If the organ pathology is amenable to therapy, the specialist makes every possible effort to eliminate the symptoms without surgical intervention. Subtotal resection of the thyroid gland is an extreme method of treatment, when all other methods of the conservative approach have been used and did not give the necessary result.
Thyroid function
The structure of the thyroid gland is represented by follicles. The synthesized thyroid hormone associated with the protein accumulates in the vesicles. If the body's need for follicular content increases, the cells of the membrane capture the hormone, destroy the protein and transport the colloid into the blood in its pure form.
With the productive work of the body, the number of follicles becomes excessive, accordingly too many hormones are synthesized. With inferior function of the gland, the bubbles swell, increase, accumulate a colloid in themselves - a lot of hormones are produced, but at the same time they are not enough supplied to the blood.
A clear sign of organ dysfunction are pathologies: hyperthyroidism, hypothyroidism.
The thyroid gland is responsible for the synthesis of hormones, they also regulate its function. The quality of the activity of all body systems depends on the full-fledged work of the body. So, if a woman’s pregnancy proceeded with deviations from the norm, and the fetus had a malfunction in the formation and functioning of the thyroid gland, then in the future, due to a lack of iodine, the child can develop and grow with mental abnormalities, cretinism. If the pathology is diagnosed in adults, the symptoms affect the nervous system, negatively affects energy metabolism.
A person’s behavior may indicate whether the hormone is in excess or deficiency. Sluggish and lethargic patients - a lack, impulsive, overexcited - an excessive content of thyroid hormone.
Symptoms of pathology
There are many symptoms that there is a thyroid dysfunction . The complexity of the situation lies in the ambiguity, as the symptoms can be suitable for many common diseases. Usually, an organ pathology is discovered by accident, turning to the therapist with complaints of annoying symptoms.
With excess, the following symptoms are observed:
- trembling hands;
- heart rhythm disturbance;
- sleep disturbance;
- diarrhea;
- hyperthermia;
- impaired appetite - overeating or loss of interest in food;
- excessive emotional excitability.
With a lack:
- lethargy;
- slow heartbeat;
- hypotension;
- apathy;
- lethargy;
- indifference.
All the symptoms lead the patient first to the endocrinologist, where he learns about unexpected problems.
Who is indicated for surgery
Subtotal resection of the thyroid gland is, unfortunately, a common operation, since the ecological situation, the quality and balanced nutrition do not meet the needs of a healthy body. Symptoms should not be ignored. Lack of treatment can trigger a hormonal crisis, heart muscle failure.
The operation is performed in the following cases:
- if neoplasms are combined with diffuse toxic goiter;
- overgrown goiter interferes with the functioning of neighboring organs, blood flow and nerve bundles;
- the disease is characterized by a complex course;
- intolerance to thyreostatic drugs;
- with adenoma;
- oncological pathologies;
- bazedovoy disease;
- when conservative methods were ineffective;
- knots more than 3, 5 cm;
- in relapses, after successful treatment or surgery;
- if the location of the goiter is behind the sternum.
Modern methods of treatment allow you to positively affect the symptoms, penetrate the focus through an endoscope - to influence locally.
Contraindications
Not for all patients, subtotal thyroid resection may be a way to solve the problem. The operation is not allowed in the following cases:
- if background pathologies are accompanied by a clear violation of the function of the myocardium, kidneys, liver;
- a history of cardiac and vascular trunk dysfunctions;
- the patient suffers from mental disorders.
Sometimes the doctor transfers the operation for an indefinite period, until the removal of concomitant pathologies, infections, inflammatory processes.
Preparation for subtotal resection
Subtotal resection of the thyroid gland is not carried out on an emergency basis. In order to excise a fragment or organ, you should undergo a training course that can stretch for several weeks.
Signs of hyperthyroidism should be eliminated, which is carried out by the appointment of drugs containing iodine. In order to prevent large losses of blood, they reduce the volume of its flow to the body (course of adrenergic blockers).
If the surgery is urgent, the patient takes glucocorticoid hormones with an increased dosage, thyreostatic drugs and drugs with iodine.
Prior to the manipulation, the patient is prescribed a number of additional studies:
- general - urine and blood;
- laboratory tests;
- blood coagulation rate;
- cardiogram.
14 hours before resection, meals and water should be excluded.
