Subscribe
12
Chen Li Ping
Endocrinology
About me
Hunan Provincial People's Hospital, Endocrinology Department, attending physician, has been engaged in clinical work in the field of endocrinology for many years, with rich clinical experience in endocrine system diseases.
Proficient in diseases
Specializes in diabetes, thyroid diseases, adrenal diseases, pituitary diseases, etc.
Voices
How is Hashimoto's thyroiditis treated?
After being diagnosed with Hashimoto's thyroiditis, treatment decisions should be made based on the size of the thyroid and the presence of symptoms. If the thyroid is relatively small and there are no significant compression symptoms, it is possible to follow up and observe without treatment. If the thyroid is significantly enlarged and there are compression symptoms, thyroid hormone preparations can be used to reduce thyroid swelling. If there is hypothyroidism, it is necessary to use thyroid hormone or levothyroxine for supplementary replacement therapy. In cases of Hashimoto's thyroiditis with hyperthyroidism, short-term treatment should follow the treatment for Graves' disease, using antithyroid treatments such as thioamides or thioureas. (Medications should be used under the guidance of a physician, and self-medication without guidance is strongly discouraged.)
How is hyperkalemia treated?
For hyperkalemia, commonly used clinical treatments include firstly diuretics, which increase the excretion of potassium, thus increasing its discharge from the body. Additionally, hypertonic glucose with insulin is used intravenously to facilitate the movement of potassium from outside to inside the cells. Sodium bicarbonate can also be used to correct acidosis, which can likewise reduce blood potassium levels. When hyperkalemia causes ventricular arrhythmias, calcium injections should be administered immediately to counteract the cardiac toxicity of high potassium. If these treatments do not result in significant effects and the condition is critical, emergency hemodialysis or peritoneal dialysis can be performed to lower blood potassium levels. (Medication should be administered under the guidance of a doctor.)
What are the causes of hyperkalemia?
The first reason is the excessive intake or administration of potassium, which can lead to hyperkalemia. For example, consuming foods that are very rich in potassium, or intravenously infusing solutions containing potassium. Additionally, the use of potassium salts of penicillin can also cause hyperkalemia, as well as the transfusion of stored blood, which can easily lead to hyperkalemia. Besides excessive intake and administration of potassium, diseases related to reduced excretion can also cause hyperkalemia, such as the most common instances during acute or chronic renal failure, where patients are prone to hyperkalemia. Furthermore, patients with reduced adrenal cortex function, such as aldosterone deficiency or Addison's disease, are also prone to hyperkalemia. Additionally, the use of diuretics that inhibit potassium excretion, notably spironolactone—a potassium-sparing diuretic—can also cause an increase in blood potassium levels. Another reason is a change in potassium distribution, such as when potassium moves from inside the cells to the outside, which can easily lead to hyperkalemia. This is common in cases of tissue damage, such as muscle contusion, or electrical burns, and tissue hypoxia, which also can easily lead to a change in potassium distribution, causing an increase in extracellular potassium. If hemolysis occurs in a test tube, such as if the venipuncture takes too long, or in conditions like leukocytosis or severe shaking of the blood sample, these might also lead to hyperkalemia. (The use of medications should be under the guidance of a doctor.)
Why should calcium be supplemented for hyperkalemia?
When high potassium levels trigger ventricular automaticity, it is recommended to administer calcium to counteract its cardiotoxicity. This is because during hyperkalemia, the excitability of the myocardium significantly increases. Calcium ions do not affect the distribution of potassium inside and outside the cells, but they can stabilize the excitability of the heart. Therefore, even if a patient's blood calcium level is normal, calcium should be injected immediately when there is severe arrhythmia. Calcium ions only temporarily counteract the toxicity of potassium to the heart and do not reduce the concentration of potassium in the blood. Thus, they can only serve as a short-term emergency medication. (Medication should be used under the guidance of a doctor.)
Does Hashimoto's thyroiditis hurt?
