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Ismailov Said Ibragimovich, Republican Specialized Scientific-Practical Medical Center of Endocrinology under the Ministry of Health of the Republic of Uzbekistan, Director, MD, Professor Ubaydullaeva Nilufar Baxromxodjaevna, Republican Specialized Scientific-Practical Medical Center of Endocrinology under the Ministry of Health of the Republic of Uzbekistan Head of the department thyroidology, PhD E-mail: [email protected] Mirzaeva Umida Zakhidovna, Tashkent Pediatric Medical Institute, Master's degree student of the department of endocrinology of Tashkent Pediatric Medical Institute E-mail: [email protected]
The quality of life of women with Graves' disease after radioiodine therapy
Abstract:
Objective: To estimate the quality of life of women undergone radioiodine therapy for Grave's disease.
Materials and Methods: the study included 79 women with Graves' disease treated with radioiodine (RIT) at the department of nuclear medicine of the RSSPMCE. According to the functional state of the thyroid gland, women were divided into 2 groups. The first group included 23 patients in stage of euthyroidism, the 2nd — 56 women in stage of hypothyroidism, and a control group consisted of 15 women without thyroid pathology. Results: marked decline in physical and mental components of QoL was observed in women with Graves' disease before RIT compared with the control group. Improvement in the quality of life of women with Graves' disease was observed after RIT. Conclusions: RIT significantly improved physical (overall score increased by 38.2 %) and psychological (by 33.4 %) components of quality of life, which became closer to those of the control group.
Keywords: Graves' disease, quality of life, radioiodine therapy.
Toxic diffuse goiter (Graves' disease, GD) is a system autoimmune disease occurring due to production of antibodies to thyroid stimulating hormone (TSH) receptor, clinically shown by thyroid gland affection with thyrotoxicosis syndrome. GD is the reason of thyrotoxicosis in 80-85 % of cases [4; 7].
Options of treatment of GD are antithyroid medicines, radioactive iodine, and also surgery (thyroidectomy). Radioactive iodine is effective, noninvasive, rather inexpensive method, with none of those complications which can develop during the surgery on thyroid. Radio iodine therapy (RIT) is used as the basic method of treatment of GD by the majority of endocrinologists in the USA and other countries [2; 8; 9].
There is a number of papers were authors assessed QoL of patients with nodular goiter and GD undergone surgery, but the results of these studies were inconsistent [1; 3; 5; 8]. There are not so many studies of quality oflife of patients with GD after radio iodine therapy though the given direction has the important medical and social value.
The objective of the study is an estimation of quality of life of women after radio iodine therapy for Graves' disease.
Materials and methods. 79 women with GD undergone radio iodine therapy at the nuclear medicine department of the RSSPMCE are included into the study. After RIT, all women were divided into 2 groups according to the functional condition of thyroid. The first group included 23 patients in euthyroid stage (average age 33.1 ± 5.74 years; Me 34.0; IQR 28.5-36.5); the second group consisted of 56 women in hypothyroid stage (average age 35.5 ± 5.93; Me 38.0; IQR 32.7-40.0). Control group included 15 women without thyroid disorders (average age 30.5 ± 5.04 years;
Me 29.0; IQR 27.0-34.5). Of total number (n = 79) of women with GD undergone radio iodine therapy were on standard doses of NaJ-131 (300 MBK). 69 (87.4 %) patients received one course of radio iodine therapy, 10 (12 %) people received two courses. Radio iodine therapy was performed with 4 months intervals after initial doses of NaJ-131.
Levels of hormones (free thyroxin (T4), free triiodothyronine (T3), thyroid stimulating hormone (TSH)) were defined by radio immune method using the commercial sets of "Immunotech" (Czechia) on the basis of RSSPMCE. Quality of life of patients was defined by means of questionnaire SF 36 (The MOS 36-item Short Form Health Survey).
The obtained data were processed using the computer programs Microsoft Excel, STATISTICA 6 and Biostat. Quantitative indicators are presented in the form of M ± SD, medians (Me), and 25th and 75th percentiles (IQR). Differences between groups considered statistically significant at P < 0.05.
Results. The study showed euthyroidism within 1 year after single intake of radioactive iodine in more than a half(12; 52.2 %) of patients of the 1st group. 34.5 % (8) ofwomen have reached euthyroid state within the period of 1-5 years, and only 13.0 % (3) women — within 5-10 years after RIT. It 6 (10.7 %) women of the 2nd group hypothyroidism was diagnosed within 1 year after RIT, in 24 (42.9 %) — in 1-5 years, in 26 (46.4 %) patients — within 5-10 years after therapy with iodine.
