Today, among all endocrine diseases, diabetes mellitus and thyroid diseases take precedence. In terms of prevalence, diabetes mellitus ranks third after diseases of the cardiovascular system and oncological pathologies, and about 8-12% of women over the age of 40 suffer from autoimmune thyroiditis.

Most of the endocrinologist's patients are women, who usually strive to look young and attractive despite their ailments, and sometimes in spite of them. Among all the methods of cosmetic correction of signs of aging, contouring is rightfully the most popular.

But if you refer to the instructions for the use of any filler, then in the section "Contraindications" diabetes mellitus and autoimmune diseases will be listed (the vast majority of cases of thyroid disease is just of an autoimmune nature). Therefore, cosmetologists usually refuse to administer gels to patients with similar ailments.

oslozhneniya-fillerov-u-patsientov-s-endokrinopatiyami-prichiny-i-strategiya-lecheniya 

Sharova Alisa Alexandrovna
candidate of medical sciences
dermatologist, cosmetologist, trichologist.

 

Thyroid disease (thyroid gland) is considered one of the most common chronic diseases in general and among endocrine diseases in particular. In most cases, thyroid diseases are accompanied by a violation of its hormone-producing function in the direction of its decrease or increase.

Hypothyroidism – it is a clinical syndrome caused by a persistent decrease in the action of thyroid hormones (TG) on target tissues. It is customary to distinguish between manifest hypothyroidism (the level of TSH in the blood is elevated, the level of free T4 is lower than normal, clinical symptoms of deficiency are usually detected) and subclinical (the level of TSH in the blood is elevated, but the content of free T4 is still remains within the normal range, there are no clinical symptoms of thyroid insufficiency). The frequency of clinically manifest hypothyroidism is 1-2%, and in women it occurs 10 times more often than in men, especially in the elderly. Subclinical hypothyroidism is detected in 6-8% of women (over the age of 55 - in 10%) and in 3% of men.

Manifestations of hypothyroid dermopathy

The most characteristic manifestation of dermopathy in hypothyroidism is pronounced edema due to a decrease in clearance and an increase in the synthesis of hyaluronic acid. In addition to mucinous edema, clinical manifestations of hypothyroid dermopathy include dryness, pallor of the skin, thinning of the epidermis with areas of hyperkeratosis, a decrease in skin temperature, and a decrease in sebum and sweating.

Features of cosmetic procedures for hypothyroidism

In patients with hypothyroidism in the stage of subcompensation or decompensation due to a violation of the metabolism of hyaluronic acid in the skin, the hydrophilicity of tissues is increased. Therefore, they have an extremely high risk of developing prolonged swelling after the administration of HA-based drugs and the likelihood of contouring the gel over the skin surface. Standard anti-edematous measures are usually not very effective. Against the background of a deficiency of thyroid hormones and a concomitant violation of immunity, poor healing and prolonged, but not too violent inflammation at the injection sites of the gel are possible. On the other hand, due to the delayed degradation of HA, the duration of the preservation of the aesthetic result may increase.

The most common cause of hypothyroidism –

autoimmune thyroiditis (AIT), and autoimmune diseases are on the list of contraindications for contouring. However, unlike systemic autoimmune diseases, antibodies are produced exclusively to the thyroid gland, and to no other organs. The treatment of AIT does not consist in influencing the autoimmune process, but only in compensating for the deficiency of thyroid hormones by prescribing L-thyroxine. The report presented several clinical cases of the use of fillers in patients with hypothyroidism.

In particular, one of the patients with poorly compensated hypothyroidism experienced prolonged pronounced edema after APTOS thread lift and contouring of the nasolabial folds with 1 ml of hyaluronic acid filler. After the procedure of threadlifting and contouring, the patient developed edema, which persisted for a month, despite all the anti-edematous procedures (Cryolift, microcurrents). A hormonal blood test revealed a slight increase in TSH levels with normal levels of thyroid hormones (T3 and T4), which indicated insufficient compensation for hypothyroidism (subclinical hypothyroidism). After adjusting the dose of the taken L-thyroxine, the swelling of the tissues resolved spontaneously and completely within 2 weeks.

Another patient asked to lift the corners of her lips and eliminate puppet wrinkles. During the interview, it turned out that 2 years earlier, the patient had undergone a correction of the nasolabial folds using a filler based on hyaluronic acid. Examination showed that in the lower third of the nasolabial folds there are painless, soft swellings. Ultrasound examination confirmed the assumption that there was an accumulation of filler residues in this area, which did not collapse even after 2 years. The introduction of hyaluronidase made it possible to quickly eliminate this defect.

The patient was recommended a hormonal examination, which revealed hypothyroidism. In general, patients with well-treated hypothyroidism (persistent normal TSH, T3, and T4 levels for at least six months) and no clinical symptoms can be treated with HA-based fillers, albeit with some caution. If the diagnosis of hypothyroidism was established recently (less than a year), the course of the disease is unstable (the dose of L-thyroxine taken needs frequent monitoring and correction), contouring should be refrained from. In addition, the introduction of fillers is not carried out in patients with thyroid nodules without a thorough examination to exclude a malignant process and the conclusion of an endocrinologist.

