Development of relapsing toxic goiter

Abstract

The causes of postoperative relapses of thyrotoxicosis are analyzed in 102 patients with various forms of toxic goiter (diffuse toxic goiter - DTG, poly nodular toxic goiter - PTC, and diffuse toxic goiter with adenomatous transformation - DTNG). AH these patients were reoperated for relapses of toxic goiter. The incidence of postoperative relapses of thyrotoxicosis and the development of relapses after surgical treatment of toxic goiter were studied. 7.1% patients previously operated for various forms of toxic goiter developed relapses of thyrotoxicosis. The causes of relapses were different, but technological errors during the first intervention were the most frequent among patients with diffuse forms (45%). Adenomatous transformation of the remaining thyroid with increase of the mass of functioning tissue was the cause of thyrotoxicosis relapse in 32.5% patients, being most frequent in patients with PTC. The intensity of autoimmune process can be responsible for thyrotoxicosis relapses in the rest 22.5% patients. High titers of antibodies to thyrotropin receptors in the presence of genetic liability to DTG essentially increase the risk of postoperative relapse of the disease, particularly in young patients.

The incidence of relapses after surgical treatment of toxic goiter can be decreased by better training of surgeons and more profound examination of the patient’s immune status.