Results of sclerotherapy for recurrent and non-recurrent nodular goiter

Abstract

Background. The problems of treating recurrent nodular goiter are still relevant. The technical difficulties of the intervention on the neck tissues altered by the scarring process and the comorbid background of patients cause an unacceptably high risk of complications of traditional surgical treatment and, as a result, a long and difficult rehabilitation period and high costs for the treatment of patients who have undergone surgery for recurrent goiter. Alternative methods, such as sclerotherapy, which reduce the risk of complications, have been successfully used in patients with non-operated thyroid, but the possibilities of minimally invasive destruction of recurrent nodules have not been studied enough, and it is not known whether it is as safe and effective as sclerotherapy of non-recurrent nodules. The aim of the study was to compare the efficacy and safety of treatment of recurrent and non-recurrent nodular goiter using sclerotherapy. Materials and methods. The study included 30 previously not operated patients with nodular goiter and 30 patients with recurrent nodular goiter. All of them underwent 4 courses of sclerotherapy, each of which included 5 sessions with a frequency of 1 session per week; polidocanol was used as a sclerosant. Results. The analysis showed that the efficiency of reduction of nodules did not decrease in patients with recurrent goiter, despite severe sclerotic changes in the tissues. The size of the nodules and the volume of thyroid tissue were reduced during sclerotherapy, regardless of the presence of a history of thyroid surgery, as well as the cure of functional autonomy and relief of symptoms of neck compression. The tolerability of sclerotherapy also did not depend on the presence of recurrent goiter, and the rate of complications was the same (0.8%). Complications of sclerotherapy were not serious in any case. Conclusions. Thus, sclerotherapy of recurrent nodules is a good alternative to traditional surgical treatment; it is not inferior in efficiency and safety to sclerotherapy of nodules in a non-operated thyroid. Its use will significantly reduce the rehabilitation period and the cost of treating patients with recurrent nodular goiter.

Keywords

nodular goiter / sclerotherapy

References

[1] Петров В.Г., Антонова Е.А., Нелаева А.А., и др. Малоинвазивная хирургия кистозно-коллоидных узлов щитовидной железы // Эндокринная хирургия. ― 2013. ― Т.7. ― №4. ― С. 39–44. [Petrov VG, Antonova EA, Nelaeva AA, et al. Minimally invasive surgery colloidal cystic thyroid nodules. Endocrine surgery. 2013;7(4):39–44. (In Russ.)]. https://doi.org/10.14341/serg2013439-44.

[2] Gharib H, Papini E, Paschke R, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. Endocr Pract. 2010;16(3):468–475. https://doi.org/10.4158/EP.16.3.468.

[3] Цуркан А.Ю. Современные подходы к лечению рецидивного зоба // Вестник новых медицинских технологий. ― 2013. ― Т.20. ― №2. ― С. 254–257. [Tsurkan AY. Modern approaches to treatment of recurrent goiter. Journal of New medical technologies. 2013;20(2):254–257. (In Russ.)]

[4] Черкасов В.А., Ефимова Н.С., Бабарыкин А.В., и др. Диагностика, лечение и профилактика послеоперационного рецидивного узлового зоба // Хирургия. ― 2004. ― №4. ― C. 20–23. [Cherkasov VA, Efimova NS, Babarykin AV, et al. Diagnosis, treatment and prevention of postoperative recurrent nodular goiter. Surgery. 2004;(4):20–23. (In Russ.)]

[5] Олифирова О.С., Нарышкина С.В., Казакова М.Г. Причины возникновения, принципы диагностики и лечения рецидивного зоба в Амурской области // Бюллетень физиологии и патологии дыхания. ― 2006. ― №S23. ― С. 87–90. [Olifirova OS, Naryshkina SV, Kazakova MG. Etiology, diagnostics and treatment of recurrent goiter in Amur region. Bulletin Physiology and Pathology of Respiration. 2006;(S23):87–90. (In Russ.)]

[6] Бельцевич Д.Г., Ванушко В.Э., Мельниченко Г.А., и др. Клинические рекомендации Российской ассоциации эндокринологов по диагностике и лечению узлового зоба (2015 год) // Эндокринная хирургия. ― 2016. ― Т.10. ― №1. ― С. 5–12. [Bel’tsevich DG, Vanushko VE, Mel’nichenko GA, et al. Russian Association of endocrinologists clinic guidelines for thyroid nodules diagnostic and treatment. Endocrine surgery. 2016;10(1):5–12. (In Russ.)].

