Diffusely toxic goiter of clinical recommendations. Thyrotoxicosis in grown-ups

Diagnosis of thyrotoxicosis is based on characteristic clinical pictures, laboratory indicators (high level of svT4 and svT3 and low level of TSH in the blood). A special marker of DTZ є antibodies to rTTG. Clinical diagnosis of thyrotoxicosis is based on evidence of symptoms of impaired thyroid function, palpation assessment of thyroid malformations and structures of thyroid gland, symptoms of thyroid disease, suppression of thyroid pathology, acceleration

2.1 Scargi and anamnesis.

2.2 Physical conditioning.

2.3 Laboratory diagnostics.

The use of amiodarone is linked to the development of dysfunction thyroid gland(ShchZ) and changes of laboratory indicators and functions. See amiodarone induction of hypothyroidism (AIH) and amiodarone induction thyrotoxicosis (RTA). There are also changes / undifferentiated forms. If AIG can develop in patients with normal thyroid disease and in the presence of an autoimmune reaction, it is most often to develop in patients with chronic autoimmune thyroiditis, as well as in females.
In all patients who were treated with amiodarone, it means early (<3 мес.) или поздние (>3 mіs.) Changes in the serum thyroid hormones in analyzes. The high amount of iodine in amiodarone increases the concentration of inorganic iodine in the blood plasma and the appearance of iodine from the cross section. Through the Wolf-Chaikov effect, the ShchZ adapts to the re-entanglement of the iodine by iodine, the smothering of the organopharmaceuticals of the iodine and the lowering of the hormones of the thyroid gland. The last effect is the main reason for the increase in the concentration of thyroid stimulating hormone.
At that hour, AIG is easy to use, AIT is diagnostic and therapeutic. Most of the patients with АІТ 2 (destructive thyroiditis) successfully use glucocorticosteroids (GC), as they may not know about amiodarone. Likuvannya AIT 1 (changed / non-differentiated forms) - more and more folding through the stiffness of the iodine-saturated zone to antithyroid drugs. With regard to the folding of diagnostic differentiation between AIT 1 and various / undifferentiated forms, often combined methods are used.

Key words: thyroid dysfunction, iodine, amiodarone-induction hypothyroidism, amiodarone-induction thyrotoxicosis, thyroid dectomy, amiodarone.

For a quote: Demidova T.Yu., Kishkovich Yu.S., Ladigina D.O. Patient management with amiodarone-associated thyroid dysfunction. News of the European Thyroidological Association 2018 r // RMZ. 2018. No. 11 (II). S. 101-104

Patient management with amiodarone-associated thyroid dysfunction. News of the European Thyroid Association 2018
T.Yu. Demidova, Yu.S. Kishkovich, D.O. Ladigina

Pirogov Russian National Research Medical University, Moscow

Treatment with amiodarone is associated with the development of thyroid dysfunction and changes in laboratory parameters of its functions. There are amiodarone-induced hypothyroidism (AIH) and amiodarone-induced thyrotoxicosis (AIT). There are also mixed / undifferentiated forms. Although AIH can develop in patients with normal thyroid and absence of an autoimmune reaction, it most often develops in patients with latent chronic autoimmune thyroiditis, prevails in women as well as in iodine-saturated areas.
All patients treated with amiodarone had early (<3 months) or late (>3 months) changes in serum thyroid hormone levels in the analyzes. The high content of iodine in amiodarone increases the inorganic iodine of the blood plasma and the excretion of iodine with urine. Due to the Wolff-Chaikoff effect, a thyroid gland adapts to iodine overload by suppressing the organification of iodine and reducing the levels of thyroid hormones. The latter effect is the main cause of an increase in serum thyrotropic hormone concentration.
While AIH is easily treated, AIT represents itself as the diagnostic and therapeutic difficulty. Most patients with AIT 2 (destructive thyroiditis) are successfully treated with glucocorticosteroids, and may not need to cancel amiodarone. Treatment of AIT 1 (mixed / undifferentiated forms) is a much more difficult task due to the resistance of the iodine-saturated gland to antithyroid drugs. Taking into account the difficulties in the diagnostic differentiation between AIT 1 and mixed / undifferentiated forms, the combined treatment is often used.

Key words: thyroid dysfunction, iodine, amiodarone-induced hypothyroidism, amiodarone-induced thyrotoxicosis, thyroidectomy, amiodarone.
For citation: Demidova T. Yu., Kishkovich Yu.S., Ladigina D.O. Patient management with amiodarone-associated thyroid dysfunction. News of the European Thyroid Association 2018 // RMJ. 2018. No. 11 (II). P. 101-104.

The statistics presented the news of the European Thyroid Association 2018 r The special features of the treatment of patients with amiodarone-associated thyroid dysfunction (hypothyroidism, thyrotoxicosis) have been announced.

Entry

The pathogenesis of thyroid disease in patients with amiodarone administration and tactics for the treatment of dysfunction

What amiodarone is poured into analyzes, how to evaluate the function of the SHZ, in everyday patients?

AIG does not require administration of amiodarone. Treatment with levothyroxine sodium (LN) is recommended in all cases of manifest hypothyroidism, at that time it can be unique in subclinical forms, especially in older people, but it is often necessary to assess the condition for advanced thyroid disease.

How many types of АІТ can be seen and what diagnostic criteria?

Chi head of АІТ - supervised situation?

How can the therapy with amiodarone be promoted in several types of AIT?

Yaka tactics of lіkuvannya at АІТ 1?

Yaka tactics with АІТ 2?

What is the tactic in case of small / non-differentiated forms of AIT?

How can you take amiodarone to get updates (which is necessary) from the patients with the previous AIT?

visnovok

literature

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Editorial materials

State Budgetary Educational Institution of Higher Professional Education "First MGMU im. I. M. Sechenov", Moscow

Key words: thyroid disease, thyrotoxicosis, hyperthyroidism, Graves' ailment, toxic goiter with nodules.

