A method for the treatment of diffuse mastopathy

 

(57) Abstract:

The invention relates to Oncology and gynecological endocrinology, may be used to treat diffuse mastopathy. Enter thyroid hormones such as L-thyroxine in the maximum-tolerated dose, lasting from 3 to 12 months, the effectiveness of therapy is determined by a comprehensive assessment of remission mastitis, after completion of the course conduct therapy with enzymes or vitamins. When mastalgia prescribed therapy aimed at correcting the disturbed function of the endocrine glands identified in the comprehensive examination before treatment based on the data revealed by the survey of women after treatment. The method allows to achieve partial remission of endocrine organs and complete remission of mastitis with the restoration of the luteal phase of the ovulatory cycle of the ovaries. 1 C.p. f-crystals, 2 tab.

The invention relates to medicine: Oncology and gynecologic endocrinology and can be used in the treatment of diffuse mastopathy.

Mastitis is one of the most common diseases in women. In the population ranges from 40 to 90%. We examined me 540 women ages is 17-60 years living in St. Petersburg, mouse.

In conservative therapy using the following medications: agonists of gonadotropin-releasing hormone, progestogen, antiestrogens, androgens, thyroid drugs, inhibitors of prolactin, microdose iodine, potassium, vitamins A, E, B1, B2, diuretic, sedative, enzymes.

Known methods of treatment of mastitis using pharmacological drugs have disadvantages: less effective treatment (except agonists gonadotropin-releasing hormone), pronounced side effects, higher cost, compared to thyroid drugs.

The effectiveness of treatment with danazol 200-400 mg/day continuously for 4-6 months is 76%. Virilization, weight gain, impaired reproductive function side effects.

Closest to the claimed method of treatment is the method proposed by Thomas B. S., and coauthors 1986: use of L-Thyroxine daily dose of 150-200 mkg when galactorhea unclear etiology in the background subletting hypothyroidism (concentration of thyroid stimulating hormone and prolactin at the upper limit of normal, and triiodothyronine and thyroxine - lower limit of normal). After clinical effect, the authors propose to reduce the dose of the preparation is retene - the use of thyroid hormones in high maximum-tolerated doses as a treatment for diffuse mastopathy, except fibrous mastopathy and related diseases in which protivopokazana therapy of thyroid hormones.

The method is as follows. The patient is carefully examined by the known methods to avoid cancer of the endocrine, reproductive systems, including mammary glands, progressive benign neoplasms, prolactin and other gormonalnaguye tumors, and diseases in which protivopokazana therapy of thyroid hormones. After diagnosis of diffuse mastopathy treatment prescribed thyroid drugs, for example, with L-Thyroxine. Hormonal therapy is most useful to hyperplastic changes of the glandular component and ineffective when macrosystem rebirth and when vibrazioni stroma of the breast. The course of treatment prescribed from 3 months to 12 months. The duration of treatment is determined by a comprehensive assessment of remission mastitis: this palpation, galaktorei, mastalgia, the maximum thickness of the glandular tissue of the mammary glands, defined the GCC dynamics of mastitis on radiographs is best done quantified using scanning densitometry. The dose is determined individually, depending on comorbidity. Assigned suppressive or maintenance dose. Substitution dose traitname hormones - the dose at which the level of thyroid hormones in the blood is within normal limits and primary hypothyroidism concentration of thyroid-stimulating hormone within the normal range. Substitution therapy is performed with hypofunction of endocrine glands. Suppressive dose of thyroid therapy dose, which is suppressed by the function of thyreotropic pituitary. Suppressive therapy with thyrotoxicosis therapy, in which the concentration of TSH in the blood is less than 0.1 mIU/L. Suppressive therapy without thyrotoxicosis therapy, in which the TSH concentration above the lower limit of normal (more 0,17 mIU/l). Suppressive therapy with subclinical thyrotoxicosis therapy, in which the concentration of TSH is less than the lower limit of normal (more 0,17 mIU/l) and higher than 0.1 mIU/L.

