Objective. To demonstrate the stages of diagnostics and successful treatment of thyrotoxicosis in a patient with severe comorbid pathology. Materials and methods. A clinical case report of a patient with toxic goiter is presented. Results. To specify the state of the thyroid gland, diagnostic and laboratory methods were applied: ultrasound examination (thyroid volume increased up to 182 cm2, isoechogenic nodule in the left lobe up to 1 cm, thyroid vascularization increased), spiral computed tomography (picture of diffuse nodular goiter with partial retrosternal location of the left thyroid lobe), hormone studies, the results of which revealed thyrotoxicosis. Thyroidectomy was subsequently carried out. Both thyroid lobes with isthmus were removed step-by-step with technical difficulties and high bleeding of tissues. The patient was discharged in 10 days in a satisfactory state. Conclusions. Thyrotoxicosis is certainly a complex surgical pathology, in which correct assessment of the diagnosis by instrumental, clinical and laboratory methods is required, as well as successful surgical intervention. Not only normalization of hormonal status of a patient has to be taken into account, but also the possibility of disease relapse, contraindications due to age, physiological status, and comorbid abnormalities.
Background. Achieving a high level of quality of life is one of the priorities in the treatment of chronic diseases. Focusing on the quality of life, it is possible to optimally adjust the treatment plan for patients, influencing the link that suffers most in this pathology. Hypothyroidism is mainly formed as a result of surgery on the thyroid gland, or autoimmune thyroiditis, and at the same time is one of the most common endocrine diseases, is of great social importance due to the potentially adverse effect on most organs and systems, resulting in a decrease in quality of life.The aim. To analyze the impact of primary hypothyroidism (postoperative hypothyroidism and autoimmune thyroiditis) on the quality of life of patients.Materials and methods. During the study, a clinical, laboratory and psychological study of 78 women with uncompensated primary hypothyroidism was carried out: 40 women aged 32–76 years with postoperative hypothyroidism (main group) and 38 women aged 36–60 years with autoimmune thyroiditis (comparison group). The quality of life was judged by the indicators of the MOS SF-36 questionnaire.Conclusion. In the examined patients with primary hypothyroidism, an association between an increase in TSH levels and a decrease in all indicators of the quality of life was revealed. First, indicators of physical functioning, general health, role and emotional functioning worsened. The dependence of indicators on the MOS SF-36 scales with the age of patients, the duration of hypothyroidism, and the level of TSH was revealed. The quality of life in patients with postoperative hypothyroidism was significantly reduced compared to patients who had hypothyroidism due to autoimmune thyroiditis.
Aim. To identify and correct cognitive impairment in patients with hypothyroidism.Materials and methods. The study included 76 patients with primary hypothyroidism. All patients were divided into 2 groups: compensated and decompensated hypothyroidism. In addition to general clinical, and hormonal blood tests all participants in the study underwent ultrasound of the thyroid gland and ECG, the neurophysiological study of cognitive evoked potentials, and testing according to the Montreal cognitive function assessment scale.Results. In the majority of patients with a lack of thyroid hormones, cognitive impairments were detected, which increase with worsening compensation for hypothyroidism according to the results of Montreal Cognitive Assessment Scale testing. The study of evoked potentials in patients with hypothyroidism revealed an increase in latency and a decrease in the amplitude of the P300 indicator, indicating the presence of cognitive deficit. The addition of ethylmethylhydroxypyridine succinate to hormone replacement therapy in patients with hypothyroidism significantly improves cognitive performance more than hormone monotherapy.Conclusions. This study showed the need to identify cognitive impairments in patients with primary hypothyroidism, and their correction with the help of complex therapy increases the cognitive potential and the effectiveness of their treatment.
Aim: to study the quality of life and the emotional state of patients with chronic pancreatitis on the background of postoperative hypothyroidism and the possibility of effective rehabilitation.Materials and methods. 270 patients with chronic pancreatitis were examined, among which 40 patients with primary postoperative hypothyroidism, who made up group 1, group 2 included 30 patients without thyroid pathology. Patients underwent a blood test according to the main biochemical parameters, hormonal blood count, ultrasound of the thyroid gland, hepatobiliary and duodenal zone. The study of quality of life and psychoemotional state by tests.Results In patients with chronic pacreatitis in combination with postoperative hypothyroidism among diseases of the hepatoduodenal zone, chronic non-calculous cholecystitis and non-alcoholic fatty liver disease were identified that are clinically characterized by abdominal pain syndrome according to the GSRS questionnaire. Patients revealed mild depressive state, high levels of personal and situational anxiety. The quality of life of patients was reduced both in physical and in psychological components, due to indicators of role-playing physical and emotional functioning. Against the background of treatment with a combination of succinate-containing drugs, the severity of depression, situational and personal anxiety decreased, and role functioning due to physical and emotional state, social functioning increased.Conclusions: The use of combination therapy with sodium levothyroxine and ethylmethylhydroxypyridine succinate in patients with comorbid pathology during postoperative hypothyroidism improves the clinical picture, psychoemotional balance and quality of life.
The aim. To study the quality of life and psychoemotional state of patients with non-alcoholic fatty liver disease against the background of primary hypothyroidism during the use of ethylmethylhydroxypyridine succinate.Materials and methods. 111 patients with non-alcoholic fatty liver were examined, among them 35 were without thyroid dysfunction, 55 with compensated primary hypothyroidism, 21 with decompensated hypothyroidism. The patients underwent general clinical, biochemical, enzyme-linked immunosorbent assays of blood, instrumental studies, testing according to psychological questionnaires.Results. With decompensation of hypothyroidism, a statistically significant increase in indicators of depression, situational and personal anxiety was revealed in comparison with patients without hypothyroidism. The examined patients showed an increase in the level of situational and personal anxiety. The presence of hypothyroidism in the examined patients significantly worsens these indicators, leading to an increase in the degree of anxiety, aggravated by decompensation of hypothyroidism. A positive dynamic was revealed in the correction of the psychoemotional status of patients in the observation group during the complex treatment with ethylmethylhydroxypyridine succinate: the severity of depression, situational and personal anxiety, manifestations of dyspeptic and reflux syndromes decreased.Conclusion. Hypothyroidism affects the quality of life and psycho-emotional state of patients with non-alcoholic fatty liver disease: it worsens the degree of depression, situational and personal anxiety. The addition of ethylmethylhydroxypyridine succinate to standard therapy with sodium levothyroxine in patients with non-alcoholic fatty liver disease in the setting of hypothyroidism improves the quality of life and psycho-emotional state.
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