Исходы оперативного лечения патологии щитовидной железы у детей

Background. In recent years there has been a tendency of increase in the proportion of nodular goiter and Graves’ disease in thyroid pathology in children, which necessitates a choice of rational tactics for treatment of these diseases. At present there is no optimal method of treatment for thyroid gland pathology, but one of the methods is surgery. Thyroid surgery due to the determination of the indications and choice of the optimal volume of the surgical intervention continues to be under debate as postoperative complications of surgical treatment of thyroid diseases in children are possible.Aim: to study the outcomes of surgical treatment for thyroid pathology in children, depending on the volume of operation.Materials and methods. This article presents the results of a survey of 77 children operated on in the period of 2002–2016 for Graves’ disease, single-node goiter, and multinodular goiter. The examination included the determination of the levels of ionized calcium and TSH, FT4, FT3 in the blood serum, the evaluation of the functional state of the pituitary-thyroid system, thyroid ultrasound examination, and examination by an otolaryngologist.Results. The incidence of adverse outcomes of surgical treatment in children with nodular goiter was 27%. Adverse outcomes were observed equally often after organ-preserving operations and after thyroidectomy, but they were of different structure. The frequency of postoperative complications after thyroidectomy performed on the nodular goiter was 27%. Complications presented as postsurgical hypoparathyroidism and vocal cord paresis. In children with nodular goiter, after thyroidectomy hypoparathyroidism occurred more frequently than paresis of the vocal folds. Symptomatic hypocalcemia was observed more frequently than the asymptomatic variant, and in most cases hypoparathyrodism was transient. Among children with a single-node goiter who underwent organ-preserving surgery on the thyroid gland postoperative complications such as hypoparathyroidism and paresis of the vocal folds were not identified. Adverse outcomes (disease recurrence, postoperative hypothyroidism) were observed equally often after hemithyrodectomy and node enucleation. But the risk of recurrence of nodular goiter was significantly more common in children after node enucleation than after hemithyroidectomy and postsurgical hypothyroidism was more common in children with nodular goiter after hemithyrodectomy than after node enucleation. The frequency of adverse outcomes of surgical treatment of Graves’ disease in children was 14%. Complications were presented by post-surgical hypoparathyroidism and vocal cord paresis. All complications occurred only after thyroidectomy. When compared adverse outcomes of thyroidectomy were equally common in both nodular goiter and Graves ‘disease, but persistent dysfunction in the form of permanent hypoparathyroidism and permanent vocal cord paresis were more common in Graves’ disease than in nodular goiter.Conclusion. The results obtained demonstrate the heterogeneity of surgical treatment outcomes structure which depends on the surgical intervention volume.Введение. В последние годы отмечается тенденция к росту доли узлового зоба и болезни Грейвса в структуре патологии щитовидной железы у детей, что определяет необходимость выбора рациональной тактики лечения этих заболеваний. Оптимального способа лечения данной патологии щитовидной железы на сегодняшний день не существует, но одним из методов лечения является хирургический. Остается дискуссионным вопрос хирургии щитовидной железы в связи с определением показаний и выбора оптимального объема оперативного вмешательства у детей, так как возможны послеоперационные осложнения.Цель исследования. Изучить исходы оперативного лечения патологии щитовидной железы у детей в зависимости от объема операции.Материал и методы. В статье приводятся сведения о результатах обследования 77 детей, оперированных в период 2002–2016 гг. по поводу болезни Грейвса, одноузлового и многоузлового зоба.Обследование включало определение значения ионизированного кальция в сыворотке крови, оценку функционального состояния гипофизарно-тиреоидной системы: исследовался сывороточный уровень тиреотропного гормона, свободного (св.) тироксина, св. трийодтиронина, проводились ультразвуковое исследование щитовидной железы, осмотр оториноларинголога.Результаты. Установлено, что частота неблагоприятных исходов оперативного лечения среди детей с узловым зобом составила 27%. Осложнения одинаково часто встречались как после органосохраняющих операций, так и после тиреоидэктомии, но отличались по своей структуре. Частота послеоперационных осложнений (послеоперационный гипопаратиреоз, парез голосовых складок) после тиреоидэктомии, выполненной по поводу узлового зоба, составила 27%. У детей с узловым зобом после тиреоидэктомии гипопаратиреоз возникал чаще, чем парез голосовых складок. Симптоматическая гипокальциемия отмечалась чаще, чем бессимптомная, и в абсолютном большинстве случаев гипопаратиреоз носил транзиторный характер.Среди детей с одноузловым зобом, которым проведена органосохраняющая операция на щитовидной железе таких послеоперационных осложнений, как гипопаратиреоз, парез голосовых складок, не выявлено. Неблагоприятные исходы (рецидив заболевания, послеоперационный гипотиреоз) одинаково часто встречались как после гемитиреоидэктомии, так и после энуклеации узла. Но риск развития рецидива узлового зоба достоверно чаще возникал у детей после проведенной энуклеации узла, чем после гемитиреоидэктомии, а послеоперационный гипотиреоз чаще возникал у детей с узловым зобом после гемитиреоидэктомии, чем после энуклеации узла.Частота неблагоприятных исходов оперативного лечения болезни Грейвса (послеоперационный гипопаратиреоз и парез голосовых складок) у детей составила 14%. Все осложнения возникли только после тиреоидэктомии.При сравнении неблагоприятных исходов тиреоидэктомии осложнения одинаково часто встречались как при узловом зобе, так и при болезни Грейвса. Но стойкие нарушения функции в виде перманентного гипопаратиреоза и перманентного пареза голосовых складок чаще встречались при болезни Грейвса, чем при узловом зобе. Полученные результаты позволяют сделать вывод о гетерогенности структуры исходов оперативного лечения, которая зависит от объема оперативного лечения

