Toxic Goiter Research Articles

Early postoperative PTH level following total thyroidectomy as a predictor of hypocalcemia: a single center-based study in Bangladesh

Background: Assessment of parathyroid hormone (PTH) following thyroid surgery assists in the prediction of hypocalcemia and permits early intervention and therapy with oral calcium and/or vitamin D supplements.
 Methods: This retrospective analysis comprised 141 individuals who had undergone a total or completion thyroidectomy over the previous four years. The blood PTH level was measured 3 hours after surgery to determine its change and to predict hypocalcemia.
 Results: Patients were predominately female (75.2%), and the mean age was 48.73 ± 13.44 years. The main surgical procedure was total thyroidectomy (80.14%), and the main cause for surgery was a multinodular goiter (34.04%). A comparable number of patients with each type of thyroid disease (multinodular goiter, papillary thyroid cancer, thyroiditis, Graves’ disease or toxic multinodular goiter were enrolled. Three hours after surgery 93 patients (65.95%) had serum PTH levels of >10 pg/ml (mean 28.06) and 90 patients (68.38%) had normal serum calcium (mean 8.66). Most of these 93 patients (65.95%) didn't require postoperative supplementation, whereas 48 patients (34.05 %) with serum PTH levels less than 10 pg/ml required some form of supplementation; 39 (27.65 %) required both oral calcium and vitamin D supplements, and 9 (6.4 %) required only oral vitamin D supplementation. There was a significant correlation between the 3-h postoperative PTH level and hypocalcemia (P-value 0.000). The type of pathology had no significant association with low serum PTH level after surgery (P-value 0.166).
 Conclusion: Asymptotic individuals with PTH levels less than 10 pg/ml, who are regarded as being in the high-risk category, can start taking calcium and/or vitamin D supplements early if their PTH levels are measured at 3 hours following complete thyroidectomy. To predict hypocalcemia, more research is required to compare the outcome of early serum PTH level with the day one serum PTH level following complete thyroidectomy.
 Central Medical College Journal Vol 6 No 2 Jauly 2022 Page: 82-89

Thyroidectomy With or Without Nerve Identification: A Personal Experience and Technique.

Careful and precise dissection of the gland, away from the typical trajectory of the recurrent and external laryngeal nerves, poses a minimal or similar risk of nerve injuries compared to directly visualizing and identifying the nerves. In a randomized controlled study involving 150 patients with various thyroid disorders who underwent different surgical procedures (total, near total, and hemi thyroidectomy), the patients were randomly assigned into two groups using a coin toss. The first group (G1) consisted of 75 patients who underwent thyroidectomy with nerve visual identification, while the second group (G2) comprised 75 patients without the requirement of nerve visualization. The aim was to determine the method with a lower risk of complications. The incidence of external laryngeal nerve palsy (ELNP) was found to be higher in G1 patients compared to G2 patients (5.3% vs2%), while no cases of permanent recurrent laryngeal nerve (RLN) palsy were observed in either group. The frequency of total nerve injury was higher in G1, with 14 patients (10.2%), compared to G2, with eight patients (5.3%). However, there was no significant association between nerve identification and the rate of nerve injury (P value = 0.452). Among the different surgical procedures, total thyroidectomy for toxic goiter was the most common operation associated with transient external laryngeal nerve (TELN) injury and permanent external laryngeal nerve (PELN) injury. By employing meticulous dissection techniques in proximity to the thyroid capsule, experienced surgeons can effectively reduce the risk of nerve injury, even in the absence of direct nerve visualization.

Patterns of thyroid tumors in Northern Saudi Arabia with a specific focus on CK19, CD56, and Galectin-3 tumor markers.

