ЦЕЛЬ: выявить особенности когорты пациентов с рецидивами первичного гиперпаратиреоза (ПГПТ), выявить прогностические факторы возникновения рецидива и его сроков. МАТЕРИАЛЫ И МЕТОДЫ: в ретроспективное исследование вошли 3818 уникальных пациентов, прооперированных в КВМТ им. Н.И. Пирогова СПбГУ с января 2011 по декабрь 2021 года по поводу ПГПТ. Из исследования были исключены пациенты с диагнозом карциномы околощитовидной железы. Пациенты, прооперированные повторно более, чем через 6 месяцев после первичной операции, классифицировались как пациенты с рецидивом ПГПТ. Пациенты, имевшие повторную операцию в течение 6 месяцев после первой, классифицировались как случаи персистенции ПГПТ и в данном случае вторая операция расценивалась как первичная. Генетический статус пациентов на дооперационном этапе рутинно не исследовался. РЕЗУЛЬТАТЫ: всего в анализ включено 3716 пациентов. Всего выявлено 34 пациента с рецидивами ПГПТ (0.9%). Время до повторной операции составило от 7 до 98 месяцев. Медиана – 18 месяцев. Группы без рецидива и с рецидивом не различались по возрасту (медиана – 58 лет). 28 пациентов на момент первичного обращения имели клинические признаки синдрома МЭН 1 типа или доказанную мутацию в гене MEN1. За наблюдаемый период только в трех случаях из 28 потребовалось выполнение повторной операции в период позднее 6 месяцев. При использовании логистической регрессии выявлено, что пол, возраст, наличие известного синдрома МЭН 1, тип операции (с выполнением или без выполнения двусторонней ревизии шеи) и количество удаленных при первой операции аденом не являются значимыми факторами, влияющими на риск рецидива ПГПТ в течение исследуемого периода наблюдения. С использованием регрессионной модели Кокса произведена оценка влияния факторов на время до наступления рецидива, выявлено что только факт выполнения двусторонней ревизии шеи при первичной операции имеет положительное влияние на уровне тенденции (p = 0.09). ВЫВОДЫ: среди пациентов исследуемой когорты, большая часть пациентов, прооперированных по поводу рецидива ПГПТ после адекватного первичного хирургического лечения, имела рецидив в течение 2 лет после первой операции. Не выявлено факторов, значимо влияющих на риск рецидива ПГПТ и время до наступления рецидива.

Thyrotropinoma is a rare pituitary tumor that causes the development of thyrotoxicosis syndrome as a result of hyperproduction of thyroid stimulating hormone (TSH). In the Russian literature over the past 10 years, one case of thyrotropinoma in a child, four cases of TSH-producing pituitary adenoma in women and only one in a man have been described. The article presents a unique clinical case of a 20-years history of observation of a patient with TSH-oma. The rarity of this disease led to the fact that it took more than 10 years to make a correct diagnosis. The first operation of thyroid gland was performed before the diagnosis of pituitary adenoma and inappropriate TSH secretion syndrome. That right hemithyroidectomy was supposed to cure a toxic adenoma of thyroid gland. The diagnosis of thyrotropin-secreting piruitary tumor was established only after 6 years even after finding a combination of pituitary adenoma and thyrotoxicosis. After that, the patient steadfastly refuses neurosurgical treatment, despite the presence of macroadenoma with intrasellar growth. The therapy with somatostatin analogs led to patient’s intolerance with gastrointestinal side effects and hospitalization for acute pancreatitis. The absence of the therapy due to low compliance led to long-term persistence of thyrotoxicosis. The absence of signs and symptoms of expanding tumor mass (visual field defects, loss of vision, headache, partial or total hypopituitarism) demonstrates the slow growth of this kind of pituitary tumor. The long-term effect of elevated TSH levels led to diffuse goiter with compression of the neck organs, and the need of the surgical treatment of the thyroid. Stable euthyroidism after the operation led to stable normoglycemia in the patient with previously diagnosed diabetes mellitus type 2. This fact should keep an attention of physicians and endocrinologists to screen for the secondary reasons of hyperglycemia in a patient with diabetes mellitus manifestation. Long-term history of thyrotoxicosis led to the deleterious effects of thyroid hormone excess on the heart (atrial fibrillation, cardiomyopathy, cardiac failure). Those effects are still observed even after thyroidectomy and medical euthyroidism achievement. This fact demonstrates the importance of early diagnosis and treatment of TSH-omas.

