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12MEDICAL SCIENCES
INDICES OF DOPPLER ULTRASONOGRAPHY OF THE VESSELS OF THE NECK AND HEAD IN PATIENTS WITH PRIMARY HYPOTHYROIDISM
Pavlovych L.B.
Bilous I.I.
MD,PhD;
Higher State Educational Institution of Ukraine" Bukovinian State Medical University"
ABSTRACT
Objective. The purpose of the work is to identify the features of cerebral hemodynamic and neurological symptoms of brain damage in patients with subclinical and clinically expressed hypothyroidism against the background of autoimmune thyroiditis and postoperative hypothyroidism.
Materials and methods. The study involved 56 patients with hypothyroidism as a result of AIT (autoimmune thyroiditis) and 20 patients with postoperative hypothyroidism. 18 patients had subclinical hypothyroidism. We used clinical-neurological examination of patients and doppler ultrasonography of the vessels of the head and neck.
Results Symptoms of damage of the cranial nerves and vestibular-cerebellar syndrome were most often detected in patients with primary hypothyroidism. Pseudobulbar disorders were found in 37,5% of patients with autoimmune thyroiditis and in 35% of patients with postoperative hypothyroidism. Neurological examination of patients showed oculomotor disturbances in 62,5% of patients with autoimmune thyroiditis and in 65% of those with postoperative hypothyroidism. Extrapyramidal syndrome was the least frequent. The significant difference in the frequency of the studied syndromes in patients with autoimmune thyroiditis and in those with postoperative hypothyroidism was not detected. It should be noted that all the studied syndromes were of a mild severity. Thus, in patients with primary hypothyroidism, doppler changes in the neck vessels were nonspecific. Only 28,2% experienced hemodynamically significant decrease in blood flow to the vertebral arteries. In other cases, the damage to vertebral, common and internal carotid arteries was hemodynamically insignificant. Stenosis of the vertebral arteries was caused by extravasal compression. Lesions in the common carotid arteries in all patients was hemodynamically insignificant (reduction of blood flow by 15-30%). Stenosis was caused by atherosclerotic changes in the vascular wall. The damage to the internal carotid arteries was also hemodynamically insignificant in all patients. However, there was no correlation between the degree of blood flow decrease and the severity of organic syndromes in the structure of the central nervous system (p> 0,05).
Conclusions. 1. The organic syndromes in the structure of the central nervous system damage mainly had a mild degree of severity and reflected the simultaneous involvement of several structures of the brain in the pathological process. Symptoms of damage of the cranial nerves and vestibular-cerebellar disorders occurred most often in patients with primary hypothyroidism. Extrapyramidal disorders were more likely to occur in patients with more severe hormonal deficiency, whereas pyramidal syndrome, cranial nerve damage syndrome, and vestibular-cere-bellar disorders were found to be approximately the same in patients with subclinical and clinically pronounced hypothyroidism.
2. Doppler changes in the neck vessels were nonspecific in patients with primary hypothyroidism. The damage of vertebral, common and internal carotid arteries was hemodynamically insignificant. Stenosis of the vertebral arteries was caused by extravasal compression. The pathology of the general and internal carotid arteries was caused by an atherosclerotic vascular lesion.
Keywords: autoimmune thyroiditis, subclinical hypothyroidism
Introduction.
The multifunctionality of the thyroid gland function and the influence of its hormones on various processes of the vital activity of the organism cause a complicacy of the symptom complexes developing in hypothyroidism: disturbance of the central nervous system, endocrine, immune, cardiovascular and other systems, dystrophy and mucosal edema of various tissues and organs. The expressed functional and organic changes in organs contribute to the emergence and manifestation of other diseases secondary to hypothyroidism. The clinical picture of hypothyroidism is due to a decrease in the influence of thyroid hormones on the metabolism, a decrease in the activity of all metabolic processes [1, 2, 5].
Subclinical hypothyroidism is of great importance, since the brain is too sensitive even to a slight
deficiency of thyroid hormones in the body. This leads to depression, aggressiveness, and loss of intelligence [3, 4, 6].
