Endocrine Abstracts (2013) 32 P330 | DOI: 10.1530/endoabs.32.P330

Persimonious indications for thyroidectomy in chronic thyroiditis

Mihai Radu Diaconescu, Mihai Glod, Ioan Costea, Mirela Grigorovici & Smaranda Diaconescu

1‘Gr T Popa’ University of Medicine and Pharmacy, IV th Surgical Clinic, Iasi, Romania; 2‘Gr T Popa’ University of Medicine and Pharmacy, Vth Pediatric Clinic, Iasi, Romania.

Background: Chronic inflammatory processes of the thyroid represents an important proportion of the gland’s pathology but the majority of them must be treated by nonsurgical methods, thyroidectomy remaining circumstantially indicated.

Patients and methods: In 14 cases (3%) from 464 operations for different thyroid lesions lesions we have encountered authentic inflammatory processes in nine cases of Hashimoto’s thyroiditis (two associated with papillary thyroid carcinoma and one with malignant lymphoma), two cases of Riedel’s thyroiditis and de Quervain’s thyroiditis , tuberculous thyroiditis and thyroid actinomycosis one case each respectively. The clinical and imaging data: biological evaluation and titer of the antibodies but the intraoperative estimations together with the paraffine examination were determinative for the diagnosis.

Results and discussions: Firm diagnosis of thyroiditis was rarely affirmed before the operation, indication for surgery being formulated on clinical criterions dominated by the cancer suspicion. Among them the diffuse or (multi)nodular thyromegaly with a dominant nodule with recent apparition and accelerate growing, hard consistence, compressive or celsian features and adenopathy in temporal or geographic proximity of the Cemobyl disaster.

More added the imaging tests but especially the suspect aspects of the FNAB (follicular smears or with Hurthle cells) and also of the frozen sections. Certainty diagnosis was established by the paraffin examination not always without hesitations or re-examinations (In one case of Hashimoto’s thyroiditis the final diagnosis was a malignant lymphoma). A large near total removal of the thyroid gland decided after Intraoperative findings induced for the most of our patients an obvious tendency toward hypothyroidism which must be monitorised and corrected for prolonged periods.

Conclusions: All the diagnosis resources must be exhausted for the precise diagnosis of the inflammatory lesions of the thyroid to avoid the unnecessary surgery. On the other side the overstimulation by the TSH of the thyroid tissue affected by the inflammatory process represent an important neoplasia producing stimulus.

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