Nodular Euthyroid Goiter Research Articles

25-year experience of surgical treatment of thyroid diseases in a multidisciplinary hospital

BACKGROUND: Every year there is an increase in the number of patients with thyroid diseases, thus improving surgical treatment methods with decreased traumatic effect and postoperative complications, remains relevant. AIM: To summarize the results of 25-year work of the team (surgeons and endocrinologists) of specialists from the multidisciplinary hospital of Saint Petersburg and the departments of the North-Western State medical university named after I.I. Mechnikov on the diagnosis and treatment of patients with surgical pathology of the thyroid gland. MATERIALS AND METHODS: The results of surgical treatment of 3977 patients with thyroid diseases operated accoding to the traditional Kocher approach, asymmetric “floating” mini-approach and video-assisted mini-approach were analyzed. RESULTS: In the analyzed time period, a rapid increase in the number of minimally invasive techniques for surgical operations on the thyroid gland is characteristic, which are used for nodular euthyroid goiter, multi-nodular euthyroid goiter and toxic thyroid adenoma. With the help of traditional approach, surgical intervention was performed mainly for diffuse toxic goiter and multinodular toxic goiter. The introduction of new techniques and approaches in the provision of medical care to patients with surgical diseases of the thyroid gland can significantly improve the results of treatment. CONCLUSIONS: 25-year experience of the endocrinological center of the Elizabethan Hospital demonstrates that collaboration of departments and doctors of a multidisciplinary hospital allows to introduce new approaches to treating surgical thyroid diseases and improve its results without increasing the number of postoperative complications.

Granulomatous Acute Interstitial Nephritis Revealing Multisystem Sarcoidosis Associated with Thyroiditis and Cushingoid Syndrome: Report of a Case and Review of the Literature

Introduction: Sarcoidosis can present with acute renal failure (ARF) due to granulomatous interstitial nephritis (GIN). We report the case of granulomatous acute renal failure (ARF) revealing multisystemic sarcoidosis in the nephrology department of the Aristide Le Dantec hospital in Dakar. Observation: Mrs. kD aged 54 with a past history of high blood pressure for 22 years, a multi nodular euthyroid goiter, referred to the nephrology department for impaired renal function. The clinical examination revealed at entry, deterioration in the general condition with weight loss and non-selective anorexia. Clinical anemia was also noted. The clinical examination also revealed Cushingoid syndrome and dry mouth syndrome. On biology, the blood count showed bicytopenia with anemia at 10.9 g/dl and leukopenia at 2620/mm3. There was an impairment of renal function with creatinine at 139.2 mg/l and blood urea at 1.76 g/l. The renal ultrasound became normal. Cervical ultrasound showed an aspect of abscessed thyroiditis of the right lobe. Chest computed tomography (CT) showed bilateral hilar adenomegaly and a band of bilateral basal linear atelectasis. The renal biopsy showed glomeruli of subnormal structure, the interstitium is riddled with tuberculoid follicles formed of epithelioid and multinucleated histiocytes of the Langhans type. The diagnosis of granulomatous acute interstitial nephritis revealing multisystemic sarcoidosis was kept. The evolution was favorable after 1 month of treatment with corticosteroid therapy with a clear improvement in renal function. Conclusion: Renal manifestations during sarcoidosis are rare. They can be indicative of the disease as in our patient. Renal biopsy is essential in any patient presenting with impaired renal function with extra-renal signs.

Compression syndrome in giant euthyroid goiter

Given the widespread iodine deficiency, diffuse and diffuse nodular euthyroid goiter is an urgent problem. A large goiter needs to be highlighted both from the perspective of possible complications for the patient, including a decrease in the quality of life and compression syndrome, as well as from the perspective of the complexity of surgical treatment, given the technical complexity of the operation and the high probability of intraoperative and postoperative complications. The article describes a clinical case of a patient admitted to the endocrinology department with a diagnosis of diffuse nodular goiter of the 2nd degree for examination with complaints of a huge deforming formation of the neck contours, difficulty breathing when walking and during sleep. It is known from the anamnesis that the patient has been observed for about 10 years by an endocrinologist with nodular goiter. The patient was repeatedly offered surgical treatment, which he categorically refused. In the Department of endocrinology, the patient underwent a comprehensive examination to assess the condition and function of the thyroid gland, as well as to identify possible complications.

