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The goal of this investigation was to study the influence of metformin on the indices of thyroid hormones, carbohydrate and lipid metabolism in patients with diffuse toxic goiter and insulin resistance. The article presents the results of the study of 21 patients with diffuse toxic goiter. Treatment was conducted in two phases and each phase lasted for 3 months. During the first phase all patients received thyreostatic therapy with thyrozol, metformin was additionally prescribed in order to correct insulin resistance on the second phase. The obtained results are the evidence in favor of HOMA-IR index normalization by reducing glucose and fasting insulin, and slight increase in thyroid stimulating hormone and free thyroxine reduction within the referential standards against the background of combined treatment with thyrozol and metformin.

The article deals with the analysis of the literature on the study of the spectrum of therapeutic properties of Potentilla alba preparation, supplemented with selenium and zinc, which is prescribed in addition to standard management of patients with thyroid hyperfunction. Drug is used alone in subclinical thyrotoxicosis degree I, as well as in achieving stable compensation of diffuse toxic goiter; and as a part of comprehensive therapy — in subclinical thyrotoxicosis degree II, diffuse toxic goiter for normalization of T4 and T3 content in the blood., Статья посвящена анализу литературы по изучению спектра терапевтических свойств препарата лапчатки белой, дополненного селеном и цинком, назначающегося в дополнение к стандартному ведению пациентов с гиперфункцией щитовидной железы. В виде монотерапии — при субклиническом тиреотоксикозе первой степени, а также при достижении стойкой компенсации диффузного токсического зоба. В составе комплексной терапии — при субклиническом тиреотоксикозе второй степени, диффузном токсическом зобе при нормализации содержания Т4 и Т3 в крови., Стаття присвячена аналізу літератури з вивчення спектра терапевтичних властивостей препарату перстачу білого, доповненого селеном і цинком, що призначається на додаток до стандартного ведення пацієнтів із гіперфункцією щитоподібної залози. У вигляді монотерапії — при субклінічному тиреотоксикозі першого ступеня, а також при досягненні стійкої компенсації дифузного токсичного зоба. У складі комплексної терапії — при субклінічному тиреотоксикозі другого ступеня, при дифузному токсичному зобі при нормалізації вмісту Т4 і Т3 в крові.

Background. Diffuse toxic goiter (DTG), or Graves’ disease, is an autoimmune thyroid disease, the prevalence of which is steadily increasing in the structure of thyroid pathology and makes up about 80 % of all causes of hyperthyroidism. The purpose of our work was to study the structural state of the thyroid gland in patients with DTG. Materials and methods. Important aspect of the work was the cytological study of the structure of focal formations against the background of DTG (Graves’ disease). The study was conducted in the clinic of the State Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Aca­demy of Medical Sciences of Ukraine” and in the Kyiv City Center of Endocrine Surgery at the premises of Kyiv City Clinical Hospital 3. A total of 310 patients with a diagnosis of DTG were examined: 285 (91.94 %) women and 25 (8.06 %) men. Their age ranged from 19 to 70 years (on average 41.25 ± 1.19 years). The duration of the disease at the start of the examination was from 1 month to 15 years (on average 25.09 ± 2.76 months). To determine the volume and structure of the thyroid gland, palpation and ultrasound examinations were performed, as well as a fine-needle aspiration biopsy with cytological examination of punctate, and computer tomo­graphy of the neck and mediastinum organs. To establish/confirm the diagnosis, a hormonal