Альманах клинической медицины. 2014; : 24-30
СРАВНИТЕЛЬНЫЙ АНАЛИЗ ВЛИЯНИЯ РАДИКАЛЬНОГО ЛЕЧЕНИЯ ДИФФУЗНОГО ТОКСИЧЕСКОГО ЗОБА НА ПОКАЗАТЕЛИ КАЧЕСТВА ЖИЗНИ, СВЯЗАННОГО СО ЗДОРОВЬЕМ
https://doi.org/10.18786/2072-0505-2014-32-24-30Аннотация
Актуальность. С учетом того, что многие психофизиологические параметры напрямую зависят как от тяжести патологического процесса и его длительности, так и от эффективности проводимого лечения, весьма актуальны исследования, оценивающие отдаленные результаты, а также показатели качества жизни, связанного со здоровьем, и психоэмоциональный статус в отдаленные сроки после радикального лечения у больных с диффузным токсическим зобом. Цель – анализ эффективности и безопасности радикальных методов лечения диффузного токсического зоба, сравнение показателей качества жизни, связанного со здоровьем, уровней тревоги и депрессии в зависимости от метода радикального лечения. Материал и методы. В исследование был включен 71 больной с диффузным токсическим зобом. Из них 37 больных получили лечение методом радиойодтерапии, а 34 была проведена субтотальная резекция щитовидной железы. До и через 12 месяцев после лечения всем пациентам выполнялось клиническое обследование, лабораторное и инструментальное исследования. Для оценки показателей качества жизни использовался опросник MOS SF-36, уровня тревоги – шкала оценки тревоги Спилбергера – Ханина, депрессии – шкала депрессии Бека. Результаты. В группе больных, получавших радиойодтерапию, медиана терапевтической активности составила 12,7 [8,5; 15,2] мКи. Цель лечения (гипотиреоз) была достигнута в 95% случаев после радиойодтерапии, в 100% случаев после субтотальной резекции щитовидной железы. Практически по всем шкалам опросника MOS SF-36 показатели качества жизни у больных после проведения радикального лечения были статистически значимо выше (р<0,05). Уровень тревоги через 12 месяцев после лечения был статистически значимо ниже (р<0,05), чем до лечения. Заключение. Вид радикального лечения не оказывает влияния на качество жизни, связанное со здоровьем. По сравнению с исходным тиреотоксикозом компенсированный гипотиреоз сопровождается значимо более высокими показателями качества жизни, связанного со здоровьем, и более низкими уровнями тревоги и депрессии.
Список литературы
1. Benker G, Reinwein D, Kahaly G, Tegler L, Alexander WD, Fassbinder J, Hirche H. Is there a methimazole dose effect on remission rate in Graves’ disease? Results from a long-term prospective study. The European Multicentre Trial Group of the Treatment of Hyperthyroidism with Antithyroid Drugs. Clin Endocrinol (Oxf). 1998;49(4):451-7.
2. Балаболкин МИ, Клебанова ЕМ, Креминская ВМ. Дифференциальная диагностика и лечение эндокринных заболеваний (руководство). М.: Медицина; 2002. (Balabolkin MI, Klebanova EM, Kreminskaya VM. [Differencial diagnosis and treatment of endocrine diseases (manual)]. Moscow: Meditsina; 2002. Russian).
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6. Pineda P, Michelsen H, Rivera M, Lillo R, Massardo T, Araya V, Sierralta P, Oviedo S, Liberman C. Treatment of hyperthyroidism with radioiodine: effects of administered dose on complications and thyroid function. Rev Med Chil. 2000;128(5):499-507.
7. Фадеев ВВ, Петрова НД. Из истории лечения тиреотоксикоза радиоактивным йодом в России. Проблемы эндокринологии. 1988;44(2):54. (Fadeev VV, Petrova ND. [From the history of thyreotoxicosis treatment with radioactive iodine in Russia]. Problemy endokrinologii. 1988;44(2):54. Russian).
8. Parle JV, Franklyn JA, Cross KW, Jones SC, Sheppard MC. Prevalence and follow-up of abnormal thyrotrophin (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol (Oxf). 1991;34(1):77-83.
9. Reinwein D, Benker G, Lazarus JH, Alexander WD. A prospective randomized trial of antithyroid drug dose in Graves’ disease therapy. European Multicenter Study Group on Antithyroid Drug Treatment. J Clin Endocrinol Metab. 1993;76(6):1516-21.
10. Surks MI, Schadlow AR, Stock JM, Oppenheimer JH. Determination of iodothyronine absorption and conversion of L-thyroxine (T 4) to L-triiodothyronine (T 3) using turnover rate techniques. J Clin Invest. 1973;52(4):805-11.
