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The World Thyroid Week. In time of Covid-19, of course, care must be taken for those who are carriers of gland problems. It is always necessary to refer to the doctor for any type of choice and if alarm bells appear, as recalled by Luca Chiovato, President of the Italian Thyroid Association, AIT and coordinator and scientific manager of the World Thyroid Week.
“The gland performs important functions for our body such as metabolism regulation, heart rhythm control, muscle strength and the correct functioning of the central and peripheral nervous system – says the expert. Conversely, Covid-19 disease it can alter thyroid function creating further diagnostic and therapeutic problems ”. But how should we behave? Here are some general rules to keep in mind.
What to do in case of Hashimoto’s thyroiditis and Basedow’s disease
“Hashimoto’s thyroiditis, very common especially in women, despite being autoimmune in nature, is not a systemic disease and does not require immunosuppressive drugs for its treatment; therefore, it does not expose those affected to a higher risk of developing a serious disease from Covid-19 ″ – explains Francesco Giorgino, President of the Italian Society of Endocrinology, SIE.
“Exceptions to this rule are cases in which Hashimoto’s thyroiditis is associated with two endocrine diseases that more severely affect the body and whose treatment is much more complex: type 1 diabetes mellitus, that is, the one that usually affects children, adolescents and young adults and is insulin dependent, e Addison’s disease, which compromises an endocrine axis critical for survival in the event of serious intercurrent illnesses such as that from Covid-19.
These patients are considered truly frail and, rightly so, have a priority for vaccination using RNA formulations that provide greater protection. The same is true of the association with other systemic autoimmune diseases such as lupus. Therefore, the good news is that, except in cases associated with more serious or systemic autoimmune diseases, there is no valid reason to consider patients with Hashimoto’s thyroiditis fragile towards Covid-19 disease, even when they are on therapy. with thyroxine to treat their hypothyroidism “.
For patients with Graves’ disease, the pandemic represented a further difficulty in an already obstacle course. “Graves’ disease it manifests itself with an excess of thyroid hormones and the inflammatory process that causes it can also extend to the orbit causing the clinical picture commonly known as exophthalmos – explains Francesco Frasca, Representative of the European Thyroid Association, ETA. In these cases, it is also necessary to pay close attention to anti-Covid-19 vaccination because the typical therapy of Graves’ orbitopathy, high-dose intravenous cortisones, can nullify the effect of the vaccine if it is administered during the therapeutic cycle ”.
“The patient with Basedow’s orbitopathy – reports Emma Bernini, President of the Basedowiani and Thyroid Association – is a very fragile patient, often burdened by diagnostic and therapeutic delays due to the complexity of his disease that requires the support of a multidisciplinary medical team ( endocrinologist, ophthalmologist, radiologist-radiotherapist, orbital surgeon, plastic surgeon).
In these patients, most of whom are women, the damage is not only functional up to, in the most serious cases, loss of vision, but also aesthetic, due to the protrusion of the eyes and the consequent deformation of the facial features. This leads to a painful loss of identity which adds to the typical manifestations of the disease. Once the hyperthyroidism and the inflammatory process have been controlled, “reconstructive” surgery of the gaze and face must therefore be considered an indispensable completion of the treatment.
It is therefore desirable that the announced strengthening of the national health service will lead to the creation of these multidisciplinary teams in more and more hospitals. The pandemic has in fact taught us how difficult the journeys of hope are in the few specialized centers often present in distant regions ”.
Beware of older people
“Covid-19 disease it turned out to be particularly aggressive and with high mortality in elderly patients and especially in the over 80s – explains Fabio Monzani, Representative of the Italian Society of Gerontology and Geriatrics, SIGG.
Covid-19 pneumonia is associated with an altered immune response that determines the massive release in the blood of inflammatory cytokines, responsible in turn for alterations in the hypothalamus-pituitary-thyroid axis with the development of the so-called euthyroid sick syndrome or syndrome with low T3 (thyroid hormone).
Preliminary data obtained from a national registry developed under the aegis of the SIGG document a particularly high prevalence of euthyroid sick syndrome (with a normally functioning thyroid gland), over 50 percent in hospitalized elderly patients. The appearance of this picture, while representing a defense of the organism in case of serious diseases, has a negative prognostic value because it is associated with a higher mortality ”.
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