#1
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Ïëàçìàôåðåç ïðè çàáîëåâàíèÿõ ùèòîâèäíîé æåëåçû
Óâàæàåìûå êîëëåãè, õîòåëîñü áû ïîëó÷èòü êîìïåòåíòíîå ìíåíèå ïî ïîâîäó ïðîâåäåíèÿ ïëàçìàôåðåçà ïðè ïàòîëîãèè ùèòîâèäíîé æåëåçû( Ãèïîòèðåîç, Òèðåîòîêñèêîç, íîñèòåëüñòâî àíòèòåë ê òêàíè ùèòîâèäíîé æåëåçû). Îáîñíîâàííîñòü íàçíà÷åíèÿ äàííîé ïðîöåäóðû, ïîêàçàíèÿ, ïðîòèâîïîêàçàíèÿ.
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#2
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ïëàçìàôåðåç ìîæåò èçðåäêà ïðèìåíÿòüñÿ ïðè îñòðîì òèðîòîêñèêîçå, êîãäà íåîáõîäèìî áûñòðî äîñòè÷ü åóòèðîèäíîãî ñîñòîÿíèÿ ïî æèçíåííûì ïîêàçàíèÿì, êîòîðîå íå óäàåòñÿ äîñòèãíóòü ìåäèêàìåíòîçíî:
When clinical deterioration occurs in thyroid storm, despite the use of all of these medications, removal of thyroid hormone from circulation would be a therapeutic consideration. Plasmapheresis, charcoal hemoperfusion, resin hemoperfusion, and plasma exchange have been found to be effective in rapidly reducing thyroid hormone levels in thyroid storm [61–63]. Thyrotoxicosis and Thyroid Storm [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#3
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Âàäèì Âàëåðüåâè÷, ñïàñèáî çà îòâåò.
Ìîè êîëëåãè óòâåðæäàþò, ÷òî ïëàçìàôåðåç îêàçûâàåò ïîëîæèòåëüíîå âëèÿíèå íà êîëè÷åñòâî àíòèòåë, îíè èõ òàêèì îáðàçîì ñíèæàþò.......... È äàæå èñïîëüçóþò ïëàçìàôåðåç ó ïàöèåíòîê ñ ïîâûøåííûìè àíòèòåëàìè, ïëàíèðóþùèõ ÝÊÎ. |
#4
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Ðàñïå÷àòàéòå êîëëåãàì. http://forums.rusmedserv.com/showthread.php?t=171173 Íîñèòåëüñòâî àíòèòåë âñòðå÷àåòñÿ ó 16-20% â îáùåé ïîïóëÿöèè è íå ÿâëÿåòñÿ ïàòîëîãèåé ùèòîâèäíîé æåëåçû. Òàêæå íîñèòåëüñòâî àíòèòåë íå ÿâëÿåòñÿ îñíîâàíèåì äëÿ êàêèõ-ëèáî äèàãíîçîâ.
Ó æåíùèí ñ ïîâûøåíèåì àíòè-ÒÏÎ íåñêîëüêî ïîâûøåí ðèñê ñàìîïðîèçâîëüíîãî ïðåðûâàíèÿ áåðåìåííîñòè - íî ÍÅ àíòè-ÒÏÎ òîìó ïðè÷èíîé, è ïûòàòüñÿ èõ êàêèì-ëèáî îáðàçîì "ñíèæàòü" ñîâåðøåííî áåñïîëåçíî. |
#5
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Ñïàñèáî, ÿ ñ âàìè àáñîëþòíî ñîãëàñíà!!!
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#6
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Ñëûøàòü ýòî ïå÷àëüíî, è âäâîéíå ïå÷àëüíî - îò ìîñêîâñêîãî êîëëåãè.. Ïëàçìàôåðåç âîâñå íå áåçîáèäåí, "ëå÷èòü" òàêèì îáðàçîì çäîðîâûõ æåíùèí "îò àíòèòåë" íåäîïóñòèìî.
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Àííà, âðà÷-ýíäîêðèíîëîã Âîðîíåæ, êëèíèêà Íåïëàöåáî |
#7
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Ïðåæäå, ÷åì ïëàçìàôåðåçèòü çäîðîâûõ ëþäåé, "ñïåöèàëèñòàì ó ìàøèíû" íåïëîõî áû îçíàêîìèòüñÿ ñî ñïåêòðîì ïîáî÷íûõ ýôôåêòîâ, êîòîðûå áûâàþò ïðè ïðîâåäåíèè ïðîöåäóðû èëè ïîñëå íåå, âêëþ÷àÿ ïîòåíöèàëüíî-æèçíåóãðîæàþùèå èëè äàæå ôàòàëüíûå:
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#8
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Íàçíà÷åíèå òèðîêñèíà æåíùèíàì ñ ïðèâû÷íûì íåâûíàøèâàíèåì è ïîâûøåííûìè òèðîèäíûìè àíòèòåëàìè è ýóòèðîèäíûì ñòàòóñîì ìîæåò ïîâûñèòü ÷àñòîòó âûíàøèâàíèÿ, ñîãëàñíî ðåçóëüòàòàì êëèí. èññëåäîâàíèé:
In women with normal thyroid function and thyroid autoantibodies the risk of miscarriage is more than tripled and the risk of preterm birth is doubled Treatment with levothyroxine can halve the risk of miscarriage in women with normal thyroid function and thyroid autoantibodies ïîäðîáíåå: Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence BMJ. 2011; 342: d2616 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#9
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Ïëîõî íå òî, ÷òî êîëëåãè óòâåðæäàþò- ãîäû íàó÷íîé èçîëÿöèè è íåêðèò÷íîå îòíîøåíèå ê òí äèññåðòàöèÿì - ïå÷àëüíîå íàñëåäèå ïîñëåäíåé ñåòâåðòè ïðîøëîãî âåêà, ïëîõî òî, ÷òî Âû íå óìååòå áûñòðî ïðîâåðÿòüóñëûøàííîå- â 21 âåêå ïðè ïðåêðàñíî ïîñòðîåííîé ñèñòåìå îöåíêè âàëèäíîñòè íàó÷íûõ ãèïîòåç è èíôîðìàöèè
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Ã.À. Ìåëüíè÷åíêî |