Types of thyroid surgery
The technique of the operation is selected taking into account the disease and the volume of pathology. In surgical practice, the following are used:
- Thyroidectomy - multinodular goiter therapy . This completely removes the gland tissue.
- Hemithyroidectomy - treatment of patients with follicular neoplasms.
- Resection of the isthmus. It is indicated for people with nodular goiter, in the case of a node location in the isthmus itself.
- Subtotal resection of the thyroid gland. It is used in the diagnosis of diffuse toxic goiter Hashimito in hypertrophic form. During the manipulation, organ tissues are cut off, leaving only a small fragment.
Subtotal Resection Technique
The best option for surgical intervention, which was evaluated by doctors, is a subtotal resection of the thyroid gland according to Nikolaev. It eliminates the occurrence of relapses and side effects.
The course of the operation of subtotal resection of the thyroid gland looks like this:
- Having retreated a centimeter above the jugular notch, a resection is made from the arcuate access.
- Fiber, superficial layers of muscles and fascia are cut, the flap is opened to the top of the cartilage.
- An incision is made between the muscles of the cervical fascia.
- In the transverse direction, the sternum-hyoid and sternum-thyroid muscles are incised.
- Novocaine is administered under the capsule. Thus, the nerve plexus is blocked, access to the gland is facilitated.
- The bubbly organ is cut off. They stop the blood.
- After blood clotting, the edge of the capsule is sutured with catgut.
The hyoid muscles are sutured with a U-shaped suture, the fascia with nodal catgut stitches, the skin with synthetic, silk threads.
Postoperative recovery
After subtotal resection of the thyroid gland, there is no need to stay in the hospital for a long time, since the method almost completely eliminates complications. But still, some deviations are possible, since an intervention on the throat can lead to damage to the laryngeal nerve. If in the process nerve bundles are affected on both sides, ligament paralysis is likely. In isolated cases, airway obstruction is manifested.
Doctors do not immediately prescribe their wards to exclude all possible risks. In case of hypertension, bleeding may occur. If the tests show an increased concentration of leukocytes, suppuration of the wound occurs. In this case, there may be hyperthermia.
Subtotal resection of the thyroid gland is an extremely safe operation, which practically does not lead to negative consequences. Before surgery, the doctor brings the patient up to date. Having completed the manipulation, gives recommendations on further actions for quick recovery. The residual fragment of the bladder tissue can fully produce the required amount of the hormone.
Hormone treatment
After subtotal resection of the thyroid gland, the dose of thyroxine is first calculated by the doctor, then there is an adjustment and a complete rejection of hormone replacement therapy. The remainder of the body over time synthesizes the amount of hormones necessary for the body.
Twice a year, the patient should be examined by an endocrinologist. Ultrasound, a blood test for hormones, scintigraphy, allow you to monitor the course of the disease.
Side deviations
Subtotal resection of the thyroid gland according to Nikolaev is carried out to eliminate the risks of signs of complications. The unhindered development of the clinical picture leads to a violation of the integrity of the laryngeal nerves and parathyroid glands. If you do not stop the process, the course of the disease may result in paresis, paralysis or hypoparathyroidism.
If a decision is made on subtotal resection of the thyroid lobe, the doctor should warn the patient that the following complications are possible:
- bleeding with bruising, provoked by trauma to the vessels;
- air embolism due to a violation of the cervical veins;
- softening of the trachea - narrowing of the rings when inhaling;
- asphyxia.
With goiter located in the retrosternal, retrotracheal, posterior esophageal space, the doctor additionally conducts a tracheostomy to exclude a lack of oxygen, a fatal outcome.
If the preparation for the manipulation has passed without observing the necessary requirements, the consequences after the operation are subtotal resection of the thyroid gland may be irreversible. Rapidly developing:
- damage to the central nervous system;
- digestive dysfunction;
- pathology of the heart muscle and blood flow;
- malfunction of the endocrine system;
- kidney and liver disease.
Signs of dysfunction of toxic goiter grow at an accelerated pace. They are able to provoke the appearance of acute psychosis, coma, hyperthermia, asphyxia, heart rhythm disturbances, pain behind the sternum.
It is necessary to clearly follow the doctor’s instructions before surgery, so that after subtotal resection of the thyroid gland, complications do not appear in any form.
The remainder of the gland in a few millimeters does not cause relapses and complications. Having changed some daily habits, gastronomic addictions and hobbies, you can lead a full-fledged lifestyle.