RU2345804C1 - Method of treatment of subacute de quervain's disease using cold ir-laser therapy and nonsteroid and steroid preparations - Google Patents

Abstract

FIELD: medicine; endocrinology.

SUBSTANCE: cold scattered laser radiation is used at wave length 0.89 mcm and power 2 Wt. Contact cutaneous technique is used for irradiation in projection of lobes of thyroid gland at exposition 3-4 minutes per each lobe. According to disease severity level, for the first 5-10^th sessions radiation 3000 Hz is used, while thereafter till the last procedure, radiation frequency is reduced to 300 Hz. For the patient with mild severity level of disease, laser therapy is applied as independent method of treatment. Though for the patient with moderate severity level of disease, laser therapy is combined with nonsteroid anti-inflammatory preparations (NAIP). Thus to patients with moderate severity level of disease, Ortofen dosed 3 ml 1-2 times a day is intramuscularly injected as NAIP. For the patient with severe disease, laser therapy and NAIP is added with introduction into thyroid gland of Kenalog dosed 20 mg per each lobe dissolved 1:1 with 0.5% novocaine solution 1 to 3 times every 5-7 days.

EFFECT: reduced treatment time.

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Description

The invention relates to medicine, and in particular to endocrinology, surgery, and can be used to treat subacute thyroiditis de Curven.

Subacute thyroiditis is an inflammatory disease of the thyroid gland, which is accompanied by the destruction of thyroid cells and follicles.

Etiology issues remain controversial (I. Krastev et al., 1990), although it is commonly believed that viruses are the main cause of the disease. Moreover, the specific causative agent of subacute thyroiditis has not been identified. The disease can develop under the influence of the Coxsackie virus, adenovirus, mumps virus, measles, flu. At the same time, people with a genetic predisposition, having the HLA - BW - 35 and DR - 35 gene get sick (Kholodova EA, 1991).

The lack of consensus on the mechanism of development of subacute thyroiditis makes it difficult to conduct specific therapy (Vagapova G.R. et al., 1995). The morphopathogenesis of this disease is known and consists of several stages: the first stage of exudation, edema and swelling of epithelial cells. The second stage is manifested by rupture of the follicles and the entry of colloid and other elements of the destruction of thyroid cells into the perifollicular space. In response to this, an autoimmune process develops in the thyroid gland, antibodies are formed, lymphocytic infiltration appears. In the third stage, scarring occurs (Kholodova EA, 1991).

The clinic of the disease is characterized by an acute onset. After the transferred flu or another infection of the oropharynx, the body temperature rises, pains appear that intensify when swallowing, swelling in the projection of the thyroid gland. Last palpation is enlarged, tightened and sharply painful.

The diagnosis is made on the basis of complaints, medical history, palpation, results of general and immunological blood tests, ultrasound and puncture-cytological examination of the thyroid gland.

According to modern concepts, the treatment of subacute inflammation of the thyroid gland should be aimed at eliminating inflammatory and autoimmune processes. An old traditional method of treatment is the long-term use of glucocorticosteroids (22 days or more), in particular prednisolone. However, prolonged use of these drugs can cause a number of serious side effects and repeated relapse of the disease when the dose is reduced (Vagapova G.R. et al., 1995). There is a point of view (Krastev et al., 1996) that it is not possible to conduct standard therapy with glucocorticosteroids in all cases until the diagnosis of thyroiditis de Curven is verified. To do this, it is imperative to do a puncture cytological study and determine the number of T - and B-lymphocytes in the blood, since quite often under the mask of de Kerven's thyroiditis, autoimmune thyroiditis of the subacute course may be hidden. Glucocorticoids in the treatment of autoimmune thyroiditis are ineffective, and their side effect significantly exceeds the therapeutic effect, therefore, they are abandoned in the treatment of this disease (G. Melnichenko et al., 1999).

The purpose of the invention: having extensive experience in the treatment of patients with autoimmune thyroiditis using infrared laser radiation (Aristarchov V.G. et al., 1998), we decided to use it in patients with subacute thyroiditis, since it has a powerful anti-inflammatory and immunomodulating effect, has penetrating ability up to 5-6 cm, enhances microcirculation in tissues and cell regeneration. Compared with the long-term use of glucocorticoids, laser therapy does not give complications, and also significantly reduces the period of disability of patients with this disease.

The treatment was carried out using a laser radiation apparatus with a scattered infrared wavelength of 0.89 μm, we used an average power of 2.0 W, using the contact cutaneous method in the projection of the thyroid glands, the exposure time was 3-4 minutes for each lobe. Depending on the severity of the disease, during the first five to ten sessions, radiation with a frequency of 3000 Hz was used, with the help of which an anti-inflammatory effect was achieved. For the purpose of immunocorrection, the radiation frequency was subsequently reduced to 300 Hz.

