Surgical treatment of unilateral nodal goiter with compression syndrome in patients with autoimmune thyroiditis

Abstract

Background. The problem of choosing the extent of surgeries on the thyroid gland for unilateral nodular goiter with compression syndrome is of concern for surgeons. In such cases, surgical treatment is absolutely indicated, and the possible variants of the extent of the operation are thyroidectomy and hemithyroidectomy. Thyroidectomy allows eliminating the focus of autoimmune aggression in the body, but in such cases, a patient should use thyroxine drugs for life. The purpose was to determine the indications for the choice of the extent of surgery in patients with unilateral nodular goiter and compression syndrome against the background of autoimmune thyroiditis (AIT) and to predict long-term results of surgical treatment. Materials and methods. The long-term outcomes of hemithyroidectomy were analyzed in 101 women aged 23 to 72 years with unilateral nodular goiter on the background of AIT and compression syndrome. We have analyzed the volume of the gland, echostructure variant, blood levels of thyroid-stimula­ting hormone (TSH), free thyroxine and triiodothyronine, thyroid peroxidase (TPO) antibodies, apoptosis and proliferation indicators before surgery in which treatment results were satisfactory and unsatisfactory. Results. Satisfactory result was revealed is 75 patients (group 1). According to the survey, they had no violations of the thyroid functional state 3 years after hemithyroidectomy, and, according to the ultrasound, in the parenchyma of the remaining lobe of the gland, the signs of AIT present before the surgery did not progress or progressed without hypothyroidism and changed ultrasound picture. The second group (unsatisfactory result) consisted of 26 patients who 3 years after hemithyroidectomy had an increase in the volume of the remaining thyroid gland and the progression of autoimmune process with the development of hypothyroidism on ultrasound. A satisfactory result of hemithyroidectomy in patients with unilateral nodular goiter on the background of AIT with compression syndrome can be expected in cases where at the time of surgery, the volume of the lobe is not more than 12.7 cm3, the echostructure is hypoechoic, heterogeneous and pseudomicronodu­lar, TSH is not more than 2.85 mIU/l, levels of free thyroxine and triiodothyronine are not lower than 16.7 and 5.3 pmol/l, respectively, TPO antibodies are not higher than 137 IU/ml. Conclusions. One of the possible options for surgical treatment of patients with unilateral nodular goiter on the background of AIT with compression syndrome may be hemithyroidectomy in conditions of preserved hormonal function of the gland with moderate processes of proliferation and apoptosis, structural changes in the parenchyma at the level of hypoechoic and heterogeneous, pseudomicronodular echostructural variants. We consider it contraindicated to use hemithyroidectomy in cases of pseudomacronodular and more severe variants of the echostructure of the thyroid parenchyma, regardless of the indicators of hormone-producing function, TPO antibodies, proliferation and apoptosis.

Keywords

• nodular goiter
• autoimmune thyroiditis
• surgical treatment