The goal of this study was to look at the patterns of thyroid tumors and how thyroid cancer markers showed up in immunohistochemistry in Northern Saudi Arabia. This study investigated retrospectively 190 patients who attended with thyroid complaints. About 140 thyroid biopsies were diagnosed in the Department of Pathology at King Salman Hospital, Ha'il, from November 2019 to November 2020. Out of the 190 patients who attended with thyroid complaints, 140/190 (73.7%) were detected with thyroid lesions (58 malignant and 82 benign). Benign lesions included goiter 49/82 (60%), follicular adenoma 17/82 (21%), Hashimoto's thyroiditis 13/82 (16%), and toxic goiter 3/82 (3%). 5/6 (83.3%) of males with benign lesions had goiters. CK19 was positive in 68.5% of the cases; 71.8% were papillary, 66.7% were follicular, and 100% were undifferentiated carcinomas. Out of the 26/54 (48%) CD56-positive cases, 18/39 (46%) were papillary, 7/12 (58.3%) were follicular, and 3/3 (100%) were undifferentiated carcinomas. Out of the 35/54 (64.8%) Galectin-3-positive cases, 69.2% were papillary, 7/12 (58.3%) were follicular, and 3/3 (100%) were undifferentiated carcinomas. Thyroid cancer is prevalent in northern Saudi Arabia, with the predominant type being papillary thyroid carcinoma. Most patients are female and younger. The combined use of CK19, CD56, and Galectin-3 tumor markers assists in the accurate differential diagnosis of thyroid neoplasms.

Association between hyperthyroidism and thyroid cancer in the Congolese hospital setting.

e18092 Background: Thyroid cancer accounts for 1% of cancers worldwide. Hyperthyroidism was long considered a protective factor against thyroid cancer. This association was rare in the literature and raised a lot of controversy in the scientific world. There are currently no studies carried out in the Congolese hospital setting to establish the association between hyperthyroidism and thyroid cancer. We hypothesize that there is an association between thyroid cancer and hyperthyroidism in the Congolese hospital setting. Methods: This is a descriptive and retrospective study, which involved 106 cases of thyroid cancer who underwent partial or total thyroidectomy and pathological examination in four laboratories in the city of Kinshasa between 2005 and 2019. These laboratories receive samples from all the medical centers in Kinshasa. Statistical analyses of the data were performed using Statistical Package for the social sciences (SPSS) for Windows version 22 software. Data were expressed as mean +/- standard deviation for metric parameters, and as absolute or relative frequencies in percentages for categorical parameters. For all tests used the p-value < 0.05 was considered as the threshold of statistical significance. This research protocol was approved by the National Health Ethics Committee of the DRC No. 197/CNES/BN/PMMF/2020. Results: Out of 106 cases of thyroid cancer, the association of hyperthyroidism and thyroid cancer was found in 5 cases (4.7%) (3.6% for women vs. 9% for men). The mean age of patients with this association was 51 ± 11 years. Papillary carcinoma (two cases), follicular carcinoma (two cases) and lymphoma (one case) were the types of cancer encountered. Etiologically, toxic multinodular goiter (four cases; 80%) and toxic adenoma (one case; 2%) were found. Conclusions: There is an association between hyperthyroidism and thyroid cancer in the Congolese hospital setting. There is a predominance of the female gender. There was an equal number of papillary and follicular carcinomas. With this study, we hope to encourage clinicians to thoroughly evaluate any suspicious nodule associated with hyperthyroidism. [Table: see text]

The Role of Methylene Blue Spray to Keep Parathyroid Gland and Recurrent Laryngeal Nerve Safe During Thyroidectomy.

Background: The main postoperative complications of thyroidectomy are hypoparathyroidism and recurrent laryngeal nerve (RLN) palsy. Methylene blue, which is a drug and dye, is safe and easy to get, and we can use it to avoid complications during thyroidectomy. Objectives: We aim to assess that we can spray Methylene blue to allow the identification of important structures intraoperative which are the parathyroid gland and recurrent laryngeal nerve. Also, to evaluate that this technique is safe, effective, technically feasible, and less dangerous than other techniques. Methods: Our study is a prospective cohort study of patients, patients who presented with simple nodular goiter, solitary thyroid nodule, controlled toxic goiter, and failed medical treatment with the indication for thyroidectomy, suspected malignancy, and retrosternal goiters at El-Demerdash Hospital from the period of August 2021 to August 2022. In the specified study period of 1 year from 1/8/2021 to 31/7/2022. Results: Sixty patients underwent thyroidectomy 54 underwent total while 6 only underwent hemithyroidectomy. The time taken to wash out the dye over the thyroid gland was 15 to 25 minutes, the parathyroid gland was 4 to 7 minutes and the recurrent laryngeal nerve (RLN) was almost 0 to 1 minute and this indicated that the RLN almost did not take the dye. In the controlled group, two patients had symptoms and signs of hypocalcemia only one of them had signs of tetany, 8 patients had laboratory hypocalcemia, two patients suffered from a change of voice and another two patients suffered difficulty breathing one of which needed temporary tracheostomy while in the interventional group, only one patient had symptoms and signs of hypocalcemia no one had signs of tetany, two patients had laboratory hypocalcemia, one patient suffered from the change of voice and another two patients suffered the difficulty of breathing but no one needed a tracheostomy tube. Conclusions: It is safe, useful, and suitable to use Methylene blue spraying to keep the parathyroid gland and RLN during thyroidectomy, which led us to reduce the percentage of incidence of postoperative complications. Also, it helped us to find the parathyroid gland and RLN during the surgery, despite some surgeons seeing that searching for the parathyroid and RLN can lead to harmful effects and increase the incidence of injury.

