Epidemiology and results of surgical treatment of euthyroid and toxic goiter depending on the peculiarities of clinical course, tracheal compression and comorbidity

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Abstract


BACKGROUND: At the time of seeking medical help, some patients have nodular/multinodular goiter of large and gigantic sizes, which leads to compression of the neck organs. In the structure of benign diseases, neck compression is diagnosed in 10% of cases, and tracheal narrowing is found in 84% of patients in this group. It was experimentally established that narrowing of the trachea leads to the development of hypertension in the pulmonary circulation. Patients with nodular/multinodular goiter with compression of the neck organs belong to the age group of 50 years and older, the peculiarity of which is comorbidity of varying severity. Cardiopulmonary syndromes may mask compression of the organs of the neck by the thyroid gland. As a rule, patients come and/or go to a cardiologist, pulmonologist, gastroenterologist and other specialists, as a result of which the timelines for timely surgical treatment are missed. Often, patients are delivered to the endocrine surgeon urgently due to the development of asphyxiation. The symptoms of impaired external respiration and the initial manifestations of pulmonary hypertension, as a result of compression syndrome, preceding this condition are evaluated only retrospectively.

AIMS: To study the frequency of tracheal compression and symptoms of chronic hypoxia in the structure of benign thyroid diseases requiring surgical treatment, as well as an assessment of the nature of comorbid pathology and the results of surgical treatment.

METHODS: A retrospective analysis of the results of surgical treatment of benign thyroid diseases for the period from March to August 2019 was carried out (100 observations).

RESULTS: Toxic goiter prevailed in the structure of benign thyroid diseases (74%). Tracheal compression was observed in 69% of cases. When trachea was compressed, arterial hypertension statistically significantly prevailed (χ2, p≤0.01). The appearance of «wheezing» on inhalation/exhalation and an increase in its frequency were detected when the trachea narrowed to the thyroid gland to 10 mm or less in 10 cases (10%) with a statistically significant prevalence of pulmonary hypertension (χ2, p≤0.01). Thyroidectomy prevailed in the structure of operations (80%). There was no statistically significant increase in surgical complications depending on the severity of tracheal compression, age, and concomitant pathology. There were no fatal outcomes.

CONCLUSIONS: Surgical treatment of patients with benign thyroid diseases complicated by compression of the neck organs is also shown safely regardless of age and associated pathology.


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About the authors

Elena A Ilyicheva

Irkutsk Scientific Centre of Surgery and Traumatology;
Irkutsk Regional Hospital

Email: lena_isi@mail.ru
ORCID iD: 0000-0002-2081-8665
SPIN-code: 3624-4643
Scopus Author ID: 16833579000

Russian Federation, 1, Bortsov Revolyutsii Street, 664003, Irkutsk, Russian Federation; 100, Yubileyniy disrict, 664049, Irkutsk, Russian Federation

MD, Professor, Head of the Scientific Department of Clinical Surgery; Thoracic surgeon of thoracic surgical unit

Gleb A Bersenev

Irkutsk Scientific Centre of Surgery and Traumatology

Email: glbersenev17@gmail.com
ORCID iD: 0000-0002-6887-8325

Russian Federation, 1, Bortsov Revolyutsii Street, 664003, Irkutsk, Russian Federation

Postgraduate

Valeriy N Makhutov

Irkutsk regional Hospital

Email: lena_isi@mail.ru
ORCID iD: 0000-0001-7318-7193
SPIN-code: 7627-5484

Russian Federation, 100, Yubileyniy disrict, 664049, Irkutsk, Russian Federation

PhD, Head of thoracic surgical unit

Gennadiy Yu Aldaranov

Irkutsk Regional Hospital

Email: aldaran87@mail.ru
ORCID iD: 0000-0003-3123-1939

Russian Federation, 100, Yubileyniy disrict, 664049, Irkutsk, Russian Federation

Thoracic surgeon of thoracic surgical unit

Eugene G Grigoryev

Irkutsk Scientific Centre of Surgery and Traumatology;
Irkutsk State Medical University

Author for correspondence.
Email: egg@iokb.ru
ORCID iD: 0000-0002-5082-7028
SPIN-code: 8969-4112
Scopus Author ID: 6603077953
ResearcherId: H-7659-2016

Russian Federation, 1, Bortsov Revolyutsii Street, 664003, Irkutsk, Russian Federation; 1, Krasnogo Vosstaniya Street, 664003, Irkutsk, Russian Federation

Corresponding member of RAS, MD, Professor, Scientific Director, Head of hospital surgery chair

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Copyright (c) 2020 Ilyicheva E.A., Bersenev G.A., Makhutov V.N., Aldaranov G.Y., Grigoryev E.G.

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