The method of treatment of autoimmune diseases of the thyroid gland
The invention relates to medicine, endocrinology. Spend discrete plasmapheresis. Perform indirect electrochemical detoxification of plasma sodium hypochlorite. For this purpose, 100 ml of plasma is mixed with 400 ml of sodium hypochlorite. The resulting mixture was ex tempore injected, drip for 40 minutes in a peripheral vein. Sessions are conducted daily for three days. The method improves the clinical effect by preventing the complications of vascular intima, has an immunomodulatory effect.
The invention relates to the field of medicine, surgery specifically, to methods of treatment of autoimmune diseases, and can be applied in the preoperative preparation of patients with diseases of the thyroid gland.
Known methods of treatment of autoimmune diseases of the thyroid gland, which consist in the use of in vitro methods - of hemosorption, plasmapheresis, ultraviolet irradiation of blood[1, 2, 3].
However, these methods have drawbacks:
- absorbtion - the procedure is quite invasive, requires adequate venous access, the catheterization of Central veins, with all opasnostyami blood system ;
- plasmapheresis is fraught with great plasmopara, which requires recovery of donor plasma or protein drugs, which can lead to infection of patients and the possibility of allergic reactions, and may not persistent effect in severe thyrotoxicosis (no more than 5 days) ;
ultraviolet blood irradiation is effective only in milder forms of hyperthyroidism .
The closest in technical essence and the achieved positive effect is the way of preoperative preparation of patients with diffuse toxic goiter , using the indirect electrochemical oxidation (NAHO) plasma sodium hypochlorite. The method involves reinfusion in vitro detektirovanii autoplasma patients diffuse toxic goiter and is carried out by the following method: extraction, centrifugation of blood, reinfuse shaped elements. The plasma was added sodium hypochlorite at a concentration of 600 mg/l in the ratio of 1:10 volume of plasma, incubated at a temperature of +6 - +8°With not less than 4 hours, and at the subsequent session of the blood sampling was reinfusions patient. During the first session NACHO infusion therapy was carried out by colloidal and crystalloids is Oh. During the preoperative preparation of patients with thyrotoxicosis moderate and severe was conducted in 3 sessions NACHO plasma. The total amount of treated plasma were 600-800 ml
However, this method has the following disadvantages:
- detoxification sodium hypochlorite is only the plasma of the patient, although thyroid condition is a characteristic of the body;
- long exposure of plasma oxidant leads to the destruction of albumin, which is not desirable when endotoxicosis and upcoming operations;
long - term, changing the plasma sodium hypochlorite, when reinfused can cause severe immunosuppression that is not advisable before surgical intervention .
New technical problem - increasing the effectiveness of treatment by reducing the time of preoperative preparation and the reduction of postoperative complications is achieved by applying a new method of treatment of autoimmune diseases of the thyroid gland, including blood sampling, the selection of plasma and reinfusion shaped elements to compensation for loss of plasma crystalloids, the preparation of a medicinal mixture by adding sodium hypochlorite to the plasma and the subsequent introduction of s and ex tempore introduce drip into a peripheral vein in the continuation of the 40 minutes, they can also make the procedure daily for 3 days.
The method is as follows.
After diagnosis by biochemical studies, clinical blood parameters, immune status, thyroid hormone, thyroid-stimulating hormone, ultrasound of the thyroid gland conduct the session discrete plasmapheresis using two plastic bags “Remocon”. The resulting plasma in a volume of 100 ml was poured into sterile vials and add a solution of sodium hypochlorite at a concentration of 600 mg/l (0,06%) with a volume of 400 ml and ex tempore injected intravenously into a peripheral vein for 40 minutes. The remaining amount of autoplasma, approximately 300-400 ml, disposed of. Loss of plasma complement by crystalloids. The sessions are held daily for three days. Volume eksponirovannoi plasma average 900-1350 ml.
Examples of the method.
