Endocrine Abstracts

Topicality: Thyroid nodules are detected by palpation in 4–8% of the adult population and in ultrasound in 10–41%. However, most of them (90%) are benign tumors and require monitoring. Indications for surgery are compression symptoms and/or hyperthyroidism, as well as cosmetic issues. One of the severe complications of the operation is intraoperative damage of the recurrent laryngeal nerve.

Research objective: Minimize the risk of damage to the laryngeal nerves during surgery on the thyroid gland.

Inclusion criteria – patients with benign symptomatic nodular formations of the thyroid gland; TIRADS/Bethesda: TIRADS2, TIRADS3, TIRADS4a/THY2.

Exclusion criteria – Patients with suspected malignant formation of the thyroid gland; TIRADS/Bethesda: TIRADS4c, TIRADS5/THY1, THY3 (a, b, c), THY4, THY5.

Materials and methods: The object of the study was 453 patients treated in the Samara Regional Clinical Oncology Center from June 2015 to December 2017. The average age of patients in the main group (operation using IONM) was 58.0±25.6 years (18–82), totaling 232 patients, in the control group (operation) – 53.9±23.5 years (27–68) only 221 patients. The average size of the nodes in the main group was 4.3 (1.5–11.5) cm. The average size of the nodes in the control group was 3.5 (1.5–9.5) cm. Before performing the operation, the patients of both groups had the necessary diagnostic manipulations and performed voice control. In both groups, operations were performed according to the standard procedure (hemithyroidectomy, thyroidectomy). In the main group, hemithyroidectomy/thyroidectomy: 198/34, in the control group hemithyroidectomy/thyroidectomy: 194/27. Introoperative neuromonitoring (IONM) of the laryngeal nerves, ISIS C2 neuromonitor, non-stimulation electrodes, electrodes for recording EMG were used in the main group during the operation. After the operation on the second day, the fifteenth day and after three months, the patient’s voice was monitored: laryngoscopy and laryngo-stroboscopy with video recording, sonographic study of the function of the vocal folds.

Results: In the main group, unilateral transient paresis of the larynx was observed in 19 patients (8.2%), in the control group in 33 patients (14.9%). Three months after the operation, a permanent unilateral laryngeal paralysis was noted in the main group for 4 patients (1.7%), in the control group for 9 patients (4.0%).

Findings: Thus, intraoperative neuromonitoring of the laryngeal nerves is a reliable and safe technology in the patients treatment with thyroid nodules with high clinical efficacy, which allows to significantly reduce the number of postoperative complications associated with damage to the laryngeal nerves.