Gambaran Kejadian Struma di RSU Negara Tahun 2019-2020

ABSTRACT
 Introduction: A goiter, also called a goiter, is a swelling of the neck due to enlargement of the thyroid gland due to thyroid gland disorders, which can be in the form of dysfunction or changes in the arrangement of the gland and its morphology can be in the form of diffuse or nodus Based on the results of research conducted, it is estimated that around 200 million people worldwide suffer from goiter. The results of research on goiter in Indonesia, show the prevalence of the total goiter rate (TGR) from 9.8% in 1998 to 11.1% in 2003. is still a public health problem in Indonesia and data on the incidence of goiters in Indonesia is still minimal. This study aims to obtain a description of the goiter based on age, gender, type of therapy.
 Method: This study used a retrospective descriptive study, the sample used was the State Hospital patient with goiter who met the criteria, the sample collection method used medical records which were then processed using the SPSS program, then presented in a table form.
 Result: Female patients were the most suffering from goiter (68.3%) in this study. The highest incidence of goiters in this study was the type of toxic goiter, namely 25 people (61%).
 Conclusion: The highest incidence of goiter in the type of toxic goiter, female sex, age 45-54 years, and most types of operative therapy.
 
 Keyword: Struma, Struma Nodusa, Goiter

Iatrogenic Graves' disease - A case of severe Graves' disease and Graves' orbitopathy occuring after radioiodine therapy for toxic nodular goitre

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Postoperative hypothyroidism and body weight dynamics in patients operated on for diffuse toxic goiter

Postoperative hypothyroidism is a consequence of thyroidectomy. However, observation of patients with diffuse toxic goiter (DTG) after thyroidectomy shows that achieving euthyroidism while taking L-thyroxine, as well as maintaining weight in some cases, is difficult or not possible at all. Thus, the study of thyroid function and body weight dynamics in the first year after thyroidectomy remains an urgent task of clinical thyroidology.Aim. To study thyroid function and body weight dynamics in patients with DTG after various types of surgical treatment.Material and methods. The study included 310 patients with DTG (234 women — 75,5% and 76 men — 24,5%), the average age was 46,46±0,99 years. In all patients with DTG before surgery, after 1 month and 1 year after the operation, the results of hormonal examination (levels of thyroid-stimulating hormone (TSH), free T4), body weight dynamics were evaluated. Levels of TSH and free T4 was determined by enzyme immunoassay. To assess the dynamics of body weight one year after the operation, depending on the change in weight, the patients were divided into 3 groups: group 1 — body weight decreased by more than 5%; group 2 — body weight did not change; group 3 — body weight increased by more than 5%. Statistical analysis of the study results was performed using the SPSS 16.0 program (SPSS Inc., USA).Results. Before surgical treatment, blood TSH levels were normal in all patients, and there were no differences between the groups (p=0,94). In patients after subtotal resection, the average level of TSH in the blood after 1 month. after surgery was significantly higher (p=0,02) than in patients who underwent extirpation of the thyroid gland (TG). Blood TSH was monitored in all patients 1 year after surgery. In patients with thyroid extirpation, the level of TSH in the blood was significantly higher compared to patients who underwent organ-preserving surgery (p=0,01).Next, the body mass index (BMI) was analyzed in the examined groups of patients. When analyzing the BMI of patients before and after surgery, there were no significant differences in both groups: group 1 — before surgery BMI 25,67±0,57 kg/m2, after surgery 25,87±0,60 kg/m2; group 2 — before surgery BMI 25,13±0,40 kg/m2, after surgery 25,67±0,46 kg/m2. In group 1, there was a decrease in weight after surgery during the first year in 14,9% of patients, while in group 2 only in 7,2% of patients (p=0,01). Weight gain was high in both groups: in group 1 — 20,7%, in group 2 — 29,0%, but in the group after thyroidectomy was significantly higher (p=0,04). In patients with weight gain, a positive correlation was found between weight gain during the year and blood TSH 1 year after surgery (p=0,02, r=0,247).Conclusion. The obtained results suggest that after thyroidectomy performed for DTG, patients have a significantly greater increase in BMI and uncompensated hypothyroidism is more common than in patients after subtotal resection of the thyroid gland.

