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Abdurakhmonov Zh.N.,Sharipova O.A.,Esakhanov Sh.N.,Melieva G.A.
Samarkand State Medical Institute, Uzbekistan
FUNCTIONAL STATE OF THE THYROID IN CONDITIONS OF IODINE DEFICIENCY IN CHILDREN WITH DISORDERS OF THE VEGETATIVE NERVOUS SYSTEM
Abstract. A study was carried out to study the functional state of the thyroid gland in children with syndrome vegetative dysfunction (SVD) under conditions of iodine deficiency and to find out the significance of the obtained parameters in the manifestation of various clinical forms of the disease. The study included 120 children aged Ills years and 25 healthy children of the same age. The surveyed were divided into 2 groups: the 1st group included 65 children with SVD against the background of iodine deficiency (main group), the 2nd group included 55 patients with SVD who had no signs of iodine deficiency (control group).
It was revealed that patients with decreased thyroid function, in contrast to patients with normal, one had a more severe course and marked clinical symptoms of the disease. According to ECGdata, deeper violations of the function of automatism and conduction functions were revealed, according to Echocardiography (EchoCG) data, a decrease in motor activity of the left ventricular myocardium. Cardiointervalography (CIG) showed that in patients with impaired thyroid functional state there was a vagotonic type of initial vegetative tone IVT, vegetative reactivity was reduced, and vegetative provision was clearly insufficient.
Keywords: thyroid gland; vegetative dysfunction syndrome; initial vegetative tone, iodine deficiency.
UB
BBSM
Disorders of the autonomic nervous system has a large share in the structure of childhood diseases. The prevalence of this pathology in the general pediatric population, according to various authors, ranges from 28.7 to 82% [4,5,6,7,8.]. The manifestations of the syndrome of vegetative dysfunctions (SVD) in 33.3% of children persist in subsequent periods of life, and in 17-20% of cases progress, transforming into other diseases of the cardiovascular system [10].
Hormonal imbalances play a significant role in the development of SVD, especially during puberty as a result of thyroid problems and unfavorable environmental conditions.
The thyroid gland is one of the most important organs of human internal secretion . The lack of thyroid hormones significantly slows down the growth and mental development of the child's body.
In recent years, there has been an increase in the number of thyroid diseases. Most often, thyroid diseases are caused by iodine deficiency, which belongs to essential microelements [9].
The close connection between the nervous and endocrine systems is recognized by most researchers [2,4]. So, according to AM Wein [5], a decrease in thyroid gland secretion entails disturbances in the endocrine-vegetative balance. A decrease in thyroxine secretion is a factor contributing to the occurrence of vegetative disorders of a generalized nature.
In general, the above data indicate the need to study SVD in children with iodine deficiency in a broader aspect.
Objectives of the study: To study the functional state of the thyroid gland in children with SVD under conditions of iodine deficiency and to find out the significance of the obtained parameters in the manifestation of various clinical forms of the disease.
Materials and methods. 120 sick children aged 11-15 years and 25 healthy children of the same age were examined. The examined patients were divided into 2 groups: the 1st group included 65 children with SVD against the background of iodine deficiency (main group), the 2nd group included 55 patients with SVD who did not show signs of iodine deficiency (control group). To confirm the diagnoses of SVD and iodine deficiency, a complex of anamnestic, clinical, laboratory, instrumental (ECG, CIG) diagnostic criteria was used.
When diagnosing SVD, the classification of N.A. Belokon was used. (1987) .
General clinical examination of sick children was carried out in the children's department of the clinic .№1 SamStateMI.
The functional state of the cardiovascular system was assessed using ECG and EchoCG research methods. ECG recording was carried out on a three-channel Geolink electrocardiograph, EchoCG - on an Interscan-256 device from Hormann using a linear and convex transducer 5.5-7.5 MHz.
First of all, the degree of thyroid enlargement was assessed. According to the WHO goiter size classification, it was found out that in 8 (12.3%)
East European Scientific Journal #1(65), 2021 69 patients, thyroid enlargement corresponded to 0, in 23 (35.4%) - 1st,degree in 34 (52.3%) - 2nd degrees, i.e. the majority of patients had thyroid hyperplasia. In 33 (50.8%) patients, the thyroid gland consistency was soft-elastic, in 21 (32.3%) - dense, in 3 (4.6%) -nodular.
Results and its discussion. The study of the hormonal status showed that in 39 (60%) patients there was a normal, in 26 (40%) - a decreased functional activity of the thyroid gland (Table 1), which made it possible to divide these patients into two subgroups, respectively. Thus, the T3 level in the 1st subgroup was 3.6 ± 0.2 nmol /1 (P> 0.1), which did not differ significantly from the indicators of healthy children, in the 2nd subgroup there was a significant decrease in this indicator to 1 , 88 ± 0.05 nmol /1 (P <0.001). The content of T4 in the blood serum of children of the 1st subgroup also practically did not differ from the standards and amounted to 148.1 ± 4.7 nmol / 1 (P> 0.1), in the 2nd subgroup this indicator was significantly reduced - 110, 7 ± 2.34 nmol /l (P <0.001). At the same time, there was a significant increase in TSH level in both subgroups, respectively: 4.14 ± 0.30 mIU /l (P <0.001) and 5.5 ± 0.22 mIU /l (P <0.001), which indicates compensatory increase in the activity of the pituitary gland in response to the low concentration of iodine in the body and, perhaps, is the reason for the normal functioning of the gland under these conditions in patients of the 1st subgroup.
