The dissertation presents a theoretical generalization and a new solution to the urgent problem of internal medicine: to improve the early diagnosis and prediction of menopausal and metabolic disorders, establishing relationships between carbohydrate, lipid metabolism, vitamin D, thyroid-stimulating and sex hormones, with the development of a new concept of complex treatment and prevention of vitamin D deficiency, estrogen deficiency and reduced risk of metabolic disorders in perimenopausal women with hypothyroidism (HT).
For the first time in the Ternopil region was carried out the assessment of iodine supply of the population according to epidemiological criteria: the frequency of neonatal hyperthyrotropinemia, the results of ultrasonographic examination of children aged 12–14 years and pregnant women in the first trimester and the median ioduria, which indicated a moderate severity of ID.
On the basis of the results of a comprehensive examination of patients a differentiated approach to the management of perimenopausal women with hypothyroidism and metabolic syndrome on the background of menopausal disorders and vitamin D hypovitaminosis was presented.
The level of vitamin D supply in perimenopausal women with HT and its relationships with anthropometric, carbohydrate and lipid parameters, levels of thyroid, sex and gonadotropic hormones was studied. It has been proven that vitamin D deficiency increases the amount of atherogenic and decreases the amount of antiatherogenic lipids, which is accompanied by insulin resistance. It is established that increase in TSH levels and decreased estrogen levels are additional factors in the development of metabolic disorders in women during menopause.
A diagnostic algorithm for menopausal and metabolic disorders, which includes assessment of environmental living conditions, the presence of stress and anxiety, level of physical activity, presence of bad habits, determination of vitamin D status, abdominal obesity, thyroid-stimulating hormone levels, indicators of carbohydrate and lipid metabolism, was proposed.
The models for predicting the development of menopausal and metabolic disorders in perimenopausal women with HT, based on the main criteria of the diagnostic algorithm, have been developed and a method for evaluating the quality of these models was proposed.
The effectiveness of levothyroxine HT replacement therapy with achieving a low-normal reference interval of TSH in perimenopausal women with HT has been demonstrated.
It was found that the use of cholecalciferol in vitamin D deficiency and insuficiency, rosuvastatin in dyslipidemia, metformin in impaired glucose tolerance and phytoestrogens (cimitsifuga extract) for the correction of estrogen deficiency and its consequences in women reduced metabolic and menopausal disorders and improved the quality of life of women with HT.
