Резюме
Москалюк І.І. Віддалені результати лікування хворих на токсичні форми зобу з синдромом подразненого кишечнику за використання метеоспазмілу та карведилолу.
У роботі визначено віддалені результати ефективності використання метеоспазмілу та карведилолу у хворих на токсичні форми зобу з синдромом подразненого кишечнику. Встановлено, що тривале використання запропонованої комплексної терапії через рік сприяло нормалізації рівня тиреоїдних гормонів, концентрації серотоніну, відновленню вегетативного балансу та покращенню якості життя пацієнтів з токсичними формами зобу та синдромом подразненого кишечнику.
Ключові слова: тиреотоксикоз, синдром подразненого кишечнику, метеоспазміл, карведилол.
Резюме
Москалюк И.И. Отдаленные результаты лечения больныхс токсическими формами зоба и синдромом раздраженного кишечника с использованием метеоспазмила и карведилола.
В работе определены отдаленные результаты эффективности метеоспазмила и карведилола у больных с токсическими формами зоба и синдромом раздраженного кишечника. Установлено, что длительное использование предложенной комплексной терапии через год способствовало нормализации уровня тиреоидных гормонов, концентрации серотонина, восстановлению вегетативного баланса и улучшению качества жизни пациентов с токсическими формами зоба и синдромом раздраженного кишечника.
Ключевые слова: тиреотоксикоз, синдром раздраженного кишечника, метеоспазмил, карведилол.
Summary
Moskaliuk I.I. Remote results of treatment of patients with toxic forms of goiter and irritable bowel syndrome by using meteospasmyl and carvedilol.
The paper defined remote results of efficiency of meteospasmyl and carvedilol in patients with toxic goiter forms and irritable bowel syndrome. It is set that prolonged use of the proposed complex therapy after a year contributed to normalization of thyroid hormones level, serotonin concentration, restoration of autonomic nervous balance and improved the quality of life of patients with toxic goiter forms and irritable bowel syndrome.
Key words: thyrotoxicosis, irritable bowel syndrome, meteospasmyl, carvedilol.

УДК 616.441 – 006.5:616.34

Bukovinian State Medical University

58002, Chernivtsi, Theatre Square. 2

Буковинский государственный медицинский университет

58002, г. Черновцы, Театральна пл., 2

ipolyanskaya@ukr.net

Increased interest of the problems of thyroid disease in recent years caused by its increasing prevalence among the population in Ukraine. In the structure of endocrine diseases principal place belongs to toxic goiter forms (TGF) (47.3%). Thyrotoxicosis is a syndrome of higher concentrations of thyroid hormones, occurs in 3% of women and 0.3%  of men.  Thyrotoxicosis has a pathological effect on all organs and systems of the body, especially the activity of the digestive system. Enteric disorders occur in 60% of patients with TGF. The problem of comorbidity - course of irritable bowel syndrome (IBS) and thyrotoxicosis poorly studied.

The purpose of research was to analyze long-term results of treatment of patients with toxic goiter forms and irritable bowel syndrome by the use meteospasmyl and carvedilol.

Materials and methods.Study involved 106 patients with TGF. The average age of patients was 32,5±1,6 years. All patients were examined, which included the collection of complaints, anamnesis, objective examination, laboratory and instrumental investigations.

            The diagnosis of thyrotoxicosis exhibited due to clinical, laboratory (level of TSH, free T3 and T4) and instrumental  data. The diagnosis of IBS exhibited due to the Rome III criteria (2006). The level of serotonin examined by ELISA using reagents "DRG" ​​(Germany).
Heart rate variability (HRV) was determined using holter ECG monitoring "ES-3N/AVR» (Labtech, Hungary). Assessment of quality of life was conducted by questionnaire MOS SF - 36.

All the patients were divided into 3 groups. The first group included 35 patients with TGF combined with IBS- diarrhea type, second group - 34 patients with thyrotoxicosis and IBS with a predominance of constipation.  3rd group consisted of 37 patients with TGF without disorders of the digestive system. Control group involved 20 healthy individuals.

In addition to basic therapy patients of 1^st and 2^nd group received meteospasmyl in a dose 1 capsule 3 times a day and α, β-blocker carvedilol in a dose 12.5 mg 1 time per day. The study was conducted in dynamics: before treatment and after 1 year.

Results. In assessing the levels of thyroid hormones in a year after treatment revealed that in all groups the concentrations of TSH, free T3 and T4 were normal, that shows the effectiveness of the proposed treatment to achieve thyroid homeostasis.

In analyzing the dynamics of the concentration of serotonin in plasma a year after treatment revealed that the use of combined treatment resulted in its stabilization. Thus, in 1^st and 2^nd group the concentration of serotonin was significantly lower compared to that before treatment. It shows recovery of neuro-humoral balance, which has a positive effect on bowel function.

In assessing HRV in remote period of treatment, it was found that heart rate one year after treatment was significantly lower than before treatment in all groups and reached physiological parameters. The value of SDNN and SDANN in patients of 2^nd group increased after a year of treatment. Index rMSSD decreased in group 1 after a year of treatment. Parameters of pNN50 in patients of 1^st group were significantly lower than before treatment, in patients of the 2^nd and 3^rd group - significantly higher. The analysis of HRV indicates the restoration of balance between sympathetic and parasympathetic nervous system by the use of meteospasmyl and carvedilol.

In estimating the parameters of the questionnaire MOS SF-36, we found differences in groups of patients depending on the type of intestinal dysfunction.

The highest parameters observed in patients of group 3, although dynamics of pre-and post-treatment was less pronounced. Lower quality of life characteristic was found in patients of group 2.
The lowest parameters of quality of life before and after treatment were found in patients of 1^st group. However, this group observed the most pronounced positive dynamics of quality of life after treatment, that indicated its effectiveness.

Conclusion. The use of meteospasmyl and carvedilol after a year contributed to normalization of thyroid hormones level, serotonin concentration, restoration of autonomic nervous balance and improved the quality of life of patients with toxic goiter forms and irritable bowel syndrome.

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