STUDY OF POST-OPERATIVE LONG-TERM RESULTS OF NODULAR EUTHYROID GOITERS OCCURING IN CHILDHOOD AND AT JUVENILE AGE

R.H. HUSEYNOV, SH.N. BAGHIROVA

Scientific Center of Surgery named after acad. M.A.Topchubashov, Baku, AZERBAIJAN

Postoperative rehabilitation period of patients with nodular euthyroid goiters occuring in childhood and at juvenile age, hormonal state, structure of the thyroid gland, recurrence, physical growth and development, etc. were investigated because of their urgency. 32 operated patients were exposed to repeated examinations (29 girls, 3 boys). Examinations were carried out 2-18 years after the operation. Hypothyroidism was detected in 21 (65,6 %) during hormonal examination. In 10 (31,2%) of them, hypothyroidism is determined visually from the clinical point of view. So, the patient did not seek medial advice and take hormonal preparation within 5-10 years. During the ultrasound examination of patients with clinically and hormonally confirmed hypothyroidism, in 2 patients there was detected enlargement of the node up to 2.0 cm, in 5 patients - diffuse enlargement of the gland, and in the rest - insignificant evident structural changes. In 2 of 11 patients euthyroidism was obtained by means of hormonal preparations. Despite the intake of hormonal preparations hypothyroidism was detected clinically in 11 patients (xerodermia, skin pallor, swelling, general weakness). When comparing pathomorphological examinations and current state of patients, signs specific of autoimmune thyroiditis prevailed in the thyroid gland of 13 (61,9%) of 21 patients with hypothyroidism. In 8 of them there was determined menstrual irregularities, miscarriage, sterility, weak working capacity of 1 male patient. Investigations determined, that the more was the preoperative enlargement degree of the thyroid gland (including a node or nodes), the more were encountered postoperatively developed hypothyroidism. Hypothyroidism was determined during hormonal examination of 2 patients with recurrence. Hypothyroidism developed in the majority of patients (23 patients-71,9%) after the operation carried out in the thyroid gland. The main reasons of the its development include postoperative intensification of autoimmune process in the thyroid gland, wrong correction of the hormonal background by means of medicinal preparations or non-intake of the preparations. Postoperative hypothyroidism has favorable prognosis, thus, it is possible to prevent it by dynamic check-up of thyroid hormones. Untimely prevention of hypothyroidism in childhood and at juvenile age, may lead to weakening of physical, mental and sexual development, and as a result negatively influences further engagement in normal professional, scientific and social activities.

RESULTS OF SURGICAL TREATMENT OF DIFFUSE TOXIC GOITERS OCCURING IN CHILDHOOD AND AT JUVENILE AGE

R.H. HUSEYNOV, SH.N. BAGHIROVA

Scientific Center of Surgery named after acad. M.A.Topchubashov, Baku, AZERBAIJAN

Diffuse toxic goiter (DTG) is one of diseases occurring in childhood and at juvenile age. Reasons of the disease include endogenous, exogenous factors, endocrine glands disturbance, genetic susceptibility, immune insufficiency etc. In the course of 30-year activity of the endocrine surgical department of the SSC, 36 patients were examined and treated for DTG. 13 of them were invited to the clinic and exposed to repeated examinations. Repeated examinations of patients were conducted 3-15 years later. Average age of patients range between 12-29 years. Their anamnestic data was collected, hormonal and ultrasound examinations were conducted. According to some literature thyrotoxicosis was removed in 45%, and according to our data – in 95% of cases. In 1 patient (7,7%) thyrotoxicosis recurred 8 months later the operation. So far it is about 1 year that the patient outpatiently takes thyreostatic preparations. In 5 patients (38.5%) signs of hypothyroidism were determined hormonally. Despite that one of them took hormonal preparations, the level of TSH in the blood was high. The results of the surgical treatment were affected by the degree of autoimmune process in the thyroid gland. As signs of autoimmune thyroiditis were immunologically and morphologically detected in 5 patients, clinically, hypothyroidism is more evident in them. Signs of dysmenorrhea, uterine fibroid tumor, mastopathy were observed in 3 of the patients. In 7 patients (53,8%)) hormonal background was normal, no recurrence were observed. Patients do not have problems with physical development and family relations, their ability to study and work is normal. When comparing surgical period and present conditions of patients with DTG it became clear that the more the degree of severity of thyrotoxicosis and enlargement of the thyroid gland, the more was the occurrence of post-surgical hypothyroidism. 2 patients (15,4%) with hypothyroidism associated with exophthalmos underwent examination. Euthyroidism was determined in the patients. Despite this fact, they had mild exophthalmos, and glitter in sclera, and have not taken specific treatment. According to the patients, weight loss was restored about 1 year after the operation. During the ultrasound examination, enlargement of the thyroid gland above norm was determined in 1 patient, small granular structure within the norm – in 10 patients, and under normal, weak hypoechoic structure in 2 patients. In conclusion it should be said that after the operation patients shall stay under regular medical check-up of endocrinologists. They shall be away of heavy manual labor, brain work, nervous stress, and shall be engaged in light manual labor. And the patients with exophthalmos shall continue postoperative specific anti-recurrence and anti-protrusion treatment.

Date: 2014-12-28; view: 819