Discussion about European Thyroid Association guidelines on diagnosis and treatment of endogenous subclinical hyperthyroidism

I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation

The article discusses European Thyroid Association guidelines on diagnosis and treatment of endogenous subclinical hyperthyroidism.

Key words: thyroid, hyperthyroidism, thyrotoxicosis, Graves "disease, toxic multinodular goiter.

In the middle of 2015, they were persistent and original in their kind CLINIC RECOMMENDATIONS European Thyroid Association (ETA) for the diagnosis and treatment of subclinical thyrotoxicosis (Stir). The stench is insanely tsіkavі, oskіlki to unite the current problem about the problem, but not to let go of the singing methodical folding. The main reason for them is the fact that in the clinical practice of dealing with the problem of treatment, Stir is involved in a syndrome, and I can help you with absolutely different etiology and pathogenesis of the disease, as they are going through it. There are more than ten such sub-options. In other words, the problem of Stir is not a problem of subclinical hypothyroidism with an opposite sign. In the rest of the way, only one nutrition is effective: start with Steer the L-T4 therapy. In case of thyrotoxicosis, as a matter of fact, the problem of the first level є the differential diagnosis of these causes, and later, in my opinion, as a rule, a larger world is the very reason for the erasure and the nature of the thyroid disease of the self (thyroid) ). The author of the recommendations went along the path of the model with two winter: steps

a decrease in the level of TTG (Steer of the 2nd step) і vіk (young and middle-aged), for which reason Steer in his worlds stinks to lower the stench, but inevitably, there are a lot of bullet-baked recommendations. Additional introductory introductions, however, are about those who are not negotiated, only the endogenous Stir and only the Stir Stir (more than 3 months, immediately a number of troubled Induced thyroid), with the blame for amiodarone-induced thyrotoxicosis type 2). In such a rank, authorize the choice of chotiri options (2 x 2) subclinical endogenous steer, which gives recommendations, at my glance, it is very abstract, some of the stench is seen from the changes in the very SCH. I would like to see, all without a blame, a clichéd recommendation, to bring even a high standard, from any incapacitation, into this world of abstract. In the out-of-town and in general it is possible to see both the minimum and the number of problems, such as immediately є the problems of basic, methodical, as well as the problems of folding and making such recommendations.

1. Nosological heterogeneity

It’s the main problem, and everything is said about her; won’t itself and mean the big world

tactics of abuse and / or caution. To this, the recommendations can be called recommendations of another ryvnya, so that according to them it is unfortunate that the problems are not brought about, for the good nobility it is necessary for the good nobility to diagnose the principle of diagnosing and treating diseases that prevent thyrotoxicosis.

2. Rizna steer turn

The recommendations presented for the first time see two stages of thyrotoxicosis, which, mabut, will be more comprehensible. The plan for the analysis of the most obvious on the current day of the weekly schoolchildren - for example, Steer Author often thinks of an excess of thyroid hormones on the basis of the turnover, as the criterion for the inclusion is to select the development of the TTG. The order of the problem is the development of "endogenous - exogenous" Steer wants to endure simplicity in clinical practice, but in scientific robots, presenters often wry. In addition, if we talk about the patients of the older age group, then Steer in them is efficiently part of the ideas of endogenous variants of functional autonomy (FA) of the thyroid gland, that is, as a suppressive therapy for the lasting Zvorotna situation in young children: they have to finish the endogenous steer and all the information about the pathological meaning of the rest of the work on the background of the patient's therapy, to be known for suppressiveness.

3. Dani about the pathological meaning - it is important for the endogenous variant in the case of the kidney disease

It’s not important to get a fresh and original look at the problem. It is important for women of postmenopausal age from endogenous erasures with low TSH levels of less than 0.1 mMO / l (category of washing of the 2nd stage in the old ones in the given recommendations). According to the day, the situation is, as a rule, the FA of the thyroid gland is poured into the bagatovodok toxic goiter. Reshta options Steer, madly, require not less respect for the position of clinical practice, or proof of the position of the given recommendations, but the formulation itself will naturally be more common.

4. Lіkuvannya "analizіv", and not a specific illness in a particular patient

Vlasne, the most universal pain point of the current endocrinology, as in the practical changes in the folding of scientific education of clinicians in the situation of minimal changes in the quiet and the lowest laboratory parameters in the absence of key manifestations and clear tributes about the future prognosis of the cich "zrushen". The value of the TTG level є the most frequent hormonal dosages in the world, and the lowering of the level of the hormonal level of interpretation, should be taken frequently. The main review of the presentations in the ts_y statti_recommendations on the Steer, at my glance, є systematization happy news about the problem, so that the document is of great scientific value. From a practical point of view, the document should be completed foldable, and it is unlikely that you can see what recommendations are made for people, especially the original Lanka, a few examples of this position, they are not concerned with the scientific value, they may be very rich. In general, in the case of thyrotoxicosis (not apparently about subclinical), I seem to be more practical nosological reasons, so that the distribution of additional recommendations is about the disease of SHZ.

In the ts_y statty, adaptations have been made to transfer the recommendations themselves with action comments, possibly sub''active. For a larger analysis of the problem, I recommend that you read the original text of the recommendations, which is available in the free access to the website of the European Thyroid Journal. For a skin recommendation, depending on the occasion, it can be considered as good, with no pluses (low - +, at least - ++, high - +++), and strength (1 - suvora; 2 - weak). The headings in the text below reflect the original recommendations.

Laboratory and ethiological diagnostics Stir

First Rivn: Confirmation of Stear's character

Validation of the level of TTG є by the test of primary diagnostics Stir. When a low level of TSH is detected, equal thyroid hormones (light T4 and zahalal (or abnormal) T3) (1 / +++) begin.