Surgical treatment of a patient with stage v multinodular toxic goiter, severe thyrotoxicosis, strangulation syndrome and severe comorbidities

The authors describe thyroidectomy in a patient with multinodular toxic goiter stage V, severe thyrotoxicosis complicated by thyro-cardiac disease, strangulation syndrome and severe comorbidities. Nodular euthyroid goiter was first diagnosed in 1992, and resection of the right thyroid lobe was performed. Progressive enlargement of thyroid gland and thyrotoxicosis occurred after coronavirus infection in February, 2020. Along with progression of thyrotoxicosis and strangulation of cervical organs, the patient suffered from portal vein thrombosis, pulmonary embolism. Myeloproliferative disease with essential thrombocythemia was also diagnosed. Volume of the right and left thyroid lobes was 69 and 101.3 cm3, respectively. X-ray examination of the esophagus revealed narrowing at C6 level up to 5-8 mm. Surgery time was 2 hours, dimension of removed right thyroid lobe - 10.0×7.5×6.5 cm, left thyroid lobe - 11.0×6.5×5.5 cm, total weight - 348 g. The patient was discharged in 6 days after surgery.

INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS IN SURGICAL TREATMENT OF NODULAR AND MULTINODULAR FORMS OF THE EUTHYROID GOITER

Intra- and postoperative complications in the surgical treatment of nodular and multinodular euthyroid goiter make up from 0.3 to 8.0% of the number of operated patients. Depending on the clinical picture, data of morphological, radiation, laboratory studies, various types of surgical interventions are used. The objective was to analyze the causes and search for ways to prevent and treat the ntraoperative and postoperative complications in the surgical treatment of patients with nodular and multinodular euthyroid goiter. Methods and materials. There was conducted the analysis of the techniques and results of surgical treatment of 303 patients with nodular euthyroid goiter and 377 patients with multinodular euthyroid goiter, divided into two groups: the main group (352 patients) and comparison (328 patients). Results. The immediate and long-term results of the treatment of patients were studied with the detailing of specific and nonspecific complications by groups. Methods for optimizing diagnostic and treatment technologies have been developed, immediate and long-term results of treatment have been evaluated. Conclusion. The use of improved technologies has reduced the number of intraoperative and postoperative complications and improved treatment results.

Epidemiology of benign thyroid disorders in the adult population of the Republic of Belarus: analysis of nationwide statistics 2009 to 2019

Nowadays, the Republic of Belarus belongs to the countries with sufficient iodine supply, which made it possible to reduce the incidence of non-toxic goiter and congenital hypothyroidism. However, even a slight change in iodine consumption influences the pattern of thyroid diseases. In addition to iodine deficiency, other environmental conditions, aswell as genetic factors, play a significant role in the etiology of thyroid diseases. To analyze the dynamics of the main epidemiological indicators of benign thyroid diseases from 2009 to 2019 in theadult population of the Republic of Belarus, using the data of official state statistics. The indicators of the incidence and prevalence of benign thyroid diseases were studied on the basis of state statistics for 2009-2019. To analyze the dynamics of the studied indicators, regression analysis was used with the construction of linear and polynomial models. A decrease in the incidence and prevalence of diffuse euthyroid goiter and an increase in the incidence and prevalence of nodular euthyroid goiter, thyroiditis, acquired hypothyroidism, Graves' disease, as well as the incidence of nodular toxic goiter were revealed. Obtained data indicate, that there is an increase in the prevalence of most of the studied thyroid diseases, despite the adequate iodine supply. The above justifies the need for further study of the causes of the identified trends, as well as the necessity of developing new methods of diagnosis and treatment of thyroid diseases.