For patients with a mild disease severity, laser therapy was used as an independent treatment method. In patients with moderate severity, laser therapy was used in combination with non-steroidal anti-inflammatory drugs, orthophene 3 ml 1-2 times a day intramuscularly. In patients with a severe degree of subacute thyroiditis, in addition to laser therapy, 20 mg Kenalog was introduced into the thyroid gland in each lobe, diluted 1: 1 with 0.5% novocaine solution, from 1 to 3 times in 5-7 days. In all patients, by the end of the course of treatment, fever and pain on palpation of the thyroid gland disappeared, although density and tuberosity still remained.

Clinical examples: a case of severe disease. Patient A., 48 years old, was admitted to the endocrine surgery department in 2004 with complaints of pain on the front surface of the neck, in the projection of the thyroid gland, discomfort expressed when swallowing, body temperature increase in the evenings to 37.6 ° C. From the anamnesis of the disease it is known that she has been ill for about 6 years, during which time repeated relapses of the disease. She was treated at the endocrine therapy department and at the endocrinologist in the community. She took prednisone according to the scheme from 30 mg / day, for 6 years 8 courses. The duration of the courses ranged from 21 days to 3 months. Reducing the dose of prednisone from 10 mg per week to 2.5 mg in 2 weeks. The longest remission is nine months. During treatment with glucocorticoids, the patient gained about 25 kg in weight. The patient was not referred to endocrinologists, she came to the clinic on her own initiative.

At the time of admission, the thyroid gland is enlarged to grade III, with palpation it is dense, painful, tuberous. On an ultrasound examination, the volume of the thyroid gland is 80.8 cc, in both lobes hypo - and isoechoic areas with a diameter of 5 to 18 mm. In the general analysis of blood ESR - 30 mm / h.

In the department, the patient was prescribed laser therapy with a pulse repetition rate of 3000 Hz, a total of 10 sessions. In the evening, orthophene 3 ml was injected intramuscularly. After 4 days of being in the department, the patient's body temperature disappeared in the evening, the soreness of the thyroid gland slightly decreased, although its increase, density and tuberosity remained. It was decided to introduce a 20 mg Kenalog into both lobes of the thyroid gland, which was done. The course of laser therapy and the introduction of orthophene continued. After 8 laser sessions, the thyroid gland decreased to II degree, but its slight pain, density and heterogeneity persisted, the volume, according to ultrasound data, decreased to 35 cc, the number and size of iso- and hypoechoic areas decreased, in the general analysis of blood ESR decreased to 17 mm / h Considering the persisting slight soreness and density of the thyroid gland, a 20 mg kenalog was introduced repeatedly in both lobes of the thyroid gland. By the time the patient was discharged from the hospital, on the 12th day, there was no pain on palpation of the thyroid gland, it became softer, more uniform. Complaints of minor discomfort in the projection of the thyroid gland persisted. After 1 week, the patient was examined again, complaints of mild pain and discomfort in the projection of the thyroid gland. Palpation of weak soreness and heterogeneity along the lateral edges of both lobes of the thyroid gland. The patient did not notice an increase in body temperature or an increase in general weakness by evening. For the third time, kenalog was introduced into both thyroid lobes of 20 mg.

Within a month, the patient did not contact herself. After 4 weeks, the patient showed no complaints at the scheduled examination, subjectively noted a significant improvement in well-being, discomfort and pain in the projection of the thyroid gland do not bother. Palpation of the thyroid gland is increased to I degree, soft, painless, slightly heterogeneous. When ultrasound examination - the volume of the gland is 19.2 cc, its echogenicity is not changed, in both lobes there are several sections of reduced echogenicity to 5 mm in diameter. In the general analysis of blood ESR - 5 mm / h. Blood tests for hormones: TSH, free T ₄ , and also for antibodies: TRO-AB, ATMS - are within normal limits.

The patient was examined after 6 months and 1 year after the course of treatment, had no complaints, the volume of the thyroid gland was 18 cc, several hypoechoic areas with a diameter of up to 5 mm were preserved. The indicators of thyroid hormones and antibodies within the normal range are recovery.

A clinical example of moderate subacute thyroiditis: Patient K., 40 years old, was admitted to the endocrine surgery department in 2006. Upon receipt of a complaint of minor pain in the projection of the thyroid gland and discomfort, an increase in body temperature in the evening to 37.2-37.5 ° C, general weakness.

