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How can patients with hypothyroidism manage themselves at home during extraordinary times?

Time:2022-12-08 07:49:59 source:psychiatricethics.com author:Emergency treatment Read:533次
How can patients with hypothyroidism manage themselves at home during extraordinary times?

At the beginning of 2020, the sudden outbreak of new coronary pneumonia put people all over the country in this "war epidemic". The prevalence of hypothyroidism (referred to as hypothyroidism) in the population is as high as about 6%. A large number of patients with hypothyroidism are isolated at home and cannot go to the hospital on time. They also start to feel anxious... Patient: Doctor, I What should I do if I dare not go out to the hospital for a follow-up consultation? Doctor: Don't worry, relatively speaking, hypothyroidism is a chronic disease that is easy to learn to self-manage. There is a lot of knowledge below. During the epidemic, I will collect it and read it slowly. Know yourself and the enemy, and you will not be in danger in a hundred battles, so don’t be afraid! About hypothyroidism Hypothyroidism is a common disease of the endocrine system caused by the reduction of thyroid hormone synthesis and secretion, which leads to a decrease in the body's metabolism. The main causes are Hashimoto's thyroiditis, hyperthyroidism after 131 iodine treatment, hyperthyroidism or thyroid tumor resection, and subacute thyroiditis. The main clinical symptoms are: body edema, dry skin, lethargy, indifference, fear of cold, muscle pain, abdominal distension, constipation, etc. Laboratory tests show a decrease in thyroid hormone levels and an increase in thyrotropin (TSH). The main treatment method for hypothyroidism is oral supplementation of thyroxine. In clinical practice, L-T4 (levothyroxine sodium tablets) is commonly used (the trade names of commonly used drugs in clinical practice include German-made Euthyrox or Ratis, and domestically produced Jiaheng). Wait). Levothyroxine (L-T4) is a synthetic thyroxine, which is the same as the thyroxine molecules secreted by the human body, and generally has no obvious side effects. The half-life of thyroxine in the human body is about 7 days, and it does not reach a stable blood concentration until 4 to 6 weeks after taking the drug. Levothyroxine sodium tablet is one of the most prescribed drugs in pharmacies in the world. Side effects are rare, but its dosage adjustment is very important. If the dosage is too small or too much for a long time, it will cause certain harm to the human body. There are many factors that affect the efficacy of thyroxine, such as food or drugs in the gastrointestinal tract, stomach problems, pregnancy, and weight changes. Pay attention to the following points when taking the medicine: 1. The time of taking the medicine shows that the blood concentration of levothyroxine sodium tablets rises the fastest within 90 minutes of fasting, and reaches the peak within 2 hours. Therefore, in order to achieve an ideal state, and according to the day and night of thyroxine secretion Due to rhythm changes, it is recommended that the best time to take the medicine is 60 minutes before breakfast, before going to bed at night (3 hours after dinner), and 30 minutes before breakfast.
  • Due to the long half-life of thyroxine, it is recommended to take the daily dose in one go.
  • If the patient is elderly, in order to reduce the stimulation of the drug to the heart, it can be taken in divided doses.
  • Infants and young children with hypothyroidism can mash the tablet with a small amount of boiled water to make a suspension, and then take it with an appropriate amount of boiled water.
2. Treatment of missed doses: Occasionally missed doses will not cause obvious discomfort. You can make up for them at any time of the day. You can take the original dose from the next day. Double your medication. Do not miss the dose often, it will cause the blood concentration in the body to be substandard and affect the therapeutic effect. Especially in patients with thyroid cancer after surgery, if repeated hypothyroidism, TSH (thyrotropin) increases, which can easily stimulate the growth of tumor cells. 3. Influence of food or drugs Levothyroxine sodium tablets are mainly absorbed in the small intestine. Some drugs and food will affect its absorption. It is best to leave enough time: more than 1 hour between tonics; with milk, beans, high-fiber Foods should be separated by more than 3 hours. More than 1 hour between vitamins and high blood pressure drugs; more than 2 hours between iron and calcium drugs; more than 3 hours between gastric drugs such as aluminum hydroxide, aluminum-magnesium plus suspension; and protons such as omeprazole More than 4 hours between pump inhibitors; more than 12 hours between cholestyramine or lipid-lowering resins. 4. Influence of combined gastrointestinal diseases L-T4 is a sodium salt, which is mainly absorbed in the small intestine. Compared with endogenous T4, it is more hydrophilic and less lipophilic. It is not completely dissolved in the environment of reduced gastric acid, which can lead to Reduced intestinal absorption. Therefore, in patients with hypothyroidism combined with Helicobacter pylori infection or atrophic gastritis, gastric acid secretion is insufficient, and the dose of L-T4 may need to be appropriately increased. 5. Taking levothyroxine during pregnancy and lactation is the same as the thyroxine secreted by the human body. L-T4 can be taken during pregnancy without affecting fetal development. If the condition requires that the drug should not be stopped on its own, the dose during pregnancy may even be increased by 30% compared to usual. Postpartum lactating mothers can also continue to take it with confidence, because the amount of L-T4 excreted through breast milk is small enough to cause abnormal thyroid function in the baby. Regarding the re-examination during the epidemic, the re-examination can be postponed, so there is no need to panic. 