Subacute thyroiditis in the treatment of disputes and suggestions

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Subacute thyroiditis (Subacute Thyroiditis) is a viral infection of the thyroid or viral infection after systemic inflammatory response, des

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Subacute thyroiditis (Subacute Thyroiditis) is a viral infection of the thyroid or viral infection after systemic inflammatory response, destructive injury caused by thyroid tissue, divided into subacute granulomatous thyroiditis, non infectious thyroiditis, transitional thyroiditis, De Quervain and other types of thyroiditis. Subacute thyroiditis is a self limiting disease, can cause permanent hypothyroidism accounted for 5%-15%. The incidence of viral infection, found non viral diseases, genetic and autoimmune factors in subacute thyroiditis. The main clinical manifestations are the gradual or sudden occurrence of thyroid area characteristic pain, can be transmitted to the ear, throat and other places, and can be changed with the neck, swallowing action aggravated. Physical examination showed diffuse or asymmetric mild / moderate enlargement of the thyroid gland with or without nodules. The laboratory examination often appeared erythrocyte sedimentation rate (ESR) was significantly increased; the serum thyroid hormone concentration and thyroid iodine uptake and reduce the two-way separation; C reaction protein increased; TgAb, TPOAb negative or low level; serum thyroglobulin (Tg) levels were significantly increased and the early thyroid fine needle aspiration cytology (FNAC abnormal etc.).

The current clinical treatment of subacute thyroiditis from remission, corticosteroids (pain, symptomatic treatment, symptoms) and remove the pathogeny (clear antigen -- three aspects of fundamental). However, there is controversy in the specific treatment. Patients with Subacute Thyroiditis Treated by relieving pain, mild symptoms of choice for patients with non steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, indomethacin and cyclooxygenase inhibitors of -2. Patients with subacute thyroiditis should be treated with beta blockers such as propranolol to reduce heart rate. Whether to give anti thyroid drugs, 2008 Chinese guidelines for the diagnosis and treatment of subacute thyroiditis pointed out that due to the excessive production of thyroid hormones did not, do not advocate the use of antithyroid drug therapy; in 2010 the American Thyroid Association (ATA) guidelines also did not mention the use of antithyroid drugs in the treatment of subacute thyroiditis. In patients with subacute thyroiditis, thyroid hormone should be added. L-T4 can be used to reduce the use of thyroid function in the short term, thyroid function test, to confirm the normal recovery of thyroid function after 3-6 months before withdrawal. Long term replacement therapy for permanent hypothyroidism. Whether the use of corticosteroids in the treatment of subacute thyroiditis, is controversial in clinic at present. Because of the destruction of the virus and the allergic reaction caused by the virus, the thyroid gland presents 3 states, the damaged part, the damaged part that has not been broken, and the normal unaffected part. Glucocorticoids can inhibit inflammation, reduce the immune response, stability of gland cell membrane structure, it can reduce further damage to an allergic reaction to thyroid follicles, effectively relieve pain; accelerate the damage but not damaged cell repair, shorten the course, reduce the risk of slipping to hypothyroidism. Compared with the chronic inflammation of the bridge, a small amount of damage, due to a part of the damage due to the more, there will be a feeling of pain. So in the non steroidal drugs can not effectively control the symptoms of pain, the need for early use of hormones. If you can control the pain, that is not much damage, you can not use hormones). Compared with NSAID, the hormone can relieve pain quickly. Shortening course. In 2010 the American Thyroid Association (ATA) guidelines suggest that NSAID patients unresponsive or severe symptoms of subacute thyroiditis patients need to be treated with glucocorticoids. Recommend the use of prednisone 40mg/ day, maintained 1-2 weeks, according to the clinical symptoms, gradually reduced to maintain 2-4 weeks or more. In 2008 Chinese subacute thyroiditis treatment guidelines recommend initial prednisone 20-40 mg/, maintained 1-2 weeks, slow reduction, the total course of not less than 6-8 weeks. In recent years, long-term corticosteroids such as compound betamethasone (Diprospan) and intramuscular injection treatment is also of concern. For hormone therapy discontinuation indications, recommended iodine uptake rate returned to normal after glucocorticoid withdrawal, the ratio in the ESR returned to normal for the withdrawal standard, improve the cure rate, reduce the recurrence rate. After the application of glucocorticoids, if the iodine uptake rate continues to decrease, suggesting that the inflammatory response continues, the use of corticosteroids should be extended.

Virus infection is a major cause of subacute thyroiditis, for the clinical use of antiviral therapy is still controversial. But based on the clearance of antigen is the key and foundation treatment of autoimmune diseases, we advocate subacute thyroiditis should use antiphlogistic antiviral drugs (subacute thyroiditis is viral infection, but also bacteria infection, small parts can be set according to the blood or use of anti-inflammatory drugs). Although there is no effective antiviral drugs, but reported Leigh Bhave Lin and half dose of prednisone curative effect is better than enough prednisone alone. Other treatments include traditional Chinese medicine treatment of detoxification (such as Qingkailing capsule, Shuanghuanglian oral liquid and so on), vitamin C (increase its resistance) and so on. Periodic review of ESR and blood.

Subacute thyroiditis treated the entire course of about 6-12 months, usually in 6-12 months, 95% patients with thyroid function returned to normal, 5% patients with hypothyroidism, 2% patients with recurrence. After the treatment of subacute thyroiditis, the thyroid injury but not damaged part was repaired, and the patient's thyroid function returned to normal. But if too much damage, even if the restoration of the damaged part, is not enough to compensate, there is permanent hypothyroidism. From this point also supports the early use of hormones, reduce immune allergic reaction, reduce thyroid destruction, accelerate the damage repair, prevent the generation of permanent hypothyroidism. Of course, the adverse reactions and contraindications to hormone. To prevent the side effects so the application process, such as gastric antacid preparations, plus calcium and vitamin D to prevent osteoporosis. For hormone contraindications, such as allergies, the glucocorticoid drugs of serious mental illness, epilepsy, active peptic ulcer, gastrointestinal anastomosis, new fractures, wound repair, herpes simplex or ulcerative conjunctivitis, severe hypertension, severe diabetes, failed to control infection (such as chickenpox, fungi, tuberculosis infection, pregnancy and the early puerperium), psoriasis vulgaris and so on, in the active treatment of the primary disease, should be used with caution or disable hormone.

 

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