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Year 2014 Vol. 22 No 1
GENERAL AND SPECIAL SURGERY
O.S. OLIFIROVA, N.N. TRYNOV, S.V. KNALYAN, L.K. RESHETNICOVA, M.A. SHTARBERG, N.I. PROCLOVA
POSTOPERATIVE HYPOTHYROIDISM: SOME CLINICAL AND HUMORAL ASPECTS
SBEE HPE “Amur State Medical Academy”,
The Russian Federation
Objectives. To specify reasons, features of humoral changes and principles of correction of the early postoperative hypothyroidism (POH).
Methods. The patients were divided into two groups depending on the conducted treatment. The first group was made up of the patients with early postoperative hypothyroidism (24), the second group – the patients (19) without clinical or laboratory signs of postoperative hypothyroidism. The content of peroxidation products and antioxidant protection, the thyroid and immune status were studied before the surgery on the thyroid gland, and on the 10th day after the surgery.
Results. It has been established that in 75% of cases the postoperative hypothyroidism appeared on the 10th day of the postoperative period after thyroidectomy and maximum subtotal resection of the thyroid gland in patients with the initial euthyroid and hypothyroid (any volume of the operation). The patients from the first group had significant decrease of indicators of cytokines (IL-4, IL-6, IL-10, TNF- α), humoral (IgA, IgG) and cellular immunity (lymphocytes, ÑD3+, CD4+, CD8+, ÑÄ16+, ÑÄ25+) in comparison with the initial level and the similar figures of the patients from the second group. In the first group patients with POH the activation of lipid peroxidation (LPO) and the reduction of antioxidant protection (AOP) due to the increasing of the level of diene conjugates and hydroperoxides lipids are registered as well as the reduction of vitamin E content.
Conclusions. The factors enabling to predict the occurrence of early POH during the recent 10 days of the postoperative period are considered to be the surgery of thyroidectomy and maximal subtotal resection of the thyroid gland on the euthyroid background as well as the initial hypothyroidism at any volume of the surgery. Early postoperative hypothyroidism is accompanied by the secondary immunodeficiency, the activation of lipid peroxidation and the decrease of hydroperoxides lipids. The rehabilitation of the postoperative hypothyroidism patients should include the correction of hormonal and immune disorders.
- Vanushko VE, Fadeev VV. Uzlovoi zob (klinicheskaia lektsiia) [Nodular goiter (clinical lecture)] Endokrin Khirurgiia. 2012;(4):11–16.
- Fadeev VV, Vanushko VE. Posleoperatsionnyi gipotireoz i profilaktika retsidiva zabolevanii shchitovidnoi zhelezy [Postoperative hypothyroidism and prevention of thyroid disease recurrence]. Moscow, RF: Izdatel'skii dom M. Vidar; 2011.72 p.
- Podzolkov AV, Fadeev VV. Gipotireoz, subklinicheskii gipotireoz, vysokonormal'nyi uroven' TTG [Hypothyroidism, subclinical hypothyroidism, high normal TSH levels]. Klin i Eksperiment Tireoidologiia. 2009;(2)5:4–16.
- Kravchun NA, Cherniavskaia IV. Gipotireoz: epidemiologiia, diagnostika, opyt lecheniia [Hypothyroidism: epidemiology, diagnosis, treatment experience]. Probl Endokrin Patologii. 2011;(3):27–34.
- Trunin EM. Diffuznyi toksicheskii zob. Kompleksnaia diagnostika, konservativnaia terapiia, khirurgicheskoe lechenie [Complex diagnostics, conservative treatment, surgery]. Saint-Petersburg, RF: ELBI-SPb; 2006. p. 149 –160.
- Morgunova TB, Manuilova IuA, Fadeev VV. Mediko-sotsial'nye aspekty zamestitel'noi terapii gipotireoza: faktory, vliiaiushchie na kachestvo kompensatsii [Medical and social aspects of substitution treatment of hypothyroidism: factors affecting the quality of compensation]. Klin i Eksperiment Tireoidologiia. 2007;(3)3:12–24.
- Morgunova TB, Manuilova IuA, Fadeev VV. Kliniko-laboratornye pokazateli i kachestvo zhizni patsientov s raznoi stepen'iu kompensatsii gipotireoza [Clinical and laboratory parameters and quality of life of patients with varying degrees of hypothyroidism compensation]. Klin i Eksperiment Tireoidologiia. 2010;(1)6:54–62.
- Kahaly GJ. Cardiovascular and atherogenic aspects of subclinical hypothyroidism. Thyroid. 2000 Aug;10(8):665–79.
- Razvi S, Ingoe L, Keeka G, Oates C, McMillan C, Weaver JU. The beneficial effect of L-thyroxine on cardiovascular risk factors, endothelial function, and quality of life in subclinical hypothyroidism: randomized, crossover trial. J Clin Endocrinol Metab. 2007 May;92(5):1715–23.
- Al-Adhami A, Craig W, Krukowski ZH. Quality of life after surgery for Graves' disease: comparison of those having surgery intended to preserve thyroid function with those having ablative surgery. Thyroid. 2012 May;22(5):494–500
- Rhee CM, Curhan GC, Alexander EK, Bhan I, Brunelli SM. Subclinical hypothyroidism and survival: the effects of heart failure and race. J Clin Endocrinol Metab. 2013 Jun;98(6):2326–36.
675000, Rossiiskaia Federatsiia, g. Blagoveshchensk, ul. Gor'kogo, d. 95, GBOU VPO «Amurskaia gosudarstvennaia meditsinskaia akademiia», fakul'tet poslediplomnogo obrazovaniia, kafedra khirurgicheskikh boleznei,
e-mail: olif.oc @ mail.ru,
Olifirova Olga Stepanivna
Olifirova O.S. MD, an associate professor, a head of the surgical diseases chair of PGEF SBEE HPE “Amur State Medical Academy”.
Trynov N.N. A post-graduate student of the surgical diseases chair of PGEF SBEE HPE “Amur State Medical Academy”.
Knalyan S.V. A post-graduate student of the surgical diseases chair of PGEF SBEE HPE “Amur State Medical Academy”.
Reshetnicova L.K. PhD, an assistant of the faculty therapy chair of SBEE HPE “Amur State Medical Academy”.
Shtarberg M.A. PhD, a senior researcher of CSRL of SBEE HPE “Amur State Medical Academy”.
Proclova N.I. A clinical resident of the surgical diseases chair of PGEF SBEE HPE “Amur State Medical Academy”.