Nodular Thyroid (non-toxic) goiter
It
is estimated that more than 1 billion people in the world live in iodine
deficient areas, which includes the Trans-Caucasus, Russia, Continental Europe,
Central parts of Africa, almost all areas in South America. Iodine deficiency
and the lack of its supply is the most common manifestation of a diffuse (whole
thyroid gland ) thyroid ( non-toxic ) goiter, without the gland functional
disorders. With iodine deficiency the enlargement of the thyroid gland is a
compensatory reaction, where the deficiency of " construction
material" iodine in the thyroid, is compensated by thyroid enlargement to
ensure the adequate hormonal synthesis. The most common manifestation of iodine
deficiency is of the development of nodular goiter. Nodes develop 2-4 - times
more frequently in women. Various studies revealed that the possibility of
malignancy in thyroid unit of palpable nodes is up to 5%. Nodular goiter
treatment: Conservative treatment can only be applied to nodular, colloid
goiter cases, when a node is larger than 3 cm in diameter. Predominantly such a nodular formations occur.
The goal of the treatment is to reduce the size of the nodes. Before treatment,
patients with nodes greater than 1 cm in diameter undergo the node biopsy,
which provides confirmed cytological diagnosis. If cytologically it is
determined that the thyroid gland shows follicular ademona and malignant tumor
is suspected, surgical treatment is indicated.
Indications for Surgery
Patients requiring surgery fall
under the following categories :
• Patients with an
established diagnosis of thyroid cancer .
(Timely operation results
into 95% - rate of full recovery) ;
• Patients of any size and
number of nodular thyroid
Formations, which may be
susceptible to turn into malignant tumors based on the biopsy results
• Patients with rapidly
growing nodular formations.
(Nodes increase twice in
size in half a year )
• Patients with nodes of
larger than 3cm – regardless of biopsy results
• Patients with chronic
nodular formations in case of autoimmune thyroiditis
( increased risk of
malignant tumors )
• Patients who have difficulty
in breathing and swallowing due to enlarged gland (due to diffuse gland or
nodes)
Surgery
Operations are carried out
in the thyroid gland using the general anesthesia (narcosis) , which gives the
opportunity to achieve better results in the treatment; reduces the risk of
complications and protects the patient from emotional trauma . Transaction
volume is determined by the nature of the injured gland, in some cases, the
patient's age and sex is also taken into account.
At
present, the thyroid gland operations include Hemithyrodectomy (partial excision
of the gland), and Thyrodectomy (excision of the full gland) . Previously
accepted operations were removal of some nodular growths in the thyroid gland has
been considered to be fallacious, since the majority of patients had to go
through necessary repeated interventions due to degeneration of parts of the nodes.
After the surgery in our clinic, all patients get cosmetic stitches. Surgeons
modern sewing materials and our experience gives us the opportunity to achieve
the best results in the majority of patients; postoperative scar remains almost
invisible.
Post operative period
Typically,
patients are released from the hospital on the second day after the operation. Stitches
are removed on the 5th-7th day. Based on the scale of the operation,
patients are prescribed hormonal treatment , which aims to compensate for the
missing functions of the thyroid tissue to prevent the growth of new nodular
growths . Hormonal treatment is prescribed under the supervision of an endocrinologist
with individual dose of the drug prescribed selectively; The dosage of the
hormonal treatment should align exactly with the need based on the size of the extracted gland tissue. Individual dose
of hormones is monitored by the endocrinologist in every 6 months.
Important notes
Patients
easily tolerate thyroid gland surgery and recover soon. The operation will take
place almost without a trace and with minimal side effects. However, operations
on the thyroid gland, are considered as one of the most complex and delicate
surgeries; Such operations should be performed only by highly skilled surgeons
who have mastered both surgical and microsurgical techniques at the highest
level.
Diffuse toxic goiter
goiter is a type of
hyperthyroidism, which is a cause of generalized increase in thyroid activity
(overall). It is names as " Diffuse " - because the pathologic
process involves the entire thyroid gland. "Toxic" because the
patient feels fever as if he has an increased temperature, as an infectious
disease. " Goiter " - because the thyroid gland is enlarged.
Causes for Diffuse toxis goiter have not be fully researched,
howevery certainly a leading role in the development of diffuse toxic goiter is
a dysfunction of the immune system , which protects us form bacteria and
viruses, as well as formation of
abnormal cells such as cancer cells.
10-15 % of people are affected by the immune system problems,
which can be inherited. In case of diffuse toxic goiter antibodies are produced
against certain proteins, which are located on the surfaces of cells in the
thyroid gland. As a result, gland cell stimulation occurs, with a focus on
increased production of hormones, followed by the hyperfunction of the thyroid
gland.
The disease occurs predominantly in women, 8 - times more often
than in men. Develops mainly middle-age (30 - to - 50 years), but it is also
quite common in adolescents and young patients, during pregnancy and menopause
, and in patients who are over 50 years of age.
Diffuse Toxic Goiter – indications for the surgical treatment:
. The large size of goiter (45 ml or more) ;
. Disease recurrence after conservative therapy;
. increased sensitivity towards thyreostatics;
. Node is palpable in thyroid gland;
. Goiter location behind
the breast;
. Pregnancy or planned pregnancy.
Surgery
Conducted only after reaching a state of compensation, because,
otherwise, the early operation may develop a thyreostatic crisis. Operations
are carried out with general anesthesia (narcosis) , which gives better treatment
results, reduces the risk of complications and protects patients from emotional
traumas. To prevent recurrence of the disease, ( maximum ) marginal subtotal resection ( maintaining 4-6 gr of thyroid tissue) , or complete
thyrodectomy (complete removal of the thyroid gland) is performed. After the surgery in our clinic, all patients get cosmetic
stitches. Surgeons modern sewing materials and our experience gives us the
opportunity to achieve the best results in the majority of patients;
postoperative scar remains almost invisible
Post operative period
Typically,
patients are released from the hospital on the second day after the operation. Stitches
are removed on the 5th-7th day. Based on the scale of the operation,
patients are prescribed hormonal treatment , which aims to compensate for the
missing functions of the thyroid tissue to prevent the growth of new nodular
growths . Hormonal treatment is prescribed under the supervision of an endocrinologist
with individual dose of the drug prescribed selectively; The dosage of the hormonal
treatment should align exactly with the need based on the size of the extracted gland tissue. Individual dose
of hormones is monitored by the endocrinologist in every 6 months.
Important
notes
Patients
easily tolerate thyroid gland surgery and recover soon. The operation will take
place almost without a trace and with minimal side effects. However, operations
on the thyroid gland, are considered as one of the most complex and delicate
surgeries; Such operations should be performed only by highly skilled surgeons
who have mastered both surgical and microsurgical techniques at the highest
level.
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removal
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