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CNAA / Theses / 2006 / June /

Surgical treatment of benign hyperplastical pathology of thyroid gland coupled with autoimmune changes in thyroid tissue


Author: Oleg Dubinin
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2006
Scientific adviser: Vladimir Hotineanu
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 28 June, 2006
Approved by NCAA on the 28 September, 2006

Abstract

Adobe PDF document1.21 Mb / in romanian

Thesis

CZU 616.441 – 007.61 – 089 – 092:612.017.

Adobe PDF document 1.51 Mb / in romanian
161 pages


Keywords

thyroid gland, autoimmune thyrohyperplasty, subtotal thyroidectomy

Summary

This research reveals the results of surgical treatment of 110 patients suffering different forms of benign hyperplastical pathology of thyroid gland, operated in Surgery Clinics #2, State University of Medicine and Farmaceutics „N. Testemiţeanu”, from 1996 till 1998.

The aim of the research was to improve the diagnostic methods of detection of autoimmune changes in thyroid tissue within the pre-operation period, as well as to optimize the techniques of surgical intervention and to identify the necessary volume of thyroid tissue ablated in compliance with the degree of autoimmune changes detected.

According to the pathology character, the patients were subdivided into three groups.

The first group consisted of patients with diffuse toxic autoimmune thyrohyperplasty.

The second group consisted of patients with nodular autoimmune thyrohyperplasty.

The third group consisted of patients with mixed autoimmune thyrohyperplasty.

Each group investigated comprised a ‘control group’ consisting of patients within whose ablated thyroid tissue autoimmune changes were not morphologically detected. That helped to reveal the characteristic features of autoimmune thyroid aggression on each stage of investigation. There was suggested a diagnostic algorithm consisting of clinical, laboratory, instrumental and cytological stages of investigation.

Patients’ examination according to this algorithm allows revealing autoimmune changes in thyroid tissue within the pre-operation period in up to 90% of cases.

It was proved that surgical treatment of autoimmune thyrohyperplasties is pathogenetically grounded for the result of ablation of antigen producing thyroid tissue is the decrease in the antithyroid antibodies level. This leads to the diminution of the autoimmune aggression degree.

The treatment follow-ups within 5 years after operation were investigated in 52 patients, representatives of all the three groups. In two patients (3.8%) results proved to be unsatisfactory due to the diffuse toxic autoimmune thyrohyperplasty relapse in one case and the development of aggravated postoperative hypothyrosis in the other case.

In 39 cases (75%) the results are assessed as good, in 11 cases (21.2%) – as satisfactory.

Surgical treatment of benign hyperplastical pathology of thyroid gland taking into account autoimmune changes in thyroid tissue combined with subsequent patiens’ monitoring is a guarantee of good results, as well as of complete social and professional reabilitation of the patients.