Volume 04 Issue 01-2024 56 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 Servi 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: https://theusajournals. com/index.php/ajbspi Copyright: Original content from this work may be used under the terms of the creative commons attributes 4.0 licence. https://doi.org/10.37547/ajbspi/Volume03Issue03-01 https://scholar.google.co.in/scholar?q= https://www.mendeley.com/search/?page=1&query= https://theusajournals.com/ https://doi.org/10.37547/ajbspi/Volume04Issue01-09 https://doi.org/10.37547/ajbspi/Volume04Issue01-09 https://theusajournals.com/index.php/ajbspi https://theusajournals.com/index.php/ajbspi https://theusajournals.com/index.php/ajbspi https://theusajournals.com/index.php/ajbspi 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 Publisher: Oscar Publishing Services Servi 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- https://doi.org/10.37547/ajbspi/Volume03Issue03-01 https://scholar.google.co.in/scholar?q= https://www.mendeley.com/search/?page=1&query= 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 Servi 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 https://doi.org/10.37547/ajbspi/Volume03Issue03-01 https://scholar.google.co.in/scholar?q= https://www.mendeley.com/search/?page=1&query= 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 Publisher: Oscar Publishing Services Servi 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 https://doi.org/10.37547/ajbspi/Volume03Issue03-01 https://scholar.google.co.in/scholar?q= https://www.mendeley.com/search/?page=1&query= 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 Publisher: Oscar Publishing Services Servi 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 https://doi.org/10.37547/ajbspi/Volume03Issue03-01 https://scholar.google.co.in/scholar?q= https://www.mendeley.com/search/?page=1&query= Volume 04 Issue 01-2024 61 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 Servi 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 https://doi.org/10.37547/ajbspi/Volume03Issue03-01 https://scholar.google.co.in/scholar?q= https://www.mendeley.com/search/?page=1&query= 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 Publisher: Oscar Publishing Services Servi 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%. REFERENCES 1. Babazhanov A. S. et al. Ways to improve the results of surgical treatment and prevention of hypothy- roidism in patients with multinodular nontoxic goiter // Issues of science and education. – 2021. – No. 10 (135). – pp. 53-59. 2. Babazhanov A. S., Zainiev A. F., Alimov Zh. I. Optimization of tactical and technical aspects of sur-gical treatment of thyroid nodules // Achievements of Science and Education. – 2022. – No. 5 (85). – P. 26-32. https://doi.org/10.37547/ajbspi/Volume03Issue03-01 https://scholar.google.co.in/scholar?q= https://www.mendeley.com/search/?page=1&query= Volume 04 Issue 01-2024 63 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 Servi 3. Gozibekov Zh. I., Zainiev A. F., Tilavova Yu. M. K. Results of surgical treatment of patients with nodular goiter // Issues of science and education. – 2019. – No. 13 (60). – P. 61-70. 4. Davlatov S.S., Rakhmanov K.E., Daminov F.S. Analysis of the results of surgical treatment of thyroid pathology //Youth and medical science in the XXI century. – 2014. – P. 548-550. 5. Zainiev A.F., Gozibekov Zh.I., Abdurakhmonov D.Sh. Clinical and morphological criteria for choos- ing surgical treatment of toxic goiter // Finland International Scientific Journal of Education, Social Sci-ence & Humanities. – 2023. – T. 11. – No. 5. – pp. 2223-2231. 6. Zainiev A.F., Yunusov O.T., Suyarova Z.S. Results of surgical treatment of patients with nodular goi-ter // Bulletin of Science and Education. – 2017. – T. 1. – No. 6 (30). – pp. 107-111. 7. Ismailov, S.I. Quality of life of patients during therapy with thyroxine and a combination of thyroxine and triiodothyronine after total thyroidectomy due to Graves’ disease / S.I. Ismailov, A.M. Akbutaev, A.A. Elov // International Journal of Endocrinology. - 2017. - T. 61, No. 5. -S. 52- 55. 8. Kurbaniyazov Z.B., Babazhanov A.S., Zainiev A.F., Davlatov S.S. Factor analysis of recurrence of nodular goiter in residents living in an iodine- deficient region. // Problems of biology and medicine. - Samarkand. - 2019, - No. 3 (111). pp. 58- 62. 9. Kurbaniyazov Z. B., Zainiev A. F., Alimov Zh. Long- term results of surgical treatment of nodular goi- ter // Volume-1. – 2022. – P. 207. 10. Rakhmanov K. E. et al. Results of surgical treatment of patients with nodular goiter // Zavadsky readings. – 2017. – pp. 145-148. 11. Rizaev Zh. A., Azimov A. M., Khramova N. V. Pre- hospital factors influencing the severity of odontogenic purulent-inflammatory diseases and their outcome // Journal of Medicine and Innovations. – 2021. – No. 1. – pp. 28-31. 12. Shin YW. et al. Diminished Quality of Life and Increased Brain Functional Connectivity. Patients with Hypothyroidism After Total Thyroidectomy // Thyroid. -2020. - Vol. 26, No. 5. - P. 641-649. 13. Schneider DF et al. Thyroidectomy as primary treatment optimizes body mass index in patients with hyperthyroidism // Ann Surg Oncol. - 2021. - Vol. 21, No. 7. - P. 2303-2309. https://doi.org/10.37547/ajbspi/Volume03Issue03-01 https://scholar.google.co.in/scholar?q= https://www.mendeley.com/search/?page=1&query=