One of complications after thyroid and parathyroid surgery is laryngeal recurrent nerve injury and subsequent vocal cords palsy. It is a serious complication with a frequency varying from 1% to 18,6%, considerably deteriorating patient’s quality of life, sometimes causing loss of patient’s work-status. That’s why it is of great importance its early detection and start of appropriate treatment. Despite laryngoscopy is a gold standard for evaluation of vocal cords mobility after thyroid and parathyroid surgery, it has several problems in permanent surgical practice. This work is focused on the possibility of using noninvasive method of visualization of vocal cords. Our results indicate that ultrasound method of evaluation of vocal cords mobility can be successfully applied in 85,9% of patients in preoperative and postoperative examination of patients. The best visualization has been achieved in female patients - in 90,6% of patients, and in male patients - only in 27,9% of patients. We consider reasonable to replace laryngoscopy by ultrasound in most cases.

There are discriminating approaches towards differentiated thyroid carcinomas due to their different prognoses according to the European, American and Japanese thyroid recommendations. Materials and Methods. We have analyzed data on 331 patients with papillary thyroid cancer, operated on during the period of 1966-2000 years. Mean observation period was 18.8 years, the maximum period of observation was 57 years.Results. Survival rate analysis after surgical treatment showed favourable prognosis for thyroid cancer patients, adjusted for that there was no ultrasonography and FNAB during those years, and patients had generally more progressive tumours. One of the most important factors for the prognosis of a patient is the size of a tumour at the moment of operation and presence of distant metastases. Long-term results of surgical treatment are practically independent of its extent (thyroidectomy or thyroid resection, prophylactic lymphodissection). Mortality and recurrence rates in patients who were not submitted to radioactive iodine treatment do not differ considerably from literature data.

Thyroid papillary cancer, one of the most frequent malignant tumors, aroused growing interest during last years due to continuous increase in number of such patients. This article is devoted to the closest results of surgical stage of treatment of patients with thyroid papillary cancer and to the analysis of complications after thyroid surgery. Material and Methods. This work is based on the analysis of results of treatment of 1156 patients with thyroid papillary cancer, who were operated during the period 2007 and 2012 at the Department of Endocrine Surgery of SPCC FGBI “NMSC named after N.I. Pirogov” of MH of RF. The diagnoses were confirmed by histological method. Results. Hemithyroidectomy was performed only in patients with rather favourable forms of thyroid papillary cancer typical, follicular and sclerosing. Patients with more aggressive forms tall cell and columnar!cell were subjected to thyroidectomy. There is increase of complications with thyroid surgery expansion hypoparathyroidism from 7.6% after thyroidectomy without lymphodissection to 13.3% after thyroidectomy with central and lateral lymphodissection, and paresis of lower laryngeal nerve from 5.1% to 6.5%. Postoperative bleeding that required repeated operative intervention was registered in 3/1156 (0.3%) of patients. There were no lethal complications after thyroid surgery. Among operated 1156 patients cancer recurrence was detected in 29 patients (2.5%).

Results of treatment of 32 Graves disease patients with fixed activity of I131 in an outpatient mode were analyzed. 131 acitivty was 15 mCi (555 MBq). Mean age of patients was 48.5 years (20–70 years). Mean thyroid volume – 23 ± 13.9 ml. In 5 (15.6%) patients relapse of thyrotoxicosis was observed. Stable euthyroid state was revealed in 1 (3.1%) patient (follow up period 18 months). In 26 (81.3%) patients hypothyroidism occurred after the treatment. Total effectiveness of the treatment was 84.4%. In a group of patients with thyroid volume less than 50 ml total effec tiveness of the treatment was 93.1%.

The goal of the study was to determine diagnostic value of fine needle aspiration biopsy (FNAB) in detection of malignant thyroid tumors based on retrospective analyses of 40696 FNAB of patients with thyroid nodules. Results. Comparison of the results of FNAB with postoperative histological examination data from 3004 patients revealed that the rate of false positive cytopathological results was 1.2% and the rate of false negative results was 1.8%. The sensitivity reached 99.67%. The specificity of FNAB when taking into account follicular lesions dropped to 16.29%, while leaving follicular lesions 94.29%. Cytological results of 49609 FNAB of patients with thyroid nodules according to Bethesda system were arranged as follows: noninformative results 8%, benign nodules 81.9% (colloid nodules 71.6%, autoimmune thyroiditis 10.2%, subacute thyroiditis and others 0.02%), follicular lesions 7.2% (follicular neoplasm 7.1%, follicular lesion of indeterminate value 0.1%), suspicious for malignancy 0.02%, malignant tumor 3%, among the latter papillary carcinoma 93%. Malignant tumors, according to postoperative histological examination, were detected among the group with cytological diagnosis “follicular neoplasm” in 16.3% of cases. After performing FNAB of regional lymph nodes with suspicious ultrasound signs the metastases of papillary carcinoma were revealed in 24.6% of cases. Application of FNAB in clinical practice at our Center to all patients with thyroid nodules of 1 cm in size and larger resulted in increment of thyroid operations for oncological indications from 12.5% in 2004 to 53% in 2012. Conclusion. FNAB under ultrasound control is the most informative differential method for thyroid diseases, permitting to reveal primary and metastatic thyroid lesions. FNAB allow to evade nonobligatory diagnostic operations in many patients.

