Thyroiditis: causes, symptoms, diagnosis, treatment

Published: 07/16/2021 11:20:00 Updated: 07/16/2021

Thyroiditis - inflammation of the thyroid tissue - is a group of pathological conditions that differ in nature, origin and clinical manifestations. This inflammation can be acute or chronic, be autoimmune or infectious, and develop after childbirth or a cytokine storm. In terms of frequency of occurrence, thyroiditis ranks second among disorders of the endocrine system.

Euthyroidism – what is it?

With euthyroidism, the functioning of the thyroid gland is disrupted, but hormone levels remain normal. The patient feels completely healthy, although this is not the case.

When analyzing hormone levels, the indicators are normal, the background of the gland is stable. This condition can persist for a long time, while pathological processes will not develop either. This is the danger, since the situation can change dramatically. This pathology provokes the appearance of nodular goiter, which is in a kind of “lethargic sleep” while the hormonal background is stable.

Medical studies have found that stable hormonal levels do not last long. And as soon as changes occur, the functioning of the thyroid gland worsens. Thyroid diseases are closely related to hormones: a significant decrease provokes hypothyroidism, an increase - hyperthyroidism.

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Rice. 1 - Location of the thyroid gland in humans

EUTHYROID GOITER

Euthyroid goiter (endemic goiter) is an enlargement of the thyroid gland, with normal hormone levels.

Why does the thyroid gland enlarge?

The fact is that the thyroid gland produces two hormones: triiodothyronine (contains 3 iodine molecules) and thyroxine (contains 4 iodine molecules). Iodine is a trace element that is not produced in the body, so we must get it daily. Therefore, no iodine means no hormones, little iodine means few hormones. However, our body requires as many hormones as it should, otherwise disturbances in all metabolic processes (protein, carbohydrate, fat, water, etc.) begin. When there is a deficiency, stimulation of the thyroid gland function by TSH (thyroid-stimulating hormone, which is produced by the pituitary gland) is triggered, as a result of which, by increasing the size of the thyroid gland, a relative stabilization of hormone production is achieved.

Rice. 2 - Enlarged thyroid gland

Why is iodine deficiency dangerous?

According to WHO (World Health Organization), populations living in regions with iodine deficiency have iodine deficiency diseases. These are dysfunctions of the immune system, autoimmune diseases of the thyroid gland, among children - an increased frequency of colds, a higher percentage of children with decreased mental abilities, and the birth of children with congenital hypothyroidism. The most socially significant iodine deficiency disease is a decrease in the intellectual potential of the population in regions where goiter is endemic, etc.

With prolonged iodine deficiency, so-called hypothyroxinemia develops, i.e. decrease in hormone levels during physical and emotional stress, pregnancy, viral diseases, etc. With hypothyroxinemia, thyroid function decreases, which leads to:

• Frequent colds and viral infections, their more severe course;
• During puberty, the thyroid gland enlarges and nodular goiter forms;
• Menstrual dysfunction, both in adolescence and in adult women, hormonal dysfunction in both women and men; during pregnancy, it negatively affects the development of the brain in the fetus;
• Development of autoimmune thyroid diseases.

Research by world scientists has proven that the role of maternal thyroid hormones in the early stages of pregnancy plays a large role in the formation of the intelligence of future offspring. According to scientific research, indicators of mental development of children living in conditions without iodine deficiency are 15-18% higher than in iodine-deficient conditions. In this regard, it is believed that long-term living of people in conditions of iodine deficiency (if the population does not take additional iodine in the form of iodized salt or iodine preparations) leads to a slow decline in the level of intelligence of the entire population living in a given area.

What kind of prevention should be done to prevent iodine deficiency diseases?

In conditions of goiter endemia it is necessary:

• Preventive intake of iodine daily and constantly, regardless of the time of year and other factors! This is iodized salt or preparations containing prophylactic doses of iodine (sometimes both).
• Ultrasound of the thyroid gland, taking into account the correct assessment of the tissue structure and nodular formations. However, the size of the thyroid gland is assessed by a doctor by palpation, since the volume of the thyroid gland by ultrasound does not (often) correspond to the size of the examined thyroid gland by palpation. These conclusions were made at the congress on thyroid diseases in Moscow.
• Determination of thyroid hormones and evaluation of results by an endocrinologist.
• Observation and treatment in case of detection of iodine deficiency diseases (doctor's recommendations).

