Destruction of thyrocytes

Operative treatment

According to modern concepts, the goal of surgical treatment, as well as discussed below yodom131 therapy, is removal of most of the thyroid, on the one hand, ensures the development of postoperative hypothyroidism and the other (which is most fundamentally), precluding any possibility of recurrence of hyperthyroidism. To this end, we recommend an extremely subtotal resection of the thyroid to the abandonment of the thyroid remnant is not more than 23 ml. Conducting subtotal resection, on the one hand, carries a high risk of saving or distant relapse of hyperthyroidism, and the other does not exclude the development of hypothyroidism. When the so-called "thrifty resection, the volume of which the world regarded as inadequate, it should be understood that leaving during the operation sufficient for the production of thyroid hormones of the thyroid gland in the body, in essence, remains a" target "for anti-thyroid antibodies producing cells of the immune system.

Thus, poleoperatsionny hypothyroidism is currently not viewed as a complication of surgical treatment of BG and its purpose. A precondition for this was the introduction of a broad clinical practice of modern preparations of levothyroxine, against which adequate reception of the patient remains stable euthyroidism and quality of life that does not differ from normal. To date, one can say without exaggeration that there is no hypothyroidism, the compensation which with proper use of modern preparations of thyroid hormones would be impossible. Failures in the treatment of postoperative and any other hypothyroidism should be sought either in the poor training of conducting replacement therapy, or failure to comply with the patient rather simple steps to receive the drug.

Radioactive iodine therapy

It is no exaggeration to say that worldwide the majority of patients with BG, as well as with other forms of toxic goiter, as a treatment receives it yodom131 radioactive therapy. This is due to the fact that the method is effective, neinvaziven, relatively inexpensive, devoid of the complications that may develop during surgery on the thyroid. The only contraindication to treatment yodom131 are pregnancy and breastfeeding.

If in our country to this day continues to conventional wisdom about what therapy yodom131 shown only to elderly patients who, for one reason or another can not perform the operation, it actually has no lower age limit for appointment yoda131, and in many countries yod131 has been successfully used for the treatment of BG in children. It was order cialis proved that, regardless of age the risk of therapy yodom131 significantly lower than that in surgical treatment.

In significant quantities yod131 accumulates only in the thyroid, after falling in her, he begins to disintegrate, emitting b-particles, which have path length of about 11.5 mm, which provides local radiation destruction of thyrocytes. Safety of this treatment method is demonstrated by the fact that in some countries, such as the U.S., where 99% of patients receiving BG yod131 as the first choice of treatment, therapy with BG yodom131 performed in an outpatient procedure. A significant advantage is that treatment yodom 131 can be carried out without prior training tionamidami. BG's disease when treatment is aimed at the destruction of the thyroid, therapeutic activity, taking into account the volume of the thyroid, the maximum capture time and half-life yoda131 of the thyroid is calculated from the estimated absorbed dose of 200 300 Gy. Hypothyroidism usually develops within 6 months after the introduction of yoda131.

Serious problem of domestic Endocrinology is the virtual absence of available endocrinologists such a wonderful way to treat BG, as a therapy yodom131.

Conclusion

BG is one of the most common autoimmune diseases in humans. His clinical presentation and prognosis in most cases determined by the persistent hyperthyroidism, which in the absence of adequate treatment may lead to severe disability patient. Currently existing treatment guidelines BG, though not without flaws, but allow you to completely rid the patient of hyperthyroidism and provide an acceptable quality of life.