The value of the TTG level is used to assess the severity of the Styr and the third grade: step 1 (TTG 0.1-0.39 med / l) and step 2 (TTG< 0,1 мЕд/л) (1/+++).

It is necessary to switch off the condition, to support transient decreases in TSH, not to be tied to the Stir, such as in the case of hypothalamic-hypophyseal pathology, mental ailments and syndrome of euthyroid (1 / + 00) pathology.

In case of a reduced or near-low level of TTG, the value must be repeated in 2-3 m / s;

Commentary. The repetition of TTG in the dynamism in the central part of the disease allows for a greater degree of malaise, as well as against destructive thyrotoxicosis, some of the triviality at any time, as a rule.

Another Rivn: The Value of Ethiology Stir

In case of high-grade goiter and erasing of the 2nd stage, scintigraphy and the possibility of 24-year accumulation of radioactive iodine (1 / + 00) are shown for the purpose of special treatment tactics.

Ultrasound with Doppler ultrasound can be informative for Stir and vnodal goiter (2 / + 00).

The value of the level of antibodies to the TSH receptor (AT-rTTG) can lead to a diagnosis of immunogenic thyrotoxicosis (2 / + 00); sintigraphically susceptible to nodular toxic goiter.

Computer tomography without contrast or MRI can be used for diagnostics of compression syndrome in patients with great bagatous nodular goiter and common symptoms and signs (1 / +++).

Third Rivne: Assessment of Riziku Associated with Stir

EKG, Holter monitoring and Doppler echocardiography are recommended for the assessment of the heart rhizik and the heart and the heart of the okremikh patients from the Steer of the 2nd stage,

sprout in children with heart arrhythmias, heart ailment (ІХС) and heart deficiency (1 / + 00).

Cystkova densitometry and in the range of types of markers in the cyst exchange can be found in okremich patients from the 2nd step of the Styr (1 / + 00).

Likuvannya is recommended for patients over 65 years of age at the 2nd stage of Stir with a decrease in the risk of uncomfortable inheritance (progression to manifest thyrotoxicosis, admission of extraordinary mortality, mortality, mortality in the first place)

Likuvannya Stir of the 1st stage in individuals over 65 years of age is recommended for the prevention of fibrillation in front of the heart. I will look at the potential risk of heart-bladder acceleration, symptoms of hyperthyroidism of the 1st stage in people over 65 years of age, it is recommended to be recommended for individuals from fellow patients with heart disease, diabetes, normal deficiency, trans-insult to attack heart failure, pathology of coronary and peripheral arteries (2 / + 00).

It is recommended to treat patients younger than 65 years old with the 2nd step of Stir in case of severe decrease in TTG and / for symptoms of thyrotoxicosis, especially if circulating AT-RTTG appear during the second stage.

Patients with symptoms of thyrotoxicosis may have selective P-blockers for the vicorian methods of treatment, direct on the SHZ. The dose of P-blockers is based on heart rate (HR) (2 / ++ 0).

Commentary. With the confidence of Graves' ailments (BG) from the Steer, the sign of R-blockers, melodiously, will be simpler from the point of view. In the first place, there are no indications of thyrotoxicosis remission in the presence of thyrostatics or P-blockers, which, as it seems, are not susceptible to. When thyrostatics are recognized, make sure to follow the term for an hour approximately by 1 pound and in the ideal control of the function of the SHZ. At the same hour, the remission of the low-flow BG can come and earlier, as it will be obvious in the situation, if there are no thyrostatics. In addition, R-blockers have a smaller number of side effects and do not allow frequent assessment of the function of the SHZ.

Likuvannya Stir is not recommended in young patients without symptoms due to decreased, ally initial TSH (1st step of Stir) (every day there is a proof base about overvoltage likuvannya). It is recommended that such patients be promoted in the dynamics of low risk of progressing Stir to obvious thyrotoxicosis, the potential for spontaneous remission and weak evidence base about the risk of acceleration in the whole group of 1 / + 00 individuals.

Caution is recommended to patients with the 1st step. Stir during the appearance of ultrasound and stage-graphic signs of pathology of the thyroid gland, normal heart rate according to the EKG data, normal cyst tissue and in the absence of serous factors / vascular disease

As long as the patient does not accept the drive of the stiff Stir, it is necessary for the skin 6-12 msec to conduct a test of the TTG level, St. T4, or even T3, and also in case of symptomatology (1 / + 00).

Thyrostatic drugs є with the first choice in the selection of young patients with Graves' ailments, against the Steer of the 2nd step, and in patients over 65 years old from BG, against

s Stir of the 1st stage, some of the difference in the amount of remission of BG during 12-18 months of therapy with thyreostatics can reach 40-50% (1 / + 00). therapy radioactive iodine It is indicated in the situation of foul tolerance of thyrostatics, as well as in case of recurrence of thyrotoxicosis and in patients with congestive heart pathology (1 / + 00).

Therapy with thyreostatics or radioactive iodine is recommended for patients with Graves' ailment and erasing in those over 65 years old and for the manifestation of heart-and-heart disease due to the high risk of decompensation (1 / + 00).

Therapy with radioactive iodine in patients over 65 years of age from the 1st and 2nd stages of treatment in cases of toxic nodular goiter or thyrotoxic adenoma, which is generally associated with thyrotoxicosis, which, as a rule, is severe in nature. In addition, by erasing the 2nd step, you can progress to a clear loss of life, or a reasonable excess of iodine. In a situation where the sign of radioactive iodine is uncomfortable (for example, people who have been abducted to patients with hospitals, and / for a great goiter and important pathology, and / or for symptoms of compression),

Surgical treatment is recommended for patients with Stir in the past with even a great goiter, symptoms of compression, suppurative hyperparathyroidism, or for patients with thyroid cancer (1 / +++). With the presence of quiet factors, it is possible to overshoot the sign of radioactive iodine in the steer of the 2nd stage, the operative vibration is total thyroid dectomy (1 / ++ 0).