Hashimoto's thyroiditis is a chronic lymphocytic thyroiditis. The typical manifestation of Hashimoto's thyroiditis is chronic diffuse goiter, but the patient is asymptomatic. The patient's thyroid will show diffuse, painless mild to moderate enlargement, firm texture, slight tenderness upon pressure, local compression in the neck, and generally not very pronounced systemic symptoms, often with discomfort in the throat. Thyroid pain or tenderness in Hashimoto's thyroiditis is still quite rare; if pain is present, differentiation from subacute thyroiditis is necessary.
What is gestational diabetes like?
Gestational diabetes refers to diabetes that appears during pregnancy, or is detected during pregnancy, or is an abnormal glucose tolerance of any degree. Gestational diabetes affects both the pregnant mother and the fetus. Although the mortality rate of pregnant women with gestational diabetes has significantly decreased, complications are still quite common. It may increase the rate of spontaneous miscarriages and preterm births for fetuses. Secondly, it can cause fetal or neonatal death, and intrauterine growth retardation. Thirdly, it leads to excessive amniotic fluid and macrosomia, and may result in neonatal polycythemia, fetal malformations, neonatal respiratory distress syndrome, neonatal hypoglycemia, as well as neonatal hypocalcemia and hypomagnesemia. For the mother, it can lead to pregnancy-induced hypertension syndrome, infections during pregnancy or childbirth, and in severe cases, diabetic ketoacidosis.
Can hyperkalemia be cured?
The main focus is on the cause of hyperkalemia. If hyperkalemia is due to consuming foods rich in potassium, administration of potassium-containing solutions, transfusion of stored blood, use of potassium-sparing diuretics like spironolactone, or prolonged venipuncture causing severe shaking of the blood sample during transport, addressing these causes can prevent the occurrence of hyperkalemia. If hyperkalemia is caused by certain diseases, such as renal failure or adrenal insufficiency, active treatment of the underlying disease is required. If the renal failure is acute, recovery of kidney function might prevent the recurrence of hyperkalemia. However, if there is chronic renal insufficiency, there tends to be a higher recurrence rate of hyperkalemia. Therefore, whether hyperkalemia can be cured largely depends on identifying the underlying cause.
Hyperkalemia
Typically, when serum potassium exceeds 5.5 mmol/L, it is referred to as hyperkalemia. However, an increase in serum potassium does not necessarily reflect an overall increase in body potassium; serum potassium can also rise when there is a deficiency of total body potassium. Therefore, in clinical practice, serum potassium is evaluated in conjunction with an electrocardiogram and medical history to determine if a patient has hyperkalemia. Hyperkalemia is an important emergency in internal medicine and can often lead to sudden cardiac arrest. It should be identified and prevented early.
Will gestational diabetes get better?
Gestational diabetes refers to diabetes that appears or is diagnosed during pregnancy and is a distinct type of diabetes. Many women with gestational diabetes may see their blood sugar levels return to normal after delivery as insulin resistance diminishes. It is recommended to conduct an OGTT (oral glucose tolerance test) screening six weeks after childbirth, as the majority of women with gestational diabetes will have normal fasting blood glucose or OGTT values at six weeks postpartum. Approximately 25% to 70% of women with gestational diabetes may develop diabetes again within 16 to 25 years after delivery. Therefore, it is essential to continue monitoring the patient's blood glucose postpartum and to screen early for diabetes.
Does gestational diabetes cause itching in the vulva?
During gestational diabetes, white blood cells have various functional defects, reduced chemotaxis, phagocytic action, and bactericidal activity. This can easily lead to infections during pregnancy or childbirth, and even develop into sepsis, often caused by bacteria or fungi. Therefore, when blood sugar is not controlled in gestational diabetes, there may be symptoms like vulvar itching, or even infections of the urinary or reproductive systems. If the infection is not further treated, it may cause preterm birth, or even septic shock. Therefore, in gestational diabetes, it is crucial to actively control blood sugar and prevent infections.