In Italy there are more than 6 million people who suffer from thyroid diseases. World Thyroid Week is an opportunity to talk about the diseases that affect this gland, the importance of a correct diagnosis and appropriate checks, without exceeding. This year too, SMT will be celebrated starting from May 20th and ending on May 25th, on World Thyroid Day.
“Chronic thyroid diseases: more information, fewer useless tests” is intended as an invitation – reports a note – addressed to the entire population, to have an active role in obtaining information, from qualified sources, on health issues and that the information is considered part of the recommended lifestyles like good nutrition and exercise. Patient organizations and the scientific community – the note reports – ask that the World Health Organization recognize thyroid diseases as non-communicable diseases which, by definition of the WHO itself, are chronic, long-term pathologies that derive from a combination of genetic, environmental and behavioral factors, thus differing from contagious infectious diseases, transmissible from one person to another, which cause epidemics.
Non-communicable diseases are the main cause of death and disability in the world: cardiovascular diseases, cancer, chronic respiratory diseases, diabetes and even obesity belong to this category. The main interest in having thyroid diseases recognized among chronic diseases lies in the fact that biomedical research – we read in the note – in this sector requires substantial funding; Recognizing thyroid diseases as chronic diseases would allow access to greater funding for new studies whose results would benefit the population affected by these diseases.
“World Thyroid Week 2024 – recalls Rossella Elisei, president of the Italian Thyroid Association (Ait) and coordinator of the SMT – is sponsored by the ISS and promoted by the main endocrinological, medical and surgical scientific societies, such as the Italian Thyroid Association (Ait), Association of endocrinologists (Ame), Italian Society of Endocrinology (Sie), Italian Society of Pediatric Endocrinology and Diabetology (Siedp), Italian Society of Gerontology and Geriatrics (Sigg), Italian Society of Endocrine Surgery (Siuec), Italian Association of Nuclear Medicine (Aimn), European thyroid association (Eta), together with Cape – Committee of endocrine patient associations and supported with an unconditional contribution from Eisai, Ibsa and Merck Serono”.
Most thyroid diseases “can rightfully enter the group of non-communicable diseases – states Gianluca Aimaretti, president of SIE – Both hyperthyroidism and hypothyroidism are chronic pathologies, in most cases of an autoimmune nature, i.e. caused by an abnormal immune reaction that turns against the thyroid cells, causing destruction in the case of hypothyroidism or excessive stimulation in the case of hyperthyroidism. In both cases these are pathologies that need to be checked periodically, without exceeding the number of checks and in the type of tests to be performed cyclically. For example, the dosage of autoantibodies, the numerical value of which can vary independently of the clinical variation of the disease, should not be repeated at each check-up, but only at particular moments of the treatment process identified by the specialist. “.
It is “important, however, to underline that, if it is true that on the one hand the frequent repetition of clinical and instrumental tests that are not strictly necessary represents one of the most expensive items, as regards the budget of our NHS, on the other – he points out Fabio Monzani, Sigg delegate – the need for monitoring thyroid function in elderly patients with known pathologies must not be forgotten, as unfortunately often happens, especially if they are being treated with thyroid hormone or antithyroid drugs”.
And “precisely due to the chronic nature of most thyroid pathologies – underlines Renato Cozzi, president of Ame – it is essential that the endocrinologist approaches these patients with empathy, who often meet the specialist after long periods of waiting”. “The nodular thyroid disease is also a chronic pathology – adds Laura Fugazzola, president of Eta – The presence of small nodules, sometimes smaller than 1 cm, is very common in the general adult population (50% of over 50s) but the their clinical relevance is very low. For this reason, the performance of thyroid ultrasound scans on large segments of the population, performed without a clinical reason, is today not recommended because it will highlight nodules which will have very little clinical importance, but which will cause unnecessary concern in the subject in whom were accidentally detected.”
“Otherwise, larger nodules – underlines Fugazzola – must be evaluated for the possibility of altering thyroid function and to verify their nature. Benign nodules that do not alter glandular function must however be checked periodically and the insertion of this clinical condition among chronic diseases could contribute to reducing healthcare spending through better planning of clinical checks, thus avoiding the repetition of unnecessary tests. At the same time, it could be envisaged to include this pathology, as it is chronic, among those exempt from payment of the ticket”.
For Antonella Olivieri of the Department of Cardiovascular, Endocrine-Metabolic and Aging Diseases of the ISS, it is essential to “do prevention through prophylaxis with iodized salt: the nodular thyroid pathology is in fact strongly conditioned by iodine deficiency. Although in Italy, thanks to the campaign on the use of iodized salt which began in 2005, iodine nutrition has improved greatly, the population must continue to be sensitized to using little salt and only iodized starting from the pediatric age, in order to significantly counteract the formation of goiter and thyroid nodules”.
Separate chapter for thyroid tumors. “They are certainly to be considered among the chronic non-communicable diseases – explains Elisei (Ait) – as very often, and fortunately, they heal or become chronic with a low probability of relapse but, since they are thyroidectomized patients and subjected to thyroid hormone therapy, must be followed for a long time. Even for this pathology there are risk factors that can be positively modified, for example by avoiding or minimizing exposure of the neck region to ionizing radiation”.
The identification of the malignancy of the nodule “takes place with needle aspiration and cytological examination – adds Elisei – which however today are reserved only for nodules larger than one centimeter and with suspicious ultrasound characteristics. It is important to remember that only 5% of thyroid nodules is malignant and rarely presents in an advanced form with distant lesions. Surgical therapy and, when appropriate, radiometabolic therapy can completely resolve the disease and treatable successfully, it is particularly important to promote comprehensive but not alarmist information, avoiding unmotivated diagnostic investigations”.
In the management of chronic thyroid pathologies, “nuclear medicine also plays an important role – highlights Marco Maccauro, Aimn delegate – in particular, two common procedures used are thyroid scintigraphy and radioactive iodine therapy. These procedures require accurate evaluation of the patient , appropriate choice of procedure, precise dosing, careful monitoring, and responsible management of radioactive waste. These practices help ensure effective and safe outcomes for patients with chronic thyroid disease.”
It therefore becomes important that those who find an effective indication are given a surgical evaluation, both for benign and tumoral pathologies, and that the patient is offered the most suitable path and possible surgical option – reiterates Giovanni Docimo, president of Siuec – There is no standard treatment for everyone but numerous therapeutic options to be verified case by case in which, after a careful evaluation of all risk factors, the conversation between the endocrinologist, the surgeon and obviously the interested party plays a fundamental role in proposing the most appropriate treatment “.
The only mass screening necessary for thyroid pathologies (in place, by law, for a long time in our country) “is screening for congenital hypothyroidism – recalls Malgorzata Wasniewska, president-elect of Siedp – which still today represents the most frequent childhood endocrinopathy and which, thanks to screening, allows affected newborns to be identified and treatment to be started immediately, which will resolve the clinical picture, but which will have to be continued throughout their life years of history, has made it possible, thanks to timely intervention, to prevent psycho-motor and mental retardation in subjects affected by the aforementioned pathology”.
Finally, Anna Maria Biancifiori, president of Cape: “We are committed to bringing and facilitating, through all our initiatives in the area, adequate and correct information that we think can help the patient to live with these chronic pathologies. Their possible recognition to of chronic non-communicable diseases will bring both a clinical and economic benefit to patients who suffer from them” he concludes.
#Thyroid #week #experts #million #information #useless #tests
