NODULAR GOITER: THE POSSIBILITIES OF MODERN DIAGNOSTIC METHODS (LITERATURE REVIEW)

There are many methods for investigating the thyroid gland pathology. None of them guarantee mistakes or false results at nodular goiter, especially before surgery. Thus, in 4-6% of patients malignant changes in nodes are diagnosed only after surgery. The aim of the work was to systematize the modern methods of nodal goiter investigation, to analyse the indications to their application and informative. All methods of nodal goiter diagnosis were conditionally divided into three groups: methods for determining the functional state of the thyroid gland, visualization methods and methods of morphological diagnosis. However, the primary and obligatory research method remains the clinical examination of the patient with palpation of the thyroid gland and neck. Auscultation of the trachea at the level of the thyroid gland has practical significance only in cases of tracheal stenosis with dense goiter. Among the laboratory methods of determining the thyroid gland functional state, the determination of the basal secretion level of the thyroid stimulating hormone is extremely sensitive. Determination of thyroxine and triiodothyronine levels is performed as for general fraction, and free fraction. For the diagnosis of the thyroid gland functional changes, a thyroliberin test is used, which is positive for hypothyroidism and negative for hyperthyroidism. In diffuse toxic goiter (DTG) and chronic autoimmune thyroiditis (Hashimoto, CATH) in the blood serum specific antibodies to the thyroid gland are specified. At CATH elevated levels of antibodies to the thyroglobulin and microsomal fraction are observed, at DTG to receptors of thyroid stimulating hormone. Among the methods of visualization, sonography is widely used. In addition to determination of the shape, size, location of nodes during the study structural changes in tissues, especially their blood supply, can be determined. The informativeness of the study is increased when conducting a pulsed spectral and energy doppler study. A spiral computer or magnetic resonance imaging is also used. Morphological studies hold a leading position in the diagnosis of nodal goiter. Thus, thin-needle aspiration puncture biopsy under sonographic control with subsequent cytological examination of punctulus is obligatory. The use of malignancy markers and wedge-shaped dehydration markers increases the informative nature of the method. Histological examination is carried out both in the traditional classical way and in the frozen sections of tissues. It can be complemented by immunohistochemical and morphometric methods of diagnosis. Intraoperative laser autofluorescence spectroscopy also allows to establish the morphological structure of the thyroid gland nodal formations. Methods of nodular goiter diagnosis have a large variety. Each of them has certain disadvantages. This does not allow to be guided by the results of only one of them in most cases. The most informative diagnostics is achieved with their complex carrying out and interpretation of the results