[Non-functioning parathyroid cysts]. / Nefunktsional'nye kisty okoloshchitovidnykh zhelez.

OBJECTIVE: To study the features of clinical course, diagnosis and treatment of true non-functioning parathyroid cysts. MATERIAL AND METHODS: We retrospectively analyzed 18 patients with non-functioning true parathyroid cysts. Inclusion criteria: US-confirmed anechoic lesion of the neck without tissue component, cytological data on cystic lesion, high cystic parathyroid hormone and no laboratory signs of hyperparathyroidism. RESULTS: Non-functioning parathyroid cysts were asymptomatic and diagnosed accidentally after ultrasound of the neck. All patients were women aged 35-77 years. Four patients had cysts near the upper parathyroid glands, 14 patients - near the lower parathyroid glands. Of these, 2 ones had cysts below the level of the clavicle. Cyst volume was 4.3-110.3 cm3 (24.1±26.2 cm3). High cystic parathyroid hormone (2012.5±946.7 pg/ml) was observed in all patients. Simple aspiration was performed in 5 patients, aspiration with sclerotherapy - in 10 patients, cystectomy - in 3 patients. Recurrence was diagnosed in 1 patient after aspiration and 2 patients after sclerotherapy. CONCLUSION: No pathognomonic clinical and ultrasonic symptoms, as well as specific cytological data lead to misdiagnosis. Analysis of PTH in non-functioning parathyroid cysts is essential for diagnosis. Minimally invasive treatment is preferable for true parathyroid cysts. However, these approaches are not radical.

[Optical sonography in differential diagnosis of thyroid nodes]. / Optosonografiya v differentsial'noi diagnostike uzlovykh obrazovanii shchitovidnoi zhelezy.

OBJECTIVE: To develop a non-invasive method for differential diagnosis of thyroid nodes. MATERIAL AND METHODS: Optical sonography was made in 623 patients with thyroid nodes including 374 women (60%) and 249 men (40%) aged 19-79 years (mean 64±15 years). All patients underwent ultrasound-assisted fine-needle aspiration biopsy. Cytological examination revealed cystic colloidal goiter (CCG) in 317 (51%) cases, follicular adenoma (FA) - in 197 (31.5%) cases, thyroid cancer - in 109 (17.5%) cases. All patients underwent surgery. Histological examination verified cystic colloidal goiter in 354 (56.8%) cases, follicular adenoma - 75 (12.0%) cases, thyroid cancer - 194 (31.2%) cases. Follicular cancer was diagnosed in 120 cases, papillary cancer - 70 cases, undifferentiated cancer - 4 cases. RESULTS AND CONCLUSION: Sensitivity, specificity and accuracy of optical ultrasonography in differential diagnosis of thyroid nodules were estimated. Sensitivity of ultrasonography in the diagnosis of thyroid malignancies was 0.75, specificity 0.62, accuracy 0.67. Sensitivity of ultrasonography in the diagnosis of thyroid adenoma was 0.85, specificity 0.62, accuracy 0.73. Sensitivity of optical sonography in the diagnosis of CCH was 0.62, specificity 0.61, accuracy 0.7. Optical sonography ensures differentiation of CCH and follicular adenoma, CCH and thyroid cancer, follicular adenoma and thyroid cancer. Sensitivity, specificity and accuracy of ultrasonography in differential diagnosis of FA and thyroid cancer are 0.85, 0.62, 0.73 and 0.8, 0.71, 0.7, respectively.

[Transoral endoscopic thyroid surgery]. / Transoral'nyi éndoskopicheskii dostup k shchitovidnoi zheleze.

OBJECTIVE: To analyze own initial experience of transoral thyroid surgery. MATERIAL AND METHODS: There were 7 patients thyroid nodules who underwent surgery for the period from March 2018 to May 2019. All patients signed an informed consent to be included in the study. Surgical approach was performed through three incisions in the lower arch of the vestibule of the mouth with deployment of 10 mm endoscope and two 5 mm tools. Gas insufflation was used. All patients were females aged 43.3±11.8 years. Thyroidectomy was performed in 2 cases, hemithyroidectomy - in 5 patients. Dimensions of nodules varied from 10 to 42 mm. RESULTS: Mean time of hemithyroidectomy and thyroidectomy was 206.4±63.8 and 232±37.5 min, respectively. Papillary carcinoma was histologically verified in 1 case. Injuries of recurrent laryngeal nerve, postoperative hypocalcemia and local complications were absent. Drainage was not applied. Postoperative hospital-stay was 3.7±1.1 days. CONCLUSION: Transoral approach to the thyroid gland is technically feasible with standard endoscopic instruments, safe for important anatomical structures and more precise due to the optical capabilities of endoscopic equipment. Any types of procedures are possible. Undoubtedly, aesthetic outcome is also favorable.

