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Purpose: to elucidate the peculiarities of perioperative clinical characteristics of female patients with genital endometriosis associated with hypothyrosis. To attain our object, the following tasks had to be accomplished:
- to determine the localization of endometrioid heterotopia and severity of endometriosis in patients with hypothyrosis;
- to study the types of surgical interventions in patients with endometriosis associated with hypothyrosis;
- to assess the frequency of endometriosis recurrence after surgical treatment in patients with endometriosis associated with hypothyrosis.
Material and methods. We examined 100 female patients: 40 patients – with endometriosis associated with hypothyrosis (main group – group I); 60 patients – with endometriosis and without thyroid pathology (group of comparison – group II). We analyzed the results of clinical, laboratory and instrumental examination, including radiological methods (CT-scan, X-ray). The diagnosis in all the patients was based on pathohistological verification. All surgical interventions were performed by the use of endovideosurgical technology.
Results and discussion. According to the results of patients` examination, we identified the following localization of endometrioid heterotopia and severity of endometriosis:
Stage I – 38,0 % of patients with ovarian endometrial cysts and adenomiosis;
Stage II – 27,0 % of patients with peritoneal endometriosis and adenomiosis;
Stage III – 23,0 % of patients with ovarian endometrial cysts, adenomiosis, peritoneal and urinary tract endometriosis;
Stage IV – 12,0 % of patients with ovarian endometrial cysts, adenomiosis, peritoneal and retrocervical endometriosis.
The 80,0 % of patients underwent organ-preserving procedures, and radical surgery was performed in 20,0 % of cases. We used the following surgical approaches to the endometrial lesions: 56,0 % − combined laparoscopy and hysteroscopy; 42,0 % − transvaginal laparoscopy; and only in 2,0 % of cases – conversion to laparotomy. The frequency of endometriosis recurrence after surgical treatment in patients with hypothyrosis was established: 4,0 % − at 6-month follow-up; 6,0 % − at 9-month follow-up; and 10,0% − at 12-month follow-up. We observed complete relief from the endometriosis symptoms in 80,0 % of patients after the surgical procedure. Additionally, the reproductive function was recovered in 24,0 % of females.
Conclusions. The surgical treatment of patients with endometriosis associated with hypothyrosis should be based on the principle of radical removal of endometriotic lesions, particularly through the combined simultaneous procedures in case of advanced extragenital endometriosis. Additionally, several aspects should be taken into account, namely: localization of endometrioid heterotopia and severity of endometriosis; the age of patients and their interest in the preservation of reproductive function; the presence of the highly qualified surgeons (gynecologists, general surgeons, urologists), as well the high level of anesthetic support with thorough postoperative monitoring.
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