Veterinary medicine - Repository of PHD, master's thesis
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An Overview of Tick-Borne Encephalitis Epidemiology in Endemic Regions of Continental Croatia, 2017–2023
No full textTick-borne encephalitis (TBE) represents an important public health problem in Europe. We analyzed the epidemiology of TBE based on data from humans, animals, and Ixodes ricinus ticks in endemic regions of continental Croatia. In the period from 2017 to 2023, cerebrospinal fluid (CSF) and serum samples of 684 patients with neuroinvasive diseases, 2240 horse serum samples, and 300 sheep serum samples were tested for TBEV. In addition, 8751 I. ricinus ticks were collected. CSF samples were tested using RT-PCR. Serological tests (serum, CSF) were performed using commercial ELISA, with confirmation of cross-reactive samples by a virus neutralization test. Eighty-four autochthonous human TBEV cases were confirmed. The majority of patients were in the age group of 40–69 years (58.3%) with a male predominance (70.2%). TBE showed a bimodal seasonality with a large peak in April–August and a small one in October–November. In addition to humans, TBEV IgG antibodies were found in 12.2% of horses and 9.7% of sheep. Seasonal tick abundance corresponds to the reported number of human infections. Continental Croatia is still an active natural focus of TBE. Continuous monitoring of infections in humans, sentinel animals, and ticks is needed for the implementation of preventive measures
Hematopoietic cell transplantation and cellular therapies in Europe 2022. CAR-T activity continues to grow; transplant activity has slowed: a report from the EBMT
No full textIn 2022, 46,143 HCT (19,011 (41.2%) allogeneic and 27,132 (58.8%) autologous) in 41,854 patients were reported by 689 European centers. 4329 patients received advanced cellular therapies, 3205 of which were CAR-T. An additional 2854 patients received DLI. Changes compared to the previous year were an increase in CAR-T treatments (+27%) and decrease in allogeneic (−4.0%) and autologous HCT (−1.7%). Main indications for allogeneic HCT were myeloid malignancies (10,433; 58.4%), lymphoid malignancies (4,674; 26.2%) and non-malignant disorders (2572; 14.4%). Main indications for autologous HCT were lymphomas (7897; 32.9%), PCD (13,694; 57.1%) and solid tumors (1593; 6.6%). In allogeneic HCT, use of sibling donors decreased by −7.7%, haploidentical donors by −6.3% and unrelated donors by −0.9%. Overall cord blood HCT decreased by −16.0%. Use of allogeneic, and to a lesser degree autologous HCT, decreased for lymphoid malignancies likely reflecting availability of new treatment modalities, including small molecules, bispecific antibodies, and CAR-T cells. Pediatric HCT activity remains stable (+0.3%) with differences between allogeneic and autologous HCT. Use of CAR-T continues to increase and reached a cumulative total of 9039 patients treated with wide differences across European countries. After many years of continuous growth, increase in application of HCT seems to have slowed down
Regionalna anestezija u djece
No full textRegional anesthesia in pediatric patients presents an integral part of pediatric perioperative pain management. Pediatric regional anesthesia is both safe and efficacious when performed by experienced anesthesiologists. Careful choice of drugs, techniques, and corresponding doses is essential to ensure optimal results and minimize risks. The anatomical and physiological differences between children and adults are an important consideration when administering anesthesia to children. Anesthetic doses and techniques need to be adjusted to accommodate ongoing growth and development, taking into account the child's age, weight, and emotional response. Types of regional anesthesia performed in children are peripheral nerve blocks, epidurals, and spinal anesthesia. The ultrasound-guided technique is the golden standard for performing blocks.Regionalna anestezija kod pedijatrijskih pacijenata predstavlja sastavni dio perioperativnog zbrinjavanja boli. Pedijatrijska regionalna anestezija je sigurna i učinkovita kada je provode iskusni anesteziolozi. Pažljiv odabir lijekova, tehnika i odgovarajućih doza ključni su za postizanje optimalnih rezultata i snižavanje rizika. Anatomske i fiziološke razlike između djece i odraslih važan su čimbenik prilikom primjene anestezije kod djece. Doze lijekova i tehnike treba prilagoditi djetetu s obzirom na kontinuirani rast i razvoj, uzimajući u obzir dob, težinu i emocionalni odgovor. U djece se primjenjuju periferni blokovi epiduralna i spinalna anestezija, a primjena ultrazvuka se smatra zlatnim standardom u izvođenju blokova
Monitoring of morbidity and mortality from influenza in Požega-Slavonia County in the period from 2014 to 2022
No full textGripa je bolest respiratornog sustava koja se lako i brzo širi. Pojavljuje se svake godine u obliku manjih ili većih epidemija te uzrokuje značajan pobol i višak smrtnost diljem svijeta. Praćena je raznim komplikacijama, osobito u osoba starije životne dobi. Uzrokuje zdravstvene, društvene i ekonomske probleme te predstavlja značajan javnozdravstveni problem.
