Dolya O. Optimization of the decision making method for Graves disease surgery

The thesis concerns the issues of surgery of the Graves' disease (GD). The aim of the work was the improvement of the outcomes of GD surgery by means of design of the algorithm which was based on the investigation of the anti-thyroid immunity and was specially intended for examination and treatment of patients with GD. The work is based on the analysis of 118 cases of the GD. Patients with GD were allocated either into the control group of 66 patients, for whom extent of thyroid resection was determined empirically, or into the investigation group of 52 patients, for whom extent of the surgery was determined according to the designed algorithm (Patent of Ukraine №53211-2010). The principal point of the algorithm was the primary testing of TSH-binding inhibiting immunoglobulins (TBII). If level of TBII exceeded 8 U/l, thyroidectomy was performed; otherwise, level of antibody thyroid peroxidase (Ab-TPO) was checked. If level of Ab-TPO exceeded 300 U/ml, thyroidectomy was performed as well; otherwise one of the variants of subtotal resections was carried out. Use of the algorithm increased the rate of carried-out thyroidectomy twofold as compared with that of subtotal resections. In spite of this, there has not been statistically significant rise of the complication rate in the investigation group by comparison with that of the control group (р = 0,83; Fisher exact). Late outcomes have been followed-up in 89 % cases. It has been revealed statistically significant fall of the recurrence rate in the investigation group as compared with that of the control group (р = 0,02; Fisher exact). Evolution of the hormone producing function during the follow-up period evidences the rise of the number of the patients with postoperative hypothyroidism in spite of their euthyroidism in the early postoperative period.