Experience of implementation of the american thyroid association consensus standards at the general surgery clinic at lviv clinical hospital at jsc "ukrainian railways" of the health center branch

Abstract

The aim of the work: evaluation of the effectiveness of the clinic's medical practice in view of the key provisions of the 2015 American Thyroid Association recommendations aimed at optimizing the surgical treatment of patients with thyroid nodules.

Materials and Methods. Carrying out a critical analysis of the individual positions and guidelines of the 2015 American Thyroid Association. A retrospective study involving 29 patients with cytologically identified cases of viscerally differentiated thyroid carcinoma who underwent surgery for the period 2015–2018 at the Surgical Department of the Lviv Clinical Hospital on Railway Transport.

Results and Discussion. The clinical effects of the updated version of the recommendations of the American Thyroid Association are controversial enough and do not always find unanimous approval from clinicians (in particular, national schools on thyroid disease). One of the possible reasons for this is the extension of indications for lobectomy (hemithyroidectomy) by increasing the admissible tumor size (in some situations up to 4 cm) and, accordingly, reducing the number of patients undergoing thyroidectomy (total thyroidectomy). Total thyroidectomy was performed in all patients in our clinic who were involved in retrospective analysis, which can be explained by the expected low level of patient compliance for long-term follow-up. At the same time, the tactics of preoperative preparation, construction and execution of the diagnostic algorithm and the subsequent management of patients in the General Surgery Clinic, in general, were in line with the recommendations and guidelines of the American Thyroid Association 2015 edition. Detection of the thyroid node involves the implementation of a multi-step algorithm to determine the nature of the neoplasm, which should ensure the formation of an optimal treatment plan and follow-up. The recommendations given, despite their comprehensiveness, play only ancillary role for the clinician in decision making, and finally, a treatment strategy is built for each patient individually.