Is there iodine deficiency in the conditions of the Irkutsk region?

Almost the entire territory of Russia belongs to regions with insufficient iodine content in the environment. Studies have shown that the actual average iodine intake currently ranges from 40 to 80 mcg per day, which is 3 times less than the recommended amount.

The Irkutsk region belongs to an iodine-deficient region. There is no iodine in Baikal water, and, consequently, in the Angara, and in the plants that grow on our land.

Until now, iodized salt is not regularly available in stores and only a small part of the population uses it. In this connection, mass iodine prophylaxis should be organized: only iodized salt is on sale and, in addition, iodization of other products (bread, dairy products).

In the absence of such conditions, we need to take medications with a prophylactic dose of iodine - iodomarin, iodine balance. For adults, 200 mcg of iodine per day is enough. Remember, these doses of iodine prophylaxis are completely harmless and do not accumulate in the body. Iodomarin, the iodine balance in these doses, can be considered to provide those doses of iodine that we could replenish with iodized salt. Therefore, these drugs can be taken at any age and for any form of goiter (diffuse, nodular).

Daily iodine requirement

There is an opinion that in case of nodular forms of goiter over the age of 60 years, taking iodomarin is contraindicated. Let's imagine that we have iodine prevention of goiter (as in other countries). And the entire population takes iodized salt regularly. If we proceed from the position of far-fetched contraindications, it turns out that people with nodular goiter and over 60 years of age should not consume iodized salt? Of course not!

In our country, only 30% of the population consumes iodized salt, so in our country it is important to use pharmaceuticals containing (unlike dietary supplements) a strictly defined amount of iodine (for example, iodomarin, iodine balance).

Iodomarin, iodine balance are undesirable in persons with thyrotoxicosis and in persons who have low levels of thyroid-stimulating hormone. These issues should be discussed with your doctor.

The use of iodine solutions and various ointments with iodine is absolutely contraindicated! since the iodine content in them significantly exceeds prophylactic doses, which can lead to disruption of thyroid function. Consumption of algae also does not provide complete prevention, since there is no specific dosage, and therefore it is impossible to determine the required amount of iodine.

REMEMBER: we need thyroid hormones from birth to old age if we want to maintain our intelligence! Therefore, recommendations that preventive doses of iodine should not be taken after 50-60 years are unacceptable in the conditions of our region!

NODUAL GOITTER

It is currently believed that the main cause of nodules in the thyroid gland is a chronic lack of iodine in food. The presence of a sufficient amount of iodine in the thyroid gland blocks growth factors, and therefore nodules rarely form. With a lack of iodine, individual areas of the thyroid tissue grow.

Nodules are benign tumors that have the ability to grow, pushing apart the surrounding thyroid tissue. At the same time, benign cells do not acquire the ability for infiltrative growth (i.e., penetration between thyroid cells), like malignant ones. Benign tumors can cause symptoms of compression of surrounding organs in the patient (for example, compression of the nearby trachea can lead to difficulty breathing), but are not capable of metastasizing, i.e. spread through the bloodstream to other organs.

What should be done when nodular formations are detected?

• Ultrasound of the thyroid gland. When performing an ultrasound, the location, quantity, shape, size and other parameters of the node are assessed.
• Ultrasound-guided fine-needle aspiration biopsy (abbreviated FNA). This procedure answers the question: is the node benign or malignant.

Fig.3. Fine needle aspiration biopsy of the thyroid gland

• Determination of thyroid hormone levels. If thyroid-stimulating hormone (TSH) decreases, it is necessary to perform thyroid scintigraphy. Particular cases of TSH levels depend on the quality of the tests by which it is determined. These tests may not be “sensitive” enough; in these cases, the doctor must evaluate the clinical symptoms and conduct repeated tests.