Long-Term Effects of Radioiodine Treatment on Thyroid Functions, Thyroid Volume, Nodule Volume and Ultrasonographic Features in Patients with Toxic Adenoma and Toxic Multinodular Goitre

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

A Prospective Comparitive Study on Cardiovascular Dysfunction and its Reversal After Treatment in Patients with Graves and Toxic Multi Nodular Goitre

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Thyroidectomy refusal and long-term anti-thyroid use in toxic multi-nodular goitre

Background: Definitive management for most patients with toxic goitres comprise thyroidectomy or radioiodine ablation.
 Method: We report a middle aged woman who refused surgery on personal grounds, and in the absence of radioiodine was managed long-term with oral anti-thyroid.
 Results: The clinical outcome was fair.
 Conclusion: Our study, the first report of long-term anti-thyroid use from our centre, highlight the peculiarities of management under this scenario.

Abstract #1386026: Outcome of Radioactive Iodine Treatment and its Association with Various Parameters in People Presenting with Hyperthyroidism at Tertiary Care Hospital of Karachi, Pakistan

Hyperthyroidism is a common disorder of thyroid gland with multiple etiologies and radioactive iodine (RAI) is one of the important modalities to treat it. The outcome after RAI treatment is unpredictable as it is influenced by many factors. Successful treatment is determined by development of euthyroidism and / or Hypothyroidism within 6 months of radioactive iodine treatment. The aim of this study was to find out the outcome of RAI treatment and its association with factors like age, gender various etiologies of hyperthyroidism, and baseline TSH, FT4 in our population. This retrospective case series study was conducted at Karachi institute of Radiology and Nuclear Medicine” (KIRAN) from January 2018 to June 2020. Among 537 who were given RAI for hyperthyroidism a total of 199 participants with complete data were recruited in study after IRB approval. Demographic details, age, gender, underlying cause of hyperthyroidism (graves disease, toxic multinodular goitre, solitary toxic nodule etc,) were obtained from medical records along with baseline FT4 & TSH. A fixed dose of 15mci of radioactive iodine was given to all patients and TSH and FT4 were measured at 6 weeks 3, 6, and 12 months to evaluate the outcome of RAI treatment. The data was analyzed by SPSS version 20 to compute mean standard deviation and percentages. A total of 199 participant’s data was analyzed, 77.9% were females and 22.1% males with mean age of 41.32±0.99 years. Seventy-four 74.4% participants had diffuse toxic goiter (Graves’ disease) and 15% had solitary toxic nodule or toxic multinodular goiter. Post RAI TSH target (either normal or high) was achieved earlier at 6 weeks in comparison to FT4 (normal or low) that attained at 3months. Outcome of RAI treatment in patients with Graves’ disease and toxic nodule revealed statistically significant and early result by normalization and or increased TSH at 6 weeks 3, 6 and 12 months (p-value <0.05), and FT4 normalization was only seen in patients with graves’ disease in each measurement compared to other etiologies. Females revealed statistically significant and early improvement in both biochemical markers i-e TSH and FT4 at all point of time (normalization of TSH at 6 weeks, increased TSH / and normalization of FT4 at 3, 6 and 12 months) in comparison to males who showed statistically significant improvement in TSH in all points of measurement. Patients with aged greater than 40 years observed early response after RAI by normalization of FT4 at 6 weeks compared to those aged < 40 years. The treatment failure rate was 24.5% at 6 and 12months whereas successful treatment was noticed in 35%, 56%, 75.6%, 75.6% at 6 weeks, 3,6,12 months respectively. Female Participants with Graves’ disease of age greater than 40 years responds better and early to RAI treatment by achieving successful treatment goals compared to elderly males with underlying diagnosis other than graves for hyperthyroidism.

