THE MODERN ASPECTS OF SURGICAL TREATMENT OF DIFFUSE TOXIC GOITER

Abstract

The presented literature review demonstrates the current aspects of surgical treatment of diffuse toxic goiter. Given the high prevalence of benign thyroid diseases, including the working population, the issue of choosing an effective treatment for diffuse toxic goiter is relevant. There is no comprehensive approach to the treatment of such patients. Surgical treatment was limited for a long time, and now radioiodine therapy dominates in many countries (USA, Western Europe). There is an increase in the number of thyroidectomies, which may be due not only to an increase in benign thyroid diseases, but also to the high effectiveness of this treatment method. Surgical treatment is widely used in Russia, Japan and Eastern Europe. In complicated forms, thyroidectomy is the only possible treatment method, assistance to such patients is provided as part of high-tech medical care. Indications for thyroidectomy according to federal clinical recommendations are the retrosternal location of goiter, diffuse and nodular goiter with compression syndrome, and patient refusal from radioiodine therapy. Foreign authors recommend expanding these indications, stating that thyroidectomy is the fastest and most effective way to eliminate thyrotoxicosis. Preoperative management involves the correction of thyrotoxicosis with antithyroid drugs until the euthyroid state is reached. With the development of pharmacology, hypothyroidism is no longer a complication of thyroidectomy. Postoperative hormone replacement therapy with levothyroxine preparations does not reduce the duration and quality of life in patients after thyroidectomy compared with healthy people. The negative results of treatment of postoperative hypothyroidism can be explained by the low compliance of patients to treatment. When performing organ-preserving operations, there is a risk of thyrotoxicosis recurrence, which will require a second operation. Based on this, there is no doubt that it is thyroidectomy that is the “gold standard” when choosing an operation for Graves’ disease. Postoperative hypocalcemia and laryngeal paresis remain the most discussed complications of thyroidectomy worldwide. Methods for their correction are being actively developed. The use of intraoperative monitoring made it possible to prevent injuries of the recurrent laryngeal nerve during thyroidectomy. Complications such as hemostasis and postoperative lymphorrhea are less28 frequently reported in the literature, but are also an urgent problem, as they can cause the development of other conditions that significantly worsen the results of treatment of diffuse toxic goiter. The data presented on the use of new technologies during surgery to achieve hemostasis, such as Harmonic or Ligasure, can significantly reduce the time of surgery. Mention of intraoperative diffuse bleeding is practically not found in the available literature. There are no studies aimed at studying changes in the vasomotor and hemostatic function of the endothelium in preparing patients for surgery for toxic goiter. Many authors for a long time tried to develop predictors of complex thyroidectomy, the scale of the complexity of thyroidectomy. Convincing data that could be used in practice has not been obtained. An analysis of the literature data indicates the relevance of complications of toxic goiter and the constant search for new methods of surgical and drug prevention of complications. Reducing the frequency of complications is an important task of modern surgery.