From the anamnesis of the disease, it is known that about 4 weeks ago she had ARVI, after which the above symptoms appeared. Treated by an ENT doctor - no effect. On examination, the thyroid gland is enlarged to the III degree, dense, somewhat painful on palpation, heterogeneous. In the general analysis of blood ESR 16 mm / h. On ultrasound examination, the total volume of the thyroid gland is 47.5 cc, the echogenicity of the gland is reduced, many sites of reduced echogenicity are up to 5 mm in diameter. In the department, the patient was prescribed a course of laser therapy of 3000 Hz, No. 10 and orthophene 3 ml / m once a day in the evening. After 3 days of treatment, the patient noted improvement: the pain in the projection of the thyroid gland disappeared, although discomfort still remained. Body temperature returned to normal. After 9 sessions of laser therapy and 11 injections of orthophene, the discomfort in the projection of the thyroid gland disappeared. In the general analysis of blood ESR - 7 mm / h, on ultrasound - the volume of the thyroid gland decreased to 33.2 cc, the contours of the gland are fuzzy, uneven, the echogenicity of the gland is slightly reduced. Discharged after 12 days in satisfactory condition, no complaints. After 5 weeks, there were no complaints at the control examination. The thyroid gland is enlarged to the II degree, soft, slightly heterogeneous. Indicators of TSH, free thyroxine, TPO-AB - blood within normal limits. The volume of the thyroid gland is 16.4 cc, the echogenicity of the gland is not changed, the contours are clear. After 6 months, a re-examination of the thyroid pathology revealed no recovery.

An example of a mild course of subacute thyroiditis. Patient P., 50 years old, was treated at the Department of Endocrine Surgery in 2006. Upon receipt of a complaint about severe discomfort in the projection of the thyroid gland, general weakness. There was no increase in body temperature. He considers himself ill for about 2 weeks, when complaints appeared after the cold on his feet. On examination, the thyroid gland is enlarged to II degree, dense, slightly painful on palpation, its structure is slightly heterogeneous. In the general analysis of blood ESR 11 mm / h. On ultrasound, the volume of the thyroid gland is 34.9 cc, the echogenicity of the gland is reduced, the structure is heterogeneous, the contours are fuzzy. The department has appointed laser therapy in the form of an independent method of treatment, with a frequency of 3000 Hz, 10 sessions. After treatment, the patient did not complain, ESR - 6 mm / h, the thyroid gland volume decreased to 25.6 cc, the echogenicity of the gland was slightly reduced. Palpation of the iron became softer and more uniform. Re-examination after 2 months. There are no complaints. The thyroid gland is soft, uniform. On ultrasound examination, the volume of the thyroid gland is 14.3 cc, echogenicity is not changed, several sections of reduced echogenicity are up to 3 mm in diameter. Complete blood count, TSH, free thyroxine and TPO-AB blood are within normal limits.

All patients at discharge from the hospital began to work.

Thanks to the use of this method, we were able to significantly reduce the time spent by such patients in the hospital and significantly reduce the time of their disability.

Information sources

1. Aristarchov V.G. The problem of treatment choice for autoimmune diseases of the thyroid gland / V.G. Aristarkhov, Yu.B. Kirillov, E.A. Stroev. - Ryazan, 1998 .-- 128 p.

2. Aristarchov V.G., Aristarchov R.V. Laser therapy as a new method for the treatment of subacute thyroiditis De Kerven. Russian Medical and Biological Bulletin named after I.P. Pavlov., 2001, No. 1-2, p.136-138. - prototype.

3. Autoimmune thyroiditis. Clinical analysis / G. Melnichenko, I. Demidova, T. Chazova and others // Doctor. - 1999.- No. 1. - S. 6-9.

4. Vagapova G.R. Treatment of patients with subacute thyroiditis / G.R. Vagapova, T.V. Nikitova, L.I. Anchikova // Kazan. honey. journal - 1995. - No. 2. - S.88-89.

5. Krastev I. About the etiological inhomogeneity of subacute thyroiditis / I. Krastev, N. Katranushkova, Y. Topov // Klinich. the medicine. - 1996. - No. 7. - S. 36-37.

6. Kholodova EA Subacute thyroiditis (de Kerven's thyroiditis): Lecture / E.A. Kholodova // Probl. endocrinology. - 1991. - No. 5. - S. 35-36.

7. Four cases of subacute thyroiditis, successful treatment with anti-anaerobic drugs / I. Krastev, Ts. Terzieva, N. Katranushkova and others // Probl. endocrinology. - 1990. - No. 5. - S. 63-64.

Claims (1)

A method for the treatment of subacute thyroiditis de Cervin, characterized in that they use laser radiation with a power of 2 W, including laser therapy with low-intensity, scattered laser radiation with a wavelength of 0.89 μm using the contact cutaneous method in the projection of the thyroid gland, with an exposure of 3-4 min per each lobe, depending on the severity of the course of the disease, radiation of 3000 Hz is used during the first 5-10 sessions, then until the end of treatment the radiation frequency is reduced to 300 Hz, while patients with a mild severity of the disease erotherapy is used as an independent treatment method, for patients with moderate disease severity, laser therapy is used in combination with non-steroidal anti-inflammatory drugs (NSAIDs), in patients with moderate disease severity, ortofen 3 ml 1-2 times a day is used intramuscularly, and In addition to laser therapy and NSAIDs, patients with a severe severity of the course of the disease are injected with a 20 mg kenalog into the thyroid gland in each 1: 1 dilution with a 0.5% solution of novocaine from 1 to 3 times through 5-7 days.