Cilj je rada prikazati pobol i smrtnost od gripe u Požeško-slavonskoj županiji u sezonama od 2014/2015. do 2021/2022. godine.
Tjedne promjene broja oboljelih i incidencija oboljelih prema dobnim skupinama prikazani su na temelju prijava oboljenja od gripe koje su pristigle u Zavod za javno zdravstvo Požeškoslavonske županije od sezone 2014/2015. do 2021/2022. Podaci o umrlima od gripe preuzeti su iz Nacionalnog javnozdravstvenog informacijskog sustava. Podaci o potrošnji cjepiva prikupljeni su iz izvješća o potrošnji sezonskog cjepiva.
U promatranom osmogodišnjem razdoblju u PSŽ-u prosječno je zaprimljeno 263 prijave oboljenja od gripe po sezoni. Najčešće obolijevaju djeca školske i predškolske dobi. Stopa incidencije najniža je u osoba 65 godina i starijih, ali je u njih ujedno najveća smrtnost. U navedenom razdoblju sve umrle osobe od gripe bile su ženskoga spola (N = 5), a većina umrlih (80 %) nije bila cijepljena protiv gripe. Cijepni obuhvati protiv gripe u PSŽ-u u svim sezonama daleko su ispod obuhvata koje preporučuje SZO, a u sezoni 2021/2022. zabilježen je silazni trend odaziva na cijepljenje.
Cijepljenje protiv gripe ključni je alat za smanjenje morbiditeta i mortaliteta od gripe, stoga je potrebno ulagati velike napore u edukaciju javnosti i zdravstvenih djelatnika o važnosti cijepljenja zbog postizanja veće učinkovitosti.Influenza is an acute respiratory system disease caused by influenza viruses. It occurs annually in the form of smaller or larger epidemics and causes significant morbidity and excess mortality worldwide. It is characterized by various complications, especially in the elderly. It causes health, social, and economic problems. Thus, it is a significant public health problem.
The objective of this study is to show the morbidity and mortality of influenza in Požega-Slavonia County from 2014/2015 season to 2021/2022.
The weekly trend of influenza cases and incidence by age groups are shown based on influenza reports collected in the Institute of Public Health of Požega-Slavonia County from the 2014/2015 to 2021/2022 season. The number and data of influenza death cases were taken from the National Public Health Information System. Vaccine consumption data were taken from seasonal vaccine consumption reports.
In the observed eight-year period, Požega-Slavonia County received an average of 263 influenza reports per season. Children of school and preschool age are most often affected. The incidence rate is lowest in people aged 65 and older, but they also have the highest mortality rate. In the observed period, all persons who died from influenza were female (N=5), and the majority of those who died (80%) were not vaccinated against influenza. Influenza immunization rates in Požega-Slavonia County in all seasons are far below the coverage recommended by the WHO. In the 2021/2022 season, a descending trend in the response to influenza immunization was recorded.
