1. leg press movement,
2. Straight leg pressure and side leg pressure are usually used.
3. Kicking exercise,
4.o-leg kicks on the outside of calf.
5. the x leg is kicked on the calf.
6. leg-clamping exercises,
7. Clamp your feet, ankles and knees at the same time and relax after a few minutes. Then repeat the usual walking, pay attention to posture, and walk eight characters.
8. Massage the leg muscles before going to bed at night.
The disease can be treated by surgery, and the success of the operation usually has no sequelae. The cost is generally around 8,000 to 20,000 yuan according to the illness and individual. The operation time is about 2-3 hours, and walking can be gradually resumed in 3 months after operation.
1. Long-term thiourea pyrimidine drugs are the main treatment methods in China at present.
1. feature
Long-term use of thiourea pyrimidine drugs is the main method to treat hyperthyroidism in China and many countries. Their characteristics are: oral administration is simple and easy, and there is no irreversible damage after administration; However, the medication takes a long time, requires regular follow-up, and the recurrence rate is high. Even if the medication rule is reasonable, the recurrence rate is still above 20%.
2. Commonly used drugs
Thiourea pyrimidine drugs (pyrimidines and imidazoles) are often selected, including propylthiouracil (PTU) and methimazole (MMI). In addition, carbimidazole (hyperthyroidism) and methylthiouracil are rarely used.
3. Efficacy
Thiourea pyrimidine drugs can inhibit the synthesis of thyroid hormones and directly affect the immunosuppression of thyroid gland, which has been fully confirmed in vitro and animal experiments and clinical observation. Clinical observation shows that: inducing the remission of autoimmune diseases; Lowering thyroid antibody; Reduce lymphocyte infiltration; Attenuated lymphocyte activation markers, such as interleukin -2 receptor and interferon-γ. Propylthiouracil can also affect deiodinase, which can weaken the transformation from T4 to T3 in surrounding tissues.
4. Pharmacokinetics
Thiourea pyrimidine antithyroid drugs are easily absorbed after oral administration, and are distributed in the whole body after absorption. After absorption, PTU is mainly metabolized in the liver, faster than MMI. These drugs can also pass through placenta and milk, and can inhibit fetal thyroid function through placenta. MMI passes through the placenta more easily than PTU. After a single oral administration, the half-life of MMI in plasma is about 6 hours, while that of PTU is about 65438 0.5 hours. Both drugs accumulate in the thyroid gland, and the antithyroid effect of a single dose of 30mg MMI can last for more than 24 hours. Therefore, for mild or moderate hyperthyroidism, it is appropriate to choose a single daily dose, and it is necessary to take PTU at shorter intervals. After taking the drug, about 60% of the drug is destroyed in the body, and the rest is excreted from the urine in the form of combination. If there is liver and kidney dysfunction, the dosage of drugs should be reduced as appropriate, and the interval between taking drugs should be appropriately extended.
Step 5 instruct
Hyperthyroidism, such as mild illness, short course of disease, small thyroid, children or the elderly, accompanied by pregnancy, serious exophthalmos, etc., are relative indications for medication.
Step 6 use
Different regions and doctors have different choices of drugs according to their working habits and experience. In North America, PTU is often chosen, while in Europe, MMI is preferred. There are many PTU and MMI in our country. The former has relatively few side effects, which can reduce the transformation from T4 to T3 in circulation, while the latter thinks that the drug has a long-term inhibitory effect on the synthesis of thyroid hormone. Experience shows that once a day is enough, and patients have good compliance.
The method of administration can be divided into three stages: controlling the disease, reducing the dosage and maintaining a small amount for a long time. Because the time when thyroid stimulating antibody (TSAb) in patients' blood turns negative is about 10 month later than the clinical remission period, it is generally advocated that the total dose should be 1-2 years. Recently, some authors have observed that the remission rate of continuous medication for 3 years is obviously higher than that of medication for 2 years. At the beginning of medication, if PTU is used, the daily dose is generally 300-600mg, and the maintenance dose is generally 50mg per day. However, according to the different conditions, the initial and maintenance doses are quite different, so the medication should be individualized. If the condition is serious, the initial dose should be large, while children, the elderly and pregnant women need to reduce the dose appropriately. It is not advisable to add more iodine when the condition is not relieved after treatment.
