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Babajanov Akhmadjon Sultanbaevich, Ph D., in Medicim, associate professor, Head of the department of surgical diseases of the Samarkand Medical Institute
E-mail: [email protected] Akhmedov Adham Ibadullaevich, assistant of the Department of Surgical Diseases, Samarkand Medical Institute E-mail: [email protected] Toirov Abdukhamid Suvonkulovich, assistant of the Department of Surgical Diseases, Samarkand Medical Institute E-mail: [email protected] Akhmedov Gayrat Keldibekovich, assistant of the Department of Surgical Diseases, Samarkand Medical Institute E-mail: [email protected] Hudoynazarov Utkir Rabbimovich, assistant of the Department of Surgical Diseases, Samarkand Medical Institute
THE STATES OF THE THYROID RESIDUE IN THE POSTOPERATIVE PERIOD IN PATIENTS WITH MULTINODAL NONTOXIC GOITER
Abstract: In order to study the state of residual thyroid tissue in the postoperative period with a multinodal nontoxic goiter, 86 patients aged 24-61 years were examined. It was revealed that in the patients with the multinodal colloid non-toxic goiter within 6 months after the different volume of operations in the thyroid remnant, three types of structural changes are revealed according to ultrasound (stable - 51.2%, hypertrophic -26.7%, hypotrophic -22.1%).
Keywords: residual thyroid tissue, multinodular nontoxic goiter, hemithyroidectomy, subtotal resection.
Introduction. Recently, there has been a significant in- been sufficiently studied so far, are of considerable interest.
crease in the interest of practicing physicians in the problems of thyroid diseases (thyroid gland) [1; 2; 4; 5]. The problems of diagnosis, treatment tactics and indications for surgery with various nosological forms of thyroid involvement are far from the final solution and are constantly discussed. Problems of goiter remain very relevant in connection with the virtually all the territory iodine deficiency and other ecologically unfavorable factors [1; 3; 8].
The choice of therapeutic tactics in the nodular formations of the thyroid gland, despite the seeming simplicity, is one of the most complex problems, and even for certain nosological forms it is ambiguous [2; 3; 6]. With any nodular formation of the thyroid gland, a malignant process can occur, which in turn presupposes an operation. However, it should not be generally accepted and used in all patients with nodules [4; 7].
In connection with this, the morphofunctional changes in the so-called " thyroid remainder" [1; 5; 6], which have not
Determination of the structural and functional dynamics of the thyroid residue after subtotal subfascial resection of the thyroid gland will allow to control the risk and evaluate the clinical significance of relapses, and also to analyze the adequacy of the choice of the volume of the primary operation.
Objective: Dynamic study of the function of residual thyroid tissue in the postoperative period in patients with multinodular non-toxic goiter.
Material and Methods: We observed 86 patients with multinodal non-toxic goiter operated in the 1st surgical department of SamSMI, between 2014 and 2017. The age of the patients ranged from 24-61 years. In the postoperative period, according to the results of instrumental and morphological studies, patients were divided into 2 groups: 1 group consisted of 49(57%) patients who underwent hemithyroidectomy. 2 group consisted of 37(43%) patients, subtotal subfascial-strumectomy was performed.
Medical science
All patients were examined according to the standard: biochemical blood tests were performed, thyroid hormone levels in the blood, ECG, ultrasound of the thyroid gland and histological examination were determined. To some according to the indications of echocardiography and MRI of the cervical region.
Ultrasound of the thyroid gland was performed by all patients in the dynamics before and after the operation period according to the standard procedure with the use of ultrasound devices ALOKA SSD-3500 SX.
Results of the study. In patients of the first group who underwent hemithyroidectomy, at a time of 3 months, the
Thus, after various resections in the volume of the thyroid gland with ultrasound for 6 months, three variants of the "be-
A stable variant was detected in 51.2% of cases, hypertrophic in 26.7% and hypotrophic in 22.1%.
Thus, the greatest increase in the volume of residual thyroid tissue of the residue is noted against the background of irregularity of thyroid hormones. As you know, an elevated level of TSH is a potent stimulator of proliferative processes in the thyroid.
In the postoperative period, the main indicators of the effectiveness of surgical treatment are: the frequency of recurrence of diseases and postoperative hypothyroidism. In our study, relapse of nodular goiter was detected in 2 cases (2.3%) at 3 years of follow-up, and developed in the 1-group (after hemithyroidectomy). In all cases, the recurrence of nodular goiter developed against a background of postoperative hypothyroidism, which confirms the correct choice of organ -preserving volumes of primary operations that preserve the necessary part of thyroid tissue.
The main manifestations of an operating trauma are edema of all structures in the surgical intervention zone, the presence of a hematoma that hinders the visualization of the
volume of the preserved intact fraction by ultrasound was 8.5 ± 0.5 cm3. In terms of 3 to 6 months, 18(36.7%) of them showed an increase in volume by 1.2_ + 0.4 cm3. In another 23(46.9%) cases, the size of the thyroid remains remained stable, in 8(16.4%) cases the hypothrophy of the thyroid residue was revealed. In the second group, after subtotal subfascial strumectomy, the volume of the thyroid residue was 5.4 ± 0.6 cm3. With ultrasound for 3 to 6 months in 21(56.7%) patients, he remained stable. In 11(29.8%) cases, the tissue volume of the gland remnant decreased to the dimensions of 3.12-3.96 cm3. 5(13.5%) of them showed an increase in volume by 1.4 ± 0.4 cm3. (Table 1).
havior" of the thyroid residue were identified, which we arbitrarily termed hypertrophic, hypotrophic and stable (Table 2).
thyroid remnant. Reduction of edema begins after 3 months, and more actively, with the improvement of differentiation of anatomical formations in the area of surgical intervention, against the background of ongoing rehabilitation measures, complete elimination of it occurs in a month. Objective evaluation of the thyroid remnant is advisable to be carried out 3 months after the operation.
Conclusions
1. In the postoperative period within 6 months in patients with a multinodal non-toxic goiter, after different volumes of operations in the thyroidremnant, three types of volumetric structural changes are revealed according to ultrasound (stable - 51.2%, hypertrophic - 26.7%, hypotrophic - 22,1%). 2. When performing organ-saving operations for multinodu-lar goiter, in the postoperative period, iodine preparations should be prescribed, in large-volume operations, thyroid preparations should be prescribed without waiting for hypothyroidism. 3. Compliance with the principle of organ-preserving surgeries will avoid gross violations from the function of the thyroid gland, including other changes in the body.
Table 1. - Characterization of the volume of the thyroid residue in the postoperative period at 3 and 6 months
Type of operation Volume of thyroid residue in 3 months (cm3) Volume of thyroid residue in 6 months (cm3)
After hemithireidectomy (1 group) 8.2 ± 0, 5 9.7 ± 0.5
After subtotal resection of the thyroid gland (2nd group) 5.4 ± 0.6 7.2 ± 0.6
Table 2.- Variations in the volume of the thyroid residue at 6 months
Group of patients Dynamics of the thyroid residue Total
Hypertrophy Hypotrophy Stable condition
Hemithyroidectomy 18 (36.7%) 8 (16.4%) 23 (46.9%) 49
Subtotal subfascial strumectomy 5 (13.5%) 11 (29.8%) 21 (56.7%) 37
Total 23 (26.7%) 19 (22.1%) 44 (51.2%) 86
4. In the postoperative period, patients should be observed dynamic monitoring of ultrasound and hormonal status, and,
in an endocrinologist or surgeon-endocrinologist, undergo if necessary, receive hormone replacement therapy.
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