The Significance of Local Intraoperative Hemostasis and Laser Influence in the Prevention and Treatment of Complications During Thyroid Surgery

The article presents the results of clinical studies on the development of a method for local intraoperative hemostasis and improvement of reparative processes during operations on the thyroid gland. For clinical evaluation of the effectiveness of the proposed method, two study groups were formed for 237 patients with mixed, nodular and diffuse toxic goiter. The main group consisted of 98 patients, and the comparison group - 139. In the main group of operated patients, hemostasis was carried out according to the method developed by us, and in the comparison group, by traditional methods. Surgery included thyroidectomy, hemithyroidectomy, and subtotal thyroidectomy. In the main group of patients, for the purpose of hemostasis, Hemoben powder crystals with a size of 25-50 microns were used at the rate of 200 mg per area of 8-9 cm2, which was applied over the wound with a thin layer until a thin translucent film was formed, followed by irradiation of the wound with low-energy laser radiation (Sogdiana apparatus) with a wavelength of 0.89 microns, a frequency of 500 Hz for 2 minutes at a distance of 5 cm from the wound; then, for 5-7 days, percutaneous irradiation sessions with the same laser at a frequency of 80 Hz were performed daily in the projection of the surgical wound. The study showed that the use of the domestic hemostatic agent Hemoben provides complete hemostasis, and the addition of the technique by treating the surgical field with low-intensity laser radiation enhances the reparative properties of the drug. The proposed method for local hemostasis and improvement of reparative processes during thyroid surgery is characterized by a quick, effective and stable stop of bleeding, prevents the development of lymphohemorrhagic complications, and also reduces the frequency of early postoperative complications due to intra- and postoperative laser exposure.

Postoperative Hypocalcemia in Hyperthyroid Patients: The Parathyroids Aren't Always to Blame

IntroductionHypocalcemia is commonly reported after thyroidectomy and has multiple possible etiologies including: parathyroid devascularization, reactive hypoparathyroidism from relative hypercalcemia in thyrotoxicosis, and abrupt reversal of thyrotoxic osteodystrophy. In patients that are actively hyperthyroid and undergoing thyroidectomy, it is not known how many experience hypocalcemia from nonhypoparathyroidism etiologies. Therefore, our aim was to examine the relationship among thyrotoxicosis, hypocalcemia, and hypoparathyroidism. MethodsA retrospective review was performed of prospectively-collected data from all patients undergoing thyroidectomy for hyperthyroidism by 4 surgeons from 2016 to 2020. All patients carried a diagnosis of Graves’ disease or toxic multinodular goiter. Patient demographics, preoperative medications, laboratory reports, and postoperative medications were reviewed. Hypocalcemia within the first month of surgery despite a normal parathyroid hormone (PTH) level was the primary outcome of interest and was compared between patients with and without thyrotoxicosis. Secondary outcomes were duration of postoperative calcium use and the relationship between preoperative calcium supplementation and postoperative calcium supplementation. Descriptive statistics, Wilcoxon rank-sum, and chi-square tests were used for bivariate analysis, as appropriate. ResultsA total of 191 patients were identified, with mean age of 40.5 y (range 6-86). Most patients were female (80%) and had Graves’ disease (80%). At the time of surgery, 116 (61%) had uncontrolled hyperthyroidism (thyrotoxic group, Free Thyroxine >1.64 ng/dL or Free Triiodothyronine > 4.4 ng/dL), with the remaining 75 (39%) considered euthyroid. Postoperative hypocalcemia (calcium < 8.4 mg/dL) developed in 27 (14%), while hypoparathyroidism (PTH < 12 pg/mL) was observed in 39 (26%). Thyrotoxic patients comprised a majority of those with hypocalcemia (n = 22, 81%, P = 0.01) and hypoparathyroidism immediately following surgery (n = 14, 77%, P = 0.04). However, a majority of initially hypocalcemic, thyrotoxic patients had normal PTH values within the first month after surgery (n = 17, 85%), pointing to a potential nonparathyroid etiology. On bivariate analysis, no significant relationship was found for thyrotoxic patients with initial postoperative hypocalcemia (18%) and hypoparathyroidism <1-month after surgery (29%, P = 0.29) or between 1 and 6 mo after surgery (2%, P = 0.24). Of the 19 patients in the nonhypoparathyroidism group, 17 (89%) were off all calcium supplements by 6 mo postop. ConclusionsIn patients with hyperthyroidism, those in active thyrotoxicosis at time of surgery have a higher rate of postoperative hypocalcemia compared to euthyroid patients. When hypocalcemia lasts >1 mo postoperatively, data from this study suggest that hypoparathyroidism may not be the primary etiology in many of these patients, who typically require calcium supplementation no more than 6 mo postoperatively.