Influenza immunization is a key tool for reducing influenza morbidity and mortality. It is necessary to invest great efforts in educating the public and healthcare professionals about the importance of vaccination in order to achieve greater effectiveness
Examining the environmental risk factors of progressive-onset and relapsing-onset multiple sclerosis: recruitment challenges, potential bias, and statistical strategies
No full textIt is unknown whether the currently known risk factors of multiple sclerosis reflect the etiology of progressive-onset multiple sclerosis (POMS) as observational studies rarely included analysis by type of onset. We designed a case–control study to examine associations between environmental factors and POMS and compared effect sizes to relapse-onset MS (ROMS), which will offer insights into the etiology of POMS and potentially contribute to prevention and intervention practice. This study utilizes data from the Primary Progressive Multiple Sclerosis (PPMS) Study and the Australian Multi-center Study of Environment and Immune Function (the AusImmune Study). This report outlines the conduct of the PPMS Study, whether the POMS sample is representative, and the planned analysis methods. The study includes 155 POMS, 204 ROMS, and 558 controls. The distributions of the POMS were largely similar to Australian POMS patients in the MSBase Study, with 54.8% female, 85.8% POMS born before 1970, mean age of onset of 41.44 ± 8.38 years old, and 67.1% living between 28.9 and 39.4° S. The POMS were representative of the Australian POMS population. There are some differences between POMS and ROMS/controls (mean age at interview: POMS 55 years vs. controls 40 years; sex: POMS 53% female vs. controls 78% female; location of residence: 14.3% of POMS at a latitude ≤ 28.9°S vs. 32.8% in controls), which will be taken into account in the analysis. We discuss the methodological issues considered in the study design, including prevalence-incidence bias, cohort effects, interview bias and recall bias, and present strategies to account for it. Associations between exposures of interest and POMS/ROMS will be presented in subsequent publications
Correlation between Cholin Peak and apparent diffusion coefficient at multiparametric magnetic resonance and Calcium sensing receptor expression in breast cancer
No full textSvrha rada: Svrha rada je bila istražiti povezanost između razine kolina, difuzijskog koeficijenta i razine CaSR u lezijama invazivnog karcinoma dojke putem MR dojki.
Metode: Uključeno je 79 pacijentica s NST karcinomom dojke te analizira morfološke i kinetičke karakteristike karcinoma. Postoperativno su preparati podvrgnuti imunohistokemijskoj analizi za razinu CaSR.
Rezultati: Rezultati su pokazali značajnu pozitivnu korelaciju CaSR s promjerom tumora, izražajnošću HER2, statusom limfnih čvorova i metastazama te negativnu korelaciju s izražajnošću ER receptora. Također, otkrivena je značajna pozitivna povezanost između CaSR i proliferacijskog indeksa Ki67. Iako nije potvrđena povezanost između kolina, CaSR i difuzijskog koeficijenta, postoji trend pozitivne povezanosti.
Zaključak: Ovi nalazi impliciraju da CaSR može biti važan prognostički čimbenik i pokazatelj malignog potencijala karcinoma dojke. Daljnja istraživanja mogla bi dodatno razjasniti ovu povezanost, što bi moglo poboljšati dijagnostiku i upravljanje karcinomom dojke.Objective: The study aimed to investigate the correlation between choline level, diffusion coefficient, and CaSR level in lesions of invasive breast carcinoma using breast MR imaging. Methods: Seventy-nine patients with NST breast carcinoma were included, analyzing the morphological and kinetic characteristics of the carcinomas. Postoperatively, specimens underwent immunohistochemical analysis for CaSR level.
Results: The results showed a significant positive correlation of CaSR with tumor diameter, HER2 expression, lymph node status, and metastases, and a negative correlation with ER receptor expression. A significant positive association between CaSR and Ki67 proliferation index was also discovered. Although the correlation between choline, CaSR, and diffusion coefficient was not confirmed, there was a positive correlation trend.
Conclusion: These findings suggest that CaSR may be an important prognostic factor and indicator of breast carcinoma's malignant potential. Further research could clarify this association, potentially improving breast cancer diagnosis and management
Simultaneous kidney pancreas transplantation in the Republic of Croatia
No full textŠećerna bolest ozbiljan je javnozdravstveni problem u Hrvatskoj, s prevalencijom od 395,058 oboljelih. Osim primarnih simptoma, bolest uzrokuje razne mikrovaskularne komplikacije, uključujući dijabetičku nefropatiju koja dovodi do kronične bubrežne bolesti. Pacijenti sa šećernom bolesti koji razviju komplikacije često završavaju na hemodijalizi, s visokom stopom smrtnosti. Simultana transplantacija bubrega i gušterače nudi dvostruku korist: prestanak potrebe za dijalizom i izlječenje dijabetesa, poboljšavajući kvalitetu i duljinu života pacijenata. Prva uspješna simultana transplantacija bubrega i gušterače izvedena je 1966. godine od strane Lilliheija i Kellyja. Unatoč početnim neuspjesima i smrti pacijenta, ovaj zahvat postavio je temelje za buduće uspjehe. Do danas, preko 67,000 pacijenata diljem svijeta podvrgnuto je ovom zahvatu, s trogodišnjim preživljenjem od preko 90%.