7. Side effects
Drug reactions include allergic reactions (such as itchy skin, rash, fever and joint pain). ), accounting for about 1%-5%.
① There are many kinds of rashes, and the common one is millet. There are more rashes after using MMI than after using PTU.
② Effects on bone marrow (such as leukopenia, thrombocytopenia, anemia, etc.). ), the incidence is less than 1%.
③ There are some rare reactions, such as joint pain, myalgia, neuritis, hepatitis (with PTU) or cholestasis (with MMI), and liver necrosis, thrombocytopenia, depigmentation and abnormality of hair, swollen lymph nodes, swollen salivary glands, dacryocystitis, rhinitis, conjunctivitis, edema, diarrhea, alopecia, loss of taste and acute pancreatitis caused by rare cholestasis. Some reactions may disappear during continuous medication, and the mechanism of these reactions is not clear.
④ In recent years, it has been noticed that patients produce antineutrophil cytoplasmic antibodies (ANCA) during PTU treatment, which can lead to autoimmune vasculitis, especially in children.
⑤ Leukopenia usually occurs 3-6 weeks after medication, but some cases can still occur in the later period of medication. The incidence of neutropenia is below 5‰. Sore throat, oral ulcer and fever often occur before leukopenia. Once granulosa cell deficiency occurs, antithyroid drugs should be stopped immediately and corresponding emergency treatment should be carried out.
8. Application of other drugs
① Beta-adrenergic receptor blockers: Beta-adrenergic receptor blockers, such as propranolol, can block catecholamine at the receptor site, and can relieve some manifestations of hyperthyroidism, and are often used as adjuvant therapy for hyperthyroidism. Hyperthyroidism patients with significantly increased heart rate or sympathetic nerve excitability are often given propranolol, a β -adrenergic blocker. Propranolol is the most widely used preparation, with little side effects, and 20-80mg is taken orally every 6-8 hours. For intravenous administration, preparations with short action time can be used. Some scholars believe that from the treatment point of view, β -adrenergic receptor blockers can quickly improve symptoms, leaving time for doctors and patients to consider which treatment is the most appropriate after administration, which is a good treatment.
Data show that lithium salt therapy can increase the therapeutic dose of radioactive iodine after stopping MMI and prevent hyperthyroidism from recurring immediately after antithyroid drugs. In addition, phenobarbital not only has sedative effect, but also can accelerate T4 metabolism and reduce T4.
③ When using thiourea antithyroid drugs, there have been many observations and studies on the simultaneous or sequential addition of thyroid preparations (thyroid tablets or L- thyroxine), and there are still different opinions. My personal opinion is that hypothyroidism patients need to add thyroid preparations while taking antithyroid drugs after the initial drug treatment (for example, 1 month), and then the goiter is obvious at the beginning of medication, or it is further enlarged during medication, and the exophthalmos is obvious at the beginning, or it is further prominent during treatment, which are all indications for adding thyroid preparations at the same time. The dosage of L- thyroxine sodium is usually 33.3- 100μg (or 20-60mg thyroid tablets). From the beginning of treatment to the end of drug withdrawal, it seems inappropriate to use it for a long time. Thyroid ophthalmopathy
2. Subtotal thyroidectomy is the best method after thyroid function control.
Subtotal thyroidectomy after drug preparation is one of the best treatment methods, and more than 90% can be cured after operation. Due to the improvement of anesthesia technology, the complications caused by operation are obviously reduced.
After antithyroid drug treatment, if hyperthyroidism improves and meets the following conditions, iodine can be further used for preoperative preparation:
(1) The symptoms of hyperthyroidism basically disappeared;
(2) The body weight rises to the pre-illness level;
(3) At rest, the heart rate drops to about 80 beats/min;
(4) Serum thyroid hormones (FT4 and FT3) returned to normal.
Hypothyroidism caused by surgery is often seen, but hypothyroidism is mostly temporary and can return to normal after a few months. Only a few patients become permanently hypothyroidism, and these patients need long-term replacement therapy.
Surgical complications
Radioactive iodine is the first choice for treating hyperthyroidism in some countries.