The frequency response of the breast depends on the dose of thyroid hormones, i.e. from level tireotroponogo hormone in the blood. The lower the concentration of thyroid stimulating hormone in the blood, the higher the probability of remission, which is confirmed by the data shown in table 1, compiled on OS is impressive: the lower thyroid-stimulating hormone in the blood, the frequency of full remission above. The dependence of the full remission of the level of thyroid-stimulating hormone according to retinogram are shown in table 2.

From table 1 it is evident that a significant difference in the frequency of occurrence of remissions of mastitis was observed at a concentration of thyroid stimulating hormone in the blood above 0,18 mIU/l and below 0,17 mIU/L.

From table 2 it follows that the probability of complete remission, compared with a partial, above, if the difference of concentrations in blood thyroid stimulating hormone above 0,13 mIU/l and lower to 0.12 mIU/L.

The conclusion from this is that when poor tolerability of thyroid hormones in high doses is not necessary to achieve suppressive doses with thyrotoxicosis. It is possible to achieve remission to limit the concentration of thyroid stimulating hormone in the blood at the lower limit of normal (0,17 mIU/l). In diffuse mastopathy on the background of hypothyroidism effectiveness of therapy of thyroid hormones as well as when autoraise depends on the concentration of TSH in the blood during treatment.

The more reduced the level of thyroid stimulating hormone in the blood, the quality of care will be higher. The effectiveness of therapy of thyroid hormones diffuse mastopathy find the both, clinical forms and degrees. The effectiveness of therapy of thyroid hormones diffuse mastopathy depends on ovulatory function and, possibly, from localeprovider steroidogeneza in the breast tissue.

At the end of the scheduled treatment conduct a comprehensive examination of the patient, including radiological control breast cancer. If necessary, the course of thyroid therapy continue. After treatment treatment with enzymes or vitamins, and continue correction of disturbed functions of the endocrine glands and treatment of chronic diseases. When mastalgia during the period of follow-up of the mammary glands and the functioning of the endocrine system - therapy aimed at correcting the disturbed functions of the endocrine glands and other organs identified in the comprehensive examination before treatment, and based on the data obtained during examination after treatment when mastalgia.

Example 1. The patient "C", 36 years old, had complained of a lump in my throat, weakness, mastalgia. In the process of examination, she was diagnosed with diffuse-nodular goiter first degree. Autres. Normogonadotropic ovarian failure. Nedostatocny therapy with L-Thyroxine in maximum-tolerated dose of 150 µg/day for 3 months. On the background of treatment showed partial remission of diffuse-nodular goiter, complete remission of mastitis: disappeared mastalgia, galaktorei was not, dynamics of mastitis according to mammograms was 50%. The concentration of thyroid stimulating hormone in the blood was of 0.04 mIU/l, ovarian function has been improved: the ovulatory cycle became normal luteal phase. It is possible to note some compaction of the tissue of the uterus: volume decreased by 9% (by ultrasound). At the same time with a course of vitamin therapy was started prophylactic treatment with potassium iodide in a daily dose of 100 μg in connection with suspected iodevicetree the condition of the patient.

Example 2. The patient "P", 24 years old, came with complaints mastalgia, irregular menstrual cycle, lump in throat, weakness, secondary infertility. In the process of examination, she was diagnosed with autoimmune thyroiditis. Autres. Chronic adnexitis out of aggravation. Normogonadotropic ovarian failure. The luteal phase deficiency. Multifollicular form ovaries. Functional cyst of the left ovary. Secondary infertility. Diffuse cystic mastopathy. Had a course of therapy with L-Thyroxine, with a gradual selection of the maximum Pei(OK). However, disappeared increased to 0.4 cm follicles. The ovarian tissue was dense: decreased ovarian volume and size of follicles from 0.8 to 0.3, see ovarian Function has been improved: the ovulatory cycle became normal luteal phase. There was complete remission of mastitis: passed mastalgia, galactorrhea, according to the radiographs revealed complete remission. The concentration of thyroid stimulating hormone in the blood was of 0.05 mIU/l after treatment pregnancy.

