Clinical case of development of thromboembolism after thyroidectomy with concomitant diseases

Abstract

Objective. To study a clinical case after a planned thyroidectomy. Venous thromboembolism in the form of deep vein thrombosis or LE is the third most common in the world, being the second only to myocardial infarction and stroke. In epidemiological studies, the annual incidence of pulmonary embolism ranges from 39 to 115 persons per 100 000 of the population; for deep vein thrombosis, the incidence rates range from 53 to 162 per 100 000 of the population. The cross-sectional analysis data show that the frequency of venous thromboembolism is almost 8 times higher in persons over 80 years of age than in the fifth decade of life. Pulmonary embolism is a stop of blood flow in the branch of the pulmonary artery due to obstruction by a clot. The most frequent places of blood clots are the deep veins of the lower extremities. Risk factors for thromboembolism may be surgical operations, varicose veins, age, overweight. This is one of the most common and severe complications of the postoperative period. Our article considers a clinical example of the development of thromboembolism after thyroidectomy, presents the results of pathomorphological studies, autopsy, histological studies.

Materials and methods. The work consisted in the study of a clinical case of pulmonary embolism after a planned surgical intervention for nodular goiter. Histological sections of organs such as the heart, kidneys, gallbladder, thyroid gland, liver were studied.

Results. The results of our study showed that thyroidectomy refers to operations of a high complexity and high risk of multiple complications as well as the occurrence of a fatal outcome. Therefore, a thorough examination of all organs and systems in patients is necessary, especially those who belong to the elderly and severe comorbid pathology groups. This is due to the fact that the risk of death without a proper preparation for surgery with available concomitant diseases (nodular colloidal goiter, empyema of the gallbladder, Gilbert's disease, persistent hepatitis, type 2 diabetes mellitus, hypertension, chronic coronary heart disease) was very high for this patient.

Conclusions. Diffuse nodular toxic goiter is a complex surgical pathology involving many organs and systems. Patients with such a diagnosis require a thorough history collection, carrying out clinical, instrumental and laboratory research methods, including successful surgical intervention.

Keywords

Thyroid gland / pulmocoronary reflex / empyema of gallbladder / complications / concomitant diseases / pulmonary embolism

References

[1] Tapson V.F. Pulmonary Embolism (PE) MD, Cedars-Sinai Medical Center, 2018, available at: https://www.msdmanuals.com/ru

[2] Tapson V.F. Тромбоэмболия легочной артерии (ТЭЛА) MD, Cedars-Sinai Medical Center, 2018, available at: https:// www.msdmanuals.com/ru

[3] Gantsev W.H., Karimov A.I., Ogiy I.I., Khusnutdinov Sh.M., Ishmuratova R.Sh., Mamatova G.U., Samyshina E.A., Kzyrgalin Sh.R. Pulmonary embolism: frequency, causes and ways of prevention in oncology. Journal of Creative Surgery and Oncology 2011; 4: 17 (in Russian).

[4] Ганцев Ш.Х., Каримов А.И., Огий И.И., Хуснутдинов Ш.М., Ишмуратова Р.Ш., Маматова Г.У., Самышина Е.А., Кзыргалин Ш.Р. Тромбоэмболия легочной артерии: частота, причины и пути профилактики в онкологии. Журнал Креативная хирургия и онкология 2011; 4: 17.

[5] Bendersky Yu.D., Kirshin A.A. Pulmonary embolism: pathophysiology, clinic, diagnosis, treatment, prevention. Izhevsk 2015 (in Russian).

[6] Бендерский Ю.Д., Киршин А.А. Тромбоэмболия легочной артерии: патофизиология, клиника, диагностика, лечение, профилактика. Ижевск 2015.

[7] Styazhkina S.N., Chernyadev E.V., Karmanova V.V., Sazhina K.I., Korobeinikov V.I. Features of the diagnosis and treatment of thyrotoxicosis in a patient with severe comorbid pathology: a clinical case. Perm medical journal 2022; 39 (1): 119–123 (in Russian).

[8] Стяжкина С.Н., Чернядева Е.В., Карманова В.В., Сажина К.И., Коробейников В.И. Особенности диагностики и лечения тиреотоксикоза у пациента с тяжелой коморбидной патологией: клинический случай. Пермский медицинский журнал 2022; 39 (1): 119–123.

[9] Stavros V.C. i dr. Rekomendacii ESC po diagnostike i lecheniyu ostroj legochnoj embolii razrabotannye v sotrudnichestve s Evropejskim respiratornym obshchestvom (ERS). Rossijskij kardiologicheskij zhurnal 2020; 25 (8): 188 (in Russian).

[10] Stavros V.C. и др. Рекомендации ESC по диагностике и лечению острой легочной эмболии разработанные в сотрудничестве с Европейским респираторным обществом (ERS). Российский кардиологический журнал 2020; 25 (8): 188.

RIGHTS & PERMISSIONS

Eco-Vector