MODERN STRATEGIES IN SURGICAL MANAGEMENT OF THE MULTINODULAR GOITER

Abstract

Introduction. Multinodular goiter represents one of the most common thyroid disorders, characterized by the simultaneous presence of multiple nodules within the thyroid gland, varying in size and functional activity. The therapeutic approach depends on the clinical and imaging features of each patient, although, in large, symptomatic, or malignancy-suspected forms, surgical treatment is required.

Aim of the study. Optimization of diagnostic and surgical treatment strategies in patients with multinodular goiter through an individualized approach.

Materials and methods. The study included 54 patients diagnosed with multinodular goiter, who were clinically evaluated and investigated through hormonal serological tests (TSH, FT3, FT4, calcitonin) and autoimmune tests (anti-TPO, anti-TG), thyroid ultrasonography, and in cases with high ultrasound suspicion, fine-needle aspiration cytology. In isolated cases, magnetic resonance imaging and intraoperative frozen section were also performed. All patients met the criteria for surgical treatment, which allowed for the confirmation of the definitive histopathological diagnosis.

Results. The study group consisted predominantly of female patients—52 cases (96.3%) compared to 2 male cases (3.7%), with a mean age of 51.64 years. Total thyroidectomy was mainly indicated in cases with bilateral goiter or suspicion of malignancy, while hemithyroidectomy was performed for unilateral lesions. Thus, 44 patients (81.5%) underwent total thyroidectomy and 10 patients (18.5%) - hemithyroidectomy. The postoperative period was favorable in all patients, with no complications observed during a 24-month follow-up period.

Conclusions. Surgical treatment represents the method of choice in the management of multinodular goiter, and the extent of thyroidectomy should be individually tailored. The results of this study confirm the safety and efficacy of total thyroidectomy and hemithyroidectomy in the treatment of multinodular goiter, provided that the surgical approach is correctly applied.