Indications for the thyroid surgery
Thyroid gland is one of the largest glands of internal secretion. Normally it weighs 15-20 grams in the adulthood. It is located next to the cartilage of the larynx which is very similar to the knight’s shield. The thyroid gland is divided to 2 fractions, left and right, and therefore its form looks like a butterfly. The main task of the thyroid gland, like any other gland, is to develop its own particular hormones. It produces two such hormones: thyroxine (T4) and triiodothyronine (T3).Diffuse toxic goiter, also known as Graves’s disease, is a widely known and spread disease. Up to 15 percent of the world population have a goiter. (Watkinson 2010) DTG is stated as immune system discombobulation, which results in the thyroid gland’s lesion of generating more hormones than needed, usually overproducing it and exceeding the normal limits. There are no clear solutions for the full recovery; however, in order to make the life easier for the patients, there are several types of operations, which all include the removal of thyroid gland (thyroidectomy) in order to stop the intoxication of the organism. The removal of the thyroid gland can be obtained by the non-operational way with the injection of radioactive iodine and operational method.
Thyroid surgery is a procedure that includes the partial or full removal of the thyroid gland. The critical function of the gland is the formation of hormones that regulate a lot of different factions within the body, such as the control of the human body temperature, rectification of metabolism and normalization of the heart rate. The main indications for the surgery include cases like formation of cysts, thyroid cancer, hyperthyroidism or the considerable size of the thyroid gland which prevents or tempers the breathing. The result of removing the gland is a lack of hormones, which can be neglected by taking the hormone pills for the rest of patient’s life. The lack of remedy may result in serious complicacy, such as birth defects, miscarriage, loss of the significant amount of calcium in bones, increased heart rate (which can lead to stroke), eye problems (which can lead to blindness), bone deprivation, tremor, and even death.
Thyroid surgery and its possible complications
Most common complications during the surge are infections and bleeding. Serious sequelae comprise the hoarseness or loss of the voice, nerve injuries, lack of breathing (tracheostomy) and lesion of calcium. If parathyroid glands are in the thickness of the thyroid gland then there is a risk of getting periodical cramp incidents throughout the life. Danger of anesthesia persists as well. Successful surgery results in a hypothyroidism (which is the main purpose of the surgery), a cosmetic scar on the neck (depends on the size of the thyroid gland), and the pill consumption throughout the life.
Currently there are 3 main schemes of treatment of Graves’ disease. First one of them is obtained by consuming Methimazole and propylthiouracil (PTU), the drugs that limit the thyroid’s production rate of hormones. While successful in calming indications inside a number of weeks, hyperthyroidism can return if the patient stops consuming pills. If the size of the gland is not large, there is a 25-30 percent chance that after going through the medicament treatment there might be a remission and the thyrotoxicosis will not return. However, if sometime later after going through full cycle of medical treatment (which usually lasts no less than 1 year) the symptoms of the Graves’ disease return, the questions of excision of the thyroid gland starts arising. Some people keep taking the pills for the rest of their lives, however, there is no use in that mostly because of the two major causes: the first is that methimazole and propylthiouracil badly affect the liver, and the second one is that no matter how long a patient keeps taking pills, drugs do not mend the thyroid gland, they only block it from generating new hormones. Especially it affects women, who have plans of having the baby. It’s crucial for them to not plan the pregnancy during the chemotherapy. In most CIS countries, endocrinologists prefer the operational method. However, it’s essential to mention that there is another alternative called the radioactive iodine. It is injected orally to the patient (be it in liquid or solid state), and due to thyroid gland’s ability to absorb the iodine from the blood, the iodine damages the thyroid gland from the inside without touching any other organs, which results in a decrease of the volume of the thyroid gland. The result can be seen in around 6-9 months, and has up to 80 percent success rate. If the dose was not sufficient enough, a patient might need to take additional radioactive iodine pill to conclude the task.
The experience of thyroidectomy in other countries
In a single medical center in US, 56 patients with thyrotoxicosis went through the surgery between May of 1994 and May of 2008. The main factor for the operation was unsuccessful medical treatment, (46.6%). Patient persistence was a big aspect in 24.1% situations. The indications of the results can show that the surgeries in the US have relatively low risk. Most of the time a failed RAI can be corrected by consumption of another sufficient dose of RAI.
The prevalence of thyroid crisis in hospitalized patients in Japan was evaluated at 0.22% out of 100000 patients with Graves’ disease per year. The fatality percentage was 10.7%. The cause of death was provoked by the overflow of the hormones and organs stopping working as intended, resulting in arrhythmia, respiratory insufficiency and heart failure. However, the situations of thyroid crisis was significantly decreased as a result of the of radioactive iodine medication and anti-thyroid drugs.
Radioactive iodine is one of the reliable ways to treat the Graves’ disease in Japan.
Current state of thyroid surgery in Kazakhstan
In Kazakhstan, like in most of the CIS countries, the Graves’ disease and is spread wide on a high level. The lack of iodine, stressful situations, bad ecological influence and heredity are all the main reasons behind such big number of ill patients. The lack of the knowledge about the hidden symptoms and ignoring them are the main causes of the late consultation and usually result in a more progressive-aggressive course of the disorder. The patients of the middle age are in danger zone, although the disease can be obtained even at young age. Usual medication includes the chemotherapy, and if unsuccessful, continues with the common surgery.
For the first time in Kazakhstan, on the basis of JSC “National Scientific Center for Surgery. A.N. Syzganov” in July 16, 2018 a unique minimally invasive surgical procedure was performed – transoral thyroidectomy, that is, the thyroid gland was removed from the patient without any cuttings. To date, the state of the patient is satisfactory. It is worth noting that the absolute advantage of using this technique is an absolute cosmetic effect – after surgery there is not a single scar on the body. Among other advantages, it is worth highlighting the reduction of the pain intolerance, the accelerated recovery from surgery, the reduction in the length of staying in the hospital and the absence of the need for bandaging and total elimination of stitches.
This technique was developed in 2014 in Thailand by Professor Angkun Anuwong (Main Police Hospital, Bangkok). The essence of the method is that access to the thyroid gland is through the oral cavity, and not through the common incision on the neck. In this case, the surgeon has a fairly wide view and field for manipulation, and a multiple increase in the endoscopic chamber makes it possible to make the procedure as safe as possible for the patient. In its capabilities, the method is superior to the other previously proposed endoscopic operations. A new method of surgical hospitalization is applicable to patients with various thyroid disorders and early forms of thyroid cancer.
The thyroidectomy is a spread operation which mostly is conducted with a surgery. Nowadays Kazakhstan is short of tools for the radioactive iodine treatment centers. Even though the costs of radioactive iodine pill are much higher than the traditional surgery and there is no medical center in Kazakhstan which provides such service and patients are usually travelling to neighborhood countries in order to get healed. Many endocrinologists are divided into two groups, the ones who approve the radioactive iodine therapy, and the others who disprove it. Of course, it all depends on the stage of the disease, the medical history and each patient individual unique body structure. However, it’s worth noting that radioactive iodine treatment is considered a “safe choice” mostly because of its benefits over the operational method. Which case is better for the most patients and which method has less risk, and is there going to be a new method for treatment is yet to be discovered.