It should be noted that when benign nodes are identified, dynamic monitoring is required: twice a year, ultrasound of the thyroid gland and determination of thyroid hormones. If the size of the node increases, a repeat puncture biopsy is performed.

Modern approaches to the treatment of nodular forms of goiter (benign):

In case of benign nodular goiter, it is necessary to assess the functional activity of the node, i.e. determination of TSH. If the TSH level is reduced, then it is necessary to exclude the functional activity of the node (carrying out thyroid scintigraphy). If the TSH level is normal, dynamic monitoring of the growth of nodes and taking medications containing preventive doses of iodine (iodomarin, iodine balance) are recommended.

Surgical treatment of benign nodes currently has strict indications. According to international and Russian recommendations for the diagnosis and treatment of nodular goiter, indications for surgery are:

• tracheal compression syndrome established on the basis of CT;
• functional autonomy with manifest or subclinical thyrotoxicosis when treatment with radioactive iodine is impossible;
• a cosmetic defect that reduces the quality of life.

In other cases, surgical treatment is NOT INDICATED!

Malignant nodes are subject to mandatory surgical treatment and, most importantly, timely treatment!

What consequences do we have in the postoperative period (after surgical treatment of benign nodes)?

• Reduction in the size of the thyroid gland and a decrease in its hormonal function, i.e. the development of hypothyroidism, requiring hormone replacement therapy, which will never replace the true hormones produced by the thyroid gland. We must not forget about combination therapy, i.e. hormonal plus preventive doses of iodine, which “feed” the remaining thyroid tissue.
• The growth of nodules can often recur after surgical removal of nodules in the remaining thyroid tissue and even on the remaining “stump,” since the entire thyroid gland “sicks” from nodulation. This is why it is dangerous to operate on benign nodes.
• During surgery, damage to the recurrent nerve is possible, which leads to weakening of the voice, hoarseness, and even complete loss of voice.
• Damage to the parathyroid glands, which regulate the exchange of calcium and phosphorus in the blood. Which, in turn, is accompanied by disruption of metabolic processes in bone tissue and requires replacement therapy.

New methods for treating benign nodes

Significant progress in the technical capabilities of endocrine surgery over the past 30 years has led to the widespread development of ultrasound examination, the introduction of fine-needle aspiration biopsy into practice, and the emergence of techniques that can eliminate problems associated with thyroid nodules without surgery. These techniques are called minimally invasive or interstitial destruction methods.

Among the destruction methods, the most widespread is the use of ethanol sclerotherapy - the introduction of ethyl alcohol into the tissue of the nodes. This method was one of the first to be introduced into clinical practice in the late 80s of the twentieth century by the Italian endocrinologist T. Livrani. The greatest effect was noted from the use of laser (laser-induced thermotherapy).

Interstitial methods are aimed at destroying nodes inside the thyroid tissue and are carried out under ultrasound control. The use of modern ultrasound devices allows the endocrinologist surgeon to work with high precision on the node that is the source of the patient’s problems. The main goal of such treatment is to destroy the tissue of the nodes without damaging the surrounding healthy tissue. Destruction of the node leads to a decrease in its size, and subsequently to the growth of the node, which makes it possible to avoid surgical treatment.

Minimally invasive methods have a number of advantages compared to surgical treatment. Firstly, they allow the patient to avoid surgery and everything associated with it - stress, anesthesia, a scar on the neck, relapse - i.e. the appearance of nodules on the remaining thyroid tissue. Secondly, it allows you to preserve the thyroid tissue surrounding the node, and therefore avoid the occurrence of hormonal deficiency after treatment. Thirdly, many minimally invasive techniques are used on an outpatient basis and without hospitalization, which allows the patient to work during treatment. This treatment is cheaper than surgery.

Minimally invasive techniques have proven to be especially useful for patients in the older age group. The occurrence of nodes in older people is almost normal - after 60 years of life, nodes appear in most people. In many patients, by the age of 70–80, these formations reach significant sizes and lead to complaints.