Long-term effects of radioiodine treatment on thyroid functions and ultrasonographic features in patients with toxic adenoma and toxic multinodular goitre.

This study aimed to investigate the long-term effect of radioiodine (RAI) treatment on thyroid functions and ultrasonographic changes in the thyroid gland and toxic nodules. Thyroid function tests and ultrasonography reports of patients diagnosed with toxic adenoma (TA) or toxic multinodular goitre (TMNG) between 2000 and 2021 were retrospectively analysed. We included 100 patients whom thyroid function and ultrasonography results were obtained from our outpatient clinic before and at least 36months post-RAI. At the end of the follow-up period, the mean thyroid volume reduction in patients with TA and TMNG was 56.6% ± 3.1% and 51.1% ± 6.7%, respectively; the mean volume decrease of all toxic nodules was 80.5% ± 1.9%. The volume of the thyroid and toxic nodules was significantly reduced up to 12years (p < 0.01). Between 3 and 10years after RAI therapy, the annual incidence of hypothyroidism was 2.0% and 1.5% in the TA and TMNG groups, respectively. Toxic nodules were more frequently solid and hypoechoic in post-RAI ultrasounds (p < 0.01). The volume of thyroid gland and toxic nodules continuously decreases, as the risk of hypothyroidism increases up to 10years after RAI treatment. After RAI treatment, patients should be followed up to check their thyroid functions. In post-RAI examinations, toxic nodules may show ultrasonographic features suspicious for malignancy. History taking should include previous RAI therapies and old scintigraphy scans should be evaluated to avoid unnecessary procedures and non-diagnostic biopsy results.

Application of oral inorganic iodine in the treatment of Graves' disease.

Iodine is a crucial trace element for the human body and the basic raw material for the synthesis of thyroid hormones. Oral inorganic iodine includes dietary iodine and therapeutic iodine, both of which are closely associated with thyroid immunity and metabolism. Graves' disease (GD), also known as diffuse toxic goiter, is characterized by hyperthyroidism and high iodine metabolism. Clinically, patients diagnosed with GD are often asked to limit iodine intake or even avoid iodine in their diet. The latest research has demonstrated that the interference of dietary iodine with antithyroid drugs (ATDs) treatment may be overestimated. In addition, as a medication for GD treatment, the administration of inorganic iodine has shown positive results in patients with mild hyperthyroidism, a low thyroid autoantibody concentration, a small thyroid volume, a high iodine diet and so on. Inorganic iodine may also be used as an alternative when patients experience side effects with traditional ATDs and for those who still prefer conservative treatment. Due to its low teratogenicity, blood toxicity and bone marrow toxicity, inorganic iodine plays a unique role in special populations, such as pregnant or lactating patients and patients receiving tumor radiotherapy or chemotherapy. In this review, the research progress, biological function, doses and effects, applicable populations and specific applications of dietary iodine and therapeutic iodine are summarized to provide references for the diagnosis and treatment of GD, thus improving the quality of life of GD patients.