The effect of aсtive hexose correlated compound on (multi) nodular euthyroid goiter: A double-blind placebo-controlled study

Aim: of the study is to evaluate the effectiveness of Аctive Hexose Correlated Compound (АНСС®) use in monotherapy and its impact on the echographic characteristics of the thyroid gland during (multi) nodular goiter. Methods: The study involved 27 people with (multi) nodular euthyroid goiter. The main treatment group consisted of 13 patients who received АНСС®. The placebo control group consisted of 14 participants. The duration of the drug intake lasted for 100 days. Three visiting schedules were arranged including initial, intermediate and final visits. Research methods included clinical examinations, laboratory tests, a thyroid ultrasound (classification by K-TIRADS) and completing a questionnaire. Results: The laboratory tests confirmed the euthyroid status of patients in both groups at baseline and at the end of the study. A decrease in the total volume of the right and left lobes of the thyroid gland was noted among the main treatment group. In addition, a decrease in the volume of all types of nodules was seen in this group. A decrease in the volume of the type 2 colloid node was statistically significant. On the contrary, a statistically significant increase in the average volume of the same type of node among the control group was seen. Overall, the average volume of the node decreased by 37.2% in the main group and increased by 4.9% in the control group by the end of the study. Conclusion: The results of this double-blind, placebo-controlled study make it possible to assess the efficiency of АНСС® in (multi) nodular goiter affecting primarily the volume of nodes (mainly of the 2nd and 3rd types). This is especially important when a potential surgery or radioiodine therapy may carry a high risk of complications among patients.

Roles of Thyroid Hormones, Mast Cells, and Inflammatory Mediators in the Initiation and Progression of Autoimmune Thyroid Diseases

Background: Interrelation between thyrocytes and immunocytes has been established. However, the roles of mast cells and thyroid hormones in the triggering mechanism of thyroid autoimmune processes have been insufficiently investigated. This study evaluated the role of thyroid hormones and mast cells in the mechanisms of losing tolerance to thyroid autoantigens. Materials and Methods: Two groups of patients were studied: patients with Graves’ disease and patients with nodular euthyroid goiter. Wistar rats with induced exogenous hypothyroidism, thyrotoxicosis, and thyrotoxicosis in parallel with administration of interleukin-2 were used. The levels of hormones, autoantibodies, and cytokines in the serum and thyroid tissue were analyzed through the enzyme-linked immunosorbent assay. Morphological verification was performed through the immune-histochemical method with antibodies against tryptase and CD86. Transmission electron microscopy and laser confocal microscopy were used. Results: In both Graves’ disease and induced thyrotoxicosis, we detected a significant increase in the levels of interferon-γ, active interfollicular infiltration and degranulation of mast cells, and the intrathyroid overexpression of CD86. Complex analysis of the rat’s thyroid morphofunctional state and systemic and local levels of cytokines in induced thyrotoxicosis and hypothyroidism demonstrated an increase of intrathyroid degranulation of mast cells and a drastic disruption of IFNγ/IL10 balance. Conclusions: When exposed to excessive amounts of thyroid hormones, an inflammatory response is triggered in the thyroid gland, and mast cells overexpress costimulating CD86 in the thyroid. This finding confirms their possible involvement in auto­antigen presentation. Significant increase in the levels of interferon-γ shows a determining influence of cytokine on the progression of the pathological process.

