DOI: 10.25881/20728255_2023_18_1_51

Authors

Sadikhov F.G.

Scientific Centre of Surgery named after Acad. M.A. Topchubashov, Baku Respublika Azerbajdzhan

Abstract

The results of surgical treatment of 207 (43,0%) of 481 patients examined and treated in the clinic for the period from 2008 to 2020 were analyzed. The group consisted of 438 (91,1%) women and 43 (8,9%) men 27 to 73 years old. Patients with hypertrophic autoimmune thyroiditis were mainly operated on. The choice of this treatment tactic was determined by the complications of this form of the disease, characterized by growth and enlargement of the thyroid gland, and formation of a nodular or multi-nodular goiter; or, alternatively, by a suspicion of a thyroid cancer. Long-term observation and conservative treatment by endocrinologists did not produce positive results. The analysis was carried out in two groups of patients. The first group consisted of 96 patients who were operated on using advanced CO2 laser-assisted surgical techniques, as a tool that facilitates surgical intervention. The second group was represented by 111 patients, who were operated on using traditional surgical techniques. The volume of surgery varied from Subtotal thyroid resection patients (69) to Extremely Subtotal thyroid resection (43) patients) and Thyroidectomy (95 patients). The proposed method of surgical treatment of patients with hypertrophic autoimmune thyroiditis using CO2 laser, as well as an advanced surgical technique that allows visual control over the localization zones of the upper laryngeal nerve and parathyroid glands, reduces the incidence of complications such as laryngeal paresis and hypoparathyroidism by about 1,5 times and reduces the patient’s hospital stay from 9,6 to 7,4 days (by 22%).

Keywords: autoimmune thyroiditis, surgery, subtotal resection of the thyroid gland, extremely subtotal resection of the thyroid gland, thyroidectomy.

References

1. Boldyreva YuV, Lebedev IA, Kruchinin EV, et al. A unified approach to the management of patients with autoimmune thyroiditis (literature review). Ural Medical Journal. 2019; 175(7): 110-113. (In Russ.) doi: 10.25694/URMJ.2019.07.25.

2. Geltser BI, Zdor VV, Kotelnikov VN. Evolution of the views on pathogenesis of autoimmune thyroid diseases and prospects for their target therapy. Klin. med. 2017; 95(6): 524-534. (In Russ). doi: 10.18821/0023-2149-2017-95-6-524-534.

3. Agaev RM, Sadikhov FG, Gardashov NT. Evaluation of immediate and long-term results of treatment of patients with autoimmune thyroiditis // Bulletin of the National Medical and Surgical Center. N.I. Pirogov. 2021; 16(3): 42-46. (In Russ.) doi: 10.25881/20728255_2021_16_3_42.

4. Zdor VV. Correlation of hormonal and cytokines regulation in case of autoimmune thyroiditis. Clinical and experimental thyroidology. 2017; 13(2): 45-56. (In Russ.) doi:10.14341/ket2017245-56.

5. Menkov AV. Surgical treatment of autoimmune thyroiditis. Modern technologies in medicine. 2011: 102-105. (In Russ.)

6. Antonyuk OS, Shapovalov IN, Shtoda DE, et al. Long-term results of surgical treatment of hashimoto disease. Bulletin of emergency and reconstructive surgery. 2020; 5(4): 7-12. (In Russ.)

7. Bezrukov OF. Surgery of thyroid gland: objects and unsolved problems. Grekov’s Bulletin of Surgery. 2015; 174(1): 73-74. (In Russ.) doi: 10.24884/0042-4625-2015-174-1-73-74.

8. Rozhko VA. Current State of the Autoimmune Thyroiditis Problem. Health and Ecology Issues. 2019; 2: 4-13. (In Russ.) doi: 10.51523/2708-6011.2019-16-2-1.

9. Belokonev VI, Kovaleva ZV, Pushkin Syu, et al. Indications for the volume of surgery and features of the technique of thyroidectomy in patients with retrosternal goiter. Tavrichesky Medical Biological Bulletin. 2020; 23(2): 15-19. (In Russ.) doi: 10.37279/2070-8092-2020-23-2-15-19.

10. Fadeev VV, Morgunova TB, Melnichenko GA, Dedov II. Draft of the clinical recommendations for diagnosis and treatment of hypothyroidism. Clinical and experimental thyroidology. 2021; 17(1): 4-13. (In Russ.) doi: 10.14341/ ket12702.

11. Peterkova VA, Bezlepkina OB, Nagaeva EV, Shiryaeva TY, Chikulaeva OA, Vadina TA, et al. Clinical guidelines «Thyroiditis in children». Clinical and experimental thyroidology. 2021; 17(3): 4-21. (In Russ.) doi: 10.14341/ket12711.

12. Al-Dhahri SF, Al-Angari SS, Alharbi J, et. al. Optimal levothyroxine dose in post-total thyroidectomy patients: a prediction model for initial dose titration. Eur Arch Otorhinolaryngol. 2019; 276: 2559-2564. doi: 10.1007/s00405-019-05523-4.

13. Alzahrani AS, Xing M. Impact of lymph node metastases identified on central neck dissection (CND) on the recurrence of papillary thyroid cancer: potential role of BRAFV600E mutation in defining CND. Endocr. Relat. Cancer. 2013; 20(1): 13-22. doi: 10.1530/ERC-12-0309.

14. Gan T, Randle RW. The role of surgery in autoimmune conditions of the thyroid. Surg Clin North Am. 2019; 99(4): 633-648. doi: 10.1016/j.suc. 2019.04.005.

15. Berber E, Bernet V, Fahey TJ, et al. American Thyroid Association statement on remote-access thyroid surgery. Thyroid. 2016; 26(3): 331-337. doi: 10.1089/thy.2015.0407.

16. Colin MD, Gilbert HD. Chronic autoimmune thyreoiditis. New. Engl. J. Med. 2016; 335: 99-107.

17. Abrosimov AYu. New international histological classification of thyroid tumors. Archives of Pathology. 2018; 80(1): 37-45. (In Russ.) doi: 10.17116/patol201880137-45.

18. Ryabchenko EV. Features of surgical treatment of thyroid tumors associated with chronic autoimmune thyroiditis. In the collection: Problems and prospects for the development of modern society. Materials of the International Scientific and Practical Conference. Under the scientific editorship of M.I. Kuter. Krasnodar, 2016: 198-203. (In Russ.)

For citation

Sadikhov F.G. Surgical treatment of patients with autoimmune thyroiditis. Bulletin of Pirogov National Medical & Surgical Center. 2023;18(1):51-57. (In Russ.) https://doi.org/10.25881/20728255_2023_18_1_51