Endocrine Abstracts

JOINT151

Diapeutic manipulations involve simultaneous diagnostic and therapeutic actions. With regard to the thyroid, it’s a combination in the hands of a specialist of non-invasive diagnostic ultrasound and invasive interventions, such as FNAB, sclerotherapy, laser destruction, radiofrequency ablation and HIFU performed under ultrasound control. The evaluation of ultrasound examination protocols of the thyroid in 1235 patients were analyzed. Ultrasound protocols included an assessment of echogenicity, structure, and size of the gland itself, as well as the identification of focal formations (in 1,041 patients; 84.3%), which were described according to the TI-RADS criteria adopted in the clinic (echogenicity, structure, evenness and clarity of contours, shape, vascularization, presence of Halos, calcifications, signs of invasiveness). In order to form surgical tactics, the number of formations, their size, volume and localization were evaluated. At an early stage, TAPB was used for diagnosis under ultrasound control (988 patients; 80.0%). Performing this diapeutic manipulation allowed us to identify a group of patients with tumors (categories Bethesda IV, V, VI) (143 people; 11.6%) who underwent traditional surgical treatment. Ultrasound monitoring was recommended for a significant number of patients (756 people; 61.2%). Minimally invasive therapeutic manipulations were used in 89 patients (7.2%) in the treatment of thyroid nodules belonging to the Bethesda II category: in 14 people (1.1%) it was sclerotherapy, in 10 patients (0.8%) high-intensity focused ultrasound (HIFU) was performed, in 65 people (5.3%) laser destruction. All patients gave informed consent to undergo diapeutic manipulations. All diapeutic manipulations were performed under the supervision of ultrasound on an outpatient basis by a team of specialists, which included a surgeon and a specialist in radiation diagnostics. They did not require special training and were well tolerated by patients. The analysis of the results showed that minimally invasive diapeutic manipulations in most cases are the final method, leading to an improvement in the patient’s quality of life and even to a complete cure of the patient. They are the method of choice for severe patients and patients who refuse surgical treatment. In these situations, the treatment was palliative. Minimally invasive therapeutic manipulations can precede open surgery, significantly reducing the size of focal formations. Ultrasound diapeutics, which makes it possible to provide significant assistance both in making a diagnosis and in the subsequent treatment of patients with focal thyroid pathology, is the prerogative of a surgeon who has special training in ultrasound diagnostics, and not a radiologist.