1. It is not required to draw blood on an empty stomach. Whether taking medicine before blood drawing will not affect the level of TSH. 2. Frequency of re-examination: Due to the supplementation of exogenous thyroid hormones, it takes 4-6 weeks to re-establish the balance of the hypothalamus-pituitary-thyroid axis. Therefore, the general re-examination interval should not be shorter than one month. Thyroid function should be reviewed every 1 to 2 months after the initial diagnosis of hypothyroidism. Once the therapeutic target value is reached, the dose can be reviewed once every six months or even once a year. If you stop taking the medicine for a period of time for various reasons and then restart the medicine, it is best to recheck the thyroid function after 4 to 6 weeks to adjust the dosage. There are multiple brands of levothyroxine sodium tablets for dressing changes, and it is recommended to maintain the same brand for a long time. If there is a shortage of medicine during the epidemic, try to review the thyroid function 4 to 6 weeks after changing the medicine and adjust the dosage to ensure that the TSH value reaches the standard. Regarding the dosage of hypothyroidism, the supplement of thyroxine is "how much is missing, how much is made up". Usually, the doctor will adjust the dose according to the patient's thyroid function and clinical symptoms, and the patient cannot change or stop the drug by himself. For patients with thyroid cancer after surgery, the dose of thyroxine usually needs to be increased. The goal is to reduce TSH to the lower limit of the normal range or even to a state of mild hyperthyroidism (also known as thyroxine suppression therapy), which is beneficial to inhibit tumor cells. grow. Most patients with thyroid cancer should preferably control TSH 0.1-0.5mU/L, and a few high-risk patients should control TSH <0.1mU/L. (Specific guidance by a professional doctor) The general adult dosage is 2 μg/kg body weight. Day, for the elderly or/and patients with severe hypothyroidism, the supplementation of thyroxine needs to start from a lower dose and supplement it slowly. A little explanation for the "artificial factors" of discontinuing L-T4 before iodine-131 treatment in patients with differentiated thyroid cancer: 1. It is necessary to stop taking thyroxine for 2 to 4 weeks before taking iodine treatment. Thyroid follicles after TSH increases to a certain extent Only cells can effectively absorb iodine 131 to achieve therapeutic effect. 2. Patients who have stopped taking iodine-131 therapy before the outbreak of the epidemic cannot be hospitalized on time and must continue taking thyroxine tablets as soon as possible, waiting for the next notification from the hospital for the time to stop taking the medicine. 3. For patients who have recently stopped taking the medicine, if they can be hospitalized at the appointment time, the epidemiological history of new coronary pneumonia should be excluded first, and protective measures should be taken. 4. For patients who are planning to receive iodine 131 treatment and have not yet reached the stopping time, if they cannot be hospitalized on time in the near future, it is recommended to contact the hospital as soon as possible to delay the treatment time. About diet and nutrition 1. Ensure protein intake: The gastrointestinal function of patients with hypothyroidism will decrease, which will cause poor digestion and absorption of protein. 2. Limit fat and cholesterol: Hypothyroidism can lead to disorder of fat metabolism in the body, which is prone to hypertriglyceridemia and hypercholesterolemia. 3. Pay attention to iron supplementation: The iron absorption capacity of patients with hypothyroidism is decreased, which may further aggravate the tendency of anemia. 4. It is advisable to reduce salt and avoid salty: too much salt intake will cause water and sodium retention in the body, aggravating edema. 5. Eat more foods rich in dietary fiber: patients with hypothyroidism are prone to constipation and abdominal distension due to slowed gastrointestinal motility. They can eat more various grains, sweet potatoes, fresh vegetables and fruits, etc. 6. Generally, there is no need to specially supplement iodine. When Hashimoto's thyroiditis is complicated with hypothyroidism, a low-iodine diet should be used as much as possible to prevent autoimmunity from aggravating and destroying thyroid cells. References 1. Teng Weiping. Modern progress in the diagnosis and treatment of thyroid diseases [J]. Chinese Journal of Practical Internal Medicine, 2019, 4:311-315.2. Li Xiaoyi, Zhang Bo, Lin Yansong. Guidelines for the diagnosis and treatment of thyroid nodules and differentiated thyroid cancer in adults (2015 US Interpretation of Thyroid Association)[J].Chinese Journal of Otolaryngology Head and Neck Surgery, 2017, 52(4):309-315.3. Mackenize EJ, Mortimer RH. Thyroid nodule and thyroid cancer[J]. MJA, 2004, 180: 242-247 . Author: Liao Ning, Department of Nuclear Medicine, Second Affiliated Hospital of Guangxi University of Science and Technology Review: Lu Keyi, Department of Nuclear Medicine, First Hospital of Shanxi Medical University Note: Image source Network There are many people, you are welcome to contribute to the Chinese Medical Science Popularization Platform: [email protected] and forward our works. You can leave a message to get in touch with us.

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