During the epidemic, it caused many inconveniences for many patients with chronic diseases to visit and follow up.
Thyroid disorders include hyperthyroidism (hyperthyroidism), Graves’ ophthalmopathy (hyperthyroidism with proptosis), hypothyroidism (hypothyroidism), thyroiditis, thyroid nodules, and post-operative thyroid cancer, most of which are chronic conditions. How can these patients manage themselves well and schedule visits?
Hyperthyroidism
Patients who have been diagnosed with hyperthyroidism and are taking antithyroid medications need to continue taking them as prescribed and not stop taking them.
Some patients may be concerned that continuing to take medication may lead to hypothyroidism or side effects. Here is some specific guidance for different situations.
1. Depending on the duration of the disease and the dose of medication
- Drug maintenance period
Patients in this period are taking smaller doses, such as methimazole less than 5-10 mg per day and propylthiouracil (PTU) less than 100 mg per day, and may not need to be seen urgently to maintain their current dose and be reviewed at a convenient visit to the doctor.
- Drug taper period
Patients in this period will need to gradually reduce the amount of medication they take based on how well their thyroid function is improving. If the situation allows, it is best to visit the hospital and adjust the medication under the guidance of the doctor.
However, due to the limited access to the clinic and the inability to have thyroid tests, patients can taper their dosage based on the TSH, FT3, and FT4 results from the last test to avoid overdose and hypothyroidism.
In general, the dose should be reduced every 2 to 4 weeks by 5 to 10 mg of methimazole and 50 to 100 mg of PTU each time. If FT3 or FT4 is high and TSH is low, the drug should be reduced slowly and in smaller doses. If the condition changes or the epidemic permits, seek prompt medical attention.
- Drug priming period
Patients in this period are newly diagnosed or have been on treatment for a short period of time, usually less than 3 months, and are usually taking higher doses, such as 20-30 mg of methimazole daily and 200-300 mg of PTU daily. It is recommended that patients should be seen in a timely manner as prescribed by the doctor, usually every 2-4 weeks after the start of treatment, which may be extended to 4-6 weeks during an epidemic. The purpose is to reduce the dose in a timely manner and to monitor the side effects of the drug.
2. Depending on the disease
- Symptoms of hyperthyroidism, such as palpitations, fear of heat, sweating, weakness, weight loss, insomnia, etc.
First rule out the above-mentioned manifestations such as anxiety and disordered work and rest schedules due to the epidemic; if it is not convenient to seek medical attention, increase the dosage of medication in small amounts as appropriate. If this is due to missed medication, make up the missed dose. If it is convenient to seek medical attention, you should promptly visit the doctor to review your nail function and adjust the dosage of medication.
- Symptoms of hypothyroidism, such as swelling, weakness, coldness, constipation, etc.
If it is inconvenient to seek medical attention, you can reduce the amount of medication you take appropriately. If it is convenient to see a doctor, you should see a doctor in time to review your nail function and adjust your medication.
- Symptoms of medication side effects
They may occur in a small number of patients, mainly within the first 3 months of taking the drug.
If milder allergic reactions such as rash and itchy skin occur, take an antiallergic medication such as loratadine; if symptoms worsen and exfoliative dermatitis develops, discontinue the medication and see a doctor.
If symptoms such as fever, sore throat, mouth ulcers, and cough occur, be alert for granulocyte deficiency, a serious side effect of antimitotic medications, which must be discontinued immediately and seen in the emergency room for blood tests. These symptoms need to be differentiated from the present-day neoconjunctivitis. Please note: If the patient does not reside in a community with reported cases, has no history of travel in the last 2 to 3 weeks, and has not been exposed to confirmed or suspected patients with neostriatal pneumonia, then they can be seen in the general emergency room with adequate protection.
If symptoms such as malaise, loss of appetite, nausea, vomiting, and jaundice are present, liver function may be impaired and prompt medical attention must be sought.
.
3. Depending on the specific type of hyperthyroidism
- Graves’ ophthalmopathy (hyperthyroidism with proptosis)
If the protrusion of the eye worsens, with poor eyelid closure, loss of vision, loss of color vision, and corneal ulcers, this suggests the possibility of severe, even vision-threatening Graves’ ophthalmopathy, and in severe cases, possible blindness, and immediate ophthalmology consultation is indicated.
If a patient with Graves’ eye disease is on hormone shock therapy, it is important to follow the doctor’s instructions and complete treatment on time; any interruptions may undo or even worsen the disease.
If the disease is stable, or if you are on maintenance medication, you can continue maintenance and see your doctor when it is convenient.
- Hyperthyroid heart disease
Patients who feel significant palpitations, arrhythmias, shortness of breath, dyspnea, inability to lie down, swelling, and little urination are most often seen in patients who are not on long-term hyperthyroidism treatment, or are not well controlled, and should be seen as soon as possible.
- Hyperthyroidism crisis
Patients whose hyperthyroidism is not well controlled and is triggered by infection, surgery, exertion, stress, etc., have worsened symptoms such as high fever, profuse sweating, cardiac arrhythmia, nausea and vomiting, abdominal pain, and anxiety, which are the most serious complications of hyperthyroidism and should be seen immediately in an emergency.
Patients with hyperthyroidism who are combined with neoconjunctivitis are prone to induce hyperthyroid crisis.