Outcomes of surgical treatment of thyroid disease in children

Background. In recent years there has been a tendency of increase in the proportion of nodular goiter and Graves’ disease in thyroid pathology in children, which necessitates a choice of rational tactics for treatment of these diseases. At present there is no optimal method of treatment for thyroid gland pathology, but one of the methods is surgery. Thyroid surgery due to the determination of the indications and choice of the optimal volume of the surgical intervention continues to be under debate as postoperative complications of surgical treatment of thyroid diseases in children are possible.Aim: to study the outcomes of surgical treatment for thyroid pathology in children, depending on the volume of operation.Materials and methods. This article presents the results of a survey of 77 children operated on in the period of 2002–2016 for Graves’ disease, single-node goiter, and multinodular goiter. The examination included the determination of the levels of ionized calcium and TSH, FT4, FT3 in the blood serum, the evaluation of the functional state of the pituitary-thyroid system, thyroid ultrasound examination, and examination by an otolaryngologist.Results. The incidence of adverse outcomes of surgical treatment in children with nodular goiter was 27%. Adverse outcomes were observed equally often after organ-preserving operations and after thyroidectomy, but they were of different structure. The frequency of postoperative complications after thyroidectomy performed on the nodular goiter was 27%. Complications presented as postsurgical hypoparathyroidism and vocal cord paresis. In children with nodular goiter, after thyroidectomy hypoparathyroidism occurred more frequently than paresis of the vocal folds. Symptomatic hypocalcemia was observed more frequently than the asymptomatic variant, and in most cases hypoparathyrodism was transient. Among children with a single-node goiter who underwent organ-preserving surgery on the thyroid gland postoperative complications such as hypoparathyroidism and paresis of the vocal folds were not identified. Adverse outcomes (disease recurrence, postoperative hypothyroidism) were observed equally often after hemithyrodectomy and node enucleation. But the risk of recurrence of nodular goiter was significantly more common in children after node enucleation than after hemithyroidectomy and postsurgical hypothyroidism was more common in children with nodular goiter after hemithyrodectomy than after node enucleation. The frequency of adverse outcomes of surgical treatment of Graves’ disease in children was 14%. Complications were presented by post-surgical hypoparathyroidism and vocal cord paresis. All complications occurred only after thyroidectomy. When compared adverse outcomes of thyroidectomy were equally common in both nodular goiter and Graves ‘disease, but persistent dysfunction in the form of permanent hypoparathyroidism and permanent vocal cord paresis were more common in Graves’ disease than in nodular goiter.Conclusion. The results obtained demonstrate the heterogeneity of surgical treatment outcomes structure which depends on the surgical intervention volume