Acta Medica Leopoliensia (Sep 2019)

Modern approaches to the diagnosis and treatment of nodular nontoxic lesions of the thyroid gland

  • Ye.V. Pleshanov,
  • A.M. Urbanovych,
  • V.I. Kolomiytsev,
  • Yu.P. Dovhan,
  • R.D. Makar,
  • M.R. Krasnyi,
  • Kh.A. Moskva

DOI
https://doi.org/10.25040/aml2019.02.046
Journal volume & issue
Vol. 25, no. 2-3
pp. 46 – 57

Abstract

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Aim. Improve the effectiveness of diagnosis and the outcome of treatment of patients with nodular nontoxic lesions of the thyroid gland. Material and Methods. During the last five years 2552 patients aged 18-84 were examined and treated, of which 2087 (81.8%) are women and 465 (18.2%) are men. The initial diagnosis was nodular goiter. The final diagnosis was established by using ultrasonography, serum blood tests on the thyrotrophic hormone, thyroxin, thyronine, thyroglubulin, calcitonin, and antibodies' titre to the thyroid peroxidase. The diagnosis was confirmed with fine-needle aspirations and cytological conclusion for 412 patients, and for 326 patients, who were operated on, the diagnosis was verified histologically. Results and Discussion. According to the results of the surveys, including morphological, nodular and multi-nodular colloid goiter was revealed in 1866 (73.1%) patients (198 were operated), thyroid adenoma in 312 (12.2%) patients (51 were operated), thyroid cancer - 43 (1.7%) patients (all operated), chronic Hashimoto's thyroiditis - 326 (12.8%) patients (60 operated), Riedel's thyroiditis and de Quervain's thyroiditis - 5 (0.2%) (two operated). 327 (12.8%) patients had cystic nodules, and 7 (0.3%) patients had multi-nodular retrosternal goiter. For 11 (3.6%) patients with confirmed benign diagnosis of cystic goiter, sclerotherapy was performed. Hormonal suppressive therapy was prescribed for 317 patients, but only 96 (30.3%), according to the results of ultrasonography had a positive temporary effect. Conclusions. For patients with benign thyroid nodules, in the absence of indications for surgery, dynamic observation using ultrasonography and a complex of laboratory tests is recommended. A fine needle aspiration with cytological examination should be performed in the case of the increase of the nodule and suspicion of malignant tumor (TIRADS - 3-4). Surgical treatment is required for patients with malignant thyroid tumors, with large (>3.5 cm) nodules, patients with goiter with the signs of compression of the neck, as well as for patients with subclinical toxic adenoma.

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