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Abstract
Today there is a scientific and clinical consensus on the algorithm for the diagnosis and treatment of thyroid nodular pathology. However, there is a number of controversial issues regarding the dynamic monitoring of benign nodes (including the list of methods and periodicity of the screening). This is especially true
for the tactics of managing patients with a history of radiation factor, which can play a significant role in the initiation and development of the thyroid node. Objective is retrospective analysis of the results of long-term observation of cytologically confirmed nodular goiter in persons exposed to radiation as a result of the Chornobyl accident. Material and methods. Among 13.243 people from the regions of radiation control who underwent the first cycle of an epidemiological cohort study of the thyroid gland in 1998-2000 within the Ukrainian-American Thyroid Project, a group of 122 people was selected with detected and cytologically confirmed benign single nodular thyroid pathology (size >1 cm), which corresponds to the category of «nodular goiter». The age of patients at the time of the Chornobyl accident was 0-18 years (mean age was 82.00±0.38), at the time of detection of nodular pathology — 13-31 years (mean age was 23.43±0.40), 33 women and 89 men among them. The distribution by dose of thyroid radiation was as follows: in 72 persons (59% of the total) — <0.3 Gy, in 34 (27.9% — from 0.3 to 1.0 Gy and in 14 (11.5%) — >1.0 Gy, and in 2 people (1.6%) — no data. The number of patients who underwent the screening examinations, according to the protocol, which were conducted every 2-3 years from 1998 to 2015 was as follows: 119 patients (2nd cycle), 114 (3rd), 100 (4th), 88 (5th) and 101 (6th) cycles. In the presence of indications, fine needle aspiration (FNA) biopsy of thyroid nodes was performed, if necessary — surgical treatment. Analysis of sonographic characteristics of the thyroid nodules (number, size, location and type) and the results of laboratory studies of the levels of thyroid-stimulating hormone (TSH), free thyroxine (fT4), thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb) and thyroglobulin (TG) was conducted. Results. Hormonal studies have shown that at the time of nodular goiter diagnosis in the majority of patients (91%) the level of TSH was within the reference values. In 99 (81%) people the level of ATPO did not exceed the normal level, an increase in its level was found in 23 (19%) respondents. Basal TG level was within normal limits in 101 (83%) patients. No significant changes in patients’ hormonal status were observed during further dynamic monitoring. Despite an increase in the number of patients (11 — on the cycle 4 vs 2 — on the cycle 1) with low levels of TSH (0-0.29 mIU/L), the level of fT4 was within the reference values. According to ultrasound data during the first cycle, solid tumors accounted for 82.8%, cystic — 4.1% and combined — 11.5%. Subsequently, multinodular goiter was diagnosed in some patients, the percentage of which gradually and significantly was increased: on cycle 6 of screening — 2-4 nodes were found in 50% of people. During the survey, the volume of thyroid nodules decreased by >50% in 26 people, by 10-50% in 8 people, and by <10% in 6 people, increased by 10-50% in 8 people, and by >50% in 41 people (the node disappeared in 7 people). Eleven members of the cohort (patients) underwent surgical treatment (4 cases of follicular adenoma, 3 cases of single-nodule goiter and 4 cases of multinodular goiter). Conclusions: Among the vast majority of patients with cytologically confirmed single-node goiter, its transformation into multinodular goiter was observed, and in 40% of individuals the primary node increased by >50. No malignant thyroid tumors were detected in 11 patients with cytologically confirmed goiter and underwent surgery during the follow-up, however, in some of them, nodular transformation and hyperplastic changes were found in the extranodal tissue of the thyroid gland according to postoperative histological examination.
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