11. Huysmans DA, Corstens FH, Kloppenborg PW. Long-term follow-up in toxic solitary autonomous thyroid nodules treated with radioactive iodine. J Nucl Med. 1991;32(1):27-30.
12. Pauwels EK, Smit JW, Slats A, Bourguignon M, Overbeek F. Health effects of therapeutic use of 131I in hyperthyroidism. Q J Nucl Med. 2000;44(4):333-9.
13. Angusti T, Codegone A, Pellerito R, Favero A. Thyroid cancer prevalence after radioiodine treatment of hyperthyroidism. J Nucl Med. 2000;41(6):1006-9.
14. Ванушко ВЭ, Федак ИР. Гипотиреоз как исход хирургического лечения диффузного токсического зоба. Лечащий врач. 2005;(8):38-41. (Vanushko VE, Fedak IR. [Hypothyroidism as an outcome of surgical treatment of the diffuse toxic goiter]. Lechashchiy vrach. 2005;(8):38-41. Russian).
15. Berchtold R, Studer H, Teuscher J. Operative strategy in thyroid autonomy and Basedow hyperthyroidism. Langenbecks Arch Chir. 1985;366:51-4.
16. Miccoli P, Vitti P, Rago T, Iacconi P, Bartalena L, Bogazzi F, Fiore E, Valeriano R, Chiovato L, Rocchi R, Pinchera A. Surgical treatment of Graves’ disease: subtotal or total thyroidectomy? Surgery. 1996;120(6):1020-4.
17. Palit TK, Miller CC 3rd, Miltenburg DM. The efficacy of thyroidectomy for Graves’ disease: A meta-analysis. J Surg Res. 2000;90(2):161-5.
18. Farkas EA, King TA, Bolton JS, Fuhrman GM. A comparison of total thyroidectomy and lobectomy in the treatment of dominant thyroid nodules. Am Surg. 2002;68(8):678-82.
19. Forde I, Corgie D, Trainer PJ. Outcome at two years of fixed dose radioiodine treatment for thyrotoxicosis. Endocrine Abstracts. Proceedings of the 21st Joint Meeting of the British Endocrine Societies; 2002 April 8-11; Harrogate, UK. Poster 285.
20. Werga-Kjellman P, Zedenius J, Tallstedt L, Träisk F, Lundell G, Wallin G. Surgical treatment of hyperthyroidism: a ten-year experience. Thyroid. 2001;11(2):187-92.
21. Крылов ВВ, Гарбузов ПИ, Дроздовский БЯ, Олейник НА, Романко СИ, Гордеева МС, Власова ОП, Доля ОП, Матусевич ЕС, Клепов АН. Социально-психологические аспекты радионуклидной терапии и качество жизни больных тиреотоксикозом при лечении радиоактивным йодом. Фундаментальные исследования. 2007(12 Часть 2):289-90. (Krylov VV, Garbuzov PI, Drozdovskiy BYa, Oleynik NA, Romanko SI, Gordeeva MS, Vlasova OP, Dolya OP, Matusevich ES, Klepov AN. [Social-and-psychologic aspects of radionuclide therapy and the quality of life in patients with thyreotoxicosis treated with radioactive iodine]. Fundamental’nye issledovaniya. 2007(12 Pt 2):289-90. Russian).
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23. Bullinger M, Alonso J, Apolone G, Leplège A, Sullivan M, Wood-Dauphinee S, Gandek B, Wagner A, Aaronson N, Bech P, Fukuhara S, Kaasa S, Ware JE Jr. Translating health status questionnaires and evaluating their quality: the IQOLA Project approach. International Quality of Life Assessment. J Clin Epidemiol. 1998;51(11):913-23.
24. Fairclough D. Method of analysis for longitudinal studies of health-related quality of life. In: Quality of Life Assessment in Clinical Trials. Oxford – N.Y. – Tokyo: Oxford University Press; 1998. p. 227-47.