Example 3. The patient "M", 40 years old, came with complaints mastalgia, lump in throat, weakness. In the process of examination, she was diagnosed with diffuse non-toxic goitre first degree. Autres. Normogonadotropic ovarian failure. The luteal phase deficiency. Functional cyst of the left ovary. Uterine fibroids nodular 7 weeks of pregnancy. Fibrocystic breast disease diffuse form. With suspected breast cancer TINOMO was sent for surgery. The diagnosis was confirmed. Performed the mastectomy. After the operation was conducted therapy with L-Thyroxine and gradually increase the dose to the maximum tolerated 150 µg/day for 4 months. On therapy - partial remission of goiter and mastitis: passed mastalgia, hostales is the function of the ovaries: the ovulatory cycle became normal luteal phase.

Example 4. The patient "P", 50 years old, came with complaints mastalgia before menstruation, expressed galactorrhea, amenorrhea, lump in throat, weakness. The patient received within 4 months of parlodel assigned to the antenatal clinic gynecologist without prior examination. 2 months after the gradual abolition of parlodel a survey was conducted. The hyperprolactinemia is not revealed. Nodular goiter. Autres. Normogonadotrophic ovarian failure. The anovulation. Uterine fibroid is a diffuse form 7 weeks of pregnancy. Fibrocystic breast disease diffuse form.

Gradually increasing doses of L-thyroxine 100 mcg/day. After 2 months, the dose was increased to 175 and reduced to 150 µg/day, which was the maximum-tolerated.

The course of treatment was 8 months. During therapy, complete remission of mastitis: passed mastalgia, is strongly expressed galactorrhea has become negligible, according to the radiographs, there was complete remission of mastitis. The nodes in the thyroid gland remained unchanged. The volume of the uterus was reduced in 2 times. The pre-menopausal women with irregular menstrual cycle during ended the age. Upon completion of the course of therapy with thyroxine in the maximum-tolerated-breaking glands without diffuse seals soft. Due to the fact that the patient was diagnosed nodular goiter was continued terpia thyroid hormone at a dose of 100 mcg/day. Remission solovovo euthyroid goiter has not been reached. Therapy with thyroxine was cancelled. The patient was taken to the dispensary account by diseases of the thyroid and mammary glands. A year later mastalgia is not disturbed, the tissue of the mammary glands - no diffuse seals, thyroid gland without dynamics.

Example 5. The patient "T", 22 years old, came with complaints of irregular menstrual cycle, lump in throat, breast engorgement before menstruation. In the process of examination, she was diagnosed autres. Normogonadotropic ovarian failure. Anovulation. Dishormonal cervical erosion. Fibrocystic breast disease diffuse form. Treatment with thyroxine was held in the maximum-tolerated dose of 100 mg/day, as the dose of 150 µg/day, the patient felt unwell: appeared heartbeat, nausea, anxiety, mastalgia. A course of therapy with thyroxine in a dose of 100 µg/day was 5 months, and the concentration of thyroid stimulating hormone in the blood was 0.22 mIU/l during therapy complete remission mastitis: disappeared mastalgia, according to control rentenna ovulatory function. Volume of a thyroid gland remained unchanged. Cervical erosion is unchanged. Local treatment sea buckthorn oil, plastic surgery was not effective. According to functional diagnosis was again registered the failure luteal phase of the cycle. Order epithelialization erosion of the cervix, cancer of the reproductive system, contraception was assigned to low-dose combined oral contraceptive: mersilon. Cervical erosion was epithelisation. After completion of the course of thyroid therapy within 1 month the patient received vitamin a and E.

1. A method for the treatment of diffuse mastopathy, including the introduction thyroid hormones, characterized in that the treatment of thyroid hormones in the maximum-tolerated dose, lasting from 3 to 12 months, as defined by the comprehensive assessment of remission mastitis, after completion of the course conduct therapy with enzymes or vitamins.

2. The method according to p. 1, characterized in that it further when mastalgia prescribed therapy aimed at correcting the disturbed function of the endocrine glands identified in the comprehensive examination.

 

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