This method was tested in 23 patients, 20 women and 3 men aged 25-54 years, with diagnoses of diffuse toxic goiter, toxic multinodular goiter, subacute thyroiditis, autoimmune thyroiditis, systemic lupus erythematosus, revmotoidny arthritis, scleroderma.
Note the mini-goiter Art. III, the hypertrophic form in combination with chronic autoimmune thyroiditis.
Complications: thyrotoxicosis Art. II, dystrophy of the myocardium, kidney stones, nephroptosis Art. II, chronic pyelonephritis in remission.
Complaints on heart rate to 100 beats per minute or more interruptions in the heart, increased blood pressure to 140/90 mm RT.article (at a rate of 100/60 mm RT.cent.), shortness of breath associated with physical activity, sweating, a progressive increase of the thyroid gland, increasing the volume of the right eye.
Anamnesis. Got sick about 2 years ago when I first mentioned quick weight loss, palpitations 100 and higher beats per min, enlargement of the thyroid gland.
Treated with mercazole 30 mg/day L-Thyroxine 50 mcg in the morning.
Recurrent disease was observed after emotional stress.
For tests: complete blood count and biochemical analysis without deviation from the norm; blood coagulation system without modification.
Thyroid ultrasound - tissue of low echogenicity, homogeneous, vascular figure is underlined; the right share to 20 ml, the left share - 12 ml.
The analysis of hormones: T3to 4.2 ng/ml (N - 0,8-2,1), T4- 147 µg/DL (N - 4,2-12,1), TSH - 0,018 med/l (- 13% (N - 15-25%), T-helpers, % - 13% (N - 40-69%), T-suppressor, % - 25% (N - 5-20%), Ig A, g/l and 1.75 (N - 1,36-1,62), Ig M, g/l - 1,0 (N - 0,6-1,02), Ig G, g/l - 10,87 (N - 9-10), CEC - 64 sm.ed.
Sessions detoxification was carried out with the aim of preparing for an operation.
After sessions detoxification according to the formula of the invention there was a strong positive trend in the subjective status: decreased heart rate up to 75 per minute, normalized blood pressure, are not marked interruptions from the heart, disappeared sweating, shortness of breath, associated with physical exertion.
The volume of the thyroid gland decreased: right lobe - 12 ml, left lobe - 10 ml Tissue cancer decreased echogenicity, homogeneous, connective tissue component is not expressed, vascular figure is underlined.
The analysis of hormones: T3to 2.0 ng/ml (N - 0,8-2,1), T4is 20.1 µg/DL (N - 4,2-12,1), TSH - 0.02 med/l (N - 0,02-2,5).
Indicators of immune status: lymphocytes - 28% (N - 18-38), T-lymphocytes, % - 45% (N - 50-65%), b-lymphocytes, % - 14% (N - 15-25%), T-helpers, % - 27% (N - 40-69%), T-suppressor, % - 14% (N - 5-20%), Ig A, g/l and 1.75 (N - 1,36-1,62), Ig M, g/l to 1.0 (N - 0,6-1,02), Ig G, g/l - 10,87 (N - 9-10), CEC - 20 sm.ed. Conclusions: quickly, after three sessions were stopped phenomena of thyrotoxicosis. The patient notes the significance of the SORS, decreased the number of immunoglobulins and the CEC. The patient was discharged in satisfactory condition without surgical intervention.
Statement of the case history No. 2719. Patient C. for 45 years. Was admitted to the hospital SSMU with Ds. Diffuse toxic goiter III senior Complications: thyrotoxicosis II Art.
The patient considers herself a patient in the course of 4 months, when I first noted the increase in the neck, weakness, insomnia. Then joined tachycardia, fatigue, sweating, dizziness, increased weakness. Was diagnosed. Treatment - mercazole in a daily dose of 40 mg For the last three months on a background of reception of a preparation has been a rapid increase in thyroid cancer. Hospitalized in clinic of SSMU.
Analysis: General and biochemical blood parameters and blood coagulation - without deviation from the norm.