Almanac of Clinical Medicine. 2014; : 24-30
COMPARATIVE ANALYSIS OF THE EFFECT OF THE RADICAL TREATMENT OF DIFFUSE TOXIC GOITER ON THE INDICES OF THE HEALTH-RELATED QUALITY OF LIFE
https://doi.org/10.18786/2072-0505-2014-32-24-30Abstract
Background: Taking into account that many psychophysiological parameters directly depend on the severity and duration of pathological process and on the efficiency of treatment, investigations asessing remote results, health-related quality of life, and psychoemotional status of patients with a diffuse toxic goiter for a long time after radical treatment – are extremely urgent. Aim: To analyse the efficiency and safety of the radical methods of diffuse toxic goiter treatment, to compare the indices of the health-related quality of life, anxiety and depression levels depending on the kind of chosen methods of radical treatment. Materials and methods: A total of 71 patients with a diffuse toxic goiter were recruited into the study (37 patients who agreed radioiodine therapy, and 34 patients who underwent subtotal resection of the thyroid gland). Clinical examination, laboratory and instrumental analyses were carried out prior to and in 12 months after treatment. The questionnaire MOS SF-36 was used to estimate the health-related quality of life, Spillberg’s Anxiety Scale – to assess the levels of enxiety, and Beck Depression Inventory – to assess the level of depression. Results: In the group of radioiodine therapy, the median of therapeutic activity was 12.7 [8.5; 15.2] mKi. After radioiodine therapy, the aim of treatment (hypothyroidism) was achieved in 95% of cases, and in 100% of cases – after subtotal thyroid resection. The MOS SF-36 questionnaire showed that the indices of the health-related quality of life in patients became significantly higher, and the anxiety level in 12 months after treatment – significantly lower than those before treatment (р<0.05). Conclusion: The obtained results demonstrated the effectiveness of both methods used for treatment of Grave’s disease. The type of radical treatment made no difference. Compared with the initial thyrotoxicosis, compensated hypothyroidism in both cases was followed by a significantly higher quality of life and lower levels of anxiety and depression. It was also shown that people who received radical treatment, despite compensated hypothyroidism, overall, had lower quality of life, than those who did not have thyroid disease.
References
1. Benker G, Reinwein D, Kahaly G, Tegler L, Alexander WD, Fassbinder J, Hirche H. Is there a methimazole dose effect on remission rate in Graves’ disease? Results from a long-term prospective study. The European Multicentre Trial Group of the Treatment of Hyperthyroidism with Antithyroid Drugs. Clin Endocrinol (Oxf). 1998;49(4):451-7.
2. Balabolkin MI, Klebanova EM, Kreminskaya VM. Differentsial'naya diagnostika i lechenie endokrinnykh zabolevanii (rukovodstvo). M.: Meditsina; 2002. (Balabolkin MI, Klebanova EM, Kreminskaya VM. [Differencial diagnosis and treatment of endocrine diseases (manual)]. Moscow: Meditsina; 2002. Russian).
3. Dedov II, Mel'nichenko GA, Fadeev VV. Endokrinologiya: uchebnik. M.: Meditsina; 2000. (Dedov II, Mel’nichenko GA, Fadeev VV. [Endocrinology: textbook]. Moscow: Meditsina; 2000. Russian).
4. Ruchała M, Sowiński J, Dolata M, Junik R, Gembicki M, Skiba A. Radioiodine treatment of hyperthyroidism in patients with low thyroid uptake. Nucl Med Rev Cent East Eur. 2005;8(1):28-32.
5. Fadeev VV, Drozdovskii BYa, Guseva TN, Mel'nichenko GA, Buziashvili II, Garbuzov PI. Otdalennye rezul'taty lecheniya toksicheskogo zoba radioaktivnym 131I. Problemy endokrinologii. 2005;51(1):3-10. (Fadeev VV, Drozdovskiy BYa, Guseva TN, Mel’nichenko GA, Buziashvili II, Garbuzov PI. [Remote results of the toxic goiter treatment with 131I]. Problemy endokrinologii. 2005;51(1):3-10. Russian).
6. Pineda P, Michelsen H, Rivera M, Lillo R, Massardo T, Araya V, Sierralta P, Oviedo S, Liberman C. Treatment of hyperthyroidism with radioiodine: effects of administered dose on complications and thyroid function. Rev Med Chil. 2000;128(5):499-507.
7. Fadeev VV, Petrova ND. Iz istorii lecheniya tireotoksikoza radioaktivnym iodom v Rossii. Problemy endokrinologii. 1988;44(2):54. (Fadeev VV, Petrova ND. [From the history of thyreotoxicosis treatment with radioactive iodine in Russia]. Problemy endokrinologii. 1988;44(2):54. Russian).
8. Parle JV, Franklyn JA, Cross KW, Jones SC, Sheppard MC. Prevalence and follow-up of abnormal thyrotrophin (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol (Oxf). 1991;34(1):77-83.
9. Reinwein D, Benker G, Lazarus JH, Alexander WD. A prospective randomized trial of antithyroid drug dose in Graves’ disease therapy. European Multicenter Study Group on Antithyroid Drug Treatment. J Clin Endocrinol Metab. 1993;76(6):1516-21.