Results of treatment of 32 Graves disease patients with fixed activity of I131 in an outpatient mode were analyzed. 131 acitivty was 15 mCi (555 MBq). Mean age of patients was 48.5 years (20–70 years). Mean thyroid volume – 23 ± 13.9 ml. In 5 (15.6%) patients relapse of thyrotoxicosis was observed. Stable euthyroid state was revealed in 1 (3.1%) patient (follow up period 18 months). In 26 (81.3%) patients hypothyroidism occurred after the treatment. Total effectiveness of the treatment was 84.4%. In a group of patients with thyroid volume less than 50 ml total effec tiveness of the treatment was 93.1%.

Были проанализированы результаты лечения 297 пациентов с первичным гиперпаратиреозом. Проводилось сравнение результатов применения двусторонней ревизии шеи, односторонней ревизии шеи, селективной паратиреоидэктомии (традиционным и видеоассистированным доступом). Результаты исследования свидетельствуют о высокой эффективности применения селективной паратиреоидэктомии в лечении первичного гиперпаратиреоза и ряде преимуществ данной методики по сравнению с двусторонней ревизией шеи (снижение уровня послеоперационной боли, улучшенный косметический результат операции, снижение длительности пребывания в стационаре).

The purpose: an approbation of intraoperative photodynamic identification of healthy and adenomatous parathyroid glands using 5-aminolevulinic acid (5-ALA) at thyroid and parathyroid operations.Materials and methods: intraoperative photodynamic identification using 5-ALA was performed in 25 patients with various thyroid and parathyroid diseases. 2–3 hours before the surgery the patients have received 1,5 g of 5-ALA per os. In 10 cases video-assisted operations were performed. In 3 cases at primary hyperparathyroidism video-assisted parathyroidectomy was used. In other cases the operative intervention was carried out using conventional technique. The operative wound surface was exposed to blue light of the light source KARL STORZ D-Light C (wavelength –380–440 nm) and the endoscope with the system of filters. During preand postoperative period we have been registering basic clinical parameters, including parathyroid hormone level and the level of ionized calcium monitoring before operation, in 24, 48 hours and 1 month after operation. Results: the parathyroid glands were identified in 23 of 25 patients. There were no cases of allergic reactions and other side effects of 5-ALA introduction.Conclusion: intraoperative parathyroid glands identification by the way of registration of their fluorescence at peroral administration of 5-aminolevulinic acid is possible for the overwhelming majority of patients.

The results of comparative preoperative cytological and postoperative histological investigation of 3714 patients with thyroid nodules are presented. The causes of discrepancies are discussed and measures of their diminution are proposed. Great value of fine needle biopsy to differ thyroid nodules but follicular neoplasia into benign and malignant are determined. Its sensitivity in our clinics is 98.7% and specificity – 100%. Necessity of the of the second FNA if the first one is non informative is established.

Для того чтобы добиться значительных результатовв лечении заболеваний щитовидной железы (ЩЖ),впрочем, как и любой другой патологии, мало создать центр, оборудованный современной аппаратурой, операционной с наличием лекарственны препаратов и имеющий высококвалифицированных специалистов, хотя мы полностью согласны со статьейИ.И. Дедова и соавт. (2008), о целесообразности введения специальности “эндокринная хирургия”и подготовки хирургов соответствующего профиля.Необходимо создать и внедрить систему, обеспечивающую современный уровень диагностики и лечебной помощи на всех уровнях, все звенья которойработали бы как единый механизм, начиная с населенного пункта, где проживает больной. Каковы жеосновные задачи, которые приходится решать тем,кто работает по нашей специальности? Диагностикаи лечение пациентов с заболеваниями ЩЖ в настоящее время – наиболее алгоритмизованные разделымедицины. Современные методы исследованиягормонов позволяют диагностировать нарушенияфункции ЩЖ. Использование тонкоигольной аспирационной биопсии (ТАБ) дает возможность безошибочно определять характер заболевания на раннейстадии при узловом зобе более чем у 90% больных,однако до сих пор значительное количество пациентов поступает в стационары с III и IV стадиями ракаи далеко зашедшими нарушениями тиреоидного статуса. Такое положение в значительной степени обусловлено 3 причинами.1. Диагностические методики достаточно сложны, требуют для их выполнения наличия необходимой аппаратуры и высококвалифицированныхспециалистов и поэтому применяются в настоящеевремя лишь в крупных лечебнопрофилактическихучреждениях (ЛПУ), расположенных, как правило,в областных центрах. Таким образом, специальноеоборудование имеется в ЛПУ в основном крупныхгородов. Решением является максимальное приближение современных методов диагностики к меступроживания потенциальных пациентов, что позволитвыявить заболевания ЩЖ на ранних стадиях и значи