Glavna indikacija za simultanu transplantaciju je kronična bubrežna bolest stupnja 4 ili 5 udružena sa šećernom bolešću tipa 1. Postoji rasprava o proširenju indikacija na pacijente s dijabetesom tipa 2 koji su ovisni o inzulinu i imaju nizak indeks tjelesne mase. Osim dijabetičke nefropatije, prisutnost drugih vaskularnih komplikacija također može biti indikacija. Apsolutne kontraindikacije uključuju teške srčane bolesti, zloćudne tumore i aktivne infekcije.
Simultana transplantacija bubrega i gušterače kompleksniji je zahvat od samostalne transplantacije bubrega. Postoji nekoliko tipova transplantacije gušterače, ovisno o načinu izlučivanja egzokrinog sekreta. Danas najčešće korištena tehnika predstavlja anastomoziranje portalne vene presatka sa sistemskom venskom odvodnjom te enteralnu sekreciju egzokrinih sokova presađene gušterače.
Komplikacije nakon transplantacije uključuju infekcije, odbacivanje i upalu presatka te krvarenja.
Program simultane transplantacije bubrega i gušterače u Hrvatskoj započeo je 2003. godine u Kliničkoj bolnici „Merkur“. Do danas je izveden značajan broj operacija, s godišnjom stopom preživljenja pacijenata koja prati svjetske trendove.Diabetes is a serious public health issue in Croatia, with a prevalence of 395,058 individuals. In addition to primary symptoms, the disease causes various microvascular complications, including diabetic nephropathy, which leads to chronic kidney disease. Patients with type 1 diabetes who develop this complication often end up on hemodialysis, with a high mortality rate. Simultaneous kidney and pancreas transplantation offers a dual benefit: cessation of the need for dialysis and curing diabetes, improving the quality and length of life for patients.
The first successful simultaneous kidney and pancreas transplantation was performed in 1966 by Lillehei and Kelly. Despite initial failures and patient death, this procedure laid the foundation for future successes. To date, over 67,000 patients worldwide have undergone this procedure, with a three-year survival rate of over 90%.
The main indication for simultaneous transplantation is chronic kidney disease stage 4 or 5 associated with type 1 diabetes. There is ongoing discussion about expanding indications to include patients with type 2 diabetes who are insulin-dependent and have a low body mass index. In addition to diabetic nephropathy, the presence of other vascular complications can also be an indication. Absolute contraindications include severe heart disease, malignant tumors, and active infections.
Simultaneous kidney and pancreas transplantation is a more complex procedure than a standalone kidney transplant. There are several types of pancreas transplantation, depending on the method of exocrine secretion drainage. The most commonly used technique today involves anastomosing the portal vein of the graft with systemic venous drainage and enteral drainage of exocrine secretions of the transplanted pancreas.
Complications after transplantation include infections, graft rejection, inflammation, and bleeding.
The program for simultaneous kidney and pancreas transplantation in Croatia began in 2003 at the Merkur Clinical Hospital. To date, a significant number of operations have been performed, with patient survival rates aligning with global trends
Soft tissue sarcomas in children
No full textMekotkivni sarkomi su rijetka pojava u dječjoj dobi. To su tumori mezenhimalnog
podrijetla, a najčešće se javlja rabdomiosarkom. Još nije utvrđeno postoji li povezanost
tumora s izloženošću okolišnim čimbenicima. Većinom se prezentiraju novonastalom tvorbom
u bilo kojem dijelu tijela koja se može naći slučajnim pregledom ili ispadom funkcije
zahvaćenog organa ili dijela tijela. Od dijagnostičkih metoda, osim anamneze i fizikalnog
statusa najvažnije su laboratorijska dijagnostika i slikovne metode (ultrazvuk, CT, MR, PET-
CT). Dijagnostika služi i razlikovanju malignih od benignih tumora te neneoplastičnih
promjena. Najčešće korištena metoda liječenja je kirurška resekcija. Ovisno o stadiju i vrsti
tumora mogu se koristiti kemoterapija te radioterapija. Rabdomiosarkomi se pokušavaju
liječiti i imunoterapijom, te ciljanom terapijom koja djeluje na mutacije koje tumor pokazuje.
