherapy of recurrent nodules is a good alternative to traditional surgical treatment; it is not inferior in efficiency and safety to sclerotherapy of nodules in a non-operated thyroid. Its use will significantly reduce the rehabilitation period and the cost of treating patients with recurrent nodular goiter.

PROBABILITY OF CANCER DETECTION DURING REPEATED OPERATIONS IN PATIENTS WITH BENIGN THYROID DISEASES

Introduction. Suspected malignant growth in patients with recurrent goiter is one of the main causes of repeated operations. Focuses of carcinoma can be detected in patients operated on for multinodular goiter with compression of the organs of the neck, recurrent diffuse toxic goiter. Objective of investigation is to assess the risk of a malignant lesion of the thyroid remnant in patients with recurrent goiter, to justify the surgical tactics in this group of patients. Material and methods. In the St. Petersburg Center of Endocrine Surgery and Oncology 28138 patients with various thyroid diseases were operated on for the period from 1973 till 2016. Results. In a retrospective analysis of the group consisting of 1106 patients with recurrent goiter, a new thyroid disease was detected in 156 (14.1%) cases. Thyroid cancer in thyroid remnant was detected in 57 (36.5%) cases or 5.2% of all the patients with recurrent goiter. The work describes the risk of malignant lesion of the thyroid remnant in patients with recurrent goiter and surgical tactics in this group of patients. Conclusion. Cancer of the thyroid gland, as a new disease of the thyroid remnant, in patients previously operated on for benign thyroid pathology, is found in 5.2% of observations. The possibilities of fine-needle aspiration biopsy in this group are reduced. Active surgical tactics in cases of multinodular transformation of the thyroid remnant is justified. The operation of choice is reresection up to thyroidectomy. Careful intraoperative study of removed tissue and close cooperation with the morphological service helps to reduce the number of diagnostic and tactical errors in patients with both recurrent and ordinary multi-node goiter.

REHABILITATION OF PATIENTS AFTER OPERATIONS ON THE THYROID

Scientists and specialists, who works in the field of treatment thyroid gland diseases, identify and eliminate the effects of surgical interventions with nodular, multinodular and recurrent goiter with symptoms of compression of the organs of the neck and upper mediastinum. In total, the study included 119 patients who underwent extirpation of the thyroid gland (43), resection of the thyroid gland (33) and hemithyroidectomy (43). Comparisons were made on the basis of the volume of the preoperative examination, the immediate surgical intervention and the features of the intraoperative technique. It was established that the severity of local pain, postoperative complications such as neck edema during hematoma and gray formation reliably depended on the size of the skin incision, dissection of the short neck muscles, mobilization of the nodding muscles and removal of the tissue from the lymph nodes. 6 months after the surgical treatment, the patients had no complaints. If hypocalcemia occurs (in 14 cases), patients undergo a comprehensive treatment according to the original scheme. As a result of the treatment in all cases, the action of hypocalcemia was stopped. The study shows that the effectiveness of surgical treatment, the postoperative period, complications, cosmetic results and quality of life, as well as rehabilitation studies aimed at reducing the effectiveness of preoperative examination, increasing the amount of operational benefits and late statement of complications.

THYROID SURGERY

Objectives: The present prospective observational study was conducted to determine frequency and thyroid conditions as likely risk factors for hypocalcaemia following thyroid surgery. Study Design: Observational study. Place and Duration: Department of surgery, Liaquat University Hospital from December 2011 to December 2015. Materials and Methods: A sample of 201 patients, undergoing thyroid surgery with bilateral exploration, was selected according to criteria. Pre operative clinical work up was conducted for patient history, neck examination, thyroid hormone assay, serum calcium, Technetium99 thyroid scanning, laryngoscopy and sonography. Serum Ca++ was estimated before and after thyroid surgery.Hypocalcaemia was defined as calcium level <8 mg/dl. Data was analyzed on SPSS 22.0 (IBM, incorporation, USA) at 95% confidence interval. Results: Of 201 patients, male and female were noted as 93 (46.2%) and 108 (53.7%) respectively. Female to male ratio was 1: 0.86. Mean± SD age was noted as 42.3 ± 7.4 years. Overall frequency of hypocalcaemia was identified in 23 (11.4%) of subjects. Mean± SD serum calcium in hypocalcemia subjects was noted as 7.1 ± 0.78 mg/dl. Symptomatic hypocalcaemia was noted in 11 (5.4%) of total subjects. Conclusion: In the present study, an overall frequency of hypocalcaemia was identified in 23 (11.4%) of subjects. Large goiters, recurrent goiter, retrosternal goiter, hyperthyroidism and Grave’s disease were noted as risk factors.