Thyroid ultrasound - tissue of low echogenicity, homogeneous, vascular figure is underlined; the right share - 27 ml, left lobe - 22 ml.
Indicators of immune status was not determined.
Thyroid hormones: T3to 3.7 ng/ml (N - 0,8-2,1), T4- 56,2 µg/DL (N - 4,2-12,1), TSH - 0,014 med/l (N - 0,02-2,5).
Sessions de the ACLs claims there was a strong positive trend in the subjective status: fully cropped phenomena of thyrotoxicosis tachycardia, sweating, weakness, insomnia. Significantly decreased the size of the thyroid gland, it has become more dense, the ultrasound volume amounted to: the right share - 19 ml, left - to-18 ml.
Thyroid hormones: T3- 1.8 ng/ml (N - 0,8-2,1), T4with 20.4 µg/DL (N - 4,2-12,1), TSH - 0,012 med/l (N - 0,02-2,5). In connection with occupational hazards, coal, CHP, the difficulty of correction immunostain, the rapid growth of the cancer, the patient decided to have the operation tradecomet.
Intraoperative: iron tight-elastic consistence, easily excreted, low bleeding. In the postoperative period, there was rapid wound healing, lack of infectious and inflammatory phenomena, the absence of endocrine and metabolic disorders (thyroid crisis). Conclusions: quickly stoped phenomenon thyrotoxicosis, 3 days, decreased the volume of the thyroid gland, which during operation are well allocated, little bleeding, smoothly flowed postoperative period. The patient was discharged in good condition.
A method of extracorporal hemocorrection indirect electrochemical oxidation of the blood, the underlying before the treatment of endotoxemia, infectious bacterial processes, burn toxemia and so on
The active ingredient is sodium hypochlorite. Acting in the blood, it releases active oxygen, oxidizing contained therein toxic and ballast substances, such as hormones, bilirubin, urea, ammonia, uric acid, creatinine, acetone, etc., By hydrolysis it can inactivate weight toxic compounds. Moreover, because of its small molecular weight sodium hypochlorite can freely penetrate the cell membrane to oxidize the toxins contained not only in blood but also in the cells. At concentrations of 600 mg/l and higher sodium hypochlorite has an immunosuppressive effect, and the effect of small concentrations gives an immunomodulating effect.
The Department of General surgery, Moscow medical Academy named after I. M. Sechenov has developed guidelines for the intravenous use of sodium hypochlorite, developed indications and contraindications to its use . Safe for the intravenous route of administration are solutions of sodium hypochlorite at a concentration of from 300 to 600 mg/l in volume 1/10 BCC.
The mode of conducting medical procedures SEL">- preparation of modified sodium hypochlorite solution by autoplasma specified ratio (4:1) will allow to achieve the expressed clinical effect;
- intravenous drip modified sodium hypochlorite solution by autoplasma for 40 minutes prevents possible complications of the intima of vessels (phlebitis);
three sessions daily is necessary and sufficient to obtain a stable therapeutic effect;
- continuity procedures due to the fact that the daily volume eksponirovannoi plasma does not lead to the disturbance of homeostasis, gives a steady immunosupressives effect required to achieve remission of the disease.
The number of sessions less than three proved ineffective (not received a stable effect of the procedure), and the number of sessions over three did not lead to a significant improvement of the patients.
Thus, the proposed method allows you to quickly, effectively and safely deal with endotoxicosis through detoxification in a whole organism. Acting on the main stages of pathogenesis of diseases, eliminates autoimmune disorders, reduces the amount of cancer, spooltreetm effects in the postoperative period when the relative cheapness of the proposed method.
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Method of preoperative preparation of patients with thyroid diseases by conducting discrete plasmapheresis and indirect electrochemical detoxification of plasma sodium hypochlorite, characterized in that for carrying out electrochemical detoxification 400 ml of sodium hypochlorite mixed with 100 ml of plasma of the patient and extempore introduce drip into a peripheral vein for 40 min, daily, for three days.