The main feature of all these techniques is the fact that the thyroid nodule is not removed during treatment. The tissue of the node is destroyed, but the node itself remains in place. After treatment, the volume of the node is usually significantly reduced. However, promising that the node will completely disappear means deceiving the patient. But most importantly, the node does not grow and does not function!

Examples from our practice

• Pregnancy and nodular goiter. Pregnancy, as a rule, stimulates the growth of the node, and therefore laser destruction is indicated.
• Substernal goiter with symptoms of compression, a history of myocardial infarction. The operation is contraindicated. When performing laser destruction, we obtain a reduction in the size of the node and the disappearance of symptoms of compression.
• In the absence of the possibility of proper dynamic observation, which is often the case, laser destruction will improve the situation.

Our center uses minimally invasive treatment methods: sclerotherapy and laser destruction. There is a specialist, Andrey Viktorovich Zybin, who has been trained in central clinics and has a certificate in the use of minimally invasive techniques. Over a long period of work, there are good results from their use.

THYROID AND PREGNANCY (3)

During pregnancy, women develop another so-called “endocrine gland” - the placenta, which creates a certain condition necessary for the development of the fetus. The level of many hormones increases, which, although bound to proteins, create the necessary “depot reserve”.

In women living in conditions of iodine deficiency, the thyroid gland cannot secrete hormones in reserve due to the lack of necessary iodine intake. “Nature,” responsible for the development of the fetus, does not recognize this and takes what the mother has into the depot. Thus, a mother living in conditions of iodine deficiency does not have sufficient amounts of either hormones or iodine, which are necessary for the normal development of the fetus and for her own body. In this regard, stimulation of the thyroid gland with thyroid-stimulating hormone (TSH) and placental hormones begins. What do we get if we do not take additional iodine supplements or thyroid hormones? A woman’s thyroid gland enlarges; if there are nodules, they can also enlarge, new nodes appear, and their malignant degeneration is possible.

Insufficiency of thyroid hormones affects the development of chronic placental insufficiency - a violation of the functional activity of the placenta, which leads to the threat of miscarriage or frozen pregnancy.

In addition, a negative effect of insufficiency of thyroid function on the fetus has been noted: chronic intrauterine hypoxia, disorders of brain formation (from decreased intelligence to cretinism), congenital hypothyroidism, often damage to the central nervous system (hydrocephalus), Down syndrome, etc.

Conclusion: it should be remembered that many disorders of the gonads in conditions of endemic goiter depend on the functional state of the thyroid gland.

Remember: an experienced endocrinologist can evaluate thyroid function based on clinical manifestations. A one-time assessment of hormone levels alone is insufficient and not informative.

When planning a pregnancy in conditions of endemic goiter (i.e., iodine deficiency, which exists in the Irkutsk region, Buryatia and other regions), it is necessary:

• Detailed examination of thyroid function
• Ultrasound diagnostics by highly qualified specialists who know all the intricacies of the thyroid structure in the presence of goiter and other thyroid diseases
• Determination of hormones
• Consultation with an endocrinologist with clinical experience in order to correctly assess ultrasound data and hormone levels (to exclude hypothyroxinemia - “hidden” symptoms of thyroid dysfunction)
• Dynamic determination of hormones during pregnancy
• Dynamic control over the size of nodular formations, if any
• Monitoring the state of the cardiovascular system in the presence of thyroid diseases Consequently, iodine deficiency during pregnancy leads to pathological changes, characterized by a decrease in the level of hormones and iodine in both the mother and the fetus and, accordingly, to obvious pathological disorders. The functioning of the thyroid gland in the fetus is completely dependent on the supply of iodine and hormones from the maternal body. With iodine and hormone deficiency, the function of the fetal thyroid gland is disrupted, which leads to disruption of the child’s brain formation (from decreased intelligence to cretinism), personality formation, damage to the central nervous system, etc.

HYPOTHYROIDOSIS (decreased thyroid function) (4)

Hypothyroidism affects all types of metabolism: protein, water, carbohydrate, fat. Characterized by damage to connective tissue (joint pain, osteoporosis, etc.), fluid retention (edema, increased blood pressure), inhibition of the function of the central nervous system, adrenal glands, and gonads. The development of mastopathy is possible. In children and adolescents – growth retardation, impaired physical and sexual development: menstrual dysfunction in girls, delayed sexual development in boys. Long-term hypothyroidism leads to an increase in prolactin levels and the development of a pituitary tumor, a decrease in the hormonal function of the adrenal glands, etc.