[Ultrasound assessment of vocal cords function after thyroid surgery]. / Pervyi opyt otsenki funktsii golosovykh sviazok ul'trazvukovym metodom issledovaniia u bol'nykh posle operatsii na shchitovidnoi zheleze.

OBJECTIVE: To analyze vocal cords function after thyroid surgery by using of ultrasound examination. MATERIAL AND METHODS: Assessment of voice quality according to GRBAS scale, ultrasound examination of vocal cords and indirect laryngoscopy were performed in 57 patients after thyroid surgery. RESULTS: Postoperative indirect laryngoscopy and ultrasound revealed normal mobility of vocal cords in all patients. However, 98.3% of patients subjectively noted deterioration of voice quality due to hoarseness and fatiguein early and long-term period, respectively. Complete restoration of vocal function occurred after 6 months postoperatively. Impaired voice quality is probably due to edema of vocal cords after intubation that is manifested by unclear contours during ultrasound. Ultrasound is useful to diagnose shortening and displacement of paretic vocal cords. CONCLUSION: Ultrasound of vocal cords could be alternative to indirect laryngoscopy for postoperative assessment of vocal cords function in patients after thyroid surgery.

[Transoral approach to thyroid gland in the experiment]. / Transoral'nyi dostup k shchitovidnoi zheleze v eksperimente (s kommentariem P.S. Vetsheva).

AIM: To develop minimally invasive and safe endoscopic access to thyroid gland. MATERIAL AND METHODS: Transoral pre-mandibular video-assisted gas-free access to thyroid gland was developed in experimental study that included 19 human cadavers. Stereometric modeling defined the evaluation criteria including the form of basal arch of lower jaw and its height. There was no conflict of instruments in working chamber under platysma. Additional trocar was deployed to resolve the conflict between working parts of instruments during thyroid gland mobilization. The angle of operative action between the instruments is close to 90°. Trocar hole is used for drainage. RESULTS: The access provides good visualization of recurrent laryngeal nerve, upper and lower thyroid arteries and parathyroid gland. It is less traumatic compared with other extra-cervical accesses to thyroid glands.

[Risk of hypocalcemia after thyroid surgery].

AIM: To reveal calcium metabolism disorders that frequently occur after thyroid surgery. MATERIAL AND METHODS: The study included 202 patients who underwent thyroid surgery for different diseases and had normal calcium level in peripheral blood at baseline. RESULTS: Based on laboratory data postoperative hypocalcemia was diagnosed in 57 (28.8%) patients. It was not always accompanied by clinical symptoms. Clinical picture depended on degree of hypocalcemia. Symptoms was diagnosed more frequently if calcium concentration was less than 2.1 mmol/l. Clinical manifestations were absent in 64.9% of cases on background of hypocalcemia. Incidence of hypocalcemia was higher after thyroidectomy compared to organ-preserving surgery. Symptoms of hypocalcemia occurred after thyroidectomy only. Casual parathyroidectomy does not always cause hypocalcemia. Only in 14% of patients with hypocalcemia excised parathyroid was identified in specimen. At the same time 7.6% of patients with postoperative normocalcaemia also had excised parathyroids in specimens. Symptoms of hypocalcemia does not always occur at 1 day after surgery. They can appear later, for example at 5 days postoperatively and depend on severity of hypocalcemia. Thyroidectomy has high risk of postoperative hypocalcemia with clinical symptoms (19.6%) that is transient in 15.5% of cases and permanent in 4.1% of patients.

[Clinical value, diagnosis and treatment of thyroid differentiated microcarcinoma].

Results of surgical treatment of 240 patients with thyroid differentiated microcarcinoma (less 1 cm in diameter) are analyzed. Papillary and follicular tumor was diagnosed at 212 (88.3%) and 28 (11.7%) respectively. Microcarcinoma had no clinical symptoms in majority cases. In some cases microcarcinoma had aggressive clinical course: at 10.8% patients the tumor was extended beyond the bounds of thyroid capsule (T3), at 2.1% patients the primary symptoms of disease were metastases into cervical nodes. Long-term results of surgical treatment were followed-up until 25 years after surgery, 5-year survival rate and recurrence-free period were 99.5 and 99% respectively. Recurrence of tumor occurred at 2 (0.8%) patients with initial III and IVA stages of disease despite previous radical operation, one of them died in 4 years after surgery. Microcarcinoma is regarded as early stage of thyroid gland cancer. Ultrasonic examination and fine-needle biopsy permit to diagnose timely this malignant tumor.

