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Zhang Jun Jun
Endocrinology
About me
Zhang Junjun, female, member of the Communist Party of China, master's degree student, chief physician, currently working at Hunan Provincial People's Hospital, member of the Chinese Women Doctors Association Youth Committee, director of the Hunan Health Services Association Metabolism and Endocrine Health Branch, engaged in endocrine work for 5 years, authored several papers and popular science articles on endocrine diseases.
Proficient in diseases
Have extensive experience in endocrine diseases such as diabetes, thyroid, adrenal gland, gonad, osteoporosis, etc.
Voices
Pre-symptomatic hyperuricemia
Hyperuricemia in the preclinical phase can be asymptomatic, only showing fluctuating or persistent hyperuricemia during blood tests. From the increase in uric acid to the onset of symptoms, it can generally take several years to decades. Additionally, some changes in the kidneys due to the deposition of uric acid can cause manifestations of gouty nephropathy. Early stages may present intermittent proteinuria and increased urine foam. As the condition progresses, the kidney's concentrating ability may decrease, resulting in increased nighttime urination. Further progression can lead to renal insufficiency, elevated creatinine and urea nitrogen, and possibly swelling and hypertension. In severe cases, acute renal failure may occur, showing symptoms of oliguria or anuria. This type of uric acid nephropathy is primarily due to the deposition in the kidneys, causing episodes of kidney stones and back pain, with stone episodes also accompanied by hematuria. Therefore, the main presentations are associated with the deposition of uric acid in the kidneys during the preclinical phase of hyperuricemia.
Does Hashimoto's thyroiditis cause a sore throat?
Hashimoto's thyroiditis does not cause a sore throat; the type of thyroiditis that primarily causes a sore throat is subacute thyroiditis. Subacute thyroiditis is a viral infection and is a self-limiting disease. Its main clinical manifestations include sore throat, thyroid enlargement, as well as accompanying fever and elevated erythrocyte sedimentation rate. Meanwhile, Hashimoto's thyroiditis is an autoimmune disease, whose most common clinical manifestation is painless thyroid enlargement, progressing to hypothyroidism in later stages. Additionally, it involves thyroid antibodies, especially positive TPO antibodies. Because the treatments for each are different, it is important to note that Hashimoto's thyroiditis does not cause a sore throat.
Which department should I go to for cholecystitis?
Firstly, it is necessary to determine the cause of the cholecystitis. The most common type of cholecystitis is caused by gallstones. If the cholecystitis is an acute episode caused by gallstones, leading to pain, nausea, vomiting, or even high fever, surgical intervention is usually indicated. It is generally recommended to consult with departments such as general surgery or hepatobiliary surgery, as emergency surgery may be needed. The second scenario involves cases where cholecystitis is detected during routine physical examinations without symptoms. Ultrasound may show gallstones or gallbladder polyps. In symptom-free situations, it is possible to consult general departments like gastroenterology, and regular follow-ups and checks of inflammation indicators, as well as abdominal ultrasonography, can be performed to monitor the dynamic changes of the cholecystitis. The third scenario pertains to cholecystitis where new techniques such as MRCP are available. With this technology, gallstones can be removed under endoscopic guidance. Generally, these procedures are performed in the gastroenterology department. Thus, for acute cholecystitis with choledocholithiasis and concurrent biliary pancreatitis, it may be treated with endoscopic techniques under gastroenterology, avoiding the need for traditional or minimally invasive surgery. Therefore, patients with cholecystitis may visit either the hepatobiliary surgery or gastroenterology departments.
Is leukopenia very harmful?
Leukopenia primarily depends on the extent of the decrease in white blood cells, which can be classified into mild, moderate, and severe levels. Mild leukopenia generally means less than 4.0 X 10⁹/L, and if granulocytes are decreased, it typically means an absolute value of granulocytes less than 2.0 X 10⁹/L. A lack of granulocytes indicates a more severe condition, usually less than 0.5 X 10⁹/L. For patients with mild leukopenia, special preventive measures are generally not necessary. However, for moderate and severe leukopenia, the greatest risk is an increased chance of infection, as white blood cells are a marker of our ability to defend against external threats. With fewer of these defensive guards, the probability of resisting infections and the chance of acquiring infections significantly increase. Therefore, for patients with moderate leukopenia, their rate of infection increases, and it is important to take precautions, reduce visits to public places, maintain hygiene, and eliminate chronic infectious foci. For patients with severe leukopenia, aseptic isolation measures should be adopted. For patients who have infections, it is crucial to find sensitive antibiotics, preferably broad-spectrum antibiotics. If there is a concurrent fungal or viral infection, antifungal or antiviral medications should also be used, as the decrease in white blood cells can destroy a person's immune capacity, lowering immunity and increasing the chance of infections and the invasion of pathogenic bacteria, which in severe cases could even lead to sepsis or septic shock.
How to Diagnose Cholecystitis
The definitive diagnosis of cholecystitis mainly involves the following aspects: First, clinical manifestations are crucial. The most common symptoms include nausea, vomiting, abdominal distension, and loss of appetite. Regarding physical examination, there is typically pain in the lower right abdomen and mid-lower right abdomen, with tenderness upon palpation. Furthermore, the onset of cholecystitis is characterized by postprandial pain, particularly after consuming fatty foods or feeling overly full. If these symptoms are present, further examination such as gallbladder ultrasound can be conducted to check for thickening of the gallbladder wall. Additionally, blood tests for inflammatory markers like complete blood count and CRP (C-reactive protein) can be performed. The diagnosis of cholecystitis can be confirmed by combining these symptoms and test results.
What are the symptoms of leukopenia?
The most common cause of leukopenia is viral infections, along with some severe bacterial infections. Common symptoms of viral and bacterial infections include dizziness, headache, nausea, vomiting, chills, fever, cough, expectoration, abdominal pain, diarrhea, urgent urination, and frequent urination. Generally, further examinations can be conducted through blood draws and routine tests of blood, urine, and stool cultures. If there is an accompanying hematological disease, such as thrombocytopenia, symptoms can include general weakness, body aches, and bone pain; further bone marrow examinations should be conducted.
Is leukopenia leukemia?
Leukopenia is not necessarily indicative of leukemia. There are many causes for a decrease in white blood cells, some of which can be due to medications. Currently, many drugs can cause a reduction in white blood cells, and in such cases, stopping the drug will typically allow the white blood cells to return to normal. A second scenario, especially in patients with an enlarged spleen or those suffering from cirrhosis, can also lead to a decrease in white blood cells. In these cases, it is mainly the abnormal function of the spleen that causes the reduction in white cells. Additionally, there are blood-related diseases, which might be leukemia or other types of blood disorders. In these situations, not only is there a reduction in white blood cells, but there is also a decrease in hemoglobin and platelets. Moreover, a significant increase in white blood cells is also a manifestation of leukemia, thus a decrease in white cells is not definitively indicative of leukemia.
What to check for the cause of leukopenia?
If there is a decrease in white blood cells, we mainly look at the total number of white blood cells and the absolute value of neutrophils in our routine blood test. The causes of leukopenia are inseparable from neutrophils, and can be mainly divided into three categories. The first category is a production defect of neutrophils, the second is excessive destruction and consumption of neutrophils, and the third is abnormal distribution of neutrophils. A major cause of decreased production of white cells and neutrophils is damage to hematopoietic stem cells by ionizing chemicals. Additionally, immune reactions and bone marrow diseases can also lead to decreased production. Another cause is a production defect due to maturation disorders in neutrophils within white blood cells, leading to reduced white blood cell production. Maturation disorders are mainly due to a lack of raw materials needed for white blood cell production. Excessive destruction and consumption of white blood cells are often due to immune factors. Immune factors are common in autoimmune diseases, thus such diseases can also lead to leukopenia. The last category, abnormal distribution, can be a severe infection that causes an abnormal distribution of white cells, retaining them alongside other substances, such as in patients with enlarged spleens, which can provoke leukopenia by causing granulocytes to be retained in circulation, especially in areas like the spleen.
How is thyroiditis treated?
Thyroiditis is primarily divided into acute, subacute, and chronic types, along with some painless and postpartum thyroiditis. If it is acute or subacute thyroiditis, it is a self-limiting disease caused by viral infections, and there is no need to use drugs that adjust thyroid function. Treatment mainly involves the use of non-steroidal or hormonal medications, as well as drugs that control heart rate. If it is autoimmune thyroiditis, commonly referred to as Hashimoto's thyroiditis, it often presents with positive thyroid antibodies. In the early stages, thyroid function may be normal, but typically progresses to reduced thyroid function over time. When thyroid function tests reveal reduced thyroid function, timely supplementation of thyroid hormone levels can control this type of autoimmune thyroiditis within a normal range. Additionally, for painless thyroiditis and postpartum thyroiditis, particularly the latter, which is often related to the mechanism of postpartum immune changes, it primarily depends on whether thyroid function has changed. If there is no change in thyroid function, treatment is temporarily unnecessary. (Medication should be administered under the guidance of a doctor.)
What to eat to quickly recover from leukopenia?
There are mainly three reasons for leukopenia: the first is the impaired production of white blood cells, the second is the excessive destruction of white blood cells, and the third is the redistribution of white blood cells. Therefore, for leukopenia, the main approach is etiological treatment. If leukopenia is suspected to be caused by certain drugs or other pathogenic factors, generally, stopping the use of these drugs and avoiding contact can lead to the recovery of white blood cells to normal levels. For this kind of secondary decrease of white blood cells, we usually treat the primary disease. Once the symptoms of the primary disease are alleviated and controlled, the white blood cell count can return to normal without the need for additional medication. Moreover, the greatest risk of leukopenia is the fear of infection, but mildly reduced patients generally do not require special treatment. However, as the severity of leukopenia increases, the risk of infection increases, and at this point, some preventative measures against infection can be taken. Particularly for patients with neutropenia who are highly susceptible to severe infections, sterile isolation may be employed, and the specific sites and types of infections identified. This allows for the use of sensitive antibiotics; for viral infections, antiviral drugs can be administered. Additionally, broad-spectrum antibiotics capable of covering both Gram-negative and Gram-positive bacteria can be used. Furthermore, while preventing infection, it is also important to promote the production of granulocytes. This typically requires ruling out serious hematologic diseases before using medications that promote white blood cell production, such as B vitamins and squalene. However, these treatments are only symptomatic. The primary focus should still be on correcting the underlying cause to maintain white blood cells within a normal range. (Please consult a doctor before using any medication and do not self-medicate.)