Clinical importance of thyroid nodules

Abstract

Introduction Thyroid nodules, although they are found in the general population with a rate of 50-65%, have become an interdisciplinary clinical problem in the endocrine surgery, unsolved so far due to their malignancy and lack of consensus on diagnostic-curative management. Purpose Optimization of tactics for diagnosis and surgical treatment of thyroid nodules. Material and methods A sequential clinical study was performed, which included 84 patients (19-69 years), who presented palpable and ultrasonographically thyroid nodules larger than 1 cm, with a rapid growth over a year, associated with “globus” sensation, dysphagia, pain in the anterior cervical region and without positive dynamics after conservative treatment. In addition to routine investigations, patients were examined by serological tests (TSH, FT3, FT4, anti-TPO, anti-TG, calcitonin), Doppler ultrasound, sonoelastography, scintigraphy, fine needle aspiration biopsy and intraoperative extemporaneous histological examination. Results Paraclinical benchmarks of thyroid nodules - elevated serum TSH levels, calcitonin, anti-thyroid antibodies; ultrasonography classes TI-RADS 4,5, scintigraphic "cold nodules", cytopathological Bethesda categories IV, V, VI, correlated with the clinical ones determined the surgical treatment. The volume of surgical interventions was established following the result of the extemporaneous histological investigation: hemithyroidectomies - 68 (80.95%) in benign tumors; total /subtotal thyroidectomy 16 (19.05%) in malignant tumors. Conclusions The clinical importance of thyroid nodules consists of the need to assess the malignant potential, dysfunction of the thyroid gland, the degree of compression on adjacent structures, and solving them by selecting the reasonable method of treatment.