Low doses of thiamazole (5-10 mg per day), if necessary, can be used for quick renewal of euthyroidism in patients from Stir (1 / + 00). Patients need to inform about potential side effects thiamazole (1 / + 00). Before the drug is prescribed, it is necessary to carry out extravagant analysis blood and assessment of pechinkov transaminases (1 / + 00).

By using radioactive iodine to achieve an euthyroid stance (on other therapy L-T4 without it) (1 / + 00).

Priznachennya tіamazolu before terapієyu radіoaktivnim iodine abo hіrurgіchnim lіkuvannyam rekomenduєtsya patsієntam 65 rokіv of Sertsevy-sudinnimi zahvoryuvannyami (fіbrilyatsіya peredserd, іshemіchna hvoroba sericite, Sertsevy nedostatnіst) and takozh patsієntam of pіdvischenim rizikom їh dekompensatsії vnaslіdok obvazhnennya thyrotoxicosis (2 / + 00). If thiamazole is indicated in the current situation, it is recommended to increase the dose of radioactive iodine by 10-15% (1 / +++).

Before the appointment of radioactive iodine therapy, it is necessary to assess the risk of progressive orbitopathy (curtsy, the value of T3 і AT-rTTG) (1 / + 00). Prophylaxis with glucocorticoids is recommended for patients with clinically obvious orbitopathy and chickens (1 / + 00).

According to the recommendations of the American College of Drugs and American Cardiological Association, these are recommended by the method of vibration to eliminate fibrillation at the heart and heart failure in case of impaired functioning of the disease due to Likuvannya Stir for the help of thyrostatic drugs є by the method of the first vibration in young patients from the Stir of the 2nd stage,

spontaneous updates sinus rhythm (1/+00).

In patients with fibrillation at the front of the heart, the steer needs prevention of thromboembolism. In accordance with the recommendations of the American Cardiological Association of MNO in patients with Styr and fibrillation at the front of the heart, it is necessary to trim in an interval of 2.0-3.0 (1 / + 00).

For therapy with radioactive iodine, it is necessary to complete a frequent assessment of the function of the thyroid gland by stretching the first fate and further rapidly in order to diagnose the development of hypothyroidism or preserve thyrotoxicosis (1 / + 00).

When developing hypothyroidism during therapy with radioactive iodine or thyroid dectomy, L-thyroxine therapy (1 / +++) is indicated.

Hirurgical treatment of Graves' ailments is possible on the basis of thyroid dectomy, as it prevents recurrence of thyrotoxicosis, which is more likely to be caused by partial resections of the thyroid gland. In case of solid autonomous higher education institutions, the hemitreoidectomy can be broken through the resection of the isthmus. Thyroid dectomy (1 / ++ 0) is indicated for toxic goiter with large nodules.

List of Literature

Biondi B, Bartalena L, Cooper DS, et al. The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism. European Thyroid Journal. 2015; 4 (3): 149-163. doi: 10.1159 / 000438750.

Fadov Valentin Viktorovich - Doctor of Medical Sciences, Professor, Head of the Department of Endocrinology of the State Budgetary Educational Institution of Higher Professional Education "First MGMU im. I. M. Sechenov".

For correspondence: Fadov Valentin Viktorovich - [Email protected]

Hyperfunction of the thyroid gland for the most widespread ailments, such as trapping yak at the children of the cholovych, as well as female stati. When you get sick, tied with the endocrine system, the whole body suffers. At the same time, the acceleration of such pathologies may not be safe. To that all people, who are in the group, should be periodically advised by the endocrinologist and passed through the retreat.

What is the hyperfunction of the thyroid gland?

We will broaden the diseases of the endocrine system є hyperfunction of the thyroid gland. This syndrome is called hyperthyroidism in medicine. At the same time, the activity of the body is increased and the hormones are violated, as a result of which the main exchange is destroyed.

With hyperthyroidism, it is often indicated that there is a breakdown in the connection between the hypophysis, the hypothalamus and the thyroid gland.

The patient may have a hypo - and hyperfunction of the thyroid gland. As a result, there are symptoms of illness, which can be either swerving or practically uncomfortable.

Hyperfunction of the thyroid gland can be of the form. The stench to lie down on the steps of the sick ailments. At an early stage, subclinical hyperthyroidism may occur. With a lot of obvious symptoms, it may not be, but anaalyzi show a change in the hormonal background. The first signs of illness are most often diagnosed only with manifestal hyperthyroidism. Iakshcho ailment does not vilikuvati on a whole stage, it is accelerated. In most cases, it is not only possible to sharpen the symptomatology, but also to problems with important organs and functions, which can be brought to unfavorable inheritances.

cause

The exact reasons for the advanced function (hyperfunction) of the thyroid gland should be folded up. Ale іsnu is a special group of people who can get sick more, less people. Most often, ailments develop in people, as they may decline in mental capacity.

Other reasons for the diagnosis of hyperthyroidism can be nerve overstrain, Infectious disease and improper use of hormonal drugs.

The hyperfunction itself is not, by itself, insecure, and can be easily worn down. Ale how do not beasts on the pathology of respect, you can accelerate.

Hyperfunction may be a symptom of an inconvenient illness. To this її diagnostics can be given directly in the statement of the correct diagnostics. For example, a small camp is possible in the offensive vipad:

• development of diffuse toxic goiter;
• with autoimmune thyroid disease;
• when receiving radioactive iodine and excess in the body;
• thyroid cancer;
• with trophoblastic thyrotoxicosis;
• with puffins of hypophilia;
• also hepatitis C.

Varto respect that because of the hyperfunction of the thyroid gland is due to reasons that are not related to the body. For example, it is also a phenomenon that is possible when the yachniks are ill.

Symptoms of thyroid hyperfunction

Symptoms in similar pathologies can be quite reasonable. All to lay down on the step of the same problems and reasons, such as wicked. Children do not have any visible symptoms.

