Endocrine Abstracts (2018) 56 EP162 | DOI: 10.1530/endoabs.56.EP162

Expectant management in patients with multinodular goiter: expected development options

Yuri Aleksandrov1, Artem Dyakiv1 & Vasilyi Semikov2


1Yaroslavl State Medical University (YSMU), Russian Federation, Yaroslavl, Russia; 2First MSMU n. a. I. M. Sechenov Of Ministry Of Healthcare (Sechenovskiy University), Russian Federation, Moscow, Russia.


Today dynamic observation are given preference in most cases multinodular goiter. Small nodes without disruption of thyroid function do not affect the quality of life of patients. Wait-and-see tactic with multinodular goiter has previously been submitted due to the lack of adequate replacement therapy. Wait-and-see tactic previously criticized because of its passivity and predictable negative effect on growth nodes. The result of passive observation is the occurrence of goiters of large size that patients are treated as a minor inconvenience. A retrospective investigation of multinodular goiter large size was made. Over 8 years of experience in the operational treatment were 2519 patients with various thyroid disease (women, 2194, men - 325). Of the total number of patients, we selected 34 cases (1.35%) multinodular goiters. The inclusion criteria in the study were: i) the presence of multiple nodes in thyroid, ii) the mass of the removed thyroid tissue 200 g or more, iii) pathological confirmation of focal lesions of thyroid (macro-microfollicular colloid goiter, thyroid adenoma, thyroid cancer). Assessed clinical and instrumental diagnostic methods in the evaluation of the severity of the changes in the thyroid gland in this disease. Describes the features of performing operations in patients with large multinodular goiters. Presents a clinical case illustrating features of the development, diagnosis, surgical treatment and postoperative rehabilitation of patients with thyroid cancer arising in the background of a giant multinodular goiter. Today there is no clear clinical criteria of the syndrome of compression that would allow to set the indications for surgery. The subjective assessment of well-being, fear of surgery prevent patients adequately assess the effects of high thyroid in human health. The necessary precise regulation of the stages of the monitoring, a must for doctors and patients, as well as an emphasis on instrumental methods in the evaluation of thyroid growing. It is proved that dynamic monitoring in multinodular goiter effective only when adequate monitoring of patients, and with pronounced negative dynamics must be indications for surgery. Among instrumental diagnostic methods the most informative has the x-ray computed tomography.

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