Secretion of TSH, fT3 and fT4 in groups with euthyroid state and compensated hypothyroidism slightly differed from the control indicators. Levels of hormones of women with decom-
The quality of life of women with Graves' disease after radioiodine therapy
pensated hypothyroidism statistically significantly differed from indicators in all studied groups.
The analysis of indicators of quality of life of patients before radio iodine therapy revealed presence of significant decrease in quality of life in comparison with the control. Women with GD before intake of radio iodine had the lowest indicators of QoL on the scale "Role physical functioning" which did not exceed 50 points. The most expressed decrease was observed on scales "Role func-
tioning" (35.2 %) and "The general health" (31.0 %). Patients of the both groups had significant increase in all indicators of physical component of health of QoL after RIT. Thus, at patients, who reached euthyroid state, increase on scale PF was 39.1 %, RP — 50.4 %, BP — 29.3 %, and GH — 35.4 %. In group of women with hypothyroidism significant growth of indicators of physical component of health of QoL (PF by 35.3 %, RP by 35.0 %, BP — by 23.1 %, and GH — by 28.0 %) was also observed (Fig 1).)
Fig. 1. Dynamics of indicators of physical and psychological components of health of quality of life of patients with GD after RIT, in percentage in relation to the control and the reference value
The comparative analysis showed that indicators of QoL of patients who reached euthyroid state are higher than those at women with hypothyroidism. Improvement of indicators of physical component of health testifies the increase in ability of women to be engaged in daily activity, including work on the house and out of the house.
At the analysis of psychological component of health, the lowest, comparing to the clinical control, was the level of the role functioning caused by the emotional condition of patients.
Indicators of vital activity (by 27.3 %), psychological health (by 23.8 %) and social functioning (by 23.2 %) were also significantly lower comparing to the control group. In patients who reached euthyroid state, increase on scale VT was 43.9 %, RE — 41.2 %, MH — 28.8 %, and SF — 21.6 %. In group of women with hypothyroidism, significant growth of indicators of psychological component of health of QoL (VT by 42.6 %, RE — by 38.4 %, MH — by 25.4 %, and SF — by 18.8 %) was also observed.
The general physical component of health was lower before treatment by 30.3 % being equal to 52.1 ± 10.7 points (vs the control 74.7 ± 5.5 points). After RIT, indicator of QoL among women of the 1st group has increased by 38.2 % comparing to the values before treatment being equal to 72.0 ± 6.5 points. Among patients of the 2nd group, the physical component of health also raised by 30.3 % being equal to 67.9 ± 4.4 points. The general psychological component of health of women with GD was lower comparing to the control (77.9 ± 5.4 points) by 26.6 % being 57.2 ± 9.4 points. In patients who reached euthyroid state, indicator of QoL has increased by 33.4 % comparing to the values before treatment and was 76.3 ± 7.1 points. In group of patients with hypothyroidism, the psychological component of health has raised by 30.9 % and was equal to 74.9 ± 7.6 points.
Discussion. According to Ismailov S. I. [4], majority of patients who were exposed to surgical interventions concerning thyroid pathology, have decrease in QoL. The combined therapy with thyroxin
and triiodothyronine provides significantly higher level of QoL in patients undergone total thyroidectomy for Graves' disease.
At the analysis of quality of a life of patients with GD it has appeared, that patients undergone surgery with preservation of thyroid tissue had significantly higher indicators of QoL comparing to the patients undergone thyroidectomy or subtotal resection with preservation of less than 2 sm 3 of thyroid tissue (p < 0.05), despite the greater number of postoperative complications in patients with nodular non-toxic goiter [5].
Scerrino G. et al. have estimated QoL of 57 patients after total thyroidectomy for GD. During the period from April, 2002 till December, 2009 questionnaires containing four blocks of questions were distributed: organic changes and clinical features, disorders of autonomous nervous system, disorders in daily activity, and psychosocial problems. The analysis of the given questionnaires showed, that about 70 % of patients had noticed significant improvement in QoL after thyroidectomy.
The objective of the research by Bukvic B et al. was the analysis of influence of various surgical methods of treatment on quality of life of patients with benign pathology of thyroid gland. Quality of life of patients has considerably improved after surgical treatment, irrespective of degree of the operation. Improvement in QoL was significant among women in all domains of the questionnaire, while among men it was significant only in three domains (symptoms of goiter, emotional susceptibility, and cosmetic complaints) and the general health. Analysis of QoL of 64 patients with relapse of nodular goiter after thyroid surgery showed unsatisfactory result at primary examination (the average level of quality of life was 8.4 ± 0.9 points). After repeated questioning in 2-3 years of follow-up, the estimation of the life by patients became much more optimistic: average index of QoL corresponded to good result (10.1 ± 0.4 points). Distinctions were statistically significant (U = 921; p = 0.042) [6].