If hyperfunction and to show oneself, then, better for everything, it will turn in such symptoms as:

• іska vrata vagi with normal consumption;
• strong gratitude;
• anxiety;
• shvidka stomlyuvanism;
• to be stronger than sercebitty;
• treminnya in kintsivkah or at all tilі;
• tearing of the eyes;
• problems with the intestinal tract;
• women do not suffer from rupture of the menstrual cycle and increased consumption;
• a person may see a decrease in potency.

I clearly recognize the hyperfunction of Graves' ailment. Tse affliction manifests itself in the viglyadi viryacheniya ochima and the growth of the thyroid gland. When the organ is large enough, there will be a lump on the shoulder, which can grow into puff. This form of ailment is most common in children.

In the summer, hyperfunction is mainly characterized by an uneven growth of the organ. Tse provokuє otvorennya bumps on the shia. Thyroid problems can also be inserted into the robot with a heart muscle, arterial vise and increased heart rate. Do not become involved in the destruction of the memory and the lowering of respect.

diagnostics

In order to put the correct diagnosis, it will be necessary to carry out a more detailed examination of the patient.

The problem of hyperfunctional polygons is that at the early stages of the diagnosis of a disease there may not be obvious signs, that the visual glance will not give any results.

That is why an important stage of diagnostics is taking blood analysis. laboratory dosage it is also possible to increase the value of antibodies to hormones. In the general order, the fachivets signifies and ultrasound the thinning of the thyroid gland. There is also the possibility of increasing the size of the body or the appearance of the nodes of the thyroid gland. This information is important for setting the correct diagnosis and value of the level of ailment.

As soon as the fakhivtsa have lost their minds, tomography may be indicated. Dodatkovo vikorystovuyutsya EKG and biopsies in case of adolescence for cancer.

lykuvannya

First, when you start to develop a hyperfunctional thyroid gland, you will not be able to preserve the patient's spoky situation without inviting paupers. The other is the child's mind, which is guilty of including domestic and dairy products. In addition, the drug is indicative of an ailing drug, which is directed to block the thyroid gland.

People who are susceptible to an advanced function of the thyroid gland are guilty of observationally being diagnosed by an endocrinologist. As soon as there is a slight damage from the side of the robot and the body, it is recognized that there are antioxidant costs and glucose.

On the side of a sick person, everyone was guilty of reducing the temperature of the body and increasing the heat of the body.

Inodi vikorystovuєtsya radioactive iodine, which pozhkodzhu klіtini zalozi. However, the method of treatment is not suitable for the representatives of the wonderful stati.

As soon as the operation is concerned, then it will only be victorious, if a new solution appears in the body. The most frequent method, when therapy will be carried out, select the ailment itself, based on the recommendation of the doctor.

People zasobi

If the hyperfunction of the thyroid gland is at the cob stage of development, you can try to do without it. With the correct use of folk medicine, you can achieve gargling results.

To get involved, in the solution of the problem, you can add clay compresses, to make food and drink infusions.

For the normalization of the thyroid gland, calendula cinnamon, gilka and nirka cherry, as well as valerian.

dyeta

For the improvement of the efficiency of any kind of treatment with hyperfunction, great respect comes to the use of food. The patient is guilty of obv'yazkovo vіdmovitisya from shkіdlivіkh svіtki. In general, there will be no result.

Diet with hyperfunction in the general order includes products with a great amount of carbohydrates, vitamins and minerals. Fakhivtsi recommend dairy products and fresh vegetables in Persha.

Victory is necessary for everything that can lead to overwhelming excitement nervous system... Go on about cava, hot chocolate, alcohol and mint tea.

accelerating

Do not put down the problem of thyroid gland, it can lead to the destruction of robotic organs. The wake of the day, heartfelt and judgmental, as I see it as a new option. Zakvoryuvannya is recognized і on the shlunkovo-intestinal tract. The most frequent accelerated hyperfunctions are severe psychosis, for whom it is difficult to fit in without the help of a psychotherapist.

What is the difference between L-thyroxine and Eutyrox?

For the elimination of hypothyroidism, synthetic preparations for the hormone T4 - L-thyroxine and its analogs - are stagnant.

Shown before consumption of L-thyroxine and Eutirox

The thyroid gland is one of the most important organs of the endocrine system. Vona viroblyaє thyroid hormones, which regulate the processes of chasing with blood, exchange of words, mental activity. Iodothyronin T3 and T4 are infused without predominantly on the level of activity of people and to increase the rate of blood circulation.

With a lack of functionality of the thyroid gland, tied to ignition processes, autoimmune diseases, or fluff in tissues, you will no longer need to use a number of hormones. Hypothyroidism is manifested by chronic vomiting, dry skin and hair, damaged heart rhythm and reaction, problems with the reproductive system, anemia and other unacceptable symptoms.

In case of hyperthyroidism (superfluous viral iodine hormones), therapy with synthetic analogs of thyroxine should be used in a set with thyrostatics (likas, which can be used to induce viroblast of hydrochloric hormones), during operation of radionuclide therapy.

In such a rank, thyroxine preparations can be recognized when:

• hypothyroidism, accumulated damage to the functionality of the thyroid clitin;
• hypothyroidism, enlarged by the lack of stimulation of the secretory organ by the hormone TSH;
• thyrotoxicosis and hyperthyroidism (in combination with thyrostatics or surgical treatment);
• euthyroid and diffuse toxic goiter;
• pislya prompt engagement to drive the cancer of the thyroid gland, in the course of a bullock the entire thyroid tissue is harnessed or part of it (in times, if the cells are overpriced, they do not want to virobate to finish the hormones);
• diagnostics (test for suppression of thyroid function by synthetic drugs thyroxine).

drug similarity

Dіyucha speech drugs, which are stagnant in a different therapy with analogs of T4, however - levothyroxine sodium. The prefix "livo" is applied to the structure of synthetic isomer - levorotatory. The transfer of one atom of iodine and a partial transition to a larger active form (triiodothyronin) is used in the form of an increase in fat and fat metabolism, tissue growth, activity of the nervous and heart-vascular systems, and the burning of fatty tissue.