Slowness of thinking, retardation, drowsiness, memory loss is found in many patients, and the degree of these disorders depends on the reduction of thyroid gland function [7, 8, 10]. The development of cretinism in children, which manifests itself as a delay in psycho-neurological and physical growth is the most severe complication of hypothyroidism. Psychoneurological disorders in children suffering from congenital hypo-thyroidism are far from having a constant tendency to reverse development, even with the early administration of the substitution therapy. This is due to the significant influence of thyroid hormones during the period of the prenatal development of the nervous system and to the inability to eliminate the defect in newborn
infants. Chronic hypothyroid encephalopathy is most often manifested by emotional disturbances. The brain is very sensitive to a deficiency of thyroid hormones in the body. It manifests itself in a depressed mood, a feeling of sorrow and severe depression [10, 11].
The aim of the study. To identify the clinical features of organic brain damage in patients with subclinical and clinically expressed hypothyroidism against the background of autoimmune thyroiditis and postoperative hypothyroidism. Materials and methods. Patients with neurological disorders secondary to endocrine pathology. Methods: clinical-neurological, dop-pler ultrasonography of the vessels of the head and neck and psychodiagnostic ones. In order to determine the peculiarities of cognitive functions, we used the MMSE test (Mini Mental State Examination), methods of evaluation of attention on the Schultz tables modified by Horbova F.D. and memory was tested by "Memorizing 10 words" (by Luria A.R.).
The study involved 56 patients with hypothyroidism as a result of AIT (autoimmune thyroiditis) and 20 patients with postoperative hypothyroidism. The control group consisted of 20 practically healthy persons. 58 (76,3%) of patients were on substitution therapy using synthetic derivatives of L-thyroxin, and 18 (23,7%) patients had subclinical hypothyroidism. We used clinical-neurological and electrophysiological examination of patients.
Research results discussion
The symptoms of hypothyroidism were detected in all patients during the clinical examination: memory impairment, decreased ability to work, fast fatigability, sleep disturbances, swelling of the face and extremities, recurrent pain in the region of the heart. Patients with hypothyroidism complained of headache, dizziness, instability while walking, noise and tinnitus in the ears and head, periodic loss of vision and hearing, increased blood pressure, emotional instability, decreased emotional background.
In the structure of the damage of the central nervous system, there have been identified and studied the symptoms of pyramidal syndrome, vestibular-cerebel-lar and extrapyramidal disorders, syndrome of the cranial nerves damage. Pyramidal syndrome was evaluated by the presence of changes in deep and superficial reflexes, the presence of pathological reflexes, increased muscle tone for spasticity type and decreased muscle strength. Vestibular-cerebellar syndrome was evaluated by the presence and degree of vertigo severity, the presence and severity of nystagmus and the accuracy of the implementation of coordinating samples. Extrapyramidal syndrome was evaluated by the presence and degree of severity of changes in muscle tone, as well as by characteristic disorders of motor actions.
The evaluation of the syndrome of cranial nerves damage was carried out by the presence and severity of pseudobulbar syndrome, oculomotor disorders and symptoms of central damage of the facial nerve.
Symptoms of damage of the cranial nerves and vestibular-cerebellar syndrome were most often detected in patients with primary hypothyroidism. Pseu-dobulbar disorders were found in 21 (37,5%) patients with autoimmune thyroiditis and in 7 (35%) patients
with postoperative hypothyroidism. Neurological examination of patients showed oculomotor disturbances in 35 (62,5%) patients with autoimmune thyroiditis and in 13 (65%) of those with postoperative hypothyroidism. Extrapyramidal syndrome was the least frequent.
The significant difference in the frequency of the studied syndromes in patients with autoimmune thy-roiditis and in those with postoperative hypothyroidism was not detected. It should be noted that all the studied syndromes were of a mild severity.
The picture of organic brain damage depended on the severity of the primary hypothyroidism. Extrapyramidal disorders were more likely to occur in patients with more severe hormonal deficiency, whereas pyramidal syndrome, cranial nerve damage syndrome, and vestibular-cerebellar disorders were found to be approximately the same in patients with subclinical and clinically pronounced hypothyroidism. Pseudobulbar disorders were observed in 6 (33,3%) patients with subclinical hypothyroidism and in 24 (41,4%) patients with clinical hypothyroidism, oculomotor disorders were observed in 11 (61%) and 33 (56,9%) respectively. However, the degree of severity of all the considered syndromes did not depend on the severity of hypothy-roidism.
