Vladimir Stefanov will answer an important question. Why ia it necessary to consult an endocrine surgeon?

January 5, 2021 by No Comments

Vladimir Stefanov for each patient becomes a family member
Vladimir Stefanov for each patient becomes a family member

The main function of the endocrine glands is the production of hormones to maintain homeostasis in the body, that is, the balance of metabolism.  Diseases of the endocrine system are very diverse, but all of them can be divided into three groups: with normal, increased (hormone overproduction) or decreased function (hormone deficiency) of the endocrine gland.  For decreased and increased function, different treatments are used.  The decreased function of the gland is usually compensated for by hormone replacement therapy.  With increased gland function, treatment tactics can be both conservative and surgical.  A separate position is occupied by tumor diseases or volumetric neoplasms of the endocrine glands, which can be combined with various functions of the gland.  Volumetric neoplasms of the endocrine system are divided into benign and malignant.  Malignant neoplasms are treated only by surgery, and benign ones are operated on in 30% of cases.

Vladimir Stefanov talk about consult an endocrine surgeon?

Many people have been seen by an endocrinologist for years, undergo regular scheduled examinations.  This is absolutely correct and must be done, because it is as a result of such examinations that changes in the gland are very often found, which are treated only with the help of an operation.  There are also situations when, already at the first visit to an endocrinologist, the doctor recommends that the patient see an endocrine surgeon.  The most common reason for consulting an endocrinologist surgeon is various masses.  They, as a rule, are found during ultrasound examination of the gland or on MRI by accident or during follow-up examination due to changes in hormone parameters. 

Vladimir Stefanov for each patient becomes a family member
Vladimir Stefanov for each patient becomes a family member

In the thyroid gland, masses or nodes can be determined by palpation, and sometimes the patient himself visually or by touch finds them in himself.  But do not worry ahead of time – not all formations are subject to mandatory surgical intervention!  Before contacting a surgeon, you first need to be examined by an endocrinologist.  Only after receiving all the results, the doctor will objectively assess the condition and decide on referral to a surgeon or conservative treatment.

Vladimir Stefanov about diagnostics

Vladimir Stefanov strongly recommends to consult a doctor prematurely for advice, because before carrying out all surgical interventions it is necessary to get a full recommendation from a doctor, a specialist in his field. Making a decision on surgical intervention is possible only with a complete exhaustive examination: blood test for hormones, mri or ct with contrast, ultrasound diagnostics, if necessary, diagnostic tests. For a more accurate diagnosis of thyroid nodules, namely their structure (benign or malignant), our clinic uses the method of ultrasound elastography.  This is a non-invasive method with a high degree of reliability, which allows differentiation of the nodules and determine those nodules that need to be subjected to a puncture biopsy.

Vladimir Stefanov tolk about tab procedure

To determine the nature of thyroid masses, the method of fine-needle aspiration biopsy (tab) is widely used.  This procedure is performed by an endocrinologist surgeon (if necessary, under ultrasound control) on an outpatient basis.

How is the procedure performed?  Without additional anesthesia, a small amount of mass tissue is aspirated through a skin puncture with a sterile syringe with a very thin needle under ultrasound control.  Then, from a syringe, the contents are applied to a specially prepared glass, marked and sent to the laboratory for cytological examination.  If several formations are punctured, then a separate syringe is taken for each sample and a new puncture is made.  Patient tolerated the procedure, as a rule, satisfactorily.  After the puncture, the patient can leave the clinic almost immediately.

Vladimir Stefanov for each patient becomes a family member
Vladimir Stefanov for each patient becomes a family member

Results.  The result is usually ready in 3 days.  If you left your e-mail when signing the informed consent, the result will be sent to your specified e-mail address.  In our clinic, the assessment of the material received is carried out by a certified laboratory according to the classification of the bethesda system for reporting thyroid cytopathology.  This international classification makes it possible to determine further clinical tactics.  In some cases, when examining a taken sample, the observed picture is difficult for unambiguous identification.  Then the laboratory additionally attracts an expert from leading federal oncological institutions for consultation, and the time for the readiness of the result may increase by 2-3 days.

According to the results of cytology, in 80% of cases, colloidal nodes, hashimoto’s thyroiditis or subacute thyroiditis are detected, and only 3% of the samples reveal a malignant tumor (papillary, medullary, poorly differentiated and other types of carcinomas), and in 7% – follicular neoplasia.  The share of uninformative samples is no more than 8%.

When do you need operational intervention?

Vladimir Stefanov for each patient becomes a family member
Vladimir Stefanov for each patient becomes a family member

Conditions that are an absolute indication for surgery include:

1. Hormone-producing tumors such as:

o thyrotoxic adenoma of the thyroid gland,

o primary hyperparathyroidism or parathyroid adenoma,

o primary hyperaldosteronism caused by adrenal adenoma,

o Cushing’s syndrome and the presence of an adrenal adenoma,

o insulinoma.

2. Volumetric formations without changes in the function of the gland, but having the characteristics of malignant neoplasms, confirmed by TAB.

3. Volumetric formations of large sizes, affecting the function of adjacent organs.

4. Conditions that caused hyperplasia of the glandular tissue and increased function of the gland (diffuse toxic goiter, nodular hyperplasia of the adrenal glands, etc.).