Current state of benign goitre surgery in the regions of Bilogora and Podravina and Slavonia and Baranja

Endemska gušavost podravskog područja, koju su ovjekovječili naivni slikari Hlebinske škole, predstavljala je do pred 20 godina veliki socijalno-medicinski problem. Sada, zahvaljujući uvođenju jodirane soli u ljudsku ishranu, endemska gušavost, a s tim u vezi i kretenizam, gotovo potpuno nestaju. Ipak, još uvijek ima sporadičnih pojava jednostavnih parenhimatoznih struma (Struma thyroidea simplex), ali glavnu masu čine nodozne strume. Anketa provedena na 11 kirurških odjela bilogorsko-podravske i slavonsko-baranjske regije pokazala je da samo 5 od njih liječe strume. U 3 medicinska centra (MC) one se liječe na odjelima za uho, nos i grlo (ORL), a u 4 MC strume se liječe i na kirurgiji i na ORL. Iz 1 MC upućuju se sve strume na liječenje u Zagreb, a iz 2 MC se šalju u Osijek. U jednom od njih dio struma ostaje na liječenju u ORL. U zadnjih 5 godina u kirurškim odjelima ovih regija liječeno je 457 benignih struma, od čega samo u Osijeku 385, a ostale 72 strume u druga 4 MC. Prema patohistološkom nalazu bilo je: Struma nodosa nontoxica 262, Struma nodosa toxica 14, Struma cystica 37, Struma parenchimatosa hyperthyreotica 59, adenoma toxicum 57, adenoma nontoxicum 7, thyreoditis ac. 2, thyreoiditis subac. 9, thyreoiditis ehr. 3, Struma parenchimatosa simplex 9. Operirano je 428 bolesnika, i to: suptotalne resekcije 134, klinaste resekcije 69, enukleacije 50, lobektomije 154, tiroidektomije 21. Medikalno je liječeno 29 bolesnika. Komplikacije su bile slijedeće: pareze n. rekurensa 4, hematoma 4, seroma 1, naknadni nalaz karcinoma 1, reoperacije 2. U svih bolesnika rana je drenirana na 24 — 48 sati, bilo gumenom laticom, bilo Redon-vakuum drenažom. Za vrijeme operacije rutinski se nisu prikazivali rekurentni živci. Starenjem stanovništva dolazi do porasta broja nodoznih struma, dok se broj parenhimatoznih struma stalno smanjuje. Zapaža se smanjenje broja struma liječnih u kirurškim odjelima, pa otuda mladi kirurzi nemaju mogućnosti da nauče operirati strume. U budućnosti bi trebalo formirati multidisciplinarne centre za bolesti štitnjače ili, još bolje, odjel za endokrinu kirurgiju. Na taj način bi se opet štitnjača našla u domeni kirurgije ne isključujući suradnju specijaliste za ORL.Endemic goitre in the region of Podravina, depicted by naive painters of Hlebine school, was a considerable social and medical problem twenty years ago. Today, thanks to iodinated salt, endemic goitre and cretenism have almost completely disappeared. There are still some sporadic cases of simple goitre, but toxic nodular goitre has the highest incidence. Goitre is treated at only five out of eleven hospitals in these regions. In three hospitals it is treated at the Ear, Nose and Throat Department (ENT) and in four hospitals both at the ENT Department and at the Department of Surgery. One hospital refers all its patients to Zagreb, while two of them refer patients to Osijek. During past five years 457 patients with goitre were treated at those five hospitals: 385 in Osijek and the remaining 72 in other four hospitals. According to pathohistological findings there were 262 non toxic nodular goitres, 14 toxic nodular goitres, 37 cystic goitres, 59 diffuse toxic goitres, 57 toxic adenomas, 7 non-toxic adenomas, 2 acute thyroiditides, 9 subacute thyrioditides, 3 chronic thyroiditides and 9 diffuse hyperplastic goitres. In 428 patients the following operations were performed: 134 subtotal resections, 69 wedge resections, 50 enucleations, 154 lobectomies and 21 thyroidectomies. Only 29 patients were treated conservatively. We had the following complications: 4 recurrent laryngeal nerve paralyses, 4 haematomas, 2 reoperations and one carcinoma of the thyroid. In all patients the wound has been drained for 24 — 48 hours. Recurrent laryngeal nerves were not identified during operation. With population growing older, there is an increased incidence of nodular goitres and a decreased incidence of diffuse goitres. The number of patients treated at surgical departments is also decreasing; hence, younger surgeons have less opportunity to learn proper techniques for goitre operations. In future, multidisciplinary centres for treating thyroid diseases or departments for endocrine surgery should be formed. In that way, thyroid diseases could be properly treated at surgical departments, with the help of the ENT specialists