Endocrine Abstracts

The purpose was to study the possibility of various diagnostic methods in patients with large goiter. In 2016–2018 years 628 people with thyroid diseases was operated. In 69 cases the volume of the thyroid was 100–1200 cm³. The correlation between thyroid volume and age is weak (0.074033), the duration of the disease is high (0.732455). Evaluation of clinical signs was not difficult, but the examination data and symptoms did not give a adequate picture of the thyroid volume. The diagnostic value of the clinical examination (ROC analisis) was low (AUC = 0.743; 95% CI = 0.715–0.811; sensitivity = 72.1%, specificity = 74.0%). All patients underwent ultrasound. The possibilities of US was low: the size, location of the thyroid and its ratio to the surrounding tissues in 84.5% did not correspond to the operating data, especially of chest goiter. In most cases, there was no assessment of tracheal and esophageal compression. There were difficulties in assessing the pathology using the TIRADS, sonoelastography and US with contrasts. The ROC analysis revealed that US was not informative for large goiter (AUC = 0.793; 95% CI = 0.735–0.832; sensitivity = 85.5%, specificity = 72.4%). The traditional approach to US as a universal method for diagnosing thyroid pathology has limitations. In this regard, for the clarifying topical diagnostics were used magnetic resonance imaging or multispiral computed tomography. The resolution was increased by bolus image enhancement. The study showed that the discrepancies between MRI and operational data in the size and volume of the thyroid were 13.3%. It was practically possible to establish the capsule and the contours of the thyroid and assess the surrounding tissues (including the esophagus, trachea and lymph nodes) in all patients. Densitometric characteristics of the thyroid were different, which gave additional opportunities for differential diagnosis based on the type of contrast accumulation and removal curve, the time of peak achievement, and the degree of maximum contrast. In multi-node goiter and adenoma, a heterogeneous structure was determined on T1 and T2 VI with a predominance of signal amplification with a gentle decrease. In thyroid cancer, the structure was heterogeneous due to hypointensive inclusions on T2 VI with early signal intensity amplification with an early peak and a long phase of contrast elimination. MRI sensitivity in thyroid pathology was 94.4%, specificity-88.7% (AUC = 0.915; 95% CI = 0.843–0.974). Based on the study, it was concluded that MRI/MSCT is mandatory for patients with large goiter when planning an operating aid.