Cognitive impairment was noted in 56 (73,7%) of the patients. No one of these patients had severe cognitive impairments leading to a violation of social adaptation. In most patients (64,5%) cognitive impairments were mild. Patients complained of a slight decrease in memory, absent-mindedness, which did not reduce their working capacity and did not lead to a social maladaptation. Among patients with hypothyroidism secondary to AIT and with hypothyroidism without AIT, the incidence of cognitive impairments was practically the same. For instance, in patients with AIT, impaired attention and memory were noted in 75% of cases (42 patients), and in patients with hypothyroidism without AIT in 70% of individuals. There were no significant differences in the severity of cognitive impairment in patients of both groups either. Among patients with subclinical and clinical hypothyroidism, there were no significant differences in the incidence or the severity of cognitive impairment. Disturbances in memory and attention were noted in 13 (72,2%) patients with sub-clinical hypothyroidism. Among patients with clinical hypothyroidism, these disorders were found in 72,4% (42 patients).
Doppler ultrasonography of the vessels of the head and neck was performed in 46 patients with primary hypothyroidism aged between 33 and 66 years. Changes in blood vessels were detected in 71,7% of cases (33 patients). In all these patients, doppler changes were observed in extracranial vessels. There were no changes in the patients' intracranial vessels, which could be seen.
In 96% of cases (44 patients) their vertebral arteries were injured. Of these, 10,8% (5 patients) had additional damage to the general and internal carotid arteries. 2 patients (4,35%) noted an isolated lesion of both carotid arteries.
A combined lesion of the right and left vertebral arteries was observed in 21,7% of the cases (10 patients). An isolated lesion of the right vertebral artery was detected in 47,8% of the subjects (22 patients). An isolated lesion of the left vertebral artery was less common, but no statistically significant difference was obtained. These changes were observed in 28,2% of the cases (13 patients), (p> 0.05).
In 11 patients (23,9%), the damage to the vertebral arteries was hemodynamically significant. Of these, three patients had a decrease in blood flow to the right vertebral artery by 40-50%, caused in one case by hy-poplasia of the vertebral artery, and in the other case, by a vascular bending against the background of extravasal compression. In other two people there was a decrease in blood flow to the left vertebral artery by 4050%, caused in both cases by extravasal compression of the vessels. In one patient the vascular bending against the background of extravasal compression led to a decrease in blood flow to the right vertebral artery by 60%. In the rest of the patients the damage to the vertebral arteries was hemodynamically insignificant (stenosis - 20-40%). The damage was caused by extrav-asal compression of the vessels.
Lesions in the common carotid arteries in all patients was hemodynamically insignificant (reduction of blood flow by 15-30%). Stenosis was caused by atherosclerotic changes in the vascular wall. The damage to the internal carotid arteries was also hemodynamically insignificant in all patients (stenosis of 20-40%), among whom one patient had atherosclerotic changes in the intima-media complex, in one patient's both vessels there were homogeneous, local atherosclerotic plates with an even surface that occupy one wall of the vessel.
Signs of noncoarse difficulty in venous outflow were detected in 13,04% of patients (6 patients) and all those experiencing a combination with lesions of the vertebral arteries.
Thus, in patients with primary hypothyroidism, doppler changes in the neck vessels were nonspecific. Only 28,2% (13 people) experienced hemodynamically significant decrease in blood flow to the vertebral arteries. In other cases, the damage to vertebral, common and internal carotid arteries was hemodynamically insignificant. Stenosis of the vertebral arteries was caused by extravasal compression. Lesions in the vertebral arteries against the background of extravasal compression was observed in patients of all age groups (33-64 years), the average age - 46.5 ± 8.9 years. The decrease in blood flow to the general and internal carotid arteries was hemodynamically insignificant in all cases. The pathology was caused by an atherosclerotic vascular lesion. This pathology was observed in patients aged 5966 years, with an average age of 62 ± 5.7 years. Patients in this group were reliably older than patients with only the lesions in the vertebral arteries (p <0.05). However, there was no correlation between the degree of blood flow decrease and the severity of organic syndromes in the structure of the central nervous system (p> 0,05).
Conclusions.
1. The organic syndromes in the structure of the central nervous system damage mainly had a mild degree of severity and reflected the simultaneous involvement of several structures of the brain in the pathological process. Symptoms of damage of the cranial nerves and vestibular-cerebellar disorders occurred most often in patients with primary hypothyroidism. Extrapyramidal disorders were more likely to occur in patients with more severe hormonal deficiency, whereas pyramidal syndrome, cranial nerve damage syndrome, and vestib-ular-cerebellar disorders were found to be approximately the same in patients with subclinical and clinically pronounced hypothyroidism.