examination was performed (serum thyroid stimulating hormone, free T3 and free T4, as well as thyroid stimulating hormone receptor antibodies were measured). Results. The ratio of patients with diffuse enlargement of the thyroid gland without focal formations accounted for 78.39 %, the number of individuals without an increase in thyroid volume was 2.58 %, and 19.03 % of people had focal formations. Among patients with focal formations, those with benign adenomatous (54.24 %) and colloid nodules (25.42 %) prevailed. Papillary carcinoma was diagnosed in 2 patients with DTG (3.39 %). Computed tomography of the neck and mediastinum organs made it possible to establish that even with relatively small sizes of diffuse goiter (18.00 ± 2.78 cm3), there was a high probability of a significant retrotracheal portion of the thyroid gland. Conclusions. The use of the name “Graves’ disease” to identify this pathology is more appropriate because it facilitates the formulation of a complete diagnosis and communication with Western colleagues., Актуальность. Диффузный токсический зоб (ДТЗ) (болезнь Грейвса) является аутоиммунным заболеванием щитовидной железы (ЩЖ), распространенность которого неуклонно возрастает в структуре тиреоидной патологии, и составляет около 80 % всех причин гипертиреоза. Целью нашей работы было исследование структурного состояния ЩЖ у больных ДТЗ. Материалы и методы. Изучали цитологическую структуру узловых образований при ДТЗ (болезни Грейвса). Исследование проводилось в клинике ГУ «Институт эндокринологии и обмена веществ им. В.П. Комиссаренко НАМН Украины» и в Киевском городском центре эндокринной хирургии. Всего обследованы 310 пациентов с ДТЗ: 285 (91,94 %) женщин и 25 (8,06 %) мужчин, возраст которых варьировал от 19 до 70 лет (в среднем составил 41,25 ± 1,19 года). Длительность заболевания на момент начала обследования колебалась от одного месяца до 15 лет (в среднем 25,09 ± 2,76 месяца). Для определения объема и структуры ЩЖ проводились пальпаторное и ультразвуковое исследование, а также тонкоигольная аспирацинная пункционная биопсия с цитологическим исследованием пунктата и компъютерная томо­графия (КТ) органов шеи. Для установления/подтверждения диагноза осуществлялось гормональное обследование (определение в крови уровней тиреотропного гормона, свободного тироксина, свободного трийодтиронина, а также антител к рецептору тиреотропного гормона). Результаты. Доля больных с диффузным зобом без узловых образований в ЩЖ составляла 78,39 %, количество пациентов без увеличения объема ЩЖ — 2,58 %, с узловыми образованиями — 19,03 %. Среди пациентов с узловыми образованиями преобладали больные с доброкачественными аденоматозными (54,24 %) и коллоидными узлами (25,42 %). Папиллярная карцинома диагностирована у двух больных ДТЗ (3,39 %). КТ органов шеи и средостения позволила установить, что при относительно небольших размерах диффузного зоба (18,00 ± 2,78 см3) существует вероятность наличия значительной ретротрахеальной части ЩЖ. Выводы. Применение термина «болезнь Грейвса» для определения данной патологии является более целесо­образным, поскольку облегчает формулировку полного диагноза и коммуникацию с западными коллегами., Актуальність. Дифузний токсичний зоб (ДТЗ) (хвороба Грейвса) є автоімунним захворюванням, поширеність якого невпинно зростає в структурі тиреоїдної патології, і становить близько 80 % всіх причин гіпертиреозу. Метою нашої роботи було дослідити структурний стан щитоподібної залози (ЩЗ) у хворих на ДТЗ. Матеріали та методи. Було проведено цитологічне дослідження структури вогнищевих утворень на тлі ДТЗ (хвороби Грейвса). Дослідження виконувалось у клініці ДУ «Інститут ендокринології та обміну речовин ім. В.