Optimization of diagnostics and medical tactics in node formations thyroid gland
Surgical intervention, as a method of treatment, continues to be considered as the main method today for many diseases of the thyroid gland. When determining the indications for surgical intervention, sometimes the morphological verification of thyroid lesion is neglected, the peculiarities of the e...
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| Formato: | article |
| Lenguaje: | EN RU UZ |
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Open Science LLC
2021
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| Acceso en línea: | https://doaj.org/article/a9bad5cbdb39489788af174423934ca2 |
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| Sumario: | Surgical intervention, as a method of treatment, continues to be considered as the main method today for many diseases of the thyroid gland. When determining the indications for surgical intervention, sometimes the morphological verification of thyroid lesion is neglected, the peculiarities of the etiology and pathogenesis of the disease are not taken into account. There is still a concept that any thyroid nodule is a potential cancer. This approach to thyroid surgery, on the one hand, ends with a large number of unjustified surgical interventions. On the other hand, where the operation is really indicated, it is performed in an inadequate volume. In view of the danger of postoperative hypothyroidism, the tactics of performing organ-preserving thyroid surgeries is quite widespread, even in malignant lesions. As a result of this approach, the number of complications increases, the quality of life of patients decreases, and in addition, the cost of their treatment and follow-up increases. The most common thyroid diseases, in which surgical treatment is widely used, are thyroid tumors and diseases occurring with thyrotoxicosis syndrome (Graves-Basedow disease), multi nodular toxic goiter). Diseases of the thyroid gland have an ambiguous rate of spread not only depending on the region, but also on the age and morphological verification of the process. According to the available literature data, 5-10% of the world's population suffers from nodular changes in the thyroid gland, which are widespread in the population, especially among people of the older age group, which a number of researchers consider as one of the variants of age-related thyroid involution. Multi nodular euthyroid goiter (MUEZ) accounts for 25 to 62%. In Germany, for example, people over 45 are most susceptible to manifestations of nodular changes in the thyroid gland, and the gender distribution of these changes corresponds to 40% in women and 30% in men. According to the US, there are already 100 mil. residents affected by nodular goiter and another 300,000 patients are re-identified annually. According to palpation, in the same USA, thyroid nodules are detected in 4 - 7% of the total population. However, the data of some population studies using ultrasound and autopsy results indicate that in the group of people over 35-40 years old, the prevalence of thyroid nodules reaches 46-50%. Another disease in which surgical treatment is actively used is diffuse toxic goiter (Graves-Basedow disease) - an autoimmune disease characterized by an increase in the production of thyroid hormones under the influence of specific thyroid-stimulating antibodies. The prevalence of DTZ is about 1% of the total population of the world. According to the available literature data, Basedow - Graves' disease is the third, after iodine deficiency goiter and diabetes mellitus, in terms of the frequency of people seeking endocrinological help. DTZ is accompanied by numerous functional disorders of almost all organs and systems of the body, which is associated with a variety of effects of thyroid hormones. Thyrotoxic changes in the cardiovascular system directly threaten the patient's life and require quick and effective treatment. When conducting a survey, radioactive iodine therapy was named the preferred method of treating DTZ; 69% of respondents in the United States, 22% in Europe, 22% in China and 11% in Japan chose it. Despite the fact that most foreign researchers prefer I¹³¹ therapy, some foreign authors recommend expanding the indications for surgical treatment, because this is the fastest way to get rid of thyrotoxicosis. However, despite the fact that the evidence of surgical treatment is real, there are still a number of issues that are quite relevant today. This is, first of all, the occurrence of postoperative complications of various forms; inaccessibility of diagnostics in the conditions of polyclinics and SVPs; insufficient preoperative diagnosis of the thyroid gland. Taking into account all the existing problems of surgical treatment, the question of clarifying the indications for surgical treatment of patients with thyroid pathology remains relevant. |
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