Application of complex immunomodulatory therapy in treatment of nodular goiter
Abstract
Keywords:nodular goiter, immunodeficiency, intestinal dysbiosis, micronutrients deficiency, treatment methods
Nodular goiter (NG) is clinical term, including colloid goiter, adenoma and malignant thyroid neoplasm, is widespread as well as in iodine-deficient areas and in regions of iodine excess. Nodular goiter is 5–10-fold more common in women, it is more prevalent in elderly, and in population of regions of radioactive contamination. There are different methods of patients with NG management: watchful waiting, surgical and conservative treatment, therapy with iodine 131, alternative methods (alcohol ablation, interstitial laser coagulation). There is no the consensus approach of endocrinologists and surgeons in indications of operation and its extension, and in alternative methods application in this pathology. Currently watchful waiting is method of choice in patients with NG without thyroid dysfunction (RAE, 2004; ATA, ААСЕ, 2006). However, generally in NG cases is observed slow multinodular thyroid enlargement. For that reason there is now consensus in many questions of treatment, and patient surveillance approaches is the choice of the doctor. In patients with NG statistically it is more common nodular abnormalities of other sites: colonic polyps, hysteromyoma, nodal mastopathy, gastric polyps, that, possible point to single pathogenesis of these diseases - immunodysfunction. Therewith, was pointed high prevalence of NG in regions of radioactive contamination, that first affects immune system of the body. Was established the depletion of T-helpers and cytotoxic cells In schoolchildren living in territories are adjacent to areas are contaminated after the Chernobyl accident. In patients which underwent surgery for NG, and which have relapse of NG, despite appropriate thyroid hormone substitutive therapy with levothyroxin, was pointed Тh1- и Тh2-cells depletion. One of the effects of Т-cells is activity against neoplasma. In trials of immunomodulators (imunofan, cycloferon) was pointed on positive effect. There is deficiency of antioxidant substances: vitamins and microelements (selenium, vitamins А, В, folates, zinc, ferrum, ascorbic acid etc.) in patients with NG, that have an immunosupressive effect. Various study works proved that combined therapy with selenium, vitamin A, ferrum and zinc have the advantage against iodine monotherapy. Micronutrients deficiency and immune disorders are able to be attributed to intestine properties, its microflora acts in synthesis and absorption of vitamins, suppressing pathogenic flora growth, as well as lymphoid tissue of intestine is origin of immune cells of the body. Numerous studies proved positive effect of bifidobacterial cell wall on immune response.
Conclusions: immune system condition is critical to pathogenesis of NG, and treatment have to be complex and directed to different components of immune system. It is reasonable to use micronutrients, immunomodulators and agents to restore normal intestinal flora.