Causes of hypothyroidism:

1. Lack of iodine in the body
2. Endemic goiter
3. Surgical interventions on the thyroid gland
4. The most common cause is autoimmune thyroiditis

Autoimmune thyroid diseases are associated with dysfunction of the immune system due to iodine deficiency. Immune system disorders are accompanied by the formation of substances (antibodies), which in some cases “kill” the cells of the thyroid gland and autoimmune thyroiditis (AIT) develops with insufficiency of the thyroid gland (i.e. hypothyroidism). As a result, we have both non-functioning cells and preserved ones, which require the presence of iodine in the body to function.

Diagnostics:

Often, patient complaints may be the only symptoms of the disease:

• Fatigue
• Lethargy
• Drowsiness (more often during the day)
• Decreased physical or mental activity
• Decreased performance
• Memory loss
• Mood changes

With hypothyroidism, many body systems are damaged: the cardiovascular, nervous system, musculoskeletal, excretory and others.

From the nervous system: perception and attention decrease, mental activity slows down, mood lability, at times there is a feeling of fussiness, internal tension, increased sensitivity, vulnerability. I feel especially bad in the morning - a feeling of inner emptiness and heaviness. In contrast to neuroses, patients often complain of difficulty articulating, awkward movements, heaviness in the muscles, bones, and joints. With a slower progression of the disease, the following is noted: a tendency to conflicts, increased excitability - patients become “grumpy”, “angry”, and a quarrelsome character appears. Mental disorders progress, which are expressed in slowing down and difficulty in mental functioning.

Patients note weight gain, increased sensitivity to cold, voice changes, and menstrual irregularities. Dermatological symptoms are characteristic: hair loss, alopecia, dry skin, hyperkeratosis, nail damage. Therefore, any disease of the skin or hair requires examination of the function of the thyroid gland.

The disease can occur atypically or with minor symptoms, for example, with a predominance in the clinic of any group of symptoms: edema, cardiac symptoms, symptoms of the nervous system or psyche, muscle weakness.

The variation of symptoms can be varied. Patients are often treated by many specialists without knowing about their disease.

Remember! You live in conditions of iodine deficiency - it is necessary to periodically check the function of the thyroid gland. But this should be done not on the basis of the conclusion of an ultrasound diagnostic doctor, but of an endocrinologist.

Hypothyroidism in children: The clinical picture of hypothyroidism in children depends on age. For newborns it is typical: weight more than 4 kg, the child sucks poorly at the breast, lethargy, difficulty in nasal breathing, delayed mental development. At an older age: delayed physical and mental development, stunted growth (especially pronounced at 3-4 years).

Treatment of hypothyroidism consists of taking thyroid hormone drugs, but not as a treatment, but as a replacement for the deficiency of hormones that “did not supply” the damaged thyroid cells, plus necessarily preventive doses of iodine for the functioning of the cells. In children, the earlier treatment is started, the more reliably intellectual development will be preserved.

The course of the disease is progressive, which requires long-term observation and dose adjustment of hormones.

DIFFUSE TOXIC GOITER

Another autoimmune disease includes diffuse toxic goiter. With this disease, antibodies are formed that stimulate the functioning of thyroid cells; as a result, thyroid hormones are synthesized in excess and enter the blood. This condition is called thyrotoxicosis. Characteristic symptoms of thyrotoxicosis: increased excitability, palpitations, sweating, weight loss, trembling in the hands and body, and in older people - an unreasonable disruption of the heart rhythm.

Rice. 5. Symptoms of thyrotoxicosis

Treatment. There are three methods of treating this disease: this is the prescription of drugs that “block” the production of thyroid hormones; surgical treatment; radioactive iodine therapy.

