[Hashimoto's thyroiditis: indications for surgical treatment].
BACKGROUND
Hashimoto's thyroiditis (HT) is the prototypical example of autoimmune thyroiditis and the primary way to treat the disease is conservative. However, there are patients with HT, in which surgical treatment is mandatory.


OBJECTIVE
Summarizing our institutional experience, to formulate the indications for surgical treatment of Hashimoto's thyroiditis.


METHODS
132 patients (131 females and 1 man, mean age 45 years) underwent surgery for HT in the period from 1.01.1987-1.01.2004. Serum thyroid hormone levels, autoimmune and ultrasonographic findings and FNA biopsy confirmed the diagnosis of HT in 115 (87.1%) patients. In the remaining 17 (12.9%) cases, the diagnosis was based on the intraoperative findings as well as on the histological results. From 1987 to 2002 year 110 patients with HT underwent surgery and for the period 01.01.2003 to 01.01.2004 - 22 (54.6%) patients 10 (45.4%) underwent conventional thyroid resection and 12 (54.6%)--argon plasma resection (APR/introduced in our practice since 2003). The indications for surgery were: thyromegaly with compression symptoms, non-responding to L-thyroxin treatment; nodular form of HT with dominant thyroid nodul over 2 cm in size; suspicion for neoplasm or an unsightly neck appearance due to a large goiter.


RESULTS
17(12.9%) patients with diffuse form of HT were surgically treated. Isthmectomy with bilateral medial partial thyroid resection was performed (in 14 cases by conventional method and in 3 by APR). In 81 (61.4%) patients with nodular form of HT isthmectomy with bilobar or unilobar partial or near total thyroid resections were performed (74 conventional resections and 7 APRs). Seven (5.5%) patients have had pseudonodules. In 6 from these cases conventional isthmectomy was performed and in 1 isthmectomy by APR. Coexistent HT with thyroid carcinoma was diagnosed in 27 (20.4%) patients. All underwent thyroidectomy (1 by APR).


CONCLUSIONS
Surgery has it's place and efficacy in the treatment of selected patients with Hashimoto's thyroiditis and compression symptoms or nodular forms with dominant nodules over 2 cm, suspicion for neoplasm or an unsightly neck appearance due to a large goiter. Argon plasma resection (APR) is a new, safe and promising technique of thyroid resection, particularly appropriate for patients with Hashimoto's thyroiditis.
Nenkov
R
R
Radev
R
R
Khristozov
K
K
Kuzmanov
Ia
Ia
Kornovski
S
S
Kuzmanov
S
S
Krasnaliev
I
I
Nanev
B
B
D001128:Argon / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood; D004564:Electrocoagulation / Q000379:methods; D005260:Female; D050031:Hashimoto Disease / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D013963:Thyroid Hormones / Q000097:blood; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography
D001323:Autoantibodies; D013963:Thyroid Hormones; D001128:Argon