This method is convenient and safe and the cure rate can reach 85-90%. In some industrialized countries, it is the first choice to treat hyperthyroidism. Symptoms disappeared slowly after treatment, and 10% patients showed permanent hypothyroidism after treatment.
1. Mechanism: After the thyroid absorbs I 13 1, it is mainly irradiated by β rays during the decay process, and the hyperthyroidism thyroid tissue is destroyed, and the hyperthyroidism state of thyroid function gradually returns to normal.
2. Indications: Diffuse moderate goiter of thyroid gland, preferably over 25 years old, allergic to thiourea antithyroid drugs, recurrent after long-term antithyroid drugs treatment, contraindications to surgery or recurrent after thyroid surgery, old age and serious cardiac and liver complications, leukopenia or hemorrhagic diseases are all relative indications for radioactive iodine treatment. In recent years, many scholars believe that nodular goiter is also suitable for this treatment, but they have different views on the age of choosing treatment, even in North American countries where this method is widely used.
3. Contraindications: People under the age of 25 should not be the first choice, but there are different views and practices at home and abroad. It was observed that radioactive iodine was used to treat young patients with Graves' disease under 20 years old (July 3-1September 9), and there were 26-65438+ 1 16 cases in 2006. After long-term observation, it is safe and effective. It should be noted that pregnant women and lactating women, people with severe renal insufficiency, and people with extremely enlarged thyroid gland and symptoms of oppression should be taboo.
Interventional arterial embolization is a new method.
Thyroid interventional embolization is a new method to treat Graves' disease since 1990s. Since 1994 was first reported, it has been carried out in some areas of China and accumulated some experience. Methods Under the digital subtraction X-ray television, the catheter was sent into the superior thyroid artery through femoral artery, and the embolic agent mixed with contrast agent-polyvinyl alcohol, gelatin sponge or bletilla striata powder was slowly injected until the blood flow basically stopped. Generally, the area of thyroid embolism can reach 80-90%, which is similar to the amount of thyroid removed by subtotal surgery.
The indication of this treatment method is thyroid enlargement; Poor or allergic to antithyroid drugs; Surgery or radioactive iodine should not be used; When the thyroid gland is very enlarged, it can also be used for preoperative treatment. However, those newly diagnosed as hyperthyroidism, with inconspicuous goiter, bleeding tendency and obvious macroangiosclerosis should not be used. This kind of treatment requires certain medical technology and equipment, and the treatment cost is expensive.
5. Chinese medicine
Hyperthyroidism is usually treated mainly by western medicine, but in some cases, the combination of traditional Chinese and western medicine or traditional Chinese medicine can be considered. Traditional Chinese medicine has long been recognized for treating hyperthyroidism. The TCM syndrome differentiation of hyperthyroidism can be roughly divided into five types: hyperactivity of fire due to yin deficiency, deficiency of both qi and yin, hyperactivity of yang and wind, stagnation of phlegm and qi, hyperactivity of fire due to liver and stomach. Arrange prescriptions and medicines according to different syndrome differentiation and treatment.
abstract
In case hyperthyroidism recurs after treatment, several commonly used treatment methods can be converted to each other. The so-called recurrence of hyperthyroidism patients after treatment refers to the recurrence of hyperthyroidism treated by some method for more than half a year to 1 year. In this case, how to deal with it better, although there is no fixed constitution to follow, there are usually some principles to follow when arranging operations.
If antithyroid drugs are used for a long time, thiourea drugs, surgery and radioactive iodine can be used after recurrence. Surgery was supposed to be used. Thiourea long-term drugs are the first choice after recurrence, followed by radioactive iodine, and surgery is generally not chosen again. Radioactive iodine was originally used, so long-term medication should be considered after recurrence, or radioactive iodine should be used again, and surgery is rarely used.
The principle of exchange between these treatments is a common practice, and they complement each other to some extent, but the operation should be closely combined with the current specific situation of patients, rather than fixed.
As for subclinical hyperthyroidism (only the serum TSH level is decreased, the thyroid hormone level is not increased, and there are no obvious symptoms and signs of hyperthyroidism), if there are obvious goiter and eye diseases, corresponding treatment can be done, otherwise, the TSH level and thyroid hormone in blood can be checked regularly (several months-1 year), and corresponding treatment can be made according to the situation at that time.
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