П. Комісаренка НАМН України» та в Київському міському центрі ендокринної хірургії на базі київської міської клінічної лікарні № 3. Усього обстежені 310 пацієнтів із ДТЗ: 285 (91,94 %) жінок і 25 (8,06 %) чоловіків, вік яких коливався від 19 до 70 років (у середньому 41,25 ± 1,19 року). Тривалість захворювання на момент початку обстеження становила від одного місяця до 15 років (у середньому 25,09 ± 2,76 місяця). Для визначення об’єму і структури ЩЗ проводились пальпаторне й ультразвукове дослідження, а також тонкоголкова аспіраційна пункційна біопсія із цитологічним дослідженням пунктату та комп’ютерна томографія (КТ) органів шиї та середостіння. Для встановлення/підтвердження діагнозу здійснювалось гормональне обстеження (визначення в крові рівнів тиреотропного гормона, вільного тироксину, вільного трийодтироніну та антитіл до рецептора тиреотропного гормона). Результати. Частка хворих із дифузно збільшеною ЩЗ без вогнищевих утворень становила 78,39 %, кількість пацієнтів без збільшення об’єму ЩЗ — 2,58 %, число хворих із вогнищевими утвореннями в ЩЗ — 19,03 %. Серед хворих із вогнищевими утвореннями переважали пацієнти з доброякісними аденоматозними (54,24 %) та колоїдними (25,42 %) вузлами ЩЗ. Папілярну карциному діагностовано у двох хворих на ДТЗ (3,39 %). КТ органів шиї та середостіння дозволила встановити, що навіть при відносно невеликих розмірах дифузного зоба (18,00 ± 2,78 см3) існує велика вірогідність наявності значної ретротрахеальної частини ЩЗ. Висновки. Застосування назви «хвороба Грейвса» для визначення даної патології є більш доцільним, оскільки полегшує формулювання повного діагнозу та комунікацію із західними колегами.

Background. Diffuse toxic goiter (DTG), or Graves’ disease, is an autoimmune thyroid disease, the prevalence of which is steadily increasing in the structure of thyroid pathology and makes up about 80 % of all causes of hyperthyroidism. The purpose of our work was to study the structural state of the thyroid gland in patients with DTG. Materials and methods. Important aspect of the work was the cytological study of the structure of focal formations against the background of DTG (Graves’ disease). The study was conducted in the clinic of the State Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Aca­demy of Medical Sciences of Ukraine” and in the Kyiv City Center of Endocrine Surgery at the premises of Kyiv City Clinical Hospital 3. A total of 310 patients with a diagnosis of DTG were examined: 285 (91.94 %) women and 25 (8.06 %) men. Their age ranged from 19 to 70 years (on average 41.25 ± 1.19 years). The duration of the disease at the start of the examination was from 1 month to 15 years (on average 25.09 ± 2.76 months). To determine the volume and structure of the thyroid gland, palpation and ultrasound examinations were performed, as well as a fine-needle aspiration biopsy with cytological examination of punctate, and computer tomo­graphy of the neck and mediastinum organs. To establish/confirm the diagnosis, a hormonal examination was performed (serum thyroid stimulating hormone, free T3 and free T4, as well as thyroid stimulating hormone receptor antibodies were measured). Results. The ratio of patients with diffuse enlargement of the thyroid gland without focal formations accounted for 78.39 %, the number of individuals without an increase in thyroid volume was 2.58 %, and 19.03 % of people had focal formations. Among patients with focal formations, those with benign adenomatous (54.24 %) and colloid nodules (25.42 %) prevailed. Papillary carcinoma was diagnosed in 2 patients with DTG (3.39 %). Computed tomography of the neck and mediastinum organs made it possible to establish that even with relatively small sizes of diffuse goiter (18.00 ± 2.78 cm3), there was a high probability of a significant retrotracheal portion of the thyroid gland. Conclusions. The use of the name “Graves’ disease” to identify this pathology is more appropriate because it facilitates the formulation of a complete diagnosis and communication with Western colleagues.

