ART OF MEDICINE 2017

 

TACTICS OF TREATMENT OF NODULE DISEASES OF THYRO-ID GLAND IN ADULTS IN THE ENDOCRINOLOGY CLINICS

 

N.V. Skrypnyk, T.S. Vatseba, O.V. Marusyn, L.V. Rybchak

          SHEI "Ivano-Frankivsk National Medical University", Department of Endocrinology, Ivano-Frankivsk, Ukraine, This email address is being protected from spambots. You need JavaScript enabled to view it.

  

Abstract

Abstract. Over the past decades, the world community has been paying particular attention to overcoming the effects of iodine deficiency on the planet, considering it as a solution to one of the global health problems of people. After the Chernobyl accident in 1986, the thyroid gland pathology took first place among all endocrinopathies in Ukraine. Nodular and multi-node goiter are very common diseases, especially in regions where iodine deficiency is present. The article is complemented by modern approaches to diagnosis, scientific and practical aspects of treatment and observation of nodular thyroid diseases based on the current international recommendations of the American Thyroid Association for adult patients with thyroid and thyroid differentiated cancers, 2015; the consensus of the American Association of Clinical Endocrinologists, the Italian Association of Clinical Endocrinologists, the European Thyroid Association (AASE / AME / ETA), 2010, based on evidence-based medicine. The definition of the degree of iodine deficiency in patients living in different climatic-geographical areas of the Precarpathian region was detected by studying the median of iodine and studying the structural characteristics of the thyroid with ultrasound. Early diagnostics of nodal nodes of the thyroid gland (nodule, thyroid cancer) allows to create a comprehensive and effective system of medical care for patients with thyroid tumors, to evaluate the initial risk and to carry out screening procedures for the detection of malignant neoplasms. The clinical significance of the diagnosis of thyroid nodal nodes is the need to exclude thyroid cancer. For the purpose of laboratory confirmation of the state of iodine deficiency, an estimate of the median of iodine was performed on the values of 90 samples of urine in patients with hypothyroidism. For this survey, patients were selected at random, with 30 people from different climatic and geographical regions: plain, foothill, and high altitude. On the basis of the results, the median iodine concentration in the region was 126.04±5.40 μg/l; in particular in the high-altitude region, 83.08±6.71 μg/l, flat 179.17±4.57 μg/l, and foothill 119.44±6.55 μg/l. The analysis of the frequency distribution of iodine concentration in urine in patients with hypothyroidism in different regions of the Carpathian region, which confirms the presence of the lowest values of ioduria in the inhabitants of the high mountainous region. Goiter was detected in 28.33% of patients with hypothyroidism. The presence of hypertrophy of the thyroid gland was positively correlated with ioduria, which confirms the etiological role of iodine deficiency in the formation of a goiter among the inhabitants of the Carpathian region. The inhabitants of the high-mountainous region of the Ukrainian Carpathians revealed iodine insufficiency of a mild degree on the median iodine, which promotes the development of nodal forms of endemic goiter. The increase of incidence rates for nodal goiter and thyroid cancer in recent years among the inhabitants of the Carpathian region has been proved. The organization of providing qualified medical care to adults with thyroid nodal diseases from the moment of suspicion or diagnosis throughout life contributes to reducing mortality, reducing disability, improving the quality of life and working capacity of patients with nodular diseases of the thyroid gland.

 

Key words: nodular thyroid disease, thyroid cancer, iodine deficiency disorder, diagnosis, treatment.

 

Full text: PDF (Rus)

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