10. Surks MI, Schadlow AR, Stock JM, Oppenheimer JH. Determination of iodothyronine absorption and conversion of L-thyroxine (T 4) to L-triiodothyronine (T 3) using turnover rate techniques. J Clin Invest. 1973;52(4):805-11.
11. Huysmans DA, Corstens FH, Kloppenborg PW. Long-term follow-up in toxic solitary autonomous thyroid nodules treated with radioactive iodine. J Nucl Med. 1991;32(1):27-30.
12. Pauwels EK, Smit JW, Slats A, Bourguignon M, Overbeek F. Health effects of therapeutic use of 131I in hyperthyroidism. Q J Nucl Med. 2000;44(4):333-9.
13. Angusti T, Codegone A, Pellerito R, Favero A. Thyroid cancer prevalence after radioiodine treatment of hyperthyroidism. J Nucl Med. 2000;41(6):1006-9.
14. Vanushko VE, Fedak IR. Gipotireoz kak iskhod khirurgicheskogo lecheniya diffuznogo toksicheskogo zoba. Lechashchii vrach. 2005;(8):38-41. (Vanushko VE, Fedak IR. [Hypothyroidism as an outcome of surgical treatment of the diffuse toxic goiter]. Lechashchiy vrach. 2005;(8):38-41. Russian).
15. Berchtold R, Studer H, Teuscher J. Operative strategy in thyroid autonomy and Basedow hyperthyroidism. Langenbecks Arch Chir. 1985;366:51-4.
16. Miccoli P, Vitti P, Rago T, Iacconi P, Bartalena L, Bogazzi F, Fiore E, Valeriano R, Chiovato L, Rocchi R, Pinchera A. Surgical treatment of Graves’ disease: subtotal or total thyroidectomy? Surgery. 1996;120(6):1020-4.
17. Palit TK, Miller CC 3rd, Miltenburg DM. The efficacy of thyroidectomy for Graves’ disease: A meta-analysis. J Surg Res. 2000;90(2):161-5.
18. Farkas EA, King TA, Bolton JS, Fuhrman GM. A comparison of total thyroidectomy and lobectomy in the treatment of dominant thyroid nodules. Am Surg. 2002;68(8):678-82.
19. Forde I, Corgie D, Trainer PJ. Outcome at two years of fixed dose radioiodine treatment for thyrotoxicosis. Endocrine Abstracts. Proceedings of the 21st Joint Meeting of the British Endocrine Societies; 2002 April 8-11; Harrogate, UK. Poster 285.
20. Werga-Kjellman P, Zedenius J, Tallstedt L, Träisk F, Lundell G, Wallin G. Surgical treatment of hyperthyroidism: a ten-year experience. Thyroid. 2001;11(2):187-92.
21. Krylov VV, Garbuzov PI, Drozdovskii BYa, Oleinik NA, Romanko SI, Gordeeva MS, Vlasova OP, Dolya OP, Matusevich ES, Klepov AN. Sotsial'no-psikhologicheskie aspekty radionuklidnoi terapii i kachestvo zhizni bol'nykh tireotoksikozom pri lechenii radioaktivnym iodom. Fundamental'nye issledovaniya. 2007(12 Chast' 2):289-90. (Krylov VV, Garbuzov PI, Drozdovskiy BYa, Oleynik NA, Romanko SI, Gordeeva MS, Vlasova OP, Dolya OP, Matusevich ES, Klepov AN. [Social-and-psychologic aspects of radionuclide therapy and the quality of life in patients with thyreotoxicosis treated with radioactive iodine]. Fundamental’nye issledovaniya. 2007(12 Pt 2):289-90. Russian).
22. Novik AA, Ionova TI. Rukovodstvo po issledovaniyu kachestva zhizni v meditsine. M.: Olma Media Grupp; 2007. (Novik AA, Ionova TI. Manual on studying the quality of life in medicine. Moscow: Olma Media Grupp; 2007. Russian).
23. Bullinger M, Alonso J, Apolone G, Leplège A, Sullivan M, Wood-Dauphinee S, Gandek B, Wagner A, Aaronson N, Bech P, Fukuhara S, Kaasa S, Ware JE Jr. Translating health status questionnaires and evaluating their quality: the IQOLA Project approach. International Quality of Life Assessment. J Clin Epidemiol. 1998;51(11):913-23.
24. Fairclough D. Method of analysis for longitudinal studies of health-related quality of life. In: Quality of Life Assessment in Clinical Trials. Oxford – N.Y. – Tokyo: Oxford University Press; 1998. p. 227-47.
