Pathomorphological changes in the thyroid gland due to combined gunshot lesions

Modern military conflicts are accompanied by gunshot injuries affecting all parts of the body. The thyroid gland is located near the carotid arteries, internal jugular veins, esophagus, larynx, and trachea. Injury to these structures creates the potential for rapid airway compromise due to compression or bleeding from adjacent tissues, while the thyroid gland itself may also serve as a potential source of hemorrhage. When determining the extent of surgical intervention, it is not always possible to clearly define the exact boundaries of a gunshot injury. This issue can be addressed by conducting pathomorphological studies of the damaged area of the thyroid gland. The aim was to study the pathomorphological changes of the thyroid gland in gunshot injuries in order to determine the volume of surgical intervention. The treatment outcomes of combatants with gunshot injuries to the thyroid gland, which accounted for 7.4 %, were analyzed. Of this number, 28.6 % of wounded patients with grade III and IV thyroid injuries were included in the group that underwent pathomorphological examination. For pathomorphological analysis, upon delivery of the material from the mobile hospital (Role 2), preliminary freezing of tissues was performed by immersion in liquid nitrogen followed by fixation in 96 % ethanol. After paraffin processing of the material from the damaged areas of the thyroid gland, sections 4-5 µm thick were prepared and stained with hematoxylin and eosin. The set of pathomorphological studies was carried out using a Primo Star microscope (Carl Zeiss) at ×280 magnification. Images were captured with a high-resolution digital camera with 8-bit digitization, AxioCam (ERc 5s), with a pixel size of 2.2 µm and Carl Zeiss AxioCam (ERc5s) Configuration Tool software. The examinations revealed large macrohemorrhages beneath the capsule and within thyroid follicles with partial destruction. The presence of colloid vacuolization within the follicular lumen indicated the onset of destructive changes in the follicle itself; however, on the 5th day after injury, partially destroyed follicles demonstrated a reverse process. In cases of complete destruction of the follicular wall, there was a high risk of hormone release into the bloodstream with subsequent development of “thyrotoxic storm” and acute mental disorder. Thus, the thyroid gland demonstrated the ability to undergo regenerative changes 4-5 days after injury, indicating the necessity of performing primary surgical wound debridement and subsequent necrectomies only within the boundaries of damaged tissues.