Remote results of hemithyroidecectomy and their prognosis in patients with unilateral goiter on the background of autoimmune thyroiditis

Authors

  • M. I. Sheremet Ternopil State Medical University, Ternopil
  • V. O. Shidlovskyi ДВНЗ “Тернопільський державний медичний університет імені І. Я. Горбачевського МОЗ України”
  • L. P. Sydorchuk Буковинський державний медичний університет, Чернівці
  • O. V. Shidlovskyi ДВНЗ “Тернопільський державний медичний університет імені І. Я. Горбачевського МОЗ України”

DOI:

https://doi.org/10.11603/2414-4533.2017.4.8320

Keywords:

nodular goiter combined with autoimmune thyroiditis, needle biopsy, apoptosis, proliferation, choice of surgery.

Abstract

The aim of the work: determining the volume of surgical intervention for nodular goiter combined with autoimmune thyroiditis, taking into account the activity of apoptosis and proliferation processes and the proliferative activity index.

Materials and Methods. Immunohistochemical studies using monoclonal antibodies against Ki-67, Fas, and FasL, Bcl-2, and P53 antigens were performed on a puncture material of thyroid gland from 80 patients with histologically verified diagnosis of nodular goiter on the background of autoimmune thyroiditis prior to surgical treatment and 1.5 to 3 years after it. According to remote results, two groups of patients were identified. The first group of 53 patients included cases in which there was no disturbance in the function of the thyroid gland and changes in the volume of the remaining part of the gland compared with the rates before the operation. The second group consisted of 27 patients with clinical and laboratory signs of postoperative hypothyroidism of moderate to severe severity, an increase in the amount of residual gland in the background of progressive lymphoid infiltration. Patients of both groups in the postoperative period received pathogenetically substantiated drug therapy for autoimmune thyroiditis.

Results and Discussion. The conducted studies allow differentiating the choice of volume of surgery – hemithyroidectomy or thyroidectomy, depending on the functional capacity of the thyroid and apoptosis and proliferation in the unharmed node of the lobe of the gland. We believe that thyroidectomy is indicated by combining the following indices of the tested tests: the volume of the unharmed nodule of the thyroid gland is greater than 10 cm³, the TSH level is greater than 3.55 mUN / l, the free T4 is less than 12.91 pmol / l, the thyroid peroxidase antibody level is greater than 80.25 UN / ml and thyroglobulin antibody more than 89.34 UN / ml with incidence of lymphoproliferative activity and apoptosis, in particular PAI (proliferative activity index) Ki-67 higher than 10.55%, IRI (immunoreactive index) FasL – 51 %, IRI Bcl-2 – for 90 %, and IRI p53 below 50 % and IRI F as below 43 %.

Author Biography

M. I. Sheremet, Ternopil State Medical University, Ternopil

MD, PhD, DSc in Medicine, professor of Department of Surgery with Urology №1 by. L.Ya. Kovalchuk, Laureate of the State Prize of Ukraine

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Published

2018-01-15

How to Cite

Sheremet, M. I., Shidlovskyi, V. O., Sydorchuk, L. P., & Shidlovskyi, O. V. (2018). Remote results of hemithyroidecectomy and their prognosis in patients with unilateral goiter on the background of autoimmune thyroiditis. Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (4), 10–16. https://doi.org/10.11603/2414-4533.2017.4.8320

Issue

No. 4 (2017)

Section

ORIGINAL INVESTIGATIONS

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