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Currently, non-infectious diseases, among which various disorders of the endocrine system play a decisive role, occupy one of the first positions in the structure of morbidity and mortality. Endocrine pathology worsens the course of other diseases and is a significant adverse factor in increasing mortality, including cardiovascular accidents. Thyroid pathology ranks second in the structure of endocrine diseases, and an increase in the incidence and prevalence of thyroid pathology in older age groups has been noted in recent decades. Thyroid hormones reduce the concentration of cholesterol, phospholipids and triglycerides in the plasma, while the amount of free fatty acids may increase. Conversely, decreased secretion of thyroid hormones dramatically increases the plasma concentration of cholesterol and phospholipids, and is almost always the cause of a sharp increase in fat deposition in the liver. In the presence of dyslipidemia and arterial hypertension, primary hypothyroidism can be considered as a risk factor for atherosclerosis and, accordingly, ischemic heart disease, especially in the elderly. In conditions of chronic iodine deficiency, a number of autoimmune factors may play a significant role in goiter development. Patients with endemic goiter reveal enzymatic defects in the synthesis of thyroid hormones, which further stimulates autoimmune aggression and degenerative changes in the thyroid gland, leading to a gradual decrease in the functional activity of the gland – hypothyroidism. Iodine deficiency and autoimmune diseases of the thyroid gland are often components of a continuum of comorbidity, which requires personalization of their treatment, taking into account the risks of mutual influences of various pathologies.

Introduction. In Russian Federation, there are no comprehensive studies assessing the quality of life and risk factors for vitamin D deficiency and insufficiency, taking into account its status in different geographic latitudes.Aim. To assess the quality of life and risk factors for vitamin D deficiency and insufficiency among the population living in the regions of the Russian Federation located at latitudes from 45 ° to 70 °.Materials and methods. The first stage of the Russian multicenter non-interventional registry study using the “cross-sectional” method was carried out from March 2020 to May 2020.Results and discussion. According to the results of the correlation analysis, qualitative and quantitative factors were identified, presumably being risk factors for vitamin D deficiency and deficiency. Qualitative risk factors include: education; alcohol consumption; being in direct sunlight for more than 30 minutes a day; visit to the solarium; using sunscreen; drinking coffee; taking medications (not vitamin-mineral complexes). Quantitative factors include: visits to specialists (total per year); smoking (duration, years); exercise for more than 30 minutes a day, once a week; being in direct sunlight for more than 30 minutes a day.Conclusion. A wide range of risk factors for vitamin D deficiency dictates the need for their further study to clarify the category of persons who are shown targeted biochemical screening with subsequent drug correction.

The prevalence of hypothyroidism in the population is high. The frequency of manifest hypothyroidism in the world, according to various data, is 0.2–2.0%, subclinical one – up to 10% for women and up to 3% for men, and in the older age group (over 70 years) reaches 14%, with the majority of cases of hypothyroidism accounted for primary hypothyroidism. Thus, a doctor of any specialty in his practice is likely to meet a patient with hypothyroidism: both with the established diagnosis, and face the need for differential diagnosis of various pathological conditions with hypothyroidism. This article presents a classification of hypothyroidism based on etiological aspects, describes the clinical picture of the disease, pays special attention to the so-called «masks» of hypothyroidism, which, in our view, can be useful for a doctor of any specialty, provides available methods for diagnosing this syndrome (special attention is paid to laboratory methods), as well as the goals and principles of treatment, highlights the need to monitor laboratory indicators in dynamics against the background of treatment. In addition, the features of correction of hypothyroidism during pregnancy are given. The article presents the peculiarities of selecting drug doses depending on the patient’s age and comorbidity. The distinctive feature and the purpose of this article, from our point of view, is its potential benefits not only for endocrinologists, but also for other health professionals.

The mechanisms of mutual influence of fat tissue and the hypothalamo-pituitary-adrenal (HPA) axis include the regulation of the metabolism of adipocytes by adrenal cortex hormones, on the one part, and the effect of adipocytes and adipocytokines on secretion, metabolism and action of steroid hormones in target cells - on the other part. Glucocorticoids contribute to the differentiation of preadipocytes into mature adipocytes; brown fat tissue transforms into white under the effect of GC. Mineralocorticoids are also involved in the process of adipocyte differentiation, regulate adipokine expression, and induce oxidative stress in fat tissue. There is evidence that suggest that circulating dehydroepiandrosterone sulfate (DHEAS), obesity, insulin sensitivity are associated with the presence of cardiovascular diseases. Orexigenic neuropeptides and inflammatory mediators, which trigger the synthesis of corticotropin-releasing hormone (CRH) in the hypothalamic paraventricular nuclei, are considered as possible mechanisms of (HPA) axis activation in obesity. Expression of 1ip-hydroxysteroid dehydrogenase type 1 (11P-HSD1) in fat tissue and the formation of cortisol from cortisone at the tissue level can be considered as one of the factors involved in development of insulin resistance. The autocrine and paracrine regulatory effect of these hormones on adipocyte function is the consequence of aldosterone production and aromatization of androgens by fat tissue.

Obesity is a chronic disease associated with cardiometabolic risk factors, primarily cardiovascular diseases and type 2 diabetes mellitus. In 2016,Russiaregistered a new drug for treating obese patients liraglutide 3.0 mg, which is an analogue of human glucagon-like peptide-1. Given the urgency of the problem, we present a clinical case that shows the efficacy of therapy with liraglutide 3.0 mg daily in a patient with obesity, and its effect on metabolic risk factors.

Summary: Natural iodine deficiency affects around 2 billion people worldwide. It is known that insufficient intake of iodine is especially dangerous at the stage of fetal development and early childhood. Changes caused by iodine deficiency in these periods of life bring about irreversible defects in the intellectual and physical development of children. A dramatic outcome of chronic iodine deficiency during fetal development and early childhood is mental disability. The urgency and procedure for iodine prophylaxis in pregnant and lactating women are defined by the World Health Organization (WHO) and the International Council for the Control of IDD (ICCIDD). Pregnant and lactating women are referred to the group of absolute risk for developing IDD. WHO recommends to administer potassium iodide to pregnant and breastfeeding women residing in the areas of iodine deficiency. The Order of the Russian Ministry of Health defined the list of essential drugs for women during pregnancy and the postpartum period which also includes potassium iodide medications. Russian guidelines for the level of iodine intake by pregnant and nursing women conform to the WHO recommendations. Federal standards of care for pregnant women stipulate prescription of potassium iodide medications.