It is necessary to take this disease seriously, since violation of the drug regimen, inaccessibility of frequent monitoring by an endocrinologist, long-term treatment (continuity of treatment for up to a year), and unreasonable combination of treatment with drugs that block the function of the thyroid gland with thyroid hormones leads to frequent relapses of the disease.

SUBACUTE THYROIDITIS (5)

The provoking factor is infection. Clinical picture: pain in the neck (usually in the thyroid gland) radiating to the back of the head, upper and lower jaw, high temperature, etc.

Rice. 6. Clinical picture of subacute thyroiditis

Treatment is the use of adrenal hormones (prednisolone).

We have developed a technique (Zybina V.D.) - local administration of hormones, which allows the use of small doses of hormones and a short period of treatment.

OPHTHALMOPATHY OR POGGY EYES

Rice.
7. Clinical picture of ophthalmopathy Often develops against the background of thyroid diseases.

An examination by an endocrinologist is necessary.

Zybina V.D. Associate Professor, Ph.D.

Reasons for development

Euthyroidism can be considered one of the most insidious diseases of the thyroid gland. It cannot be diagnosed immediately, hormone levels are always normal, and more dangerous diseases have already begun to develop.

The main causes of thyroid euthyroidism include the following:

• processes in the body associated with improper functioning of the immune system;
• unfavorable environment;
• heredity;
• thyroid diseases associated with the inflammatory process.

Classification of thyroiditis

The classification of thyroiditis according to the International Classification of Diseases, 10th revision, distinguishes the following types of pathology:

• acute thyroiditis - an infectious lesion of the thyroid tissue: can lead to the formation of abscesses (purulent thyroiditis);
• subacute thyroiditis - De Quervain's thyroiditis (giant cell or granulomatous thyroiditis);
• chronic autoimmune thyroiditis - Hashimoto's disease or goiter (chronic lymphocytic thyroiditis or lymphoid goiter);
• Riedel's chronic thyroiditis or Riedel's goiter.

Thyroiditis induced by drugs or radiation does not have significant clinical significance, since this pathology is self-limiting and usually does not require serious measures.

Gestational or postpartum thyroiditis occurs during or after pregnancy due to changes in the immune system. It does not require serious treatment and usually goes away on its own.

One of the forms of euthyroidism is nodular goiter

Nodular goiter is the formation of outgrowths in the thyroid gland. There are 5 types of goiter:

• nodular goiter, where the nodes are interconnected;
• endemic goiter caused by iodine deficiency;
• goiter with a large number of nodes;
• nodular goiter with a single node.

When the pathology begins to occur in a more acute form, the thyroid tissue enlarges, and nodules, both malignant and benign, form.

The main symptoms of euthyroidism include:

1. chest discomfort or pain;
2. sudden loss of body weight;
3. the heartbeat is rapid, arrhythmia appears.

Nodular goiter requires immediate treatment. Untimely therapy can lead to serious consequences: malignant formation or compression of the trachea. In such cases, the thyroid gland is surgically removed.

Prognosis for thyroiditis

The prognosis for thyroiditis depends on the severity of the pathology, the accuracy of diagnosis and timely treatment. Advanced cases, with goiter of large and enormous sizes, are now practically never encountered due to the availability of diagnostic and treatment methods. Most patients with acute, subacute and autoimmune thyroiditis (Hashimoto's disease) have a favorable prognosis.

With Riedel's thyroiditis, the prognosis depends on the success of treatment and the presence of damage to other organs. Deaths in patients receiving treatment are extremely rare.

Diagnostics

To diagnose diffuse nodular goiter, an initial examination by an endocrinologist is necessary. It allows you to identify signs of the disease through visual assessment and palpation. If there is a suspicion of diffuse nodular goiter, the doctor will prescribe additional tests to clarify the diagnosis:

• blood test - to check the concentration of thyroid hormones;
• stool and urine analysis;
• Ultrasound examination allows you to find out the cause of the nodular formation.

To exclude the possibility of developing cancer, a fine-needle aspiration biopsy is used. It is performed if the diameter of the nodular formation reaches a centimeter or more. Scintigraphy is also performed - radioisotope scanning, which makes it possible to study the autonomy of the functional thyroid gland. Computed tomography provides the doctor with information about the size of the organ, its contours and structure, and the features of regional lymph nodes. X-rays are needed to ensure that foreign objects do not enter the esophagus or sternum area.

Only after laboratory tests are carried out, the endocrinologist selects drug therapy for the patient, which can gradually reduce the manifestations of the disease.

Diet and other aspects of nutrition

If it has been established that the cause of euthyroidism is hidden in iodine deficiency, then you can try to cope with the problem with the help of diet.

The menu should include products such as:

• Sea fish: hake, pollock, haddock, capelin, cod.
• Shrimps.
• Squid.
• Feijoa.
• Sea kale.
• Persimmon.
• Liver.
• Spinach.
• Eggs.

Most iodine can be obtained from fish, algae and seafood.

When a person develops obesity against the background of euthyroidism, it is necessary to adjust the diet so that it contributes to weight loss.

The following foods and drinks are excluded from the menu:

• Flour dishes.
• Fatty food.
• Smoked meats.
• Fast food.
• Alcohol.
• Confectionery and other sweets.

A person should eat food that is a source of fiber. Salads should be prepared from fresh vegetables. Be sure to supplement the diet with bran, cereals, and nuts. Among the cereals, oatmeal and buckwheat are considered especially healthy.

Combination therapy

Thyreostatic drugs are administered only to achieve euthyroidism, and then they are used together with thyroxine, for example, 20 mg of methizol + 50 mcg of thyroxine. The purpose of administering thyroxine is to prevent the onset of hypothyroidism and to prevent the goiter from enlarging due to unblocking of TSH.

Be aware of the beneficial effects of beta blockers, B vitamins, and possibly sedatives.

Beta blockers - the main effect of drugs in this group is to block beta receptors, which reduces the activity of the adrenergic system. Let us recall that with hyperthyroidism there is an increase in the sensitivity of beta receptors to catecholamines and an increase in their density.

Combination therapy

These drugs also reduce the conversion of peripheral T4 to T3.

The most commonly used:

• propranolol at a dose of 80-160 mg/day;
• Metocard at a dose of 100-200 mg/day;
• Atenolol at a dose of 50-200 mg/day.

In case of contraindications to the use of drugs from this group, calcium channel blockers, for example, Isoptin, can be prescribed as an alternative.

Additional notes:

• During the initial period of treatment, physical activity should be avoided (valid medical certificate);
• the course of treatment may be aggravated by stress factors;
• preventive vaccinations are contraindicated;
• the patient should be instructed about the possibility of granulocytopenia and associated symptoms, as well as the need to consult an endocrinologist if they occur;
• granulocytopenia can also be a symptom of Graves' disease itself, so its detection before treatment is not a contraindication to the use of thyreostatic drugs;
• If Graves' disease has been cured, iodine should not be given as this medicine may cause the disease to recur.

In cases of drug intolerance, relapse of hyperactivity after treatment or very strong patient resistance, we turn to radical treatment, that is, 131 I treatment, or nowadays, less commonly, to surgical treatment.

Symptoms

People are often surprised by the diagnosis of euthyroidism. Only ultrasound and some additional studies show that they have this disease. However, there are a number of symptoms that are an indicator that there is something wrong with the thyroid gland, even if the hormone test is normal.

These symptoms include:

- excessive, sometimes groundless nervousness;

- fast fatiguability;

- small swelling in the neck area;

- sometimes there is difficulty swallowing, a lump is felt in the throat;

- upon palpation, the doctor may detect small nodular formations in the neck area; They are mostly painless, and only occasionally do patients complain of discomfort, for example, when the neck is compressed by a clothing collar.

Treatment

When diagnosed with euthyroidism, treatment is required only in cases where the pathology of the thyroid gland progresses. If her condition is stable, measures are limited to more frequent monitoring by a doctor. The patient is recommended to have a gentle daily routine and a balanced diet. If necessary, conservative treatment with iodine preparations or Levothyroxine may be prescribed. If the thyroid gland is too large, surgery is possible. The operation is also performed if several nodules are found on the neck, the size of which is more than 1 centimeter.