ПОКАЗАНИЯ К ОБЪЕМУ ОПЕРАЦИИ И ОСОБЕННОСТИ ТЕХНИКИ ТИРЕОИДЭКТОМИИ У ПАЦИЕНТОВ С ЗАГРУДИННЫМ ЗОБОМ

The paper is devoted to determining the frequency, features of the clinical course and technique of safe thyroidectomy in patients with retrosternal goiter. Materials and methods. We analyzed the treatment of 26 patients with retrosternal goiter. All patients underwent the neck-approach thyroidectomy with the identification of the recurrent laryngeal nerve during surgery. Results. It was found that patients with Graves’ disease did not have retrosternal goiter, with mixed toxic goiter the frequency was 13.7%, with nodular euthyroid goiter – 26.1%. In 11.5% of patients with retrosternal goiter, the diagnosis was made by chest x-ray, in 76.9% - by ultrasound imaging, in 19.2% - by CT imaging. Of the 26 patients, 1 (3.8%) was hospitalized urgently due to respiratory failure and compression syndrome, and 25 (96.2%) were admitted as planned. Operations in 25 (96.2%) were performed under endotracheal, in 1(3.8%) – under mask anesthesia. Intraoperatively, it was found that the location of the recurrent laryngeal nerve changed in the case of chest goiter that required special care when mobilizing the posterior surface of the thyroid gland from the trachea in the zone of the lower thyroid artery and in Berry ligament. Technical manipulations aimed at preventing damage to the recurrent laryngeal nerve at different stages of thyroidectomy are proposed. Conclusion. The results of operations in patients with substernal goiter show that if it is carefully performed and the recurrent laryngeal nerve is preserved, the postoperative period does not differ from that in the usual location of the thyroid gland and even relieves, since the compression syndrome is eliminated.

The optimal diagnostic complex in the surgical treatment of nodular euthyroid goiter

Different methods for preoperative diagnosis of nodular euthyroid formations of the thyroid gland are compared. The sensitivity and specificity of ultrasonic examination (based on the study of the semeiotics of nodular formations of the thyroid), fine-needle aspiration biopsy (under palpation and ultrasonic control), and complex diagnosis (simultaneous assessment of ultrasonic semeiotics of the nodular formation and controlled biopsy under ultrasonic control followed by cytological examination of puncture biopsy specimens) are assessed. With this aim in view, 342 patients with nodular euthyroid formations were examine^ in 1994-1996. Benign nodular formations were detected in 316 (92.4%)) and thyroid cancer in 26 (7.6%o) patients. In the group with benign formations, colloid goiter was diagnosed in 204 (59.7%), follicular-cell adenomas in 78 (22.8%)), and hypertrophic autoimmune thyroiditis in 34 (9.9%) cases. The authors consider that ultrasonic examination combined with fine-needle aspiration biopsy is the most available, safe, and highly effective complex for the diagnosis of nodular euthyroid formations at the preoperative stage. Complex preoperative ultrasonic examination with fine-needle biopsy help single out the group with suspected malignant involvement of the thyroid with a high probability. Use of this complex and intraoperative ultrasonic examination correctly identified the type of thyroid involvement and its morphology in 92.4%o of cases, and thus helped choose adequate volume of intervention.

THE IMMUNOHISTOCHEMICAL ASSESSMENT OF THE CHARACTER OF LYMPHOID INFILTRATION IN VARIOUS FORMS OF THYROID PATHOLOGY

Objective: to characterize the phenotype of lymphocytes in lymphoid infiltrates in various forms of thyroid pathology. Material and methods . The operating material of 112 cases of thyroid diseases has been studied. The immunohistochemical examination using monoclonal antibodies to the antigens CD3, CD4, CD1α, CD23, CD25, CD8 and TGF-β has been conducted. Results. The quantitative assessment of lymphocyte subpopulations in lymphoid infiltrates in the tissue of the thyroid gland in thyrotoxic goiter, autoimmune thyroiditis, nodular euthyroid goiter, and thyroid cancer has been given.