Napredak terapijskih metoda povećao je i preživljenje. Uspjeh terapije i preživljenje su veći
ako se tumor otkrije u ranijoj fazi i ako ima povoljan histološkom tip. Preživljenje kod
rabdomiosarkoma niskog stupnja zloćudnosti iznosi oko 90%, a intermedijarnog stupnja do
70%. Nažalost bolesnici s rabdomiosarkomima visokog stupnja malignosti preživljavaju
svega oko 30%, taj podatak upućuje na važnost ranog postavljanja dijagnoze i što ranijeg
početka liječenja.Soft tissue sarcomas are rare in the pediatric population, but their importance is
heightened due to the diagnostic and therapeutic challenges they present. These are tumors of
mesenchymal origin. Among malignant types, rhabdomyosarcoma is the most common. So
far, no exact correlation has been established between these tumors and exposure to
environmental factors. They generally present as a newly developed mass in any part of the
body, which may be discovered incidentally during an examination or due to dysfunction of
the affected organ or body part. Diagnostic methods include medical history, physical
examination, laboratory diagnostics, and imaging methods (ultrasound, CT, MRI, PET-CT).
Diagnostics also serve to differentiate malignant from benign tumors and non-neoplastic
changes. The most commonly used treatment method for this type of tumor is surgical
resection. Depending on the stage and type of tumor, additional methods such as
chemotherapy and radiotherapy may be used. New therapeutic methods for
rhabdomyosarcomas are being developed, including immunotherapy and target cell therapy
against specific mutations found in the tumor but not in healthy tissue. Advances in therapy
have also increased survival rates. The success of therapy and long-term survival are greater
when the tumor is detected at an earlier stage and also depend on the histological type of the
tumor. Overall survival for low-grade rhabdomyosarcoma is up to 90%, for
intermediate-grade up to 70%, and for high-grade rhabdomyosarcomas up to 30%,
highlighting the importance of early diagnosis and treatment
Addition of progesterone during fresh and frozen embryo transfer
No full textProgesteron je ključan hormon za prijelaz endometrija iz proliferativne u sekretornu fazu, što je vitalno za implantaciju embrija i održavanje trudnoće. Ovaj hormon regulira menstrualni ciklus, mijenja cervikalnu sluz i sprječava kontrakcije mišića maternice. Progesteron se sintetizira iz kolesterola u jajnicima, nadbubrežnim žlijezdama i mozgu, pri čemu se kolesterol pretvara u pregnenolon, a potom u progesteron. Medicinski pomognuta oplodnja (MPO) obuhvaća metode kao što su intrauterina inseminacija (IUI), izvantjelesna oplodnja (IVF), intracitoplazmatska injekcija spermija (ICSI), embriotransfer prethodno zamrznutih embrija (FET), donaciju gameta, predimplantacijsko genetičko testiranje (PGT), pomognuto izlijeganje (AH), očuvanje plodnosti i surogatstvo. Embriji se prenose u maternicu s pomoću katetera nakon kultivacije, a kvaliteta prijenosa može se poboljšati pravilnim rukovanjem embrijima i minimiziranjem izloženosti nepovoljnim uvjetima. Nakon prijenosa embrija, podrška lutealnoj fazi ključna je za održavanje funkcije žutog tijela i uspješnu implantaciju, što se postiže primjenom progesterona ili ponovljenim injekcijama hCG-a. Dodatak progesterona značajno poboljšava ishod trudnoće kod prijenosa svježih i zamrznutih embrija. Krioprezervacija embrija uključuje metode poput sporog zamrzavanja i vitrifikacije, koje sprječavaju formiranje kristala leda i toksičnih koncentracija otopina. U prirodnim i modificiranim prirodnim ciklusima FET-a (dodavanje progesterona može smanjiti kontraktilnost maternice, potaknuti imunološke prilagodbe i poboljšati uvjete za implantaciju embrija. Sve ove metode i postupci imaju za cilj poboljšanje stope uspješnosti trudnoće, uz posebnu pažnju na pravilno vrijeme i način primjene progesterona kako bi se osigurao optimalan ishod prijenosa embrija.Progesterone is a key hormone for transitioning the endometrium from the proliferative to the secretory phase, which is vital for embryo implantation and the maintenance of pregnancy. This hormone regulates the menstrual cycle, alters the cervical mucus, and prevents uterine muscle contractions. Progesterone is produced from cholesterol in the ovaries, adrenal glands, and brain, where cholesterol is converted into pregnenolone and then into progesterone. Medically assisted