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American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 01 PAGES: 56-63 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

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ABSTRACT 

The study included the results of treatment of 368 patients with benign thyroid nodules who were admitted to the 

surgi-cal department of the multidisciplinary clinic of Samarkand State Medical University in the period from 2010 to 

2023. Depending on the volume of the thyroid gland to be removed, the following types of operations were 

performed: Thy-roidectomy, Subtotal resection of the thyroid gland, Hemithyroidectomy with partial resection of the 

other lobe of the thyroid gland, Hemithyroidectomy, Partial resection of the thyroid gland. The developed algorithm 

for choosing tactics for surgical treatment of thyroid nodules, taking into account the volume of removal of the thyroid 

gland according to the conclusion of fine-needle aspiration biopsy or express bopsy, made it possible to improve the 

quality of care provid-ed by reducing the frequency of immediate postoperative complications from 14.8% (40 patients 

in the group compari-son) to 2.9% (4 patients in the main group) (χ2 criterion = 4.954; Df=1; p=0.027) and unsatisfactory 

results in the long-term postoperative period from 32.1% (52 patients in the comparison group) to 11, 3% (in 12 patients 

in the main group) (χ2 criterion = 4.692; Df = 1; p = 0.031). 

KEYWORDS 

Nodular goiter, surgical treatment, relapse. 

INTRODUCTION

Treatment of thyroid nodules (TNO) is a complex 

surgical problem. The most common method of sur-

gery remains strumectomy with various options for 

removing thyroid nodules (TG), which is performed in 

  Research Article 

 

ANALYSIS OF THE RESULTS OF SURGICAL TREATMENT OF THYROID 

NODULES 
 

Submission Date: January 08, 2024, Accepted Date:  January 13, 2024,  

Published Date: January 18, 2024  

Crossref doi: https://doi.org/10.37547/ajbspi/Volume04Issue01-09 

 

 

Salokhiddinov Jurabek Saidakhmatovich 
Samarkand State Medical University, Republic of Uzbekistan, Samarkand 

 

 

 

Journal Website: 

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com/index.php/ajbspi 

Copyright: Original 

content from this work 

may be used under the 

terms of the creative 

commons attributes 

4.0 licence. 

 

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Volume 04 Issue 01-2024 57 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 01 PAGES: 56-63 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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the vast majority of cases (90.6%) of PTG [1, 2, 3, 7, 10]. 

“However, a fairly high frequency of post-operative 

complications and numerous cases of postoperative 

relapses of the disease (15-44%), postop-erative 

hypothyroidism (25 - 63%) indicatelack of effectiveness 

and reliability of common surgical tac-tics” [4, 6, 8, 9, 

12, 13]. 

The analysis of the literature also indicates that at the 

present time, treatment and diagnostic tactics for PTG 

is one of the pressing and unresolved problems of 

modern healthcare [5, 11]. In this regard, there is a need 

to revise the criteria for the radicality of surgical 

intervention for PTO, depending on the information 

content of visualization methods and morphological 

studies, which allow, at the preoperative stage, to 

assess the features of the structure of the node and 

identify signs of disease aggression, and therefore, 

optimization of the diagnostic algorithm in order to 

select the most radical tactics of surgical treatment in 

each specific case. 

Purpose of the study 

Improving the results of surgical treatment of patients 

with parathyroid gland. 

METHODS 

The study included the results of treatment of 368 

patients with benign PTG who were admitted to the 

surgical department of the multidisciplinary clinic of 

Samarkand State Medical University in the period from 

2010 to 2023. Our study did not include patients with 

toxic forms of PTO. 

The patients were conditionally divided into two 

groups. In 2010-2018 230 (62.5%) patients were 

operated on and made up the comparison group, the 

main group - 138 (37.5%) patients operated on in the 

period 2019 - 2023. The comparison group was also 

conditionally divided into two subgroups: sub-group 1 

consisted of 127 (55.2%) patients operated on in the 

period 2010-2014, subgroup 2 - 103 (44.8%) - patients 

operated on in 2015 - 2018. 

The examination of patients with parathyroid gland 

met the clinical standards recommended by WHO and 

the Ministry of Health of the Republic of Uzbekistan: - 

general clinical (examination of the neck area, 

palpation of the thyroid gland); - general clinical 

laboratory tests; - determination of the level of thyroid 

hormones (TSH, T3, T4); - examination by an 

endocrinologist; - examination by an ENT doc-tor in 

case of phonation disturbance. 