2. Doppler changes in the neck vessels were nonspecific in patients with primary hypothyroidism. The damage of vertebral, common and internal carotid arteries was hemodynamically insignificant. Stenosis of the vertebral arteries was caused by extravasal compression. The pathology of the general and internal carotid arteries was caused by an atherosclerotic vascular lesion.
References
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БЮШПЕДАНСОМЕТРШ В Д1АГНОСТИЦ1 ТА КОРЕКЦП НАДЛИШКОВО1 ВАГИ У ХВОРИХ НА ЦУКРОВИЙ Д1АБЕТ 2 ТИПУ
Добровинська О.В.
Державна установа «1нститут ендокринологИ та обмгну речовин 1мет В.П. Комгсаренко», науково-консультацшний вгддщ к.м.н.
Орленко В.Л.
Державна установа «1нститут ендокринологИ та обмгну речовин 1мет В.П. Комгсаренко», кергвник науково-консультацтного вгддту, к.м.н.
BIOIMPEDANCE MEASUREMENTS IN DIAGNOSIS AND CORRECTION OF OVERWEIGHT IN PATIENTS WITH 2 TYPE DIABETES
Dobrovynska O.
State Institution "Institute of Endocrinology and Metabolism named after V.P. Komisarenko",
Scientific advisory department, Orlenko V.
State Institution "Institute of Endocrinology and Metabolism named after V.P. Komisarenko"
Head of scientific advisory department, PhD
PhD
АНОТАЦ1Я
Стаття присвячена пошуку додаткових методiв дiагностики надлишково! ваги у хворих з цукровим дiабетом. Ми використовували метод бшмпедансометрп, який зарекомендував себе, як простий та ефек-тивний для визначення надлишку маси тша.
ABSTRACT
The article is devoted to the search of additional methods of diagnostics of overweight in patients with diabetes. We used the bioimpedance measurements method that proved itself as simple and effective to determine excess body weight.
Ключевые слова: дiабет, надлишкова вага, iмпедансометрiя, ож^ння, метаболiчний синдром, ш-декс маси тша.
Keywords: diabetes, overweight, bioimpedance measurements, adiposity, metabolic syndrome, body mass index.
Вступ:
Ожиршня e одшею з найактуальшших проблем сучасно! охорони здоров'я. Кшьшсть oci6, яш мають надлишкову вагу, прогресивно збшьшу-еться. При цьому зростае i частота дiагностики ме-таболiчного синдрому - комплексу метаболiчних, гормональних i клiнiчних порушень, тюно асоцшо-ваних з цукровим дiабетом 2 типу. Ожирiння i ЦД 2 типу e факторами ризику розвитку серцево-су-динних захворювань, в основi яких лежить шсуль норезистентшсть i компенсаторна гiперiнсулiнемiя [1, 2].
До тепершнього часу немае едино! думки про першопричину метаболiчних порушень в патоге-незi метаболiчного синдрому. Багато дослiдникiв вважають, що спадкова схильнiсть до шсулшорези-стентностi та ожиршня в поеднанш з низькою фiзи-чною активнiстю i надмiрним харчуванням визна-чае розвиток ожиршня i тканинно! шсулшорезисте-нтностi [3, 4, 5].
На сьогодш найбшьше уваги придiляeться зв'я-зку мiж цукровим дiабетом 2 типу та ожиршням,
що вiдiграe провiдну роль у розвитку шсулшорези-стентного синдрому як такого [6, 7]. Практично 80% хворих на ЦД 2 типу страждають на ожиршня, наявнють якого несе тдвищений ризик розвитку ще! патологи. Так, якщо в загальнш популяцii, ЦД у цшому рееструеться у 4 % випадшв, можливiсть його прояву в оаб iз надлишковою масою тiла ста-новить 20-30 % [8, 9]. Цей факт набувае особливого значення з огляду на епiдемiчний характер поши-рення ожирiння й ЦД на планетг Окрiм вiдомого зв'язку ожиршня з ЦД 2 типу, воно також асощю-еться з високим ризиком розвитку низки шших па-тологш, зокрема захворювань серцево-судинно! си-стеми, атеросклерозу, дислiпiдемii, артерiальноi п-пертензп, гшеркоагуляцп, що в свою чергу призводить до тдвищеного ризику розвитку судин-них ускладнень [10, 11].
Цукровий дiабет 2 типу - поширене нешфек-цшне захворювання, яке представляе собою незале-жний фактор ризику розвитку серцево! недостатно-стi i серцево-судинних ускладнень. Як ввдомо, основна причина смертей у 52% пащенпв з ЦД -
