Method of predicting risk of thyroid gland diseases in women of perimenopausal age

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to endocrinology. The following data are determined: cause of menopause, application of estrogen preparations, value of index of body weight and thyroid gland volume, concentration of antibodies to thyroid peroxidase and thyrotropic hormone. On the basis of obtained data prognostic coefficient which makes it possible to predict presence or absence of risk of developing thyroid gland diseases in the nearest five years is calculated.

EFFECT: method makes it possible to determine risk of thyroid gland diseases in women of perimenopausal age, which will make it possible for a doctor of any specialty to select the most optimal way of said pathology prevention and treatment.

3 ex

 

The invention relates to medicine, namely to endocrinology, and can be used by doctors of other specialties.

In the perimenopausal period is observed relatively high prevalence of thyroid diseases. But the diagnosis of this pathology in women in this period is extremely difficult, given the similarity of symptoms of thyroipathies have been looked into with age-related changes, mutual masking with manifestations of the climacteric syndrome.

During perimenopause, the combination of high prevalence of thyroid disease in women after 45 years of estrogen deficiency, especially after surgical menopause, increases the risk of cardiovascular disease. Consequently, this requires a more thorough examination of women in the perimenopausal age for early detection, treatment and prevention of diseases of the thyroid gland that will improve health, prevent the development of manifest clinical forms of thyroid diseases and improve the quality of life for patients older than 45 years.

The level of technology

Analogs

In the works[1, 2, 3, 4, 5, 6] we studied the risk factors, pathogenesis and diagnosis of thyroid disease, including perimenopausal, but not determined the effect of the causes of menopause on the development of thyroid pathology.

Prototype

In [7] to study what are the risk factors pathogenesis, diagnosis, treatment and prevention of thyroid cancer in women after menopause, however, not proposed a method for predicting the risk of development of thyroid disease in women of perimenopausal age.

The INVENTION

The aim of the invention is to develop a method for predicting the risk of thyroid disease in women 45-55 years.

This goal is achieved by calculating a prognostic index, resulting in possible to conclude whether the patient's risk of developing thyroid cancer in the next five years or not.

The method is as follows. During the history taking women 45-55 years ask, came after her menopause, and specify its cause (natural or surgical), as to whether it accepts preparations containing estrogens, when viewed measured her height and weight and calculate body mass index (BMI) using the formula: BMI = weight in kilograms/(height in meters)2. To determine the functional status of the thyroid gland determine the concentration of thyroid stimulating hormone (TSH) and antibodies to thyroid peroxidase (at-TPO) in serum enzyme-linked immunosorbent assay (ELISA) using test systems company "Alkor Bio" (S.-Petersburg, Russia) for TSH, the company "Biomerica (USA) for at-TPO and semi-automated analyzers Mltisken MCC/340, Labsystems, Finland) and Victor2(company Wallac, Finland) (normal values TTT=to 0.4 to 4.0 mIU/l, at-TPO=0-40 IU/ml). The sampling of venous blood is carried out in the morning before a meal. To assess the size, structure, presence of thyroid nodules spend her ultrasound investigation (USI) on the device Diagnostic Ultrasound System 3535 (firm&K Medical, Denmark) linear sensor 8 MHz with color Doppler mapping. Volume of a thyroid gland are calculated according to the formula Brunn J. (1981): volume = k·(T1·W1·D1+T2·W2·D2), where k = 0,479 - factor ellipsoidal, T - thickness, W - width, L is the length of the lobes. The volume of the gland to 18 ml regard as the appropriate norm. And on the basis of the obtained data to calculate a prognostic index F risk of development of diseases of the thyroid gland by the formula:

F=-0,372·P1+in 0.288·P2+1,879·P3+0,397·P4+0,084·P5+0,382·P6-6,918,

where

P1 is the cause of menopause, if you are premenopausal or natural menopause, then P1 = 0, if surgical menopause (panhysterectomy), then P1 = 1,

P2 - the volume of the thyroid gland (ml)

P3 - concentration of antibodies to thyroid peroxidase (at-TPO) in the blood (IU/ml), if the at-TPO > normal, P3 = 1, if the at-TPO ≤ norm, P3 = 0,

P4 - the concentration of thyroid stimulating hormone (TSH) in the blood (mIU/l)

P5 - body mass index (BMI)BMI = weight in kilograms / (height in meters)2,

P6 - taking medication, sod is rasih estrogens, if accepts, then P6 = 1, if not, P6 = 0,

Const=-6,918.

If the value of the derived index F is greater than zero, then predict an increased risk of developing thyroid cancer in the next five years, and if the value of F is less than zero, then make a conclusion about the absence of this risk to the patient. The specificity of the method is 75,25%, sensitivity - 68,4%, efficiency -74,2%.

Example 1. Patient T., 50 years old, pre-menopausal women. In the past year is taking medication "klimonorm" about climacteric syndrome of moderate severity. Ultrasound examination of thyroid gland volume 16 ml, echostructure homogeneous, normal echogenicity. Thyroid function is normal (TSH = 1,8 mIU/l), the titer of at-TPO increased (at-TPO =to 163.1 IU/ml). BMI = 29.6 kg/m2. Thus, P1 = 0, P2 = 16, P3 = 1, P4 = 1,8, P5 = 29,6, P6 = 1. We will substitute the data into the formula for predicting the risk of thyroid cancer:

F=-0,372·0+0,288·16+1,879·1+0,397·1,8+0,084·29,6+0,382·1-6,918=3,15.