Morphological studies of the parathyroid gland 

included fine-needle aspiration biopsy, intraopera-tive 

express biopsy, and routine histological examination of 

removed thyroid tissue. At the same time, in the 

comparison group (230 patients), TPAB and a final 

histological examination of the removed thyroid 

specimen were performed to determine the likelihood 

of malignancy of the node. In the main group of 

patients (138 patients), in addition to determining the 

factor of possible thyroid cancer, the nature of be-nign 

changes in nodular and perinodular tissue was 

differentiated. The algorithm for morphological stud-

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Volume 04 Issue 01-2024 58 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 01 PAGES: 56-63 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

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ies in the main group of patients also included an 

intraoperative express biopsy of thyroid tissue. 

Depending on the volume of the thyroid gland to be 

removed, the following types of operations were 

performed: Thyroidectomy, Subtotal resection of the 

thyroid gland, Hemithyroidectomy with partial 

resection of the other lobe of the thyroid gland, 

Hemithyroidectomy, Partial resection of the thyroid 

gland (Table 1). 

Table 1. 

Performed surgeries for PTG 

Type of surgery 

Number of operations performed 

Main group 
Comparison group 

Total 
1 subgroup 2 subgroup 

Thyroidectomy 10 4 15 29(7.9%) 

Subtotal resection of the thyroid gland 54 23 62 139(37.8%) 

Hemithyroidectomy with partial 

resection of another lobe of the thyroid 

gland 
23 18 9 50(13.6%) 

Hemithyroidectomy 37 51 12 100(27.1%) 

Partial resection of the thyroid gland 14 31 5 50(13.6%) 

Total: 138 127 103 368(100%) 

  

127 patients 1 - subgroup of the comparison group 

underwent the following operations: thyroidec-tomy 

in 4 patients, subtotal resection in 23 patients, 

hemithyroidectomy with partial resection of the other 

lobe in 18 patients, hemithyroidectomy in 51 patients 

and partial resection of the thyroid gland in 31 pa-

tients, i.e. In 78.7% of cases, organ-preserving 

operations were performed. 

103 patients of the 2nd subgroup of the comparison 

group underwent the following operations: 

thyroidectomy in 15 patients, subtotal resection in 62 

patients, hemithyroidectomy with partial resection of 

the other lobe in 9 patients, hemithyroidectomy in 12 

patients and partial resection of the thyroid gland in 5 

patients. In this subgroup, preference is given to 

performing more radical surgical interven-tions. As can 

be seen from Table 1, in this subgroup, radical 

operations were performed in 74.7% of cases: 

thyroidectomy was performed in 14.6% and subtotal 

resection in 60.2% of cases. 

138 patients of the main group underwent the 

following operations: thyroidectomy in 10 patients, 

subtotal resection of the thyroid gland in 54 patients, 

hemithyroidectomy with partial resection of the other 

lobe in 23 patients, hemithyroidectomy in 37 patients 

and partial resection of the thyroid gland in 14 patients. 

In the main group of patients, 53.6% underwent organ-

preserving operations, 46.4% under-went radical 

operations, i.e. approximate ratio 1:1. 

RESULTS 

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Volume 04 Issue 01-2024 59 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 01 PAGES: 56-63 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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The results of surgical treatment of PTG in the 

immediate postoperative period were assessed by the 

following indicators: bleeding during and in the 

postoperative period, the course of the postoperative 

period, the presence of signs of paresis of the 

recurrent laryngeal nerve, the presence of convulsions, 

the nature of healing of the surgical wound, the length 

of stay of patients in the hospital (bed/day) , duration 

of operation (min.), increased body temperature, signs 

of peritracheal and subcuta-neous hematomas 

according to ultrasound data. 

Improving the choice of tactics for surgical treatment 

of parathyroid gland, surgical technique, re-ducing the 

trauma of surgical access and other innovations 

developed and implemented within the framework of 

this study could not but affect the immediate results of 

managing this category of patients. So, compared to 

2015-2018. the frequency of immediate postoperative 

complications decreased from 33.0 to 5.1%, i.e. 6 times 

(Table 2). Complications such as bleeding (5 times), 

paresis of the recurrent laryngeal nerve (3 times), 

hypoparathyroidism (15 times) became much less 

common; there were no such dangerous complications 

as persistent paralysis of the recurrent laryngeal nerve 

and asphyxia, inThe duration of inpatient treatment 

was reduced by 2 times – from10.2±1.2 to 5.9±0.3 days 

(Table 3). 

Table 2. 