Clinical case of development of thromboembolism after thyroidectomy with concomitant diseases

Objective. To study a clinical case after a planned thyroidectomy. Venous thromboembolism in the form of deep vein thrombosis or LE is the third most common in the world, being the second only to myocardial infarction and stroke. In epidemiological studies, the annual incidence of pulmonary embolism ranges from 39 to 115 persons per 100 000 of the population; for deep vein thrombosis, the incidence rates range from 53 to 162 per 100 000 of the population. The cross-sectional analysis data show that the frequency of venous thromboembolism is almost 8 times higher in persons over 80 years of age than in the fifth decade of life. Pulmonary embolism is a stop of blood flow in the branch of the pulmonary artery due to obstruction by a clot. The most frequent places of blood clots are the deep veins of the lower extremities. Risk factors for thromboembolism may be surgical operations, varicose veins, age, overweight. This is one of the most common and severe complications of the postoperative period. Our article considers a clinical example of the development of thromboembolism after thyroidectomy, presents the results of pathomorphological studies, autopsy, histological studies.&#x0D; Materials and methods. The work consisted in the study of a clinical case of pulmonary embolism after a planned surgical intervention for nodular goiter. Histological sections of organs such as the heart, kidneys, gallbladder, thyroid gland, liver were studied.&#x0D; Results. The results of our study showed that thyroidectomy refers to operations of a high complexity and high risk of multiple complications as well as the occurrence of a fatal outcome. Therefore, a thorough examination of all organs and systems in patients is necessary, especially those who belong to the elderly and severe comorbid pathology groups. This is due to the fact that the risk of death without a proper preparation for surgery with available concomitant diseases (nodular colloidal goiter, empyema of the gallbladder, Gilbert's disease, persistent hepatitis, type 2 diabetes mellitus, hypertension, chronic coronary heart disease) was very high for this patient.&#x0D; Conclusions. Diffuse nodular toxic goiter is a complex surgical pathology involving many organs and systems. Patients with such a diagnosis require a thorough history collection, carrying out clinical, instrumental and laboratory research methods, including successful surgical intervention.

ВЛИЯНИЕ ПАНДЕМИИ COVID-19 НА ХИРУРГИЮ ЩИТОВИДНОЙ ЖЕЛЕЗЫ: РЕТРОСПЕКТИВНОЕ ИССЛЕДОВАНИЕ

Introduction. The COVID-19 pandemic has affected the pathomorphism of many diseases due to the pathophysiological impact of the infectious process and its drug therapy, and sometimes due to changes in the organization of medical care. During the pandemic, the number of patients with thyroid nodules has increased. Aim. To analyze the impact of the COVID-19 pandemic in Crimea on the surgical aspects of thyroid diseases. Material and methods. A study was made of the impact of the COVID-19 pandemic in Crimea on the surgical aspects of thyroid diseases. Statistical work was carried out with the data of the conclusions of cytological and pathomorphological diagnostics in 1244 patients during the period before, during and after the pandemic. A detailed analysis of cytology according to Bethesda was performed with the calculation of the percentage of conclusions of classes I-VI, morphological data of histological studies with a detailed assessment of malignant neoplasms. Results and discussion. After the start of the epidemic, at the preoperative stage of diagnosing thyroid nodules, an increase in the percentage of nodes with signs of cancer was noted compared to the period of 2019. During the pandemic, a reversible increase in the number of operations for toxic goiter and an irreversible increase in the proportion of malignant tumors were established; an increase in the incidence of B-cell adenomas; the prevalence after the pandemic of more differentiated forms of cancer with a low-risk prognosis, as well as tumors at earlier stages. Such dynamics is probably associated with a complex of factors: antigenic mimicry of the virus, its tropism for thyrocytes, stress and immunosuppression, paradoxically more timely seeking surgical care. Conclusion. The pandemic is characterized by an increase in the number of patients with primary manifestations of thyroid diseases, an increase in the number of toxic goiters and adenomas against the background of gland hyperfunction, a change in the incidence of papillary cancer - an increase in the number of patients, but the identification of prognostically more favorable forms.