Лечение узлового эутиреоидного зоба лазериндуцированной интерстициальной термотерапией

Лечение узлового эутиреоидного зоба лазериндуцированной интерстициальной термотерапией

Структурні зміни щитоподібної залози в постраждалих внаслідок аварії на ЧАЕС, хворих на цукровий діабет 2-го типу

Відповідно до мети роботи нами було проведено дослідження клінічних зв’язків між цукровим діабетом (ЦД) 2-го типу та незлоякісними захворюваннями щитоподібної залози (ЩЗ) у потерпілих внаслідок аварії на Чорнобильській атомній електростанції (ЧАЕС) у віддалені поставарійні терміни (148 осіб) та в контрольній групі (38 осіб). Отримані дані стосовно характеру та частоти органічної патології ЩЗ. Частота органічної патології ЩЗ у хворих на ЦД 2-го типу, потерпілих внаслідок аварії на ЧАЕС (58,3 ± 6,3 %), статистично вірогідно (р < 0,05) вище, ніж у групі контролю (43,1 ± 3,9 %). Домінуючою патологією у хворих на ЦД 2-го типу, потерпілих внаслідок аварії на ЧАЕС, є вузловий еутиреоїдний зоб, частота якого (26,7 ± 5,7 %) більше ніж в 3,3 раза вища (р < 0,01), ніж у групі контролю (8,1 ± 2,2 %), та залежить від статі, віку, тривалості основного захворювання.

Study of gustatory sensitivity to phenylthiocarbamide in thyroid diseases

The aim of the study was to reveal a relationship between gustatory sensitivity to phenylthiocarbamide (PTC) and thyroid disease. The distribution of PTC sensitivity was studied in 198 healthy individuals, 100 patients with autoimmune thyroiditis (AIT), 139 patients with nodular euthyroid goiter, and 100 patients operated on for thyroid cancer. There was a statistically significant decrease in the number of PTC-resistant male and females patients in the thyroid cancer group and an increase in the proportion of PTC-resistant male patients in the AIT and nodular euthyroid goiter groups.

Stimulation of the growth of "normal" thyrocytes by lymphocytes infiltrating the tissue of diffuse toxic goiter

The capacity of lymphocytes isolated from diffuse toxic goiter (DTG) tissue to stimulate the proliferation of normal thyrocytes isolated from paranodular tissue adjacent to nodular euthyroid goiter was studied. Normal and DTG thyrocytes were incubated for 24 h with fetal calf serum (FCS) in various concentrations, DTG orparanodular lymphocytes, or both FCS and lymphocytes. The proliferation rate of normal thyrocytes in the presence of FCS alone increased with increase of the serum concentration, while the proliferation rate of DTG thyrocytes did not depend on the concentration of FCS. DTG lymphocytes, but not paranodular ones, stimulated the proliferation of normal thyrocytes. The growth-stimulating effect of DTG lymphocytes was paralleled by loss of normal thyrocytes sensitivity to growth factors (FCS). These data indicate a probable role of intrathyroid lymphocytes in increase of thyrocyte count characteristic of DTG and confirm a previous hypothesis on decrease in expression of surface antigens (receptors) on DTG cells under the effect of intrathyroid lymphocytes.

L-thyroxine in the treatment of solitary nodular non-toxic goiter in concomitant coronary heart disease

Endocrinological and cardiological parameters were assessed in coronary patients with nodular euthyroid goiter before and during treatment in order to define the optimal protocols of L-thyroxin therapy. Ultrasonic examination of the thyroid, fine needle puncture biopsy and cytological analysis of biopsy specimens, measurements of thyrotropic hormone, electrocardiography, and high resolution electrocardiography were carried out. The results helped distinguish the cardiological criteria for decreasing the dose of L-thyroxin or its discontinuation in coronary patients with nodular goiter and define the indications for such therapy in this patient population. Therapy with L-thyroxin is justified in the above patient population only on condition of monitoring the cardiovascular status. Therefore, the presence of coronary disease or its risk factors in a patient with nodular colloid proliferating goiter is not a contraindication preventing thyroxin therapy in adequate doses.