[Thyroid hormones, thyrotropin, cortisol and corticotropin in postoperative recurrence of diffuse toxic goiter].
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Biomedical subjects
Publications and source records attributed to T S Grinchenko.
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Disorder of function of the hypothalamus-thyroid system in patients with diffuse toxic goiter is accompanied by change of the hormonal activity of the hypothalamohypophyseal-adrenocortical and hypothalamohypophyseal-ovarian systems. It is particularly marked in persons with heredity aggravated by thyroid diseases or/and diabetes mellitus.
Radioimmunoassays, immunological and radioreceptor methods were used for a study of the levels of T3, T4, TSH, thyroglobulin, antibodies to thyroglobulin and microsomal antigen, immunoglobulins suppressing thyrotropin binding in 92 patients with diffuse toxic goiter aged over 50. There was discrepancy between the prevalence of severe types of disease in this group of patients and an insignificant rise of T3 and T4 levels. Changes in the immune status pointed to an increase in immunodeficiency which became progressive with aging of the organism, and increasing sensitivity to damaging agents.
The immune status was studied in patients with a familial nature of thyrotoxicosis and without complicated heredity. Disorders in the immune homeostasis, mostly expressed in thyrotoxicosis of familial nature, were revealed. Proceeding from the above the authors proposed a method of multimodality therapy of thyrotoxicosis with antithyroid drugs and immunomodulator levamisole causing a fast disappearance of the clinical signs of thyrotoxicosis, a decrease in thyroid activity and density and the reduction of the number of surgical interventions. The effect may be probably due to the normalization of the immune status.
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A study of 190 patients with diffuse toxic goiter combined with autoimmune thyroiditis has revealed some clinical features: a torpid course and a solid-elastic consistency of the thyroid. In 37.4% of the cases autoimmune thyroiditis was combined with a severe form of thyrotoxicosis. The combined form of diffuse toxic goiter correlated with a greater frequency of the detection of thyroid autoantibodies to thyroglobulin and microsomal antigen (in 83 and 78.3% of the patients respectively) as compared to the common form of diffuse toxic goiter (in 47.3 and 48.1%). A study of the hormonal thyroid status of 43 patients with diffuse toxic goiter combined with autoimmune thyroiditis showed that T3, T4 and TTH levels in patients with the presence of autoantibodies to thyroid antigens did not differ from the levels of these hormones in the common form of diffuse toxic goiter, and in the group of the patients with the absence of autoantibodies there was a tendency to the development of T3-toxicosis. The absence of pathognomic symptoms in combined forms of diffuse toxic goiter makes their preoperative diagnosis difficult. Interrelationship of the hormonal thyroid status and humoral antithyroid immunity was noted.
A comparative study of the peculiarities of the course of diabetes and metabolic disturbances, and also of the indices of capillary permeability, biomicroscopy of the conjunctival vessels, platelet aggregation, coagulorgam and blood clot retraction was carried out in the group of patients treated with insulin and sacharreducing sulfanilamides. Marked derangements in the microcirculatory system concerning both the vascular wall proper and of the rheological properties of the blood were revealed. These derangements were more distinct in the patients over 45 years of age with prolonged affection and the presence of vascular complications but proved to be independent of the therapy carried out.