Surgical treatment of diffuse toxic goiter and the possibility of predicting its results

Most of the most respected researchers in the field of thyroidology agree that the ideal treatment for diffuse toxic goiter (DTZ) should ensure the rapid elimination of the clinical symptoms of thyrotoxicosis and be accompanied by a minimal risk of complications for the patient [1, 2, 7]. Unfortunately, at present, clinical practice does not have a treatment method that fully meets these requirements. The choice of treatment method for DTZ is largely determined by the commitment of specialists and their experience in the application of a particular treatment method, the characteristics of national endocrinological and surgical schools, the capabilities of a particular medical institution, as well as the sex, age of the patient, options for the clinical course of the disease, the patient’s wishes and some others factors. It can be noted that the recommendations given by experts in Europe, the USA and Japan are different. Conservative therapy with antithyroid drugs is quite widespread in European countries, but the low frequency of achieving stable remission of the disease does not satisfy endocrinologists [1,5, 32, 40, 42]. Radioactive iodine therapy, which is widely used in the USA and Western Europe, which is a rather effective method of treating DTZ, over time leads to the development of hypothyroidism in almost all patients [16, 20], it is also necessary to take into account the risk of developing thyroid cancer, breast, infertility and severe osteoporosis in women in the premenopausal period [10, 13, 18, 19]. Surgical treatment occupies a significant place in the treatment of DTZ, providing the patient with the most rapid achievement of the euthyroid state, however, like any surgical intervention, it is accompanied by a number of characteristic complications [2, 46]. Nevertheless, in Japan, thyroidectomy is considered the main treatment for DTZ.