PREPARATION OF PATIENTS WITH THYROTOXICOSIS TO OPERATIVE TREATMENT TAKING INTO ACCOUNT PSYCHOVEGETATIVE STATUS AND HEMODYNAMIC PECULIARITIES

Aim. To estimate the psychovegetative status and hemodynamic peculiarities of patients with noncompensated thyrotoxicosis, to determine contribution of these factors into efficiency of pre-and postoperative management of patients with thyrotoxicosis. Materials and methods. The study included 30 patients with Graves-Basedow’s disease (mean age 47,31±10,74; mean duration of disease 4,52±3,05) in the status of thyrotoxicosis: TSH<0,005 mME/l, free T4 5,35±2,71 ng/dl, free T3 12,90±3,04 pmol/l. Instrumental investigation of cardiovascular system including daily arterial pressure monitoring, Holter ECG monitoring; cardiac rhythm variability was analyzed using Holter’s records. Psychoemotional status was assessed by means of psychometric testing. The initial vegetative tonus was studied with A. M. Vein method. Eight patients with subclinical thyrotoxicosis (TSH 0,2±0,1 mMe/l, free T4 1,1±0,1 ng/dl) and 11 patients with compensated hypothyrosis after strumectomy (TSH 2,8±0,2 mME/l, free T4 1,1± 0,1 ng/dl) taking into account their psychovegetative status formed the comparison group. Results. In patients with thyrotoxicosis, there were cardiovascular disorders in the form of ventricular and supraventricular extrasystoles, atrial tachycardia paroxysms (10% of patients), absence of adequate decrease in nocturnal pressure (daily systolic arterial pressure index 3%, daily diastolic arterial pressure index 6,2), growth of pulse pressure, fall in general cardiac rate variability (75% of patients). Psychoemotional status was characterized by presence of anxious-depressive disorders. Pathological effect of anxious status on cardiac rhythm (positive correlation between anxiety level and ventricular premature beats frequency r =0,67, p =0,04) was noted. When estimating emotional sphere in patients with standard TSH level, we paid attention to expression of depressive disorders. Conclusion. Change in thyroid function (thyrotoxicosis) is characterized by disturbance of vegetative regulation of cardiovascular activity and psychoemotional disorders. Complex of instrumental studies and psychometric tests detect these disorders. Anxiety-depressive disorders existing for a long time, changes in initial vegetative tonus are able to deepen cardial dysfunction, to complicate preparation of patients to operative treatment and to decrease compliance after the conducted radical therapy.

Thyrotoxicosis, psychovegetative disorders, operative treatment