LONG-TERM RESULTS OF INTERVENTIONAL TREATMENT IN PATIENTS WITH CYSTIC THYROID NODULES

Thyroid nodules, including cystic degeneration, are widespread and require high costs for examination and treatment. The treatment approach depends on preoperative diagnosis. The results of both operative and minimally invasive treatment show good results, although aspects of patient quality of life after interventions are not sufficiently explored. Questionnaires such as MOS SF-36 are used to study the quality of life. Aim of the study was to compare the long-term life quality of patients with cystic thyroid nodules after different methods of interventional treatment. Materials and methods. A retrospective analysis of 189 patients, who underwent interventions due to cyst-ic thyroid nodules, was conducted in the period from 2003 to 2012. Sclerotherapy with 96% ethanol solution was performed in 63 patients (group I). In 65 cases (group II), there was a traditional hemithyroidectomy; in the remaining 59 cases (group III), modified method – with intraoperative aspiration of cystic content. All patients were proven with euthyroid condition. The frequency of neck discomfort and voice dis-turbance were studied. Vocal cord palsy was analyzed as well. Quality of life parameters comparison was per-formed using a universal questionnaire MOS SF-36 for 3 months, 1 year and 5 years after interventions for all studied groups. Results and discussion. After 3 months, patients after sclerotherapy had a significantly lower frequency of discomfort and voice disturbances than after surgery. Vocal cord palsy was recorded only after surgery. After 1 year, observation was received from few-er patients. The number of complaints and complications decreased. There were no cases of vocal disturbances in patients after sclerotherapy. However, vocal palsy after the traditional operation was in two cases (4.7%) and one (2.4%) after modified operation (p=0.585). However, the difference in the frequency of complaints between pa-tients after sclerotherapy and the traditional operation was one (2.1%) vs 6 (14%) cases of discomfort (p=0.034). In 5 years after sclerotherapy, no specific com-plaints were noted. There was only one case (3.7%) com-plicated with vocal cord palsy after traditional operation. Discomfort was noted in two patients (7.4%) after tradi-tional operation and one (5%) after modified (p=0.739). MOS SF-36 data, within 3 months after inter-vention, showed a significant difference in all compo-nents of physical health between patients after sclerothe-rapy vs patients after traditional and modified operations (p<0.05), which can be explained by consequences of operation and general anesthesia. Results obtained after 1 year showed equal pa-rameters of physical health in groups I and III (sclerother-apy and modified surgery) and higher compared to group II (after traditional operation). Long-term results, 5 years or more after interven-tions, showed similar results with those obtained after 1 year. Groups III and I demonstrated better physical health outcomes than patients after traditional operation. While the physical health parameters in patients after sclerotherapy and modified surgery were almost the same. After surgical treatment, up to 26% of patients needed replacement therapy with thyroid hormones and only 4% after sclerotherapy. Conclusions. Sclerotherapy of cystic thyroid nodules is a safe alternative, has no complications and specific complaints, and has an advantage in physical component of quality of life in comparison with tradition-al operation. Patients after modified operation showed higher long-term physical health compared to traditional operation.