Surgical treatment of patients with nodular toxic goiter

Authors

DOI:

https://doi.org/10.14739/2310-1210.2021.3.229724

Keywords:

nodular toxic goiter, endocrine diseases, surgery

Abstract

Nodular toxic goiter (NTG) accounts for 7.3 % to 10.0 % of the goiter population. There are difficulties in the preoperative differential diagnosis between NTG and other thyroid diseases. There is also controversy about the benefits of resection surgery over thyroidectomy in patients with NTG.

The aim of the study: a comparative assessment of the diagnosis and treatment results of patients with NTG in the early and late postoperative periods after resection surgery and thyroidectomy.

Materials and methods. The study enrolled 51 patients with NTG. The mean age of patients in the group was 51.7 ± 12.9 years.

Results. Bilateral multinodular lesions prevailed – 34 (66.7 %) patients. Free T3 level was measured only in 15 (29.4 %) patients, 7 (46.7 %) of them had elevated T3 level. 15 (29.4 %) patients underwent hemithyroidectomy including the isthmus, 2 (3.9 %) had subtotal resection, 34 (66.7 %) patients underwent thyroidectomy.

Conclusions. Multinodular bilateral thyroid lesions dominated the structure of NTG – 34 (66.7 %) patients who underwent thyroidectomy. Uninodular and multinodular unilateral pathology was diagnosed only in 17 (33.3 %) patients who underwent organ-preserving surgery. The measurements of free T3 level in patients with NTG allowed the diagnosis of T3-thyrotoxicosis in almost half of patients (46.7 %), which is a diagnostic criterion for detection of functional nodal autonomy. Following the organ-preserving surgery, 17 (33.3 %) patients with NTG required the use of hormone replacement therapy with levothyroxine at a mean dose of 25.0 (25.0; 50.0) mcg/day in the late postoperative period (>1 year).

Author Biographies

S. M. Zavhorodnii, Zaporizhzhia State Medical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of General Surgery and Postgraduate Surgical Education

M. S. Gatia, Zaporizhzhia State Medical University, Ukraine

MD, Postgraduate student of the Department of General Surgery and Postgraduate Surgical Education

М. А Kubrak, Zaporizhzhia State Medical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of General Surgery and Postgraduate Surgical Education

M. B. Danyliuk, Zaporizhzhia State Medical University, Ukraine

MD, PhD, Assistant of the Department of General Surgery and Postgraduate Surgical Education

References

Pankiv, V. I. (2020). Syndrom tyreotoksykozu: novi klinichni mozhlyvosti korektsii tyreoidnoi dysfunktsii [Thyrotoxicosis syndrome: new clinical opportunities for the correction of thyroid dysfunction]. Mizhnarodnyi endokrynolohichnyi zhurnal, 16(1), 58-62. https://doi.org/10.22141/2224-0721.16.1.2020.199129 [in Ukrainian].

Brandt, F., Thvilum, M., Almind, D., Christensen, K., Green, A., Hegedüs, L., & Brix, T. H. (2013). Morbidity before and after the Diagnosis of Hyperthyroidism: A Nationwide Register-Based Study. PLOS ONE, 8(6), Article e66711. https://doi.org/10.1371/journal.pone.0066711

Garmendia Madariaga, A., Santos Palacios, S., Guillеn-Grima, F. & Galofrе, J. C. (2014). The Incidence and Prevalence of Thyroid Dysfunction in Europe: A Meta-Analysis. The Journal of Clinical Endocrinology & Metabolism, 99(3), 923-931. https://doi.org/10.1210/jc.2013-2409

Biondi, B., Bartalena, L., Cooper, D. S., Hegedіs, L., Laurberg, P. & Kahaly, G. J. (2015). The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism. European Thyroid Journal, 4(3), 149-163. https://doi.org/10.1159/000438750

Devereaux, D., & Tewelde, S. Z. (2014). Hyperthyroidism and Thyrotoxicosis. Emergency Medicine Clinics of North America, 32(2), 277-292. https://doi.org/10.1016/j.emc.2013.12.001

Cooper, D. S., & Biondi, B. (2012). Subclinical thyroid disease. The Lancet, 379(9821), 1142-1154. https://doi.org/10.1016/S0140-6736(11)60276-6

Gilbert, J. (2017). Thyrotoxicosis - investigation and management. Clinical Medicine, 17(3), 274-277. https://doi.org/10.7861/clinmedicine.17-3-274

Donangelo, I. & Suh, S. Y. (2017). Subclinical Hyperthyroidism: When to Consider Treatment. American Family Physician, 95(11), 710-716.

LiVolsi, V. A. & Baloch, Z. W. (2018). The Pathology of Hyperthyroidism. Frontiers in Endocrinology, 9, Article 737. https://doi.org/10.3389/fendo.2018.00737

Pankiv, V. I. (2018). Suchasni pidkhody do laboratornoi diahnostyky y menedzhmentu syndromu tyreotoksykozu [Modern approaches to the laboratory diagnosis and management of hyperthyroidism syndrome]. Mizhnarodnyi endokrynolohichnyi zhurnal, 14(5), 508-513. https://doi.org/10.22141/2224-0721.14.5.2018.142689 [in Ukrainian].

Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., & Walter, M. A. (2016). 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid, 26(10), 1343-1421. https://doi.org/10.1089/thy.2016.0229

De Leo, S., Lee, S. Y., & Braverman, L. E. (2016). Hyperthyroidism. The Lancet, 388(10047), 906-918. https://doi.org/10.1016/S0140-6736(16)00278-6

Liulka, O. M., Kovalyov, O. P., Lyakhovskiy, V. I., Nemchenko, I. I., & Kizimenko, O. O. (2018). Vuzlovyi zob: mozhlyvosti suchasnykh metodiv diahnostyky (ohliad literatury) [Nodular goiter: the possibilities of modern diagnostic methods (literature review)]. Visnyk problem biolohii i medytsyny, (2), 50-54. https://doi.org/10.29254/2077-4214-2018-4-2-147-50-54 [in Ukrainian].

Shidlovskyi, V. O., Deykalo, I. M., & Shidlovskyi, O. V. (2012). Khirurhiia zobu v endemichnomu rehioni [Surgery of goiter in endemic region]. Shpytalna khirurhiia, (2), 24-29. [in Ukrainian].

Cramon, P., Winther, K. H., Watt, T., Bonnema, S. J., Bjorner, J. B., Ekholm, O., Groenvold, M., Hegedüs, L., Feldt-Rasmussen, U., & Rasmussen, Å. K. (2016). Quality-of-Life Impairments Persist Six Months After Treatment of Graves' Hyperthyroidism and Toxic Nodular Goiter: A Prospective Cohort Study. Thyroid, 26(8), 1010-1018. https://doi.org/10.1089/thy.2016.0044

Downloads

Published

2021-06-07

How to Cite

1.
Zavhorodnii SM, Gatia MS, Kubrak МА, Danyliuk MB. Surgical treatment of patients with nodular toxic goiter. Zaporozhye Medical Journal [Internet]. 2021Jun.7 [cited 2024Nov.2];23(3):370-4. Available from: http://zmj.zsmu.edu.ua/article/view/229724

Issue

Vol. 23 No. 3 (2021)

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)