Endocrine Abstracts

JOINT64

Rehabilitation of patients with thyroid cancer includes medical, instrumental, psychological and social support. It begins with the establishment of a preliminary diagnosis (ultrasound, cytology, laboratory tests) and continues after surgery for the rest of the patient’s life. All patients need to be monitored using the necessary studies aimed at detecting relapses and metastases, as well as medical support. We analyzed 1,382 cases (1,194 women, 186 men operated on for thyroid cancer in 1996-2021). The tumor prevalence corresponded to T1 and T2 (54% and 22%, respectively), the common forms - 24%. Metastatic lesion of the neck lymph nodes was observed in 331 (23.9%) patients, including patients with T1. The main type of surgery was thyroidectomy (74%), hemithyroidectomy - in 25% of cases (with T1), thyroid resection – in 1%. The main morphological form was papillary cancer (1272 patients; 92%). 5.8% of patients had postoperative complications. In 504 people (36.5%), radioiodine therapy was included in the complex of postoperative treatment. Repeated surgical intervention was performed in 134 patients (9.7%). All patients were prescribed medication therapy. When prescribing doses of L-thyroxine, the variants of the presence of genetic mutations in patients affecting the metabolism of the drug (the SLCO1B1 Val174Ala gene) were taken into account. After 13-28 years, 734 patients (53.1%) remain under observation. During the follow-up, 415 patients died from other causes (stroke, heart attack, covid-19, and others). 33 patients (2.4%) died of thyroid cancer. Some patients refused medical examination. To assess the effectiveness of suppressive therapy, TSH and thyroglobulin levels were determined in the blood. The group of patients with a good decrease in TSH levels (less than 0.1 IU/ml and thyroglobulin less than 1 ng/ml) was large (78.4%). 11.3% of patients had impaired L-thyroxine intake. Some patients (8.5%) (after hemithyroidectomy) did not undergo medical examination and refused L-thyroxine. In 19.4% of patients who did not take suppressive doses of L-thyroxine, signs of desymination were revealed. Clinical and laboratory manifestations of hypoparathyroidism were observed in 1.4% of patients. Research by psychologists has shown that the first six months after surgery are the most "difficult", it is at this time that "positive training", "life continuation training" is needed. In the future, the level of anxiety and "immersion in the disease" tended to decrease, which ensured good professional and social adaptation for more than 10 years.