The result is greater than zero, therefore, it is possible to judge the presence of this patient's risk of thyroid disease in the next five years. After four years at the annual examination in this patient was diagnosed hypothyroidism. Therefore, the prediction was correct.

Example 2. Patient C., 52 years, surgical menopause - 1 month. The estrogens are not accepted. Complaints from Sch is Coveney gland no. Ultrasound examination volume of a gland of 14.5 ml, in both lobes are education about 4 mm in diameter. Thyroid function is normal (TSH = 1,1 mIU/l), the titer of at-TPO modestly increased (at-TPO = 47,5 IU/ml). BMI = 28 kg/m2. Thus, P1 = 1, P2 = 14,5, P3 = 1, P4 = 1,1, P5 = 28, P6=0. We will substitute the data into the formula to predict the risk of development of thyroid cancer:

F=-0,372·1+0,288·14,5+1,879·1+0,397·1,1+0,084·28+0,382·0-6,918=1.55V.

The result is greater than zero, therefore, it is possible to judge the presence in the patient of the risk of thyroid disease in the next five years. After a year at the annual examination in this patient was diagnosed diffuse endemic goiter. Therefore, the prediction was correct.

Example 3. Patient B., 50 years of pre-menopausal women. The estrogens are not accepted. Ultrasound examination gland volume = 11,2 ml Thyroid function normal (TSH = 2,1 mIU/l), the titer of at-TPO is not increased (at-TPO = 10,5 IU/ml). BMI = 20,8 kg/m2. Thus, P1 = 0, P2 = 11,2, P3 = 0, P4 = 2,1, P5 = 20,8, P6 = 0. We will substitute the data into the formula to calculate the prognostic index risk of thyroid cancer:

F=-0,372·0+0,288·11,2+1,879·0+0,397·2,1+0,084·20,8+0,382··0-6,918=-1,11.

The result is less than zero, therefore, it is possible to judge about the absence of risk of thyroid cancer in this patient.

During 5 years of observation of the patient thyroid pathology it is not revealed. Sledovat is Ino, the forecast was correct.

Thus, the proposed method allows to predict the risk of developing thyroid disease in women of perimenopausal age within 5 years, or to judge the absence of such risk, which gives the doctor an opportunity to choose the most optimal way to prevent this disease.

Sources of information

1. Diseases of the thyroid gland. TRANS. from English. Ed. Lieberman. - M.: Medicine. - 2000. - 432 S.: ill.

2. Melnichenko G.A., Berketova T.U., Magefilename E.A. and other Clinical features of the course of the menopause in women with diffuse toxic goiter and primary hypothyroidism // Menopause. - 2001. No. 3. - P.55.

3. Fadeev V.V., Melnichenko G.A. Hypothyroidism: a guide for physicians. - M.: RCT Sovero press, 2002. - 216 C.

4. Arai T., S. Kurashima, Utsuyama M, et al. Measurement of anti-increase and anti-antibodies. wash buffer using a highly sensitive radioimmunoassay: an effective method for detecting asymptomatic focal lymphocytic thyroiditis in the elderly // Endocr. J. - 2000. - Vol.47, No. 5. - P.575-582.

5. Hak A.E., H.A. Pols, T.J. Visser et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study // Ann. Intern Med. - 2000. - Vol.132. - P.270-278.

6. Knudsen N., I. Bulow, T. Jorgensen et al. Comparative study of thyroid function and types of thyroid dysfunction in two areas in Denmark with slightly different iodine status // Eur. J. Endocrinol. - 2000. - Vol. 143. - P.485-491.

7. Vanderpump M., Tunbridge W., J. French et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey // Clin. Endocrinol. (Oxf) - 1995. - Vol. 43. - P.55-68.

a Method for predicting the risk of disease of the thyroid gland in women of perimenopausal age, characterized in that on the basis of data about the cause of menopause, use of estrogens, the value of body mass index, volume of the thyroid gland, the concentration of antibodies to thyroid peroxidase and thyroid-stimulating hormone calculate prognostic index F by the formula F=-0,372·P1+in 0.288·P2+1,879·P3+0,397·P4+0,084·P5+0,382·P6-6,918,
where: P1 is the cause of menopause, if you are premenopausal or natural menopause, then P1=0; if surgical menopause (panhysterectomy), then P1=1, P2 is the volume of the thyroid gland in ml, P3 - concentration of antibodies to thyroid peroxidase (at-TPO) in the blood (IU/ml), if the at-TPO>normal, P3=1, if the at-TPO≤norm, P3=0, P4 - concentration of thyroid stimulating hormone (TSH) in the blood (mIU/l), P5 - body mass index (BMI)BMI = weight in kg/height in m2, P6 - receiving preparations containing estrogens, if accepts, then P6=1, if not, P6=0, Const=-6,918 and when the value of F is greater than zero predict an increased risk of developing thyroid cancer in the next five years, and when the value of F is less than zero make a conclusion about the absence of this risk to the patient.



 

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