Consequently, the results of the study of the functional state of the thyroid gland in children with SVD showed its statistically significant decrease in it in patients of the 2nd subgroup, who, turned out, to have a more significant degree of iodine deficiency. The functional activity of the thyroid gland in patients of the 1st group is normal, however, with a tendency to decrease. At the same time, in both groups there was an increase in the TSH level, to a greater extent in those examined with a reduced thyroid function. A reliably significant increase in the TSH content in patients with normal thyroid function indicates the intense functioning of the organ under conditions of iodine deficiency and, probably, under certain conditions, such a state of the organ can lead to a hypothyroid state. This fact indicates that in SVD children with iodine deficiency, there is a disturbance of the hormonal balance of the thyroid gland, which reduces the adaptive capabilities of children.
Since the main reason for changes in the thyroid gland in our studies is iodine deficiency, we considered it necessary to study the data on the level of iodine in the body of our patients. One of the most reliable indicators showing the level of iodine intake into the body is the daily excretion of iodine in the urine. It was revealed that the daily excretion of iodine in the urine in healthy children is 162.2 ± 15.6 mkg / l. In patients with SVD of the 1st subgroup, this indicator was 82.5 ± 3.9 mkg /l (P <0.001), which corresponds to mild iodine deficiency, in the 2nd subgroup - 37.8 ± 3.9 mkg /l (P <0.001), which indicates the moderate severity of iodine deficiency (Table 1.).
70 East European Scientific Journal #1(65), 2021
Table 1.
№ Indicators Healthy children n=25 1st subgroup n=39 2nd subgroup n=26
1. HT, мIUl 2,01±0,1 4,14±0,30 P<0,001 5,5±0,13 P<0,001
2. Тз, nmol/l 4,05±0,1 3,6±0,2 P>0,1 1,88±0,05 P<0,001
3. T4, nmol/l 154,5±3,6 148,1±4,7 P>0,1 110,7±2,34 P<0,001
4. Daily excretion of iodine in urine, mk/l 162,2±15,6 82,5±9,9 P<0,001 37,8±6,8 P<0,001
Note: R - significance of the difference between healthy and children with SVD.
After studying the functional state of the thyroid gland and identifying two categories of patients with SVD against the background of iodine deficiency, it is of interest to study the features of clinical, instrumental parameters, as well as the functional state of the vegetative nervous system in these patients.
Thus, we noted a more severe permanent course of SVD in patients with decreased thyroid function. Signs
of vagotonia were observed more often in them (Table 2.), sympathicotonia was noted in only 1 (3.9%) patient, 7 (26.9%) patients were eutonic. Among patients with normal thyroid function, vagotonics and eutonics were approximately the same, respectively: 14 (35.9%) and 16 (41.0%), a smaller proportion made children with a sympathicotonic type of initial autonomic tone (IAT) (9 (23.1 %)).
Table 2.
Distribution of patients in the main group, taking into account IVT
Group IVT
Eitonia Sympathicotonia Vagotonia
1st subgroup 16 (41,0%) 9 (23,1%) 14 (35,9%)
2nd subgroup 7 (26,9%) 1 (3,9%) 18 (69,2%)
Clinical manifestations also had their own characteristics in patients of both subgroups. Children from the 2nd subgroup had a more severe, permanent course of SVD. Complaints and symptoms of vagotonia were more marked in comparison with patients of the 1st subgroup. For example, syncope condition occured 2 times more common in children with reduced thyroid function: we noted crises in 7 (17.9%) patients of the 1st subgroup and in 10 (38.5%) patients in the 2nd subgroup; fainting in 6 (15.4%) patients of the 1st and 9 (34.6%) patients of the 2nd subgroup. Moreover, in the 1st subgroup, vasovagal syncope was observed, in the 2nd: in 4 (13.8%) patients, vagal syncope and in 5 (17.2%) - vasovagal type of syncope.
When comparing ECG indicators in patients with SVD with normal and decreased thyroid function, the following was established. In patients of group 1, ECG features can be considered as frequent (35 (89.7%)) detection of respiratory arrhythmia with a tendency to tachyarrhythmia in 14 (35.9%), bradyarrhythmia in 12 (30.8%) patients, supraventricular extrasystole was detected in 2 (5.1%), ventricular - in 3 (7.7%) examined patients. Incomplete right bundle branch block was recorded in 3 (7.7%), supraventricular crest syndrome in 5 (12.8%), intra-atrial conduction disorders in 4 (10.3%), metabolic changes in the ventricular and atrial myocardium in 17 ( 43.6%) of patients in this group.
