After operation in occasion of a nodal struma

[Elena Jurevna]

Hello, the doctor! To me-35 years. Two weeks ago to me scheduled operation in occasion of nodal struma SHCHZH (gemitireoidektomija at the left with an isthmus) has been spent. One of factors in favour of operative treatment was my family anamnesis: at mum of 7.5 years back follicular cancer 2 oh degrees and at me-absence of positive dynamics or changes at treatment L-by a thyroxine within 4 years and my intention to plan pregnancy. After operation to me have told or said, that I had in n/ adenomatous 1.5 site sm in a capsule (also it is written down in an extract which to me today have given out on an arm or a hand, in the column the MACROPREPARATION). The Same conclusion was and on a picture of US. Further, in an extract the conclusion of the histologist is written: a lion. A share - 0.9 sites and 0.7 sm in diameter, have a structure of a micromacrofollicular struma; in extranodal tissue SHCHZH - the diffusive or diffuse fibrosis expressed hr. A thyroiditis. The extract to me was given by I doctor and to ask there was nobody.

First, I have not understood, what at me actually was - an adenoma or simply site and more why the histologist has specified two sites, on US in fact there was one? I feel now well, I accept a L-thyroxine 50.

When it is possible to start to plan pregnancy after operation?

Also what, except for massage of cicatrix, it is recommended during the regenerative period?

Can, any regenerative complex?

Excuse for set *quot; ?N?O*quot;.

Thankful in advance for the answer.







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[Melnichenko]

Dear Elena Jurevna!

We will not manage to solve on distance a problem of histological structure or frame of sites - the term in the theory should speak an adenomatous struma that there was a nodal colloid struma with the expressed proliferation. We hope, what exactly this sense put also by the histologist in the conclusion. Possibly, two sites have been close located and perceived as one, in the theory it would be interesting to know, whether both of the small site had the identical histological characteristic.

Let's leave in the party or side (for you personally) that circumstance, that otjagoshchennyj the family anamnesis on a follicular cancer is not the absolute indication to operation and we shall consider or examine;survey the fact of the occured or happened operation as blago-you planned pregnancy, and in our edges or territories doctors very quiveringly concern to pregnancy with sites.

Where other circumstance - how to provide prophylaxis of relapse of a nodal colloid struma (the adenoma in the theory does not recur, nodal kolloidnyj-naturally recurs, time we imeeem the happiness to live in iododefitsitnyh regions) is more important.

And so, an output or exit from this position - to prepare on iodirovannoj for the salts, most to receive an iodide of a potassium of 200 mkg.

Even more important - and how the gland works? By the description (a fibrosis around of sites) as though was not dekompensirovannogo gipotiroza. Time there have passed or there have taken place 2 weeks after operation, it is meaningful to look or see over 4 (in day of delivery of a blood on over 4 to accept a thyroxine AFTER delivery of the analysis).

The factor limiting your pregnancy is indemnification gipotiroza - gipotiroz is compensated, become pregnant, please.

During pregnancy the dose of a thyroxine increases usually or is usually enlarged, control TTG, ATTRO, over 4 on 8-12 week.

[Elena Jurevna]

Hello, the dear professor!

I wish to express you the gratitude for the operative and substantial answer. As soon as you have enough patience and opportunities at your employment to give our problems so much attention! It is obvious, that you very sensitive, sympathetic person, and the expert very competent. You are the present or true DOCTOR! Thanks once again.

At me still a small question: whether tell or say, please, operation on menstr.tsikl can on SHCHZH affect or influence. Monthly send or have come in time, for 28 day, but for a week the bottom of a stomach or belly, lomilo a loin (it is usual, such does not happen) strongly hurted or was ill;was sick, and for 25 day were insignificant smearing allocation. At the gynecologist and on US was the last month then handed over all analyses. Pathologies have not revealed.

Thanks for the answer.

[Melnichenko]

Elena Jurevna, spsibo, is glad, that I can help or assist YOU - also because Dnepropetrovsk not another's city for me.

In itself operation quite often breaks cyclic activity of ovaries, but it is important to consider still possible or probable essential change of a level tiroidnyh hormones. T.e in practice the decision of a problem in the following-control over 4, decision-making on change of a dose of a thyroxine if it will be necessary, in 2 months from the moment of change of a dose - control ttg.otklonjajushchiesja over norm or rate levels over 4 and TTG can become the reason and disturbances of a cycle (though, it is probable, a little bit less often, than we have got used to think).

[Elena Jurevna]

Galina Afanasevna! First of all excuse, that has addressed to you, as to the man - *quot; road OoN??O*quot; (itself I do not know, why).

Question at me such: whether it is possible for the child of 9 years to give widely at us advertised or promoted jodomarin? If yes, whether that needs to be seen a doctor or made before it or this US (2 years ago in kardiotsentre we passed or took place US shchitovidki - all was in norm or rate).

Thanks for the answer.

.S.. The phrase, that Has touched Dnepropetrovsk for you - not another's city. In this connection, it would be desirable to tell or say, that if something will be necessary in Dnepropetrovsk, can be execute any assignment or order, can count on my help.

