Clinical and Pathomorphological Analysis of the Secondary Postoperative Recurrences of Some Thyroid Diseases
Issue: 3/1998
Author: M. Velkov, Iv. Mendizov, G. Dashev, Clinic of Endocrine Surgery, Laboratory of Pathomorphology, Clinical Center of Endocrinology and Gerontology, Medical University Sofia
Abstract:
The study group included 61 patients with recurrent thyroid diseases reoperated twice in the Clinic of Endocrine Surgery for the period 1985 – 1996. The distribution according to sex and age included 8 males aged from 17 to 59 (39.6 years average age) and 53 females aged from 15 to 73 (42.7 years average age).
All patients were reoperated by reason of the following diseases: nodular recurrent goiter – 42 cases, recurrent Hashimoto thyroiditis – 1 case, recurrent Craves' disease – 2 cases, recurrent multifocal thyroidal autonomy – 4 cases, alien corpuscle – 3 cases, regional lymphogland metastases from thyroid carcinoma – 8 cases, secondary thyroidectomy – 1 case.
The aim of the study was to analyse the characteristics of secondary thyroid recurrences,the appearance period after the second surgery in connection to the extent of reoperation, hormone replacement therapy and family history.
The pathomorphological investigation of all hystological specimen was made parallel with the clinical study. Its aim was to establish the morphological substrate of the secondary thyroid recurrences and to create some individual criteria in respect to different recurrent thyroid diseases. The appearance period of second recurrences concerning the patients with nodular recurrent goiter was up to 6 months in 9 cases, up to 1 year in 9 cases and up to 5 years in 15 cases. 35 out of 61 patients had pseudo-recurrence (57.37%). Prophylaxis with thyroid hormones was applied only in 15 patients (24,59%). Family predisposition was established in 10 cases (16.39%).
Morphological signs in the primary operative findings as prevalance of microfollicles, presence of micronodules, secondary papilliferity, stronger proloferative reaction of the folicular structures appeared very important markers for the persisting process in the thyroid. The possibility for a recurrent development in these cases seemed extremely high.
Keywords: thyroid recurrence, reoperation, pathomorphological investigation, hormone therapy.
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