26 May 2020

Diseases of the thyroid take the second place among the diseases of the endocrine system. Up to 01.01.2020, thyroid diseases were registered in 43 557 adult patients in Minsk. Over the past 10 years the prevalence of thyroid diseases among Minskers has increased by 1,8 times, the primary incidence – 1,7 times.

In the structure of thyroid diseases among the adult population of Minsk, hypothyroidism is in the 1st place – 48%, in the 2nd – non-toxic goiter (including nodular forms) – 34%, patients with thyrotoxicosis accounted for 2,5%.

Since 1997, work to eliminate iodine deficiency has been carried out at the state level using the most effective method of mass prevention – iodized salt, which is produced by the domestic food industry. The result of the implementation of this strategy allowed the International Council for Control of Iodine Deficiency Disorders and the Iodine Global Network (IGN) to include Belarus in the list of countries that have reached target levels of providing iodine nutrition. The primary incidence of the adult population of Minsk with non-toxic goiter, including nodular forms, is reduced and in 2019 amounted to 237,7 per 100 thousand adults.

For the diagnosis of thyroid diseases, an ultrasound examination of the thyroid is used (it allows determine the size and structure of the organ). In 2019, 110 thousand ultrasound examinations of the thyroid gland were performed on a budgetary basis for residents of Minsk, the examination is carried out at the level of each city polyclinic.
Hormonal examinations are performed to determine thyroid function. As a test of the first level, the concentration of thyroid-stimulating hormone (TSH) in the blood serum is determined. In 2019, 530 thousand TSH examinations were performed in the clinical diagnostic laboratories of city healthcare organizations.

Thin-needle puncture aspiration biopsy of the thyroid (TPAB) is used to exclude thyroid cancer and is performed for residents of Minsk at the department of ultrasound diagnostics of the City Endocrinology Dispensary. The opportunity to carry out this examination is also available in the healthcare institutions «Minsk City Clinical Consultative and Diagnostic Center» and «Minsk City Clinical Oncological Dispensary». In 2019, 6482 TPAB were performed, 215 patients with suspected malignant neoplasm of the thyroid were revealed.

Surgical treatment of thyroid diseases is carried out in the Minsk City Clinical Oncological Dispensary, on the basis of which the Republican Center of Thyroid Tumors operates. In 2019, 674 thyroid operations were performed, 11 of them – to children.

Head non-staff endocrinologist of the Healthcare Committee of the Minsk City Executive Committee A. Jurenia

 

Thyroid: frequently asked questions for 2020

What thyroid diseases are the most dangerous?

Most thyroid diseases are chronic, not life-threatening diseases. However, like any chronic disease, they require dynamic monitoring and timely full-scale treatment. In the case of irregular intake of medicines prescribed by a doctor, lack of control over the course of the disease, decompensation development and, accordingly, a threat to health are possible. The most worrying are thyroid cancers. It should be noted that in 95% of cases patients with an established diagnosis of thyroid cancer and timely treatment have a high life expectancy and an extremely low risk of relapse. Thus, most forms of thyroid cancer, being malignant, have a low degree of malignancy. Currently the endocrinology service of Minsk is aimed at early detection of thyroid cancer. Endocrinologists work closely with oncologists to quickly transfer of a patient with an established diagnosis of thyroid cancer. A system of genetic testing for people with a family anamnesis of the most malignant form of thyroid cancer – medullary cancer – has been introduced.

Should Belarusians regularly take iodine preparations?

For a long time the Republic of Belarus belonged to countries with iodine deficiency. According to recent WHO estimates, Belarus is no longer a country with iodine deficiency. Regular intake of iodine preparations by country residents over the age of 18 is not required. However, pregnant women and women in the period of breastfeeding should add iodine preparations at a dose of 200-250 mkg per day.

How often should an ultrasound examination of the thyroid be performed?

Like any examination, an ultrasound examination of the thyroid should be performed according to indications. First of all, this examination is indicated in case of the presence of complaints of difficulty in swallowing, feeling of pressure in the neck, the appearance of a cosmetic defect in the neck area, a family anamnesis of thyroid cancer, and radiation to the neck organs. Also, in case of appearing of the symptoms of an increase (hyperthyroidism) or a decrease (hypothyroidism) of thyroid function, an ultrasound examination can be prescribed.

Is autoimmune thyroiditis dangerous?

Autoimmune thyroiditis is a disease in case of which the number of antibodies to one of the components of the thyroid cells increases, which ultimately can lead to their gradual destruction and, as a result, a decrease in thyroid function (hypothyroidism). In the presence of only an increased level of antibodies to thyroid peroxidase (AB to TPO), it is not necessary to worry. This condition requires dynamic monitoring of thyroid function and control over the level of thyroid stimulating hormone (TSH).

Is there an increased risk of contracting COVID-19 or a more severe disease in people with autoimmune thyroiditis and Graves disease?