The offense for polishing up for taking into account will be taken strictly on the heart, for six months before the first reception, and with a great amount of water - to maximize the absorption of the active component. It is not recommended to add pills (due to the wine of therapy in young children with a special treatment).

The offense of the drug can indicate the hour of vaginosti, because thyroxine does not penetrate the placental bar. During the period thoracic treatment It is recommended to take more care of the patient and change the dose of the hormone. The release of all tablets with thyroxine analogs should be followed strictly according to the prescription.

The effect of "Eutirox" and "L-thyroxine" was infused approximately after one and the same term: the drug is less clinically useful for 3-5 additional doses of therapy, the symptoms of hypothyroidism appear in 7-12 days later.

Evidence "Eutirox" and "L-thyroxin"

However, if both of them have one and the same component, then why is the difference and more beautiful - Eutyrox or L-thyroxine?

Thyroid hormone preparations are used by young virobniks. Naybilsh requested on the market є chotiri brands of liquor:

• L-thyroxin Berlin-Chemi (virobniztva Nimechchini, European Pharmacological Concern);
• L-thyroxine (virobnitva RF);
• L-thyroxine-Acri (virobnitstva RF);
• Eutirox (virobnitstva Nimechchini).

The effectiveness of the drug in a significant world is due to the rigor of the application of technology in the course of its development, that is, the European style is more superior in the economy. It is not often endocrinologists to write a prescription because of the meaning of deprivation of speech (levothyroxine) and dose, in such a case a patient can think of an expensive generic drug.

Unimportant to those, all of the drugs have gone through the form of censorship and reconsideration, it is not easy to be hostile, as long as the same brand is less effective, less so. There is a difference in syruvin and reagents, which can be used to recover in case of rejection synthetic hormone The gown can be tied with:

• pomos in the scheme of reception or addition of liquids;
• counterfeit products;
• nedotrimannyam minds zberigannya drug seller or buyer;
• difference in cleanliness to additional components of the line.

Apparently, the consumption is promoted in prices for the preparation. Russian analogs of thyroxine are 1.5-2 times cheaper for patients. Such a difference is tied to the fact that the virobniks use ready-made technology, and do not carry out the classic viprobation and bagatorazovy dough testing with the vibrator of the most effective warehouse. Also, the lower price for the drug can be tied to the cheap prices and the lower price of the product.

Retrieval from auxiliary speeches

The main reasons for the use of drugs are in the turn of additional speeches. A lot of active speech borrows less than a few more pills: the whole amount of borrowed “balast” from additional speeches, which is poured into the moisture content of the active component.

The drug "Eutirox" has:

• corn starch;
• croscarmellose sodium;
• gelatin;
• magnesium stearate;
• milk succor (lactose).

"L-thyroxin Berlin-Chemi" is provided with a simple set of additional words:

• calcium hydrogen phosphate;
• microcrystalline cellulose;
• sodium salt carboxymethyl starch;
• partial dovolantsyugov glitserida;
• dextrin.

The likes of Russian brands are to take revenge on lactose, magnesium stearate and ludipress.

Deyakі components of the drug can lead to allergic reactions. At the same time, if there are any problems with an allergen in some patients, there may be a sprinkling of water, an embryo, and a sverbіzh and іnshі show of immune reactions. It is not recommended to use a hormone replacement therapy through an allergy. Name the drugs to indicate the patient's course of antihistamines and change the main drugs. For example, if you are allergic to lactose, you can get a change from the Russian "L-thyroxin" or "Eutirox" to "L-thyroxin Berlin-Chemi".

Bagato paciєntіv by definition, but the effect of "L-thyroxin" is infused shvidshe, below "Eutiroksu". The prominence of the signs can be enhanced by the addition of additional words and the quality and pressure of the hormone from the intestinal tract. According to the official data, statistically significant growth in pharmacokinetics (the processes of motivation and development of speech in the body of people), the drug is not revealed by brands.

dosage of drugs

Dobova hormone dose is taken by an endocrinologist. According to the flexibility of the choice of the individual scheme of drug administration, the unique drug "Eutyrox" is meaningfully played by the other brands: wine is dispensed with doses of 0.025, 0.05, 0.075, 0.088, 0.1, 0.112, 0.125, 0.137 and 0.15 mg of levothyroxine.

L-thyroxine of the European and vitality virus can be used in a wide range of doses. The Russian brand can propose to patients only tablets with 0.05 and 0.1 mg hormone. At the therapeutic practitioner, you want to be victorious to stay.

The drug with non-standard dosage is good for folded treatment schemes for patients with high dryness to thyroxine. Small doses will become stagnant in cases of hypothyroidism in children.

It’s no less important to change the dose for a long period of time, but you can provoke the appearance of boredom, headache, tachycardia, sleeplessness, nervousness; Zvorotn_y substitute for a brand that is not sensitive to the smallest inheritance, nor is it correct. Even the dose of the drug is very low, symptoms characteristic of hypothyroidism develop:

• drowsiness;
• apathy;
• improvement of vagi;
• intestinal atony;
• dryness of hair and scalp.

When choosing a drug, it is necessary to comply with the recommendations of the doctor. Detection of allergies, susceptibility to levothyroxine, purchase of a drug on its own, or for a quota - all prices are paid for. The effectiveness of the course of treatment is controlled by blood tests for the hormone TSH. If you have low dryness, you can recommend a change in dosage and preparation.

Is it assigned to oxytocin - if and what I mark?

Injection to gistamina on the zhoryuvannya

Inspection of hormonal preparations with estrogen in tablets

Specific features of hormonal medications in women aged 50 and older

Zastosuvannya phonophoresis with hydrocortisone

How can you make a child grow up in an old age?

