Optimization of the indications for surgical treatment and choice of surgery volume in patients with nodular endemic goiter and autoimmune thyroiditis

Abstract

Introduction. The main treatment of autoimmune thyroiditis (AIT) is conservative. However, there are patients with AIT in whom surgical treatment is mandatory. The growing experience and reports of surgical intervention with newer indications challenges this traditional view of AIT. The objective of the study was to determine the choice of surgery volume in patients with nodular goiter and AIT, taking into account the activity of apoptosis, index of proliferative activity and polymorphisms of cytotoxic T-lymphocyte antigen-4 (CTLA-4) gene. Material and methods. 95 patients with nodular goiter and autoimmune thyroiditis (NGAIT) were included in the study. We determined the activity of the apoptosis index of proliferative activity and gene polymorphism of CTLA-4. Results. The correlation analysis of markers used to optimize surgical treatment, namely the choice of the surgery volume in patients with NGAIT, showed that the studied tests are objective and reliable for the long-Term results of surgical treatment: The volume of the thyroid gland not affected by the nodes less than 10 cm3, the level of antibodies to thyroid peroxidase (TPO Ab) <80.25 IU/mL, the level of antibodies to thyroglobulin (TG Ab) < 89.34 IU/mL, index of the immunoproliferative activity (IPA) Ki-67 <10.55%, index of immunoreactive cells (IIRC) Fas >43%, IIRC Bcl-2 <90%, IIRC p53 >50%; AA and AG-genotype of the CTLA-4 gene. Conclusions. The study allowed to determine new criteria for selecting the volume of surgery in patients with NGAIT.