Comparative analysis of the frequency of immediate postoperative complications in patients with PTG 

Type of complication 

Group of patients 

Total, 

n=368 

Comparison group 

main, n=138 1-subgroup, 
n=127 

2-subgroup, 
n=103 

abs. % abs. % abs. % abs. % 

Complications arising during surgery 

Bleeding 4 3.1 7 6.8 2 1.4* 13 3.5 

Asphyxia 0 0 1 0.97 0 0 1 0.3 

Complications that occur after surgery 

Bleeding with development of 
hematoma 

2 1.6 3 2.9 0 0 5 1.4 

Transient paresis of the recurrent 

laryngeal nerve 
2 1.6 9 8.7 4 2.9* 15 4.1 

Persistent recurrent laryngeal 

nerve palsy 
0 0 1 0.97 0 0 1 0.3 

Hypoparathyroi

dism 

Transitory 5 3.9 10 9.7 1 0.7 16 4.3 

Permanent 1 0.8 2 1.94 0 0 3 0.8 

Complications from the wound 2 1.6 1 0.97 0 0 3 0.8 

Total complications 16 12.6 34 33.0 7 5.1*** 57 15.5 

Number of patients with 

complications 
eleven 8.7 23 22.3 4 2.9* 38 10.3 

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Volume 04 Issue 01-2024 60 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 01 PAGES: 56-63 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Note: * - differences relative to the comparison group data are significant (* - P<0.05, *** - P<0.001) 

 

Table 3. 

The course of the postoperative period in patients with PTG 

Group of patients 
Number of bed days 

Total before surgery ICU after operation 

C
o

m
p

ar
is

o
n

 

g
ro

u
p

 

1-subgroup, n=127 10.2±1.2 3.0±0.3 2.1±0.1 6.2±1.2 

2-subgroup, n=103 9.4±0.6*** 2.3±0.3** 1.7±0.1** 5.4±0.5*** 

Main, n=138 5.9±0.3***^^^ 2.0±0.2** 1.0±0.1* 2.9±0.3***^^^ 

Total, n=368 14.9±0.7 3.5±0.2 2.9±0.1 7.4±0.5 

Note: * - differences relative to the data of the 1st subgroup of the comparison group are significant (* - P<0.05, ** - P<0.01, 

*** - P<0.001), ^ - differences relative to the data of the 2nd subgroup comparison groups are significant (^ - P<0.05, ^^^ 

- P<0.001) 

 

Long-term results were analyzed in 268 (72.8%) of 368 

patients operated on for PTG. One of the main 

indicators characterizing the effectiveness of surgical 

intervention for PTG is the frequency of dis-ease 

relapses. When studying the nature of the relapse, the 

localization of the initially operated and re-identified 

node, the timing of the relapse, the features of 

previously used methods of surgical interven-tion, the 

number, size and morphological forms of primary PTC 

were compared. 

Of 268 patients examined long-term, recurrence of 

PTG was observed in 33 (12.3%) patients, while in the 

group of patients operated on in 2010-2014, this figure 

reached 26.4% (Table 4). Subse-quently, the frequency 

of disease relapses was reduced in the 2nd subgroup of 

the comparison group to 8.0%, and in the main group 

to 3.8% (χ2 criterion = 4.692; p = 0.031). 

We studied and analyzed the long-term results of 

surgical treatment of PTG in order to determine the 

influence of the choice of the volume of surgical 

interventions in the study groups and compared them 

with each other (Table 5). 

 

Table 4. 

Recurrence rate of PTC 

Nature of relapse 

Comparison group 
Main group n=106 Total n=268 

1-subgroup n=87 2-subgroup n=75 

abs. % abs. % abs. % abs. % 

Nodular goiter 10 11.5 2 2.7 1 0.9 13 4.8 

Multinodular goiter 13 14.9 4 5.3 3 2.9 20 7.5 

Total 23 26.4 6 8.0 4 3.8 33 12.3 

Criterionχ2 Df=1;χ2 = 4.692; p=0.031 

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VOLUME 04 ISSUE 01 PAGES: 56-63 

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Table 5. 