[Melnichenko]

Ukraine concerns to regions with iodnym deficiency (longly to tell why the list of these regions is expanded in comparison about from time to time USSR). With the purpose of prophylaxis of development iododefitsitnyh diseases to people of all age at cooking recommend to use instead of usual salt iodirovannuju (salt in this case - the carrier or bearer of an iodine), and to children, pregnant, feeding in addition to use or preparations of an iodine (special vitamins C an iodide of a potassium, a potassium an iodide, an iodide, iodomarin - in the latter case a German preparation of a potassium the iodide specially for the Russian market is named beautifully iodomarinom that reminded alimentary additives) Preliminary researches are not necessary, surveys vrachej-within the limits of routine inspections as a whole. Details - on site Tironet for patients.

[introuble]

And to me spoke what enough to smear ranki with an iodine and if you want it is simple vermja from vermeni to grease neboshoj a site kozhy with an iodine and all.

[Melnichenko]

Alas, greasing of a skin by an iodine cannot be a method of prophylaxis iododefitsitnyh statuses.

Problem in that the person should proluchat daily very small doses of an iodine - during novorozhdennosti nearby 90 (microgram, t.e a thousand share of a milligram which, in turn, is a thousand share of gram which..., etc.), during pregnancy and feeding - 200 mkg, in a usual life - 150 mkg, in advanced age - 150 mkg.

With our usual delivery we receive in Moscow roughly 50 mkg-80 mkg of an iodine, that quite dostaochno to not have obvious attributes of shortage of an iodine, a struma and a cretinism (see a picture from the school textbook - *quot; a cretin from the Alpes, 1899 and quot;) .kak it manages to be made?



The thyroid gland increases or enlarges quantity or amount of cells (hyperplasia), their quality (hypertrophy) changes, the volume of a gland changes, sites are formed.... And cells of these sites and strive to grasp more iodine, and inside of sites is postponed much - a lot of colloid..

The problem is aggravated, if the woman is pregnant or feeds, she should divide an iodine for two - into herself and the child.



And here the iodine already can elementary not suffice even on synthesis of hormones - for a cortex of a brain of the child. That is why intellectual factor of the faces which have born in region where there is a shortage of an iodine even average gravity, on the average on 10 items or points below, than in region with normal rasperedeleniem an iodine.



And now let's talk about greasing a skin by an iodine. You can grease a skin of 3 or 5 % O-rum of an iodine. That these percent or interests mean are means, that in 100 ml a solution - 3 grams of an iodide of a potassium (if r-O three-percent - or 5, if 5 %), in 10 ml (it is a teaspoon) - 300 mg, in 1 ml-30 mg. 1 0, 5 ml is and there is that quantity or amount, which uzodit on vatku with which you will grease a skin (ranku). Quantity or amount of the smeared iodine of 30 mg-15 mg, ..30000 - 15000, t.e.v 200-100 times more, than daily need or requirement (150 mkg). The percent or interest of the soaked up iodine can be very great, but, estestevenno, kolebletsja.

Fortunately, protective systems usually reliably work - kidneys will deduce or remove and so forth

Besides at healthy people works so-called effect Volffa - CHajkova, and at izbytkae an iodine of iron simply blocks its or his entering.

Overwhelming majority of people the friend will easy sustain advice or councils of yours, and, bringing, on kind Russian custom, rats. Offers in the reference the CART, begin to smear everything, that is possible, thus not realizing, that run on red light....

Swisses and the Austrians, nprm., from the beginning of 20 centuries iodirujut salt, and now, instead of pictures *quot; a cretin from C?y*quot; we can hang out a photo of 16 years or summer champions in mountain skiing from Switzerland....



But I have distracted. And so, the majority will sustain.. And diseases of a thyroid gland at such method of prophylaxis can arise at elderly, at relatives of patients with Bazedovoj illness or disease and gipotirozom. m.b., at novorozhdennnyh...



Well and now mine vopros-tell or say, and why advice or council to grease a skin periolicheski has seemed to you more comprehensible, than r to cook food on iodirovannoj salts (instead of usual) _?

[introuble]

Well and now mine vopros-tell or say, and why advice or council to grease a skin periolicheski has seemed to you more comprehensible, than r to cook food on iodirovannoj salts (instead of usual) _?



The doctor, in no event to me so not pokazolos. It is not pleasant to easier me, that some (many) companies let out or release products, medicines, vitamin complexes which cost or stand decently or considerably, but effect from which it is no more than from medicines or food stuffs which we have got used to see on counters of drugstores already, maybe, not one decade. In this case I meant jodomarin. And against jodirovannoj salt I have nothing.

[Melnichenko]

Iodides with the preventive purpose can be applied to the adult person only during pregnancy \ feedings (details on tironete), prophylaxis at other adults is carried out by means of iodirovannoj salts. TREATMENT at the adults operated in occasion of a nodal colloid struma, also should include iodides.

The industry of the USSR let out or released an iodide of a potassium in the form of an antistrumin - unfortunately, in a tablet was a lot of iodide kalija-1000 mkg - and to split up for 4 parts not too reliably.. I.e. the problem of dearness could be solved, if release of a domestic iodide of a potassium in the necessary dosage has been renewed. As it was found out, to work this not so simply.... The Prices for medicines in other countries differ from ours - alas, as well as the salary...