Conclusions: 3. Women with GD have decreased quality of life, as shown
1. Within 1 year after single intake of radioactive iodine 52.2 % by low indicators of physical (by 30.3 %), and psychological of patients of the 1st group were diagnosed euthyroid. 34.5 % of (by 26.6 %) components of health.
women have reached euthyrosis during the period of 1-5 years, 4. After RIT, physical (the general count has increased
13.0 % within 5-10 years after RIT. by 38.2 %) and psychological (by 33.4 %) components of quality of
2. In 10.7 % of women of the 2nd group, hypothyroidism was life considerably improved and became closer to the similar indica-diagnosed within 1 year after RIT, in 42.9 % — in 1-5 years, in tors of the group of clinical comparison. Patients in euthyroid state 46.4 % of patients — within 5-10 years after therapy with iodine. are characterized by the better indicators of quality of life.
Referenses:
1. Zaycev I. A., Kirienko V. T., Jidkix V. N. and others. Evolution of the quality of life in healthy individuals. - 2010. - № 2 (48). - P. 30-36.
2. Ismailov S. I., Ubaydullaeva N. B., Nasirkhodjaev Ya. B., Mirzaeva U. Z. Pregnancy and, delivery outcomes in women with diffuse toxic goiter after radioiodine//Infection, immunity and pharmacology. - 2014. - 5. - P. 66-72.
3. Ismailov S. I., Akbutaev A. M., Elov A. A. The quality of life of patients on thyroxine and combination thyroxin and triiodothyronine after total thyroidectomy in patients with Graves' disease//International Journal of Endocrynology. - 2014. - № 5 (61). - P. 52-55.
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Israilov Khikmatjon Tuygunovich, Doctor of Republican Specialized Science Practical Medical Center of Dermatology & Venereology, Republic of Uzbekistan
E-mail: [email protected]
The clinical manifestations of recurrence of genital herpes
Abstract: The clinical manifestations of genital herpes (GH) was characterized as vesicular in 67.3 % cases, in 18.2 % erosive, in 10 % erosive- ulcer and in 4.5 % cases as a ulcer lesion of the skin and mucous membranes of the genitals by predisposing a massive discharge of herpes viruses into the environment and which is epidemiologically unfavorable factor due to the spreading of these viruses among the population.
Keywords: genital herpes, symptom, new approaches.
The main clinical evidence of genital herpes has been vesico-bullous and erosive — ulcerative elements, affecting the skin and mucous membranes of the genitals [1; 3; 4]. Destructive elements transpire as the main symptoms ofherpes infection lead to dissemination of herpes viruses into the environment as well as being a gateway for other STIs and especially for HIV infection [3].
Material and methods. 220 patients had been observed with symptomatic recurrence of genital herpes. Exploring of the duration of disease relapse revealed that the clinical manifestations of genital herpes in 15.5 % of patients was up to 6 months, 12.7 % — up to 1 year, at 29.1 % and 20.0 % up to 2 and 3 years, respectively; 10.9 % of patients herpes symptoms recurred within 5 years and in 11.8 % the disease relapsed more than 5 years. The basic amount of 66 patients (60.0 %) had disease duration from 1 year to 5 years.
Results and discussions
Studying the frequency of recurrences of genital herpes showed that core group of86 (39.1 %) patients with a frequency relapse was from 6 to 8 times per year. 32 (14.5 %) patients had two relapses per year, 58 (26.4 %) patients 4 relapses per year. In 36 (16.4 %)
cases of relapse were established 9-12 times per annum. 8 (3.6 %) patients — from 1 to 2 times a month, which was accounted more than 12 recurrences per year.
Changes in localization of the lesion elements in each new relapse of genital herpes was diagnosed in 64 (29.1 %) patients. Compare to the 70.9 % of cases (156 patients) rash relapse which was observed at the primary place of the initial lesion.
In 41.8 % of cases patients indicated repeated recrudescence of GH after sexual contact, frigorism or cold-related diseases, intake of alcohol, to be more detailed, women had GH often in the period before or after menstruation. The majority — 58.2 % of the patients were not able to specify the obvious reasons for the recurrence of the disease.
The study of the clinical manifestations of genital herpes in the examined group of patients admitted to determine some appropriate characteristics in the clinical course of the disease. In the study of lesions of genital herpes was found that of 178 male patients in 100 of them (56.2 %) lesions were observed on the skin of phallus with a common site elements in the bridle or coronal sulcus. In 60 (33.7 %) patients localized on the skin of the pubis or at the root of the coles,