For today, there is no convincing evidence that patients with autoimmune thyroid diseases such as autoimmune thyroiditis, Graves disease are at greater risk of contracting COVID-19 or severe disease course.

It should be remembered that in the case of the development of a viral infection, a dose adjustment of the medications to intake (levothyroxine or methimazole, depending on the disease) may be necessary. And, of course, it is necessary to always follow the rules of hygiene: frequent hand washing, social distance, the use of masks when visiting public places. In case of sickliness, you should consult a doctor and be sure to inform about the existing thyroid disease.

Is there a deficiency of the levothyroxine medication in the pharmacy network of Minsk?

Currently the supply of the levothyroxine medication in Minsk is sufficient. Patients that regularly take replacement therapy for hypothyroidism are advised to have a supply of the levothyroxine medication for a period of 4 months to reduce the frequency of visits to the polyclinic. When purchasing levothyroxine for the full cost and the availability of an electronic card for medical care in polyclinics of Minsk, remote prescription issuing via the application in the polyclinic is provided. A paper prescription is not required, a patient with an electronic card for medical care can appeal directly to the pharmacy. Delivering of preferential recipes for home is provided for elderly people.

How do patients that take methimazole for hyperthyroidism determine the difference between COVID-19 infection and the side effects of methimazole?

Many patients with Graves disease and other types of hyperthyroidism are treated with a medication known as methimazole (mercazolil, tyrosol). A rare side effect of methimazole is a condition called agranulocytosis (found in 0,2-0,5% of people that intake the medication), in which the number of immune cells fighting the infection decreases. Against the background of the development of this complication, a fever, sore throat may appear. If these symptoms occur, consult a doctor immediately. And inform the doctor about the treatment of thyrotoxicosis with methimazole.

Since fever and signs of the disease may also coincide with symptoms of COVID-19 infection, many patients who also intake methimazole may be worried that they have become infected with COVID-19. Should they maintain self-isolation if they have some of these symptoms?

Since febrile agranulocytosis is a serious health hazard, this should not be ignored. Agranulocytosis is less common in patients who intake methimazole for a long time or when the dose is small (15 mg or less). If a fever or other symptoms of infection appear while taking methimazole, it is best to consult a doctor.

Patients should always seek medical attention for symptoms that seem to be urgent or life-threatening. Any patient with a high body temperature, cough, or other typical symptoms of a COVID-19 infection should see a doctor immediately, regardless of the intake of methimazole.

If a puncture biopsy of the thyroid nodule is recommended, is it safe to postpone the examination, taking into account the epidemiological situation?

Most thyroid nodules are benign. If there are signs of malignancy, a puncture biopsy may be recommended. As a rule, taking into account the accumulated data about the low degree of malignancy of most forms of thyroid cancer, it is generally safe to postpone this examination for a month or two. However, each situation should be evaluated individually, taking into account the anamnesis and clinical status.

Is it true that patients with thyroid cancer are at greater risk of becoming infected with COVID-19 because they have weakened immunity?

Unlike many other types of cancer, most patients with thyroid cancer do not receive chemotherapy or other treatment that can weaken their immune systems. A presence of thyroid cancer in the anamnesis and intake of levothyroxine replacement therapy do not increase the risk of contracting COVID-19 or a more severe disease course.

Is it safe to delay surgery for thyroid disease due to the COVID-19 pandemic?

The most common initial treatment for thyroid cancer is an operation to remove the thyroid. Due to the ongoing COVID-19 pandemic, many operations that were planned to treat thyroid cancer had to be postponed, which raises concerns about the timely treatment of thyroid cancer.

Despite the fact that operation is necessary, most types of thyroid cancer are very slowly developing tumors, and the likelihood of cancer progressing if the operation is postponed for several months is extremely small. This is true even if thyroid cancer spreads to the local lymph nodes in the neck.

Nevertheless, thyroid operation will be important and should be performed more urgently for patients with symptoms conditioned by the size of the thyroid tumor, such as difficulty breathing or swallowing, when the tumor spreads to nearby tissues.

Is it safe to postpone treatment with radioactive iodine due to the ongoing COVID-19 pandemic?

Radioactive iodine therapy (RIT) is often used to treat patients with thyroid cancer after surgery and usually involves several visits to a doctor or medical facility. During the ongoing COVID-19 pandemic, these treatments are often postponed to a later date, and that is worrisome for patients to whom RIT have been prescribed.

RIT is often used to remove any remaining normal (non-cancerous) tissue of the thyroid or to reduce the likelihood of recurrence even in those cases when all thyroid cancer has been surgically removed. Therefore, delays due to waiting of the end of the current COVID-19 pandemic are unlikely to reduce the effectiveness of treatment with RIT.

Deputy Head Doctor in Medical Issues of the City Endocrinology Dispensary, Candidate of Medical Sciences     V. Šyško