Thyrotoxicosis – a condition opposite to hypothyroidism and is a clinical syndrome associated with excessive production of thyroid hormones. In conditions of hyperthyroidism, the skin of patients becomes thin, smooth, warm to the touch. The result of the compensatory activation of heat transfer mechanisms is an increase in skin moisture and sweating, which are significantly enhanced even with minimal physical exertion.

Dermatological symptoms of thyrotoxicosis

The most common dermatological symptoms of thyrotoxicosis are pruritus and alopecia. Sometimes there is also hyperpigmentation, palmoplantar hyperkeratosis, urticaria, itching. Palmar erythema is also characteristic. Thyrotoxicosis syndrome most often occurs with multinodular toxic goiter or Graves' disease. Many (but by no means all) patients with Graves' disease develop exophthalmia due to hypertrophy and edema of retrobulbar fat. In severe and prolonged course of the disease, a specific peritibial myxedema may form.

Features of cosmetic procedures for thyrotoxicosis

In terms of health risks, thyrotoxicosis is a more serious problem than hypothyroidism. Therefore, without stable compensation for thyrotoxicosis, it is absolutely impossible to carry out any traumatic cosmetic procedures! Any stressful painful procedure can cause a sharp deterioration in the patient's condition. In addition, with untreated thyrotoxicosis, the effectiveness of contouring will be less, since the destruction of the fillers will take place at an increased rate. Against the background of treatment with thyreostatics, it is also worth refraining from any injections, since immunity during this period may be somewhat reduced, and the tendency to bleeding – increase.

In the presence of thyrotoxic ophthalmopathy, the introduction of biorevitalizants and fillers based on HA is better not to be carried out, as this may cause additional swelling of the bulbar tissue with a deterioration in the patient's condition. Thus, the introduction of fillers in patients with thyrotoxicosis is possible only in the case of a stable remission for at least a year after the complete cessation of thyrostatic therapy.

Diabetes mellitus – a group of endocrine diseases that develop as a result of absolute or relative insufficiency of the hormone insulin, resulting in hyperglycemia. There are two types of diabetes mellitus:

insulin-dependent (type 1 diabetes) and insulin-independent (type 2 diabetes). Type 1 diabetes is based on a genetic predisposition and the development of immune aggression against one's own pancreas, which leads to the complete destruction of insulin-producing cells. Type 2 diabetes is also based on a genetic predisposition, combined with the influence of environmental factors, such as excessive consumption of high-calorie foods and low physical activity. In fact, these are two completely different diseases, but clinical manifestations, Dermatological symptoms of diabetes

About 30% of patients with diabetes mellitus have pathological changes in the skin. The skin becomes rough to the touch, its turgor decreases, dryness and peeling develop. Often a pronounced yellowish coloration of the skin develops. The nails are deformed and thickened, subungual hyperkeratosis develops. Often dermatological manifestations, such as itchy skin, dry skin and mucous membranes, recurrent skin infections (fungal, parasitic, bacterial), can act as tell-tale signs of diabetes. Skin manifestations can be detected several years before the diagnosis of diabetes, and may be the first symptom or appear already during treatment.

Peculiarities of cosmetic procedures for diabetes

Diabetes mellitus is dangerous due to its complications, which are based on malnutrition of tissues due to damage to microvessels and nerves that regulate the vital activity of various organs. The most serious complications are damage to the kidneys, eyes, soft tissues of the lower extremities with the development of ulcers first, and then gangrene. People with diabetes have an increased risk of developing various complications, primarily pyoinflammatory. In diabetes mellitus, immunity is impaired, microvessels in all organs and tissues suffer, in the skin – including. This leads to the fact that any trauma can give rise to serious suppuration.

Thus, contouring can be performed in patients with diabetes mellitus, but only with great care and many restrictions. Contour plastic is contraindicated in patients receiving insulin, as there is a high probability that they already have changes in microvessels and increased tissue reactivity. We are not talking about the introduction of fillers in patients with poorly controlled diabetes (with frequent episodes of rising blood glucose levels and an increase in glycated hemoglobin), or with existing complications.

If diabetes was established recently (less than 5-7 years), there are no complications, it is well compensated by diet or medication (normal glucose and glycated hemoglobin in the blood), then contouring can be performed. However, deep supraperiosteal injections should be avoided, and in some cases it is advisable to conduct a preventive (3 days) course of antibiotics and anti-inflammatory drugs. It is also desirable to conduct a course of angio- and neurotrophic therapy (lipoic acid), antiplatelet agents (dipyridamole) in advance.

Thus, patients with endocrinopathies have an increased risk of side effects and complications during contouring. However, the symptoms and severity of endocrine disorders can vary widely. Therefore, with a competent assessment of all risk factors, the introduction of fillers in some patients is still possible.

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