[Ultrasonic method of study and puncture biopsy in diagnosing thyroid nodules]. / Ul'trazvukovye metody issledovaniia i punktsionnaia biopsiia v diagnostike uzlovykh obrazovanii shchitovidnoi zhelezy.

Results of diagnosis of thyroid nodes in 404 patients are analyzed. Ultrasonic examination and US-assisted puncture biopsy were carried out before operations. Their results were compared with ones of morphologic study performed after surgery. Solitary nodes were diagnosed in 171 (42.3%) patients, multiple--in 233 (57.7%). The most specific ultrasonic symptoms of different forms of thyroid nodes were revealed. Thyroid cancer is imaged as hypoechogenic node with clear and unclear contour, heterogeneous structure, multiple zones of hyperechogenicity and calcification. Adenomas are presented as isoechogenic homogenic nodes with clear border and cystic cavities. Colloid nodes picture is the same. Rathen often different morphologic forms of nodes are similar, thus ultrasonic examination permits to detect morphologic structure of nodes hypothetically only. Sensitivity of puncture biopsy for goiter, adenomas and cancer was 87.1, 92.9 and 69.7% respectively. Cancer was not diagnosed before surgery in 30.3% cases when colloid goiter or adenomas were suspected. In these cases small cancer was located amidst colloid nodes and didn't differ by ultrasonic symptoms. Diagnosis of malignant tumor in nodular goiter was highly precise. Morphologic form of cancer was verified cytologically in majority of cases.

[Clinical and morphological characteristics and peculiarities of differentiated thyroid gland cancer course]. / Kliniko-morfologicheskaia kharakteristika i osobennosti techeniia differentsirovannykh form raka shchitovidnoi zhelezy.

221 patients were operated for cancer of the thyroid gland during the last 12 years. Adequate preoperative diagnosis including ultrasound examination, and fine needle aspiration biopsy made it possible to operate 88.7% of patients at earlier (I and II) stages of the disease. Long term results of radical surgical treatment have been studied in 197 (89.1%) patients followed up 5 to 16 years, 49.2% of patients being followed up for no less than 10 years. Majority of patients (95.9%) had differentiated forms of tumors, medullar cancer was detected in 4.1% of patients. Clinical and morphological analysis of differentiated thyroid cancer was carried out in 212 patients. Metastases to lymph nodes of the neck occur more frequently in younger patients, and extracapsular spread of the tumor was revealed in aged persons. Risk factors were male sex, old age, follicular cancer and growth of the tumor through the capsule of the gland. The minimal procedure in case of location of the differentiated tumor in a single lobe of thyroid is extrafascial hemithyreoidectomy with resection of the istmus. Prognosis in radically operated patients is relatively favourable, 5-year survival rate made up 97.5%.

[Late results of surgical treatment of differentiated thyroid cancer]. / Otdalënnye rezul'taty khirurgicheskogo lecheniia differentsirovannogo raka shchitovidnoi zhelezy.

Retrospective analysis of 94 patients who were operated on in the clinic in 1981-1987 for differentiated carcinoma of the thyroid was conducted with the use of the classification of the disease formulated by the American United Cancer Committee and the Committee TNM of the International Anticancer Union which takes into account the patients's age. According to the new system of stages, 34 patients under 45 years of age with any indices of T, N, and MO, and 14 patients over 45 years of age with indices Tl, NO, and MO were related to stage I. The postoperative follow-up period ranges from 4 to 9.5 years. During that time, metastases to the regional lymph nodes developed in 9 (9.5%) patients, remote metastases in one (1.1%) patient, and local recurrence of the tumor was diagnosed in 14 (14.5%) patients, with the tumor recurring in most or them 5 years after the operation. Six (6.4%) patients died from carcinoma. The work appraises the prognostic significance of dividing the patients according to stages from the standpoint of the tendency to recur and metastasize, and the carcinoma mortality rate. It is shown that patients who underwent operation for thyroid carcinoma must be kept under observation for a long time.