reproduction (MAR) includes methods such as ovulation induction, intrauterine insemination (IUI), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), frozen embryo transfer (FET), gamete donation, preimplantation genetic testing (PGT), assisted hatching (AH), fertility preservation and surrogacy. After the embryos have been cultivated, they are transferred into the uterus using a catheter. The quality of the transfer can be enhanced by ensuring proper handling of the embryos and minimizing exposure to unfavorable conditions. Following the embryo transfer, it's essential to provide luteal phase support to maintain corpus luteum function and facilitate successful implantation. This can be achieved through the administration of progesterone or repeated hCG injections. Progesterone supplementation significantly improves pregnancy outcomes in both fresh and frozen embryo transfers. Embryo cryopreservation includes methods like slow freezing and vitrification, which prevent the formation of ice crystals and toxic concentrations of solutions. In natural and modified natural cycles of FET adding progesterone can reduce uterine contractility, promote immunological adaptations, and improve conditions for embryo implantation. All these methods and procedures aim to improve pregnancy success rates, with special attention to the proper timing and method of progesterone administration to ensure optimal embryo transfer outcomes
Subclinical hypothyroidism
No full textSupklinička hipotireoza definira se kao povišena razina serumskog tireoidnog stimulirajućeg hormona (TSH) uz normalne serumske vrijednosti hormona štitnjače, tiroksina (T4) i trijodtironina (T3).
Češće je zapažena kod žena i osoba starije dobi, a rizični čimbenici još su pretilost, sklonost autoimunim bolestima i neadekvatan unos joda. Najčešći uzrok supkliničke hipotireoze je kronični limfocitni tireoiditis, poznatiji kao Hashimoto tireoiditis. Ostali uzroci su parcijalna tireoidektomija, infiltrativni poremećaji štitnjače, subakutni tireoiditis, radioterapija, neadekvatno liječenje hipertireoze, nedostatak joda, disgeneza štitnjače i utjecaj nekih lijekova. Uglavnom je asimptomatsko stanje. Iznimno, javlja se uz simptome karakteristične za hipotireozu, kao što su slabost, konstipacija, suha koža, poremećaji kognitivne funkcije, povišenje tjelesne mase. Dijagnoza se postavlja laboratorijskom analizom serumskog TSH, uz kontrolno testiranje za 2 - 3 mjeseca kako bi se isključili reverzibilni uzroci i prolazno povišenje TSH. Poželjno je utvrditi jesu li pozitivna antitireoidna protutijela i otkriti etiologiju poremećaja. Smjernice za liječenje nisu detaljno definirane i potreba za terapijom određuje se individualno.
Preporučena je terapija levotiroksinom pri serumskim razinama TSH višim od 10 mIU/L, trudnicama, simptomatskim bolesnicima i ako postoji kardiovaskularni rizik. Pacijente je nužno redovito kontrolirati kako bi se odredila optimalna terapija ovisno o kliničkoj prezentaciji i razinama TSH.Subclinical hypothyroidism is defined as an elevated level of serum thyroid stimulating hormone (TSH) with normal serum values of thyroid hormones, thyroxine (T4) and triiodothyronine (T3).
It is more frequent in women and elderly people. Other risk factors are obesity, autoimmune diseases and inadequate iodine intake. The most common cause of subclinical hypothyroidism is chronic autoimmune thyroiditis, better known as Hashimoto thyroiditis. Other causes are partial thyroidectomy, infiltrative thyroid disorders, subacute thyroiditis, radiotherapy, inadequate treatment of hyperthyroidism, iodine deficiency, thyroid dysgenesis and some medications. It is mostly an asymptomatic condition. Exceptionally, it occurs with symptoms common in hypothyroidism, weakness, constipation, dry skin, cognitive disorders, weight gain. The diagnosis is established by laboratory analysis of serum TSH, with control testing in 2 - 3 months to rule out reversible causes and transient TSH elevation. It is necessary to check the levels of antithyroid antibodies, and to define the etiology of the disorder. The need for therapy is determined individually.
Levothyroxine therapy is recommended for patients with serum TSH levels higher than 10 mIU/L, pregnant women, symptomatic patients and if there is a cardiovascular risk. Patients should be monitored regularly to determine optimal therapy depending on clinical presentation and TSH levels