In children with decreased functional activity of the thyroid gland, ECG revealed such conditions as respiratory arrhythmia in all patients, with tachyarrhythmias in 7 (26.9%), bradyarrhythmias in 15 (57.7%) children, sick sinus syndrome (SSS) in 4 (15.4%), blockade: of the right bundle branch - in 6 (23.1%), of anterior - in 2 (7.7%) and of posterior
branches of the left bundle branch - in 1 (3.8%) patient, intra-atrial conduction disturbances in 7 (26.9%), including intra-atrial blockade in 3 (11.5%) patients, grade I-A-V blockade in 2 (7.7%). We observed the syndrome of premature ventricular excitation (CLC -syndrome) in 1 (3.8%), WRW - syndrome - in 2 (7.7%) patients with decreased thyroid function.
As follows from the above data, profound changes in ECG indicators (SSSU, blockade, extrasystole, WRW syndrome) were more often recorded in patients with decreased functional activity of the thyroid gland, which indicates a significant effect of this organ on such heart functions as automatism and excitability.
Echocardiography showed disturbance of the systolic function of the left ventricle in the main group, and these changes were unequal. During the echocardiography study, we noted reliably high values of the main indicators reflecting the systolic function of the left ventricle: Vc -19.1 ± 1.18 ml (P <0.001), Vd -86.9 ± 5.11 ml (P> 0, 1), SV - 67.8 ± 3.33 ml (P <0.001), PI - 0.78 ± 0.03 (P <0.001) in 10 (25.6%) patients with normal thyroid function, as well as in 5 (19.2%) with reduced function. In 12 (46.2%) patients with thyroid dysfunction, hypokinesia of the walls was revealed, and, on the contrary, a tendency to a decrease in left ventricular systolic function: Vc - 29.0 ± 1.25 ml (P> 0.1), Vd - 65 , 9 ± 3.06 ml (P> 0.1), SV - 36.9 ± 2.13 ml (P <0.01), PI - 0.56 ± 0.03 (P> 0.1).
Summarizing the results of echocardiography -examination, we can conclude that in a number of patients with reduced thyroid function there is a significant change in the main indicators characterizing the systolic function of the left ventricle. A more vivid reflection of the influence of the functional state of the
East European Scientific Journal #1(65), 2021 71
thyroid gland in this study can be considered hypokinesia of the walls of the left ventricle in almost half of the patients in this subgroup.
We carried out a comparative assessment of CIG indices in patients of the main group, depending on the activity of the thyroid gland. Based on the definition of SI1, we divided the patients into the studied subgroups according to the type of IVT (Table 2.).
When assessing the vegetative reactivity in the groups, it turned out that the rhythm of the functioning of the vegetative nervous system in patients of the 1st subgroup (SVD with normal thyroid function) is characterized by the eutonic type of IVT, and the indicators Mo, AMo did not differ significantly from those in healthy children (P> 0.1). This is probably due to the fact that most of the patients have eutonic and sympathicotonic types of IVT, and patients with
CIG indices in patients with SVD, depending
vagotonia did not have such marked disorders of the vegetative status as vagotonics of the 2nd group. AX and SI2 in patients with SVD and normal thyroid function significantly differ from the standards (P <0.05, P <0.001), which suggests some, most likely, compensatory stress of the adaptive processes. However, VR in this subgroup is normal, which, apparently, is also explained by the patients contingent here.
In patients with decreased thyroid function, according to cardiointervalography (CIG), the IVT type can be characterized as vagotonic, and the value of the SI2 / SI1 ratio indicates an asympathicotonic type of autonomic reactivity in them. Almost all the CIG indices determined in this group significantly differed from the indices of the healthy group (P <0.001) (Table 3).
Table 3.
Group Mo, c AMo, % AX, c SIi, y.e. SI2, y.e. SI2/ SI1
Healthy (n=25) 0,79±0,02 23,0±1,2 0,25±0,02 58,2±2,7 63,1±3,9 1,08±0,4
1st group (n=39) 0,84±0,02 P>0,1 20,3±1,2 P>0,1 0,18±0,02 P<0,05 67,1±4,4 P>0,1 90,2±5,8 P<0,001 1,3±0,5 P>0,1
2nd group (n=26) 0,92±0,02 P<0,001 17,1±1,1 P<0,01 0,38±0,02 P<0,001 24,5±2,7 P<0,001 21,2±2,1 P<0,001 0,87±0,3 P>0,1
P - reliability of indicators in relation to the group of healthy persons
Summarizing the results of CIG, we can conclude that the vagotonic type of IVT and weak vegetative reactivity in patients with SVD and decreased thyroid function compared with patients having a normal thyroid state.
Conclusion. Thus, there are certain differences in clinical manifestations and instrumental parameters in sick children with SVD on the background of iodine deficiency, but with different functional activity of the thyroid gland. In patients with reduced function, in contrast to patients with normal, a more severe course and marked clinical symptoms of the disease were noted. According to ECG data, deeper disturbances of the function of automatism and conduction were revealed, according to EchoCG data, a decrease in motor activity of the left ventricular myocardium. CIG showed that in patients with impaired thyroid functional state there was a vagotonic type of IVT, vegetative reactivity was reduced, and autonomic support was clearly insufficient.
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