Comprehensive treatment of patients with autoimmune thyroiditis using laser technologies

Abstract

Background. The frequency of autoimmune thyroiditis reaches up to 40% among all thyroid gland diseases and ranks second among endocrinological diseases.

Aim. Carrying out a comparative evaluation of the effectiveness of laser photodynamic therapy and traditional conservative treatment in diffuse form of autoimmune thyroiditis.

Material and methods. The work is based on the examination and treatment data of 235 patients hospitalized in the Scientific Center of Surgery named after M.A. Topchubashov for the period from 2008 to 2021. Patients were divided into two groups based on the applied methods of treatment. Patients of the main group (106 people, 45.1%) received sessions of laser photodynamic therapy in combination with intravenous laser blood irradiation with low-intensity laser radiation. Patients in the control group (129 people, 54.9%) received a course of conservative therapy in combination with sessions of intravenous laser blood irradiation with low-intensity laser radiation. To test the statistical significance of differences in the concentrations of thyroid hormones, pituitary gland and antibodies to thyroid tissues in the blood serum of patients before and on the 15th day after treatment, Pearson's χ2 test was used. In each group, the mean values of the analyzed clinical parameters, their mean error (±m), 95% confidence interval, and the significance of intergroup differences were calculated according to Pearson's χ2, Mann–Whitney U, and Student's t criteria. Differences were considered statistically significant at p <0.050.

Results. In the main group on the 5th day of treatment, normalization of the main indicators of the inflammatory response occurred in 26 (24.5%) patients, in the control group — in 16 (12.4%) patients (χ2=5.9, p=0.010). In patients of the main group, the levels of antibodies to thyroperoxidase on the 15th day after treatment, compared with their values before treatment, decreased by 5.65 times (t=8.4, p ≤0.001), the content of thyroid-stimulating hormone decreased by 2.18 times (t=6.9, p ≤0.001), free thyroxine increased 2 times (t=3.4, p ≤0.01), free triiodothyronine increased 1.71 times (t=1.4, p ≥0.05). The average values of antibodies to thyroperoxidase in the main group after treatment were within the normal range (31.57±5.75 IU/ml).

Conclusion. The use of laser photodynamic therapy provides the best results in the treatment of patients with diffuse autoimmune thyroiditis.

Keywords

autoimmune thyroiditis / lymphocytic infiltration / laser photodynamic therapy

References

[1] Rozhko VA. Current state of the autoimmune thyroiditis problem. Health and ecology issues. 2019;(2):4–13. (In Russ.)

[2] Рожко В.А. Современное состояние проблемы аутоиммунного тиреоидита. Проблемы здоровья и экологии. 2019;(2):4–13. EDN: ZBMLRM.

[3] Boldyreva YV, Lebedev IA, Kruchinin EV, Alekberov RI, Tarasov DO, Tyapkin AV, Kozlov MV, Akhmetianov MA, Lukashenok AV, Mokin EA, Fidomatova ZSh. A unified approach to patient management with autoimmune thyroiditis (literature review). Uralskiy meditsinskiy zhurnal. 2019;(7):110–113. (In Russ.) DOI: 10.25694/URMJ.2019.07.25.

[4] Болдырева Ю.В., Лебедев И.А., Кручинин Е.В., Алекберов Р.И., Тарасов Д.О., Тяпкин А.В., Козлов М.В., Ахметьянов М.А., Лукашенок А.В., Мокин Е.А., Фидоматова З.Ш. Единый подход к ведению пациентов с аутоиммунным тиреоидитом (обзор литературы). Уральский медицинский журнал. 2019;(7):110–113. DOI: 10.25694/URMJ.2019.07.25.

[5] Menkov AV. Surgical treatment of autoimmune thyroiditis. Modern technologies in medicine. 2011;(2):103–105. (In Russ.)

[6] Меньков А.В. Хирургическое лечение аутоиммунного тиреоидита. Современные технологии в медицине. 2011;(2):103–105. EDN: NXTLJT.

[7] Samsonova AM, Levin AV, Gavrilova NA. Computer reflexotherapy in the rehabilitative treatment of patients with chronic autoimmune thyroiditis, hypothyroidism. Vestnik novykh meditsinskikh tekhnologiy. Elektronnyy zhurnal. 2016;(4):159–164. (In Russ.)

[8] Самсонова А.М., Левин А.В., Гаврилова Н.А. Компьютерная рефлексотерапия в восстановительном лечении пациентов с хроническим аутоиммунным тиреоидитом и гипотиреозом. Вестник новых медицинских технологий. Электронный журнал. 2016;(4):159–164. EDN: XGRQQB.

[9] Kim KW, Park YJ, Kim EH, Park SY, Park DJ, Ahn SH, Park DJ, Jang HC, Cho BY. Elevated risk of papillari thyroid cancer in Korean patients with Hashimoto’s thyroiditis. Head Neck. 2011;33(5):691–695. DOI: 10.1002/hed.21518.

[10] Ryabchenko EV, Shipkova IN. Indications for surgical treatment of patients with a diagnosis of “autoimmune thyroiditis with nodulation”. Kubanskiy nauchnyy meditsinskiy vestnik. 2012;(1):141–144. (In Russ.)

[11] Рябченко Е.В., Шипкова И.Н. Показания к хирургическому лечению пациентов с диагнозом «аутоиммунный тиреоидит с узлообразованием». Кубанский научный медицинский вестник. 2012;(1):141–144. EDN: OWZAMV.

[12] Nikonova LV, Davydchik EV, Tishkovskiy SV, Gadomskaya VI. Thyroid disease and pregnancy. Part I. Autoimmune thyroiditis, hypothyroidism, thyrotoxicosis in pregnancy: modern methods of diagnosis and treatment. Journal of the Grodno State Medical University. 2016;(1):82–87. (In Russ.)

[13] Никонова Л.В., Давыдчик Э.В., Тишковский С.В., Гадомская В.И. Заболевания щитовидной железы и беременность. Часть I. Аутоиммунный тиреоидит, гипотиреоз, тиреотоксикоз при беременности: современные принципы диагностики и лечения. Журнал Гродненского государственного медицинского университета. 2016;(1):82–87. EDN: VSKSRZ.

[14] Titova LYu. Laser therapy of the thyroid gland in the autoimmune thyroiditis in women with menstrual disorders. Laser medicine. 2016;20(3):73. (In Russ.)

[15] Титова Л.Ю. Лазеротерапия щитовидной железы при аутоиммунном тиреоидите у женщин с нарушением менструального цикла. Лазерная медицина. 2016;20(3):73. EDN: WTRYGL.

[16] Shidlovskyi VA, Shidlovskyi AV, Sheremet VI, Tverdokhlib VI. Hashimoto’s thyroiditis — a therapeutic or surgical problem? (literature review). International Journal of Endocrinology. 2020;16(3):245–250. (In Russ.) DOI: 10.22141/2224-0721.16.3.2020.205274.

[17] Шидловский В.А., Шидловский А.В., Шеремет В.И., Твердохлеб В.И. Тиреоидит Хашимото — терапевтическая или хирургическая проблема? Международный эндокринологический журнал. 2020;16(3):245–250. DOI: 10.22141/2224-0721.16.3.2020.205274.

[18] Ghorbani J, Rahban D, Aghamiri S. Photosensitizers in antibacterial photodynamic therapy: An overview. Laser Ther. 2018;27(4):293–302. DOI: 10.5978/islsm.27_18-RA-01.

[19] Stranadko EPh, Malova TL, Volgin VN, Ryabov MV. Laser photodynamic therapy — a new medical technology for treating skin cancer at “uncomfortable” critical locations. Laser medicine. 2016;20(4):5–8. (In Russ.)

[20] Странадко Э.Ф., Малова Т.И., Волгин В.Н., Рябов М.В. Лазерная фотодинамическая терапия — новая медицинская технология лечения рака кожи «неудобных» критических локализаций. Лазерная медицина. 2016;20(4):5–8. EDN: XHDQEV.

[21] Radjabov AA, Derbenev VA, Ismailov GI, Spokoiny AL. Antibacterial photodynamic therapy of purulent wounds in soft tissues. Laser medicine. 2017;21(2):46–49. (In Russ.)

[22] Раджабов А.А., Дербенев В.А., Исмаилов Г.И., Спокойный А.Л. Антибактериальная фотодинамическая терапия мягких тканей. Лазерная медицина. 2017;21(2):46–49. EDN: ZBKGRZ.

[23] Tolstykh PI. Teoreticheskie i prakticheskie aspekty fotodinamicheskoy terapii ran razlichnogo geneza. Prolegomeny. (Theoretical and practical aspects of photodynamic therapy of wounds of various origins. Prolegomena.) Tolstykh PI, editor. Moscow: Altair; 2012. p. 247–249. (In Russ.)

[24] Толстых П.И. Теоретические и практические аспекты фотодинамической терапии ран различного генеза. Пролегомены. Под ред. П.И. Толстых. М.: Альтаир; 2012. c. 247–249.

[25] Aristarkhov RV, Aristarkhov VG, Puzin DA, Ugolnikova EV. Comparative aspects of traditional therapy and laser therapy for the treatment of subacute thyroiditis de quervain. Laser medicine. 2016;20(4):19–24. (In Russ.)

[26] Аристархов Р.В., Аристархов В.Г., Пузин Д.А., Угольникова Е.В. Сравнительные аспекты традиционной терапии и применения лазера для лечения подострого тиреоидита де Кервена. Лазерная медицина. 2016;20(4):19–24. EDN: XHDQGT.

[27] Li A, Liang C, Xu L, Wang Y, Liu W, Zhang K, Liu J, Shi J. Boosting 5-ALA-based photodynamic therapy by a liposomal nanomedicine through intracellular iron ion regulation. J Acta Pharm Sin B. 2021;11(5):1329–1340. DOI: 10.1016/j.apsb.2021.03.017.

[28] Stranadko EF, Kuleshov IYu, Karakhanov GI. Photodynamic effect on pathogenic microorganisms. Laser medicine. 2010;14(3):52–56. (In Russ.)

[29] Странадко Е.Ф., Кулешов И.Ю., Караханов Г.И. Фотодинамическое воздействие на патогенные микроорганизмы. Лазерная медицина. 2010;14(3):52–56.

RIGHTS & PERMISSIONS

Eco-Vector