RESULTS THE USE OF VARIOUS SURGICAL METHODS FOR THE TREATMENT OF PATIENTS WITH DIFFUSE TOXIC GOITER

Abstract

This article discusses the problems of surgical tactics in diffuse - toxic goiter and its complications, both in the early
postoperative period and in the long term. The above complications require surgeons to search for the most optimal method
of surgical treatment.
Aim: Evaluation of immediate, long-term results and hormonal status with various methods of surgical treatment of
diffuse-toxic goiter.
Materials and research мethods. The article presents the experience of treating 149 patients. The analysis of
immediate and long-term results of surgical interventions in relation to thyroid status is given. In 90 patients, subtotal
resection of the thyroid gland was performed, in 31 - thyroidectomy, in 28 cases - embolization of the thyroid artery. Thyroid
status was analyzed 1, 6, 12, 24 months after surgery. The patients were divided into subgroups depending on the initial
volume of the thyroid gland (less than 45 cm3 and more than 45 cm3
). Statistical analysis of numerical series was carried out
using the Mann-Whitney method, relative values - using Fisher's two-sided exact test.
Research results. A moderate number of postoperative complications was revealed, with a predominance of extirpation
of the gland in the group and no extirpation in patients undergoing arterial embolization.
On the contrary, a higher incidence of recurrence of the hyperthyroid state was characteristic for the latter group, where it
was 28.6% over a follow-up period of 24 months. With subtotal resection, the corresponding indicator was 14.4%; after
extirpation, no cases of relapse were observed. Extirpation led to the development of total hypothyroidism in all patients, in
other groups this condition was observed in about half of the cases.
An excess of the initial gland volume of 45 cm3 was characterized by a sharp increase in the incidence of postoperative
hypothyroidism.
Conclusions: The use of different approaches to the surgical treatment of diffuse-toxic goiter gives differences in the
frequency of perioperative complications (excess during extirpation of the thyroid gland) and late complications. Among the
late complications, hypothyroidism dominates, which is subject to compensation with the help of substitution therapy.
The frequency of recurrence of thyrotoxicosis has a double dependence on the approach to treatment and the initial
volume of the thyroid gland. In order to prevent relapse for surgical treatment of DTG with a gland volume of more than 45
cm3, the most rational is extirpation.