Severe thrombocytopenia in a patient with diffuse toxic goitre

Abstract Introduction Diffuse toxic goitre is an autoimmune disorder with a marked prevalence in women. Thrombocytopenia may coexist with diffuse toxic goitre. Nevertheless, the mechanisms of decline in platelet count alongside with autoimmune thyroid disease have not been extensively investigated. Clinical Case A case of diffuse toxic goitre is reported in a 55-year-old man who has been receiving continuous treatment with methimazole for 7 years. The physical examination revealed an asthenic man, with an enlarged thyroid gland, inactive bilateral orbitopathy and multiple ecchymosis, but no lymphadenopathy or hepatosplenomegaly. Laboratory analysis revealed suppressed thyroid stimulating hormone (TSH) 0.01 mlU/ml, normal free T4 level 21.60 pmol/l, increased free T3 6.99 pmol/l and thyroid stimulating immunoglobulin (TSI) level of 23.60 IU/L. Complete blood count revealed severely decreased platelets 3×10^9 / l, decreased hemoglobin 110.00 g/l and hematocrit 21.90%, normal leucocytes 9.58×10^9/l, low prothrombin Index 11% and International normalized ratio (INR) 7.00. Additional serological investigations excluded HIV infection and C viral hepatitis. The bone marrow aspiration disclosed a rich cellular and polymorph marrow, an increased number of megakaryocytes suggesting that the thrombocytopenia is due to platelet destruction. The patient has recovered from viral pneumonia caused by SARS-COV-2, 1 month prior to the medical consultation. He received platelet transfusion and was started on 1 mg/kg oral prednisolone followed by a gradual taper and improvement of platelet count. Thrombocytopenia observed in diffuse toxic goitre may be mediated by both metabolic and immunological phenomena. In our case, the following causes may be considered: (1) an overlapping autoimmune process; (2) methimazole creating destructive antibodies; (3) COVID-19 disease. An autoimmune process is capable of triggering both conditions by activation of the reticuloendothelial system by thyroid hormones along with a cross-reaction between thyroid antibodies and platelet epitopes. Methimazole generates a drug-dependent immune response against platelets, involving platelet endothelial cell adhesion molecules and thus provoking thrombocytopenia. SARS-CoV-2 can induce thrombocytopenia by increasing the number of autoantibodies and immune complexes that destroy platelets. Lung damage by decreasing pulmonary capillary bed and platelet aggregation in the lungs indirectly leads to a reduced number of circulatory platelets. Conclusion Severe thrombocytopenia was detected in a patient with Grave's disease, in whom the number of platelets was 50 times below the lower limit of the reference range. Coexistence of thrombocytopenia may be explained by (1) an overlapping autoimmune process; (2) the effect of methimazole; (3) its occurrence or aggravation secondary to COVID-19.

Prevalence of thyroid cancer in hyperthyroidism: Identifying risk factors for malignancy

Objective: Contrary to the previously held belief that hyperthyroidism may be protective against the development of cancer, a growing number of studies suggest a link between hyperthyroidism and thyroid cancer. The purpose of this study is to investigate the incidence of malignancy in patients undergoing total thyroidectomy for hyperthyroidism with toxic adenoma (TA), toxic multinodular goiter (TMNG), and/or Graves' disease (GD), and to identify factors predictive of malignancy. Materials and Methods: This is a retrospective study of patients aged 18 years and older who underwent total thyroidectomy for toxic adenoma and toxic multinodular goiter associated with hyperthyroidism and Graves' disease. Thyroidectomies were performed by a single surgeon at a tertiary teaching hospital between January 2014 and December 2020. Our cohort was divided into two separate groups based on whether the pathology results were malignant or benign. Results: Between January 2014 and December 2020, 199 patients were included, 66.3% were female and the average age was 44.6 years. Hyperthyroidism cases included 52.7% toxic multinodular goiter (TMNG), 9.1% toxic adenoma (TA), and 38.2% Graves’ disease (GD). The cohort revealed a 32.6% thyroid cancer incidence in hyperthyroid patients. The leading malignancy was papillary carcinoma. Hyperthyroidism causes significantly predicted malignancy; TMNG had a 42.8% malignancy rate, compared to 22.4% for GD and 16.3% for TA (p=0.005). Fine needle aspiration biopsy (FNAB) findings were significant for malignancy prediction (p=0.001), with 62.9% malignancy after non-diagnostic FNAB results. Conclusion: The study emphasizes the need for careful consideration of malignancy risk in hyperthyroidism cases. Factors such as FNAB results and the type of hyperthyroidism condition significantly influenced malignancy prediction. The results underscore the necessity for a thorough evaluation of hyperthyroid patients at risk of malignancy.