[7] https://doi.org/10.14341/serg201615-12.

[8] Cerbone G, Spezia S, Colao A, et al. Percutaneous ethanol injection under power Doppler ultrasound assistance in the treatment of autonomously functioning thyroid nodules. J Endocronol Invest. 2009;22:752–759.

[9] Hamburger JL. Evolution of toxicity in solitary nontoxic autonomously functioning thyroid nodules. J Clin Endocrinol Metab. 2010;50:1089–1093. https://doi.org/10.1210/jcem-50-6-1089.

[10] Zbranca E, Mogos V, Vulpoi C, et al. Fine needle puncture – method of treatment in nodular pathology of the thyroid. Ann Endocrinol (Paris). 2016;57(5):433–437.

[11] Барсуков А.Н., Киселев Е.В. Склерозирующая терапия этанолом рецидивного узлового зоба // Вестник новых медицинских технологий. ― 2005. ― Т.12. ― №2. ― С. 113–114. [Barsukov AN, Kiselev EV. Sclerosing ethanol therapy for recurrent nodular goiter. Journal of New medical technologies. 2005;12(2):113–114. (In Russ.)]

[12] Щеголев А.А., Ларин А.А., Когут О.Б., и др. Реабилитация больных после хирургического лечения и чрескожной склерозирующей терапии этанолом узлового зоба // Вестник восстановительной медицины. ― 2008. ― №3. ― С. 69–71. [Shhegolev AA, Larin AA, Kogut OB, et al. Rehabilitation of patients after surgical treatment and percutaneous sclerosing therapy with ethanol of nodular goiter. Bulletin of rehabilitation medicine. 2008;(3):69–71.

[13] (In Russ.)]

[14] Кузнецов Н.А., Родоман Г.В., Сумеди И.Р., и др. Склеротерапия в лечении функциональной автономии щитовидной железы // Хирургия. Журнал им. Н.И. Пирогова. ― 2010. ― №8. ― С. 11–15. [Kuznecov NA, Rodoman GV, Sumedi IR, et al. Sclerotherapy for the treatment of thyroid functional anatomy. N. I. Pirogov Journal of Surgery. 2010;(8):11–15. (In Russ.)]

[15] Xiaohua Gong, Fang Wang, Haiyan Du, et al. Comparison of ultrasound-guided percutaneous polidocanol injection versus percutaneous ethanol injection for treatment of benign cystic thyroid nodules. J Ultrasound Med. 2018;37(6):1423–1429. https://doi.org/10.1002/jum.14482.

[16] Gong X, Zhou Q, Chen S, et al. Efficacy and safety of ultrasound‐guided percutaneous polidocanol sclerotherapy in benign predominantly cystic thyroid nodules: a prospective study. Curr Med Res Opin. 2017;33:1505–1510.

[17] Родоман Г.В., Сумеди И.Р., Свириденко Н.В., и др. Склеротерапия как альтернатива операции при лечении больных с рецидивным узловым зобом // Хирургия. Журнал им. Н.И. Пирогова. ― 2020. ― №5. ― С. 87–92. [Rodoman GV, Sumedi IR, Sviridenko NV, et al. Sclerotherapy as an alternative to surgery for recurrent nodular goiter. N. I. Pirogov Journal of Surgery. 2020;5:87–92. (In Russ.)].

[18] https://doi.org/10.17116/hirurgia202005187.

[19] Родоман Г.В., Шалаева Т.И., Сумеди И.Р., и др. Эффективность и безопасность склеротерапии при рецидивном узловом зобе // Хирург. ― 2020. ― №9-10. ― С. 39–51. [Rodoman GV, Shalaeva TI, Sumedi IR, et al. Efficiency and safety of sclerotherapy for recurrent nodular goiter. Hirurg. 2020;(9-10):39–51. (In Russ.)].

[20] https://doi.org/10.33920/med-15-2005-04.

RIGHTS & PERMISSIONS

Eco-Vector