Comparative analysis of the localization of recurrent nodes in the thyroid gland 

Scope of surgery 
Localization of relapse 

Total 
Operated lobe Contralateral lobe Both beats Pyramidal process 

abs. % abs. % abs. % abs. % abs. % 

1-subgroup of the comparison group (n=87) 

STC (n=14) - - - - 1 12.5 - - 1 4.3 

GTE+PR (n=13) - - - - 2 25.0 - - 2 8.7 

GTE (n=35) 2 25.0 3 50.0 2 25.0 - - 7 30.4 

PTC (n=23) 6 75.0 3 50.0 3 37.5 1 100 13 56.5 

Total 8 100 6 100 8 100 1 100 23 100 

2-subgroup comparison group (n=75) 

STC (n=45) - - - - 1 33.3 - - 1 16.7 

GTE+PR (n=7) - - - - 1 33.3 - - 1 16.7 

GTE (n=8) - - 1 50.0 - - - - 1 16.7 

PTC (n=4) 1 100.0 1 50.0 1 33.3   3 50.0 

Total 1 100 2 100 3 100 - - 6 100 

Main group (n=106) 

Sthyroidism (n=73) - - - - - - - - - - 

GTE+PR (n=7) - - - - - - - - - - 

GTE (n=41) - - 1 33.3 - - - - 1 33.3 

PTC (n=4) 1 100.0 2 66.7 - -   3 66.7 

Total 1 100 3 100 - - - - 4 100 

Total 10 30.4 eleven 33.3 
elev

en 
33.3 1 3.0 

33 12.3% 

 

According to Table 5, postoperative relapse of nodular 

or multinodular nontoxic goiter developed in 33 (12.3%) 

patients during follow-up periods of up to 12 years. 

Moreover, in 11 (4.1%) cases, nodular formations were 

identified in the thyroid tissue, where at the time of the 

primary operation there were no signs of nodular 

transformation, which was confirmed by the results of 

sonography and intraoperative revision data. 

Of 33 patients with recurrent PTG, relapse occurred in 

the operated lobe in 10 (30.4%) cases, in the 

contralateral lobe in 11 (33.3%) cases, relapse in both 

lobes occurred in 11 (33.3%) cases and in the pyramidal 

process in 1 (3.0%) case. 

Hypothyroidism in the long-term postoperative period 

is also considered a relatively unsatisfactory result of 

treatment. The clinical picture varied significantly 

depending on the severity and duration of thyroid 

hormone deficiency, as well as on the age of the 

patient and the presence of concomitant diseas-es. The 

faster hypothyroidism developed after surgical 

removal of the thyroid gland, the faster it was ac-

companied by obvious clinical manifestations. On the 

other hand, even with the same severity and dura-tion 

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Volume 04 Issue 01-2024 62 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 01 PAGES: 56-63 

SJIF IMPACT FACTOR (2021: 5. 705) (2022: 5. 705) (2023: 6.534) 
OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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of hypothyroidism, the clinical picture was very 

individual. That is, on the one hand, completely obvious 

hypothyroidism could not have any clinical 

manifestations and was discovered by chance, on the 

other hand, some patients with subclinical 

hypothyroidism could present a lot of complaints 

charac-teristic of complicated severe hypothyroidism. 

Thus, the developed algorithm for choosing tactics for 

surgical treatment of PTG, taking into ac-count the 

volume of thyroid removal according to the conclusion 

of TPAB or express bopsy, made it possible to improve 

the quality of care provided by reducing the frequency 

of immediate postoperative complications from 14.8% 

(40 patients in the comparison group) to 2 .9% (4 

patients in the main group) (χ2 criterion = 4.954; Df=1; 

p=0.027) and unsatisfactory results in the long-term 

postoperative period from 32.1% (52 patients in the 

comparison group) to 11.3% (in 12 patients in the main 

group) (χ2 crite-rion = 4.692; Df=1; p=0.031). 

CONCLUSIONS 

• Factor analysis of the results of treatment of 

patients with PTO showed that the cause of re-

lapse in 26.4% was the performance of organ-

preserving surgical interventions for nodular cystic 

colloid goiter with foci of adenomatosis and a 

combination of various types of adenomas with 

multinodular col-loid goiter. The cause of the 

development of postoperative hypothyroidism in 

24% of cases was exceed-ing the indications for 

performing operations associated with total 

removal of the thyroid gland. 

• In the morphological diagnosis of PTG, the 

information content of TPAB was 91.8%, express 

biopsy was 94.4%, the combination of these 

methods increased the information content to 

98.1%. The introduction into clinical practice of 

morphological diagnosis of changes in the nodular 

and perinodular tissue of the thyroid gland in 

patients with PTG has made it possible to select the 

optimal volume of sur-gical intervention. 

• The developed algorithm for selecting the volume 

of surgical intervention for PTG, taking into 

account the data from the conclusion of TPAB 

and/or express bopsy, made it possible to improve 

treat-ment results by reducing the frequency of 

immediate postoperative complications from 14.8% 

to 2.9% and unsatisfactory results in the long-term 

postoperative period from 32 .1% to 11.3%. 

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(ISSN – 2771-2753) 
VOLUME 04 ISSUE 01 PAGES: 56-63 

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OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

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