Low-grade hypothyroidism
Patients diagnosed with hypothyroidism who are taking levothyroxine therapy should continue to take their medication regularly.
The medication should be taken 1 hour before breakfast on an empty stomach, more than 2 to 4 hours apart from milk, soy milk, coffee, soy products, or calcium supplements.
Homebound during an epidemic, you may be irregular in your work and rest, resulting in missed doses, which can be made up within a week. It is recommended to mark the amount of medication for a week. If the medication is not used at the end of the week, indicating a missed dose, be sure to take the missed dose evenly and separately the following week.
The following are recommendations for dose adjustments and follow-up times based on the condition:
- Patients who have normal nail function
The medication should not be discontinued without authorization, but should be continued according to the original prescription, and the time to review the nail function can be extended to 6 to 12 months.
- Patients whose nail function has not yet normalized and who are in the adjustment phase of medication
Continue to take the medication as prescribed by the physician at the last visit and extend the follow-up period to 8 weeks as appropriate (except for pregnant women).
- Patients with a change in condition
If symptoms of hyperthyroidism such as panic, fatigue, sweating, or weight loss occur while taking the medication, the medication may be overdosed and can be reduced appropriately, for example by 12.5 to 25 micrograms per day, if it is not convenient to visit the doctor. If the symptoms are relieved after the reduction, you can continue to take the new dose. If your symptoms do not resolve, you should see a doctor to review your nail function and adjust your dosage.
If symptoms such as swelling, coldness, apathy, or drowsiness occur, you should be alerted to the development of a mucus edema coma and seek immediate medical attention.
Thyroiditis
Autoimmune thyroiditis (Hashimoto’s thyroiditis)
People with elevated autoantibodies to the thyroid gland alone and normal thyroid function do not need to be seen urgently, but should keep a good attitude and usually be rechecked once or twice a year. If you are pregnant, you should be seen early for thyroid tests.
If you have symptoms of hyperthyroidism or hypothyroidism, you should see a doctor for a thyroid test.
Subacute thyroiditis
The recent sudden onset of swelling, pain, and pressure on the front of the neck and/or both sides of the trachea radiating behind the ear, fever (possibly low- or high-fever) with palpitations, fatigue, muscle aches, and even cold symptoms such as sore throat and cough, must be very worrisome to the patient who is infected with a novel coronavirus, which are in fact also typical of subacute thyroiditis. Careful recollection of whether you have a history of suspicious exposure can help in identification. Prompt medical attention is recommended.
If it is subacute thyroiditis, there is no need to panic. Oral NSAIDs or glucocorticoids, which are symptomatic anti-inflammatory, pain relieving, and fever reducing, usually heal in 2 to 3 months.
If you have been diagnosed with subacute thyroiditis and are taking NSAIDs or glucocorticoids, you can gradually reduce the dosage to discontinue if the fever and neck pain have disappeared, and there is no need to rush to the hospital for laboratory testing.
Thyroid nodules
Benign nodules
The majority (85%) of thyroid nodules are benign and usually change slowly, so there is no need to rush to follow-up, even if the doctor’s recommended time for review has come and gone, and no significant adverse findings occur with a delay of 1 to 3 months.
Nodules suspected of being at risk for malignancy
Most malignant thyroid tumors are papillary thyroid cancers, even tiny ones less than 1 cm in diameter, which usually develop slowly and therefore do not need to be overly alarming and can be reviewed when the hospital can see them normally.
Recently discovered rapidly enlarging nodule
If you find a sudden and obvious enlargement or new mass in the front of the neck or on both sides of the trachea recently, with symptoms such as hoarseness, dyspnea, difficulty swallowing, and choking on water, you may have tracheal and laryngeal nerve compression, and you should seek immediate medical attention.
Postoperative thyroid cancer
Patients need to be treated with levothyroxine. The doctor will determine treatment goals and drug doses on a case-by-case basis.
If the patient has met treatment goals and has stable thyroid function, he or she can continue on the current regimen, even if it is time for a follow-up visit, which is allowed to be delayed due to the epidemic. If the medication dose was adjusted at the last visit, a 1 to 3 month extension of the follow-up visit will not significantly affect the condition.
If new masses, hoarseness, or dyspnea develop, seek early medical attention.
Summary:
- Thyroid disease is easily aggravated by bad mood and stress, and during an epidemic, people are prone to mood swings such as anxiety, tension, sadness, anger, and excitement, so patients should maintain a good attitude and believe that the battle against the epidemic will be won.
- It is recommended to listen to music, read books, watch entertainment and other relaxing programs to relax and maintain mental balance.
- Keep a regular work schedule, avoid staying up late, and stop smoking and drinking.
- Long-term home or break the rhythm of life in the past, easy to miss or forget whether to take the medication, it is recommended to place the medication on the dining table and other places where it is easy to see, according to the weekly dose set up, and regularly check whether to miss or take more.
- If you must go to the hospital, be sure to protect yourself and your family. Do disinfection, hand washing, and indoor ventilation when you get home.
- Finally, if you still have questions about your condition or changes in symptoms and are not sure if you need to see a doctor, many hospitals and major medical online platforms in China now offer online consultation services, so you can find a professional endocrinologist for advice through the Internet.
.