The main reasons for thyrotoxicosis

cause sickness

Thyrotoxicosis is a pathological stan- dard, such as a hypoothyroidism. The difference between them is in the fact that in case of hypothyroidism instead of hormones in the human body it seems to decrease, and in case of thyrotoxicosis it is more likely to cause excessive viral growth.

The main cause of thyrotoxicosis is diffuse toxic goiter, and according to medical statistics, it appears in about seventy people with ailments. The ailment can also be of a spasmodic nature, manifest and develop autoimmune thyroiditis.

Autoimmune thyroiditis on uvaz chronically inflamed thyroid glands and autoimmune genesis of follicular clitin formation. In most cases of ailment, there are no characteristic symptoms, which are even more accelerated.

Autoimmune thyroiditis is diagnosed due to the additional ultrasound monitoring and the results of analyzes, based on thin-brain biopsies. In addition, it means that autoimmune thyroiditis becomes about thirty times a hundred from the backward number of all ailments, which are tied to the thyroid gland.

Among the representative of the weak stati of ailment occurs twenty times more often, not among the representatives of the strong stat, which is tied to the flow of estrogen system on the lymphoid system. Unimportant to those who, at the moment, no specific therapy has been broken, the elimination of autoimmune thyroiditis is guilty only by a qualified endocrinologist.

Suchaska medicine is not good effective methods They allowed the pathological process of thyroid formation without progressing to hypothyroidism, or in case of frequent occurrence of autoimmune thyroiditis, and the indication of an adequate method of elimination of positive thyroid function to achieve a decrease in thyroid function.

The first manifestation of a pathological process can be found in infants, in older children, and in older children. Thyrotoxicosis in case of vaginosis is susceptible to occur in approximately three cases of diagnostics of all types. From the medical point of view, thyrotoxicosis and vaginism are two crazy witnesses, as with such a pathological process, the threat of a weekday is spared.

At the present moment, in medical practice, it is accepted to see a few forms of this pathological process - the whole is easy, the middle and the importance of the form. For dermal forms, I will show my own specific symptoms.

at easy form spostering slightly lowering the mass of til, the heart rhythm to become approximately one hundred beats in khilina. With the middle form, the patient significantly engages his vagu, and the sertsebitty is spared at the end of one hundred and twenty strokes in the whale.

To be ashamed of an important form, then to produce such a camp before the dysfunction of all organs and systems of human organism is important. The very fact, to prevent thyrotoxicosis of the thyroid gland, you need to follow the camp of your health and when you have first characteristic signs it is innocent to turn into medical pledge for the qualified help fakhivtsya.

Main symptoms

When looking at such a pathological process, such as thyrotoxicosis, it is important to find that the symptomatology is abundant in what might be found among the onset factors: the triviality of the given camp, the steps of the turn and become ill.

It is important to note that the representatives of the beautiful half of the population are hungry more often, not the representatives of the strong stati, before that, the main part of the population is able to survive in the period of the statutory dosage, when the people are in the middle of the day.

Thyrotoxicosis with vaginosti is accelerated by the threat of the day or by the front canopy. For the scientific statistics, the child spends an hour in the development of such a pathological process in the minds of the mother, to become approximately forty number of verses. Thyrotoxicosis in case of vaginosis does not appear as a characteristic symptomatology;

Thyrotoxicosis symptoms:

• Rizka zmіna wagi;
• Overwhelmingly overwhelming, as it is not explained by the minds of the new middle-class, nor by the physical ones;
• As soon as possible to see the heat, as it spares on all parts of the body;
• Pay attention to the improvement of the heart rhythm;
• There are treminnya kintzivok abo all til;
• Patient shvidko get tired;
• The patient becomes easy to concentrate on his respect;
• Representatives of weak statis are susceptible to snakes in the menstrual cycle;
• The choloviks are discouraged from reducing their sexual cravings.

There are also symptoms of thyrotoxicosis, which are not immediately felt by the patient himself, but by his relatives, however, additional information fahіvets all at once I respect the animals for them. Allow up to such symptoms to lie: deranged dichotomy and difficulty in handling, as well as swelling in the area of ​​the shia.

So it is itself as one often a symptom appears - the prism of the eyes, the level of which without a priori lie down from a long time ago. Besides, it’s rich in patrons, it means that they co-ordinate the process of morganing;

Due to the fact that the symptoms of thyrotoxicosis are susceptible to the presence of a dermal patient, the number of forms of this pathological process was accepted by people: mild form, middle and important. It is important to understand that it is not the level of hormones, which is the thyroid gland, but the frequency of the characteristic symptoms.

methods of treatment

Schob vibraty naybilsh effective method lіkuvannya thyrotoxicosis, fakhіvtsya is necessary due to the main reason. I will show you the current medical practice is most often diffuse goiter.

Lykuvannya thyrotoxicosis:

• A conservative method, which is based on respect for the consumption of liquids and radioactive iodine. Likuvannya thyrotoxicosis for the additional help of radioactive iodine, which is absolutely painless. As a rule, it’s a good idea that the patient will take it in the middle of the capsule with radioactive iodine, which he’s drinking in the middle of the sick person, he’s accumulating his cells and znischu їkh, when they replace it with a full tissue;
• Promptly eliminating thyrotoxicosis is recognized as a lichen facie in that case, when conservative methodsє ineffective;
• Comprehensive study of two techniques.

I especially respect the people who have come to increase the level of uncontrolled storing of liquids, at the warehouses of which there is Tironina or Thyroxin. A representative of a weak stati can live in such a situation in a struggle because of a busy vagina, however, such self-abuse cannot lead to anything good, as a result of which the patient appears on the drug lid with a characteristic clinical picture of thyrotoxicity.

Viability with thyrotoxicosis is becoming problematic, as it promotes an increase in thyroid hormone levels, as well as changes in favor of estrogen and progesterone. However, thyrotoxicosis and the vagina are all possible, even if the steps of the turn of such lesions are spared at an insignificant level.

As soon as the methods of treatment have been absorbed, compensation for thyrotoxicosis in the body of the woman has been reached, then the vagina is possible, and only a little later, then the child can come from the important vads of development. In addition, since the patient develops thyrotoxicosis during vaginosis, I strongly recommend that she be interrupted.

Likar is guilty of explaining to the patient that the success of the marriage and the power of a healthy child can only be attributed to the understanding of the main cause of this pathological process and in order to achieve a new remission.

It is important for the nobility, for lіkuvati dana dania for help people's efforts It is generally proven, as thyrotoxicosis is an important camp, as if it is adequate methods of treatment with obovazkovy drug intake. If you will catch an ailment due to the diseases of the people's diseases from the thyroid gland, if you can please your friends and know, then you will not bring any result, but only destroy the health of the autoimmune.

It is more correct to eat dairy products, vegetables and fruits. It is also important to vrahovuvati, how to harchuvannya maє buti we shot. In order to make a start, it is necessary to consult with a fakhivtsy, who will give you an individualized attitude. Adopting the rules of hacking with thyrotoxicosis and recommendations from the side of the doctor, it is possible to identify the further development of this pathological process.

Diffuse toxic goiter (DTZ) - autoimmune disease Thyroid gland, it is clinically manifested in thyroid gland lesions with the development of thyrotoxicosis syndrome.

Thyrotoxicosis of difuzno goiter (difuzno of toxic goiter, hvoroba Graves-Basedow) - System autoіmunne zahvoryuvannya scho rozvivaєtsya vnaslіdok viroblennya stimulyuyuchih antitіl to rhTSH, klіnіchno proyavlyaєtsya urazhennyam SHCHZ of rozvitkom syndrome hyperthyroidism in poєdnannі of ekstratіreoіdnoy patologієyu (POC, pretіbіalnaya mіksedema, akropatіya).

Diagnosis by ICD:

EOP can be diagnosed before the appearance of functional damage to the thyroid gland (26.3%), as well as at the manifestation of thyrotoxicosis (18.4%), or even if the patient is in euthyroidism due to medication.

One hour after all, all the components of the systemic autoimmune process develop clearly and not necessarily for diagnosis. In most cases, the most important value in thyrotoxicosis with diffuse goiter has a decrease in thyroid gland.

Thyrotoxicosis with vuzlovym / bagatovymus goiter develops in the form of an autonomous, independently of the TTG, the function of the higher-education institutions of the SHZ.

Skargi and anamnesis

Patients with thyrotoxicosis are prone to anxiety, emotional lability, tearfulness, sleep deprivation, meticulousness, loss of concentration of respect, weakness, fatigue, heartiness

Often ailments are associated with an increase in SHZ, a part of an increase, a deterioration of the menstrual cycle, a decrease in potency.

It is even more often ailments to skarzhayutsya on meat weakness. Seriously, I am not safe for the kidnapped person to present the heart of thyrotoxicosis. Fibrillation at the front - a danger of accelerating thyrotoxicosis.

Fibrillation in front of the heart does not develop only in particular with manifest, or in particular with subclinical thyrotoxicosis, especially it may cause a concomitant heart-sudin pathology.

On the cob, fibrillation appears at the front of the heart to be paroxysmal in nature, or, if thyrotoxicosis occurs, to pass into a post-form.

In ailments with thyrotoxicosis and fibrillation, the atrium of thromboembolic rhizic disorders is accelerated.

With trivial thyrotoxicosis in ailments, dilatation may develop, as a result of a decrease in the functional reserve of the heart and the appearance of symptoms in heart failure.

Approximately 40-50 patients with DTZ develop EOP, which is characterized by the amount of soft tissues of the orbit: retrobulbar cells, okorukhovyh muses; from the lesions of the healthy nerve and the additional eye apparatus (capital, horny, conjunctivism, tears).

In ailments, spontaneous retrobulbarna develops, bile, when the ochim collapses, erythema povik, swelling of the swelling, conjunctival hyperemia, chemosis, proptosis, intercourse of the collapse of the mucous membranes.

Some important accelerated EOP є: neuropathy of the healthy nerve, keratopathy with bloom formation, corneal perforation, ophthalmoplegia, diplopia.

The development of functional autonomy, it is important, for a person who has been kidnapped by the origin of the key features of this ailing.

In the classroom picture, as a rule, heart-shaped and mental disorders dominate: apathy, depression, appetite, weakness, heart rate, heart rhythm disturbance, symptoms of lack of blood circulation.

Heart-related illness, pathology of the herbal tract, neurological problems mask the main cause of illness.

On the basis of the functional autonomy of universities in the ShchZ, when there is a poor history of high-grade goiter / bagate-nodular goiter, with DTZ, there is a short history of symptoms: symptoms develop and develop rapidly.

Prevention and dispensary caution

Primary prevention of the day.

However, in patients who suffer from DTZ, it means more stressful events in patients with toxic goiter with ailments, in which the number of stressful situations is similar to that in the control group.

Patients with functional autonomic thyrotoxicosis can develop thyrotoxicosis with higher levels of iodine, introduced by iodine-containing medications.

Conservative treatment of DTZ is carried out for 12-18 months. The main reason is the renewal of the euthyroid standard and normalization of the level of svT3, svT4 and TTG.

The patient is shown until T3 and T4 last 4 months. Then we start the TTG level. For normalization of the TTG to reach the final level.

before kasuvannyam conservative politics viznachayut the level of antibodies to rTTG. In case of recurrence of thyrotoxicosis, the nutritional status is radical.

Patients with functional autonomy (with vuzlovym / bagatovym nodal toxic goiter) for normalization of svT3 and svT4 are sent for radioiodine therapy or promptly elimination.