The author has revealed the specific characteristics of the formation, development and functioning of the fetoplacental complex in gravidas with exophthalmic toxic goiter. It has been established that the rate of primary placental insufficiency elevates in case of the onset of pregnancy against a background of diffuse toxic goiter decompensation that is manifested by a decrease of the concentration of placental lactogen, progesterone and alpha-fetoprotein. Placental dysfunctional disturbances are directly correlated with the duration of the compensation of diffuse toxic goiter and cause a high rate of a delay of the fetal intrauterine development., Выявлены особенности формирования, развития и функционирования фетоплацентарного комплекса у беременных с диффузным токсическим зобом. Установлено, что при наступлении беременности на фоне декомпенсации диффузного токсического зоба увеличивается частота первичной плацентной недостаточности, которая проявляется в снижении концентрации плацентного лактогена, прогестерона и α-фетопротеина. Функциональные нарушения плаценты находятся в прямой корреляции с длительностью компенсации диффузного токсического зоба и определяют высокую частоту задержки внутриутробного развития плода., Виявлено особливості формування, розвитку і функціонування фетоплацентарного комплексу у вагітних з дифузним токсичним зобом. Встановлено, що при настанні вагітності на тлі декомпенсації дифузного токсичного зоба зростає частота первинної плацентарної недостатності, що проявляється в зниженні концентрації плацентарного лактогена, прогестерону і α-фетопротеїну. Функціональні порушення плаценти перебувають у прямій кореляції з тривалістю компенсації дифузного токсичного зоба і зумовлюють високу частоту затримки внутрішньоутробного розвитку плода.

Objective:To analyze agreement between Peak Systolic Velocity (PSV) of inferior thyroid artery (ITA) and Tc99m Thyroid Scan for evaluation of thyrotoxicosis(diffuse toxic goiter and sub-acute thyroiditis) Patients and Methods: This prospective cross sectional study was conducted in National Institute of Nuclear medicine and Allied sciences (NINMAS)From July 2016 to June 2017.Total sixty four patients with thyrotoxicosis were included in the study. History, clinical examination and thyroid function tests were done for all patients. The thyroid glands of all patients wereevaluated by gray scale ultrasonography for size, shapeand echotexture. Color-flow Doppler ultrasonographyof the thyroid tissue was performed and spectral flowanalysis of both inferior thyroid arteries were assessed. Tc99m Thyroid scan was done for all patients. The patients were divided into two groups. Group A- Diffuse toxic goiter(DTG) and Group B- Subacute thyroiditis(SAT).The diagnosis of diffuse toxic goiter and subacute thyroiditis was supported by the clinical picture, RAIU uptake and Thyroid Scan. Results:All patients had suppressed thyrotropin.Thyroid blood flow, measured by PSV of ITA (CFDS) was highthan normal in DTG patients, while low PSV ofITA than normal was found in SAT.According to Thyroid Scan,Radiotracer concentration (RTC)was diffusely increased with low BKG (background) and almost absent RTC with high BKG was noted in DTG and SAT respectively.In our study Tc99m Thyroid Scan shows agreement with Peak Systolic Velocity of ITA.Here Kappa value was 0.818 and 0.871 in DTG and SAT respectively with P value

This article discusses the problems of surgical tactics in diffuse - toxic goiter and its complications, both in the early postoperative period and in the long term. The above complications require surgeons to search for the most optimal method of surgical treatment. Aim: Evaluation of immediate, long-term results and hormonal status with various methods of surgical treatment of diffuse-toxic goiter. Materials and research мethods. The article presents the experience of treating 149 patients. The analysis of immediate and long-term results of surgical interventions in relation to thyroid status is given. In 90 patients, subtotal resection of the thyroid gland was performed, in 31 - thyroidectomy, in 28 cases - embolization of the thyroid artery. Thyroid status was analyzed 1, 6, 12, 24 months after surgery. The patients were divided into subgroups depending on the initial volume of the thyroid gland (less than 45 cm3 and more than 45 cm3). Statistical analysis of numerical series was carried out using the Mann-Whitney method, relative values - using Fisher's two-sided exact test. Research results. A moderate number of postoperative complications was revealed, with a predominance of extirpation of the gland in the group and no extirpation in patients undergoing arterial embolization. On the contrary, a higher incidence of recurrence of the hyperthyroid state was characteristic for the latter group, where it was 28.6% over a follow-up period of 24 months. With subtotal resection, the corresponding indicator was 14.4%; after extirpation, no cases of relapse were observed. Extirpation led to the development of total hypothyroidism in all patients, in other groups this condition was observed in about half of the cases. An excess of the initial gland volume of 45 cm3was characterized by a sharp increase in the incidence of postoperative hypothyroidism. Conclusions: The use of different approaches to the surgical treatment of diffuse-toxic goiter gives differences in the frequency of perioperative complications (excess during extirpation of the thyroid gland) and late complications. Among the late complications, hypothyroidism dominates, which is subject to compensation with the help of substitution therapy. The frequency of recurrence of thyrotoxicosis has a double dependence on the approach to treatment and the initial volume of the thyroid gland. In order to prevent relapse for surgical treatment of DTG with a gland volume of more than 45 cm3, the most rational is extirpation., В данной статье рассматривается проблемы хирургической тактики при диффузно - токсическом зобе и ее осложнениях, как в раннем послеоперационном периоде, так и в отдаленном периоде. Вышеуказанные осложнения требуют от хирургов поиска наиболее оптимального метода хирургического лечения. Цель работы: Оценка непосредственных, отдаленных результатов и гормонального статуса при различных методах хирургического лечения диффузно-токсического зоба. Материалы и методы исследования: В статье представлен опыт лечения 149 пациентов. Дан анализ непосредственных и отдаленных результатов хирургических вмешательств в отношении тиреоидного статуса. У 90 больных проведена субтотальная резекция щитовидной железы, у 31 – тироидэктомия, в 28 случаях – эмболизация артерии щитовидной железы. Тиреоидный статус анализировался через 1, 6, 12, 24 месяца после операции. Пациенты были распределены на подгруппы в зависимости от исходного объема щитовидной железы (менее 45 см3 и более 45 см3). Статистический анализ числовых рядов проведен по методу Манна-Уитни, относительных значений – с применением двустороннего точного критерия Фишера. Результаты исследования. Выявлено умеренное число послеоперационных осложнений с преобладанием в группе экстирпации железы и отсутствием у пациентов, подвергавшихся эмболизации артерии. Напротив, более высокая частота развития рецидива гипертиреоидного состояния была характерна для последней группы, где она составила 28,6% за период наблюдения 24 месяца. При субтотальной резекции соответствующий показатель составил 14,4%, после экстирпации случаев рецидива не наблюдалось. Экстирпация привела к развитию тотального гипотиреоза у всех пациентов, в остальных группах это состояние наблюдалось примерно в половине случаев. Превышение исходного объема железы 45 см3 характеризовалось резким ростом частоты развития послеоперационного гипотиреоза. Выводы: Применение различных подходов к оперативному лечению диффузно-токсического зоба дает отличия в частоте периоперационных осложнений (превышение при экстирпации щитовидной железы) и поздних осложнений. Среди поздних осложнений доминирует гипотиреоз, подлежащий компенсации с помощью заместительной терапии. Частота рецидивов тиреотоксикоза имеет двойную зависимость от подхода к лечению и исходного объема щитовидной железы. С целью предотвращения рецидива для оперативного лечения ДТЗ при объеме железы более 45 см3 наиболее рациональной является экстирпация., Бұл мақалада диффузды- токсикалық зоб кезіндегі хирургиялық тактиканың мәселелеріжәне оның операциядан кейінгі ерте кезеңдегі және ұзақ мерзімді асқынулары туралы айтылады. Жоғарыда аталған асқынулар хирургтардан хирургиялық емдеудің оңтайлы әдісін іздеуді талап етеді. Жұмыстың мақсаты: Диффузиялық-токсикалық зобты хирургиялық емдеудің әртүрлі әдістерімен жедел, ұзақ мерзімді нәтижелерді және гормоналды статусты бағалау. Зерттеу материалдар және әдістері. Мақалада 149 науқасты емдеу тәжірибесі көрсетілген. Қалқанша безінің статусына байланысты хирургиялық араласудың жедел және ұзақ мерзімді нәтижелерін талдау берілген. 90 науқасқа қалқаншабезінің субтотальды резекциясы, 31-де- тиреоидэктомