Thyroxine treatment of patients with thyroid diseases, foreign experience and its use in Russia (lecture)

Thyroxine is one of the 13 most commonly prescribed drugs in the United States. Thyroxine is even more frequently prescribed to patients in several countries of Western Europe, where, due to iodine deficiency, there is a high prevalence of thyroid diseases. Indication for the use of thyroxine is either conventional replacement therapy in patients with hypothyroidism, or blocking the secretion of thyroid stimulating hormone (TSH) in patients with nodular goiter or after surgery for thyroid cancer. Hypothyroidism is a common disease: according to foreign authors, from 1.5 to 2% of women and about 0.2% of men suffer from it. Among people over 60, the prevalence of hypothyroidism is even higher: up to 6% of women and 2.5% of men have a TSH level that is 2 times higher than the upper limit of normal. According to foreign studies conducted in areas without iodine deficiency (UK), thyroid nodules are found in 0.8% of men and 5% of women, and the frequency of nodes increases after 45 years. In areas with iodine deficiency in the biosphere, which includes the vast majority of the territory of Russia, the frequency of nodular goiter in women of reproductive age reaches 10% or more. Thyroid cancer is the most common endocrine localization of malignant tumors. In 1984, 10,000 new cases of thyroid cancer were reported in the United States. For a long time, the selection of thyroxine doses for substitution and suppressive therapy was purely empirical and was based mainly on clinical signs: dynamics of mass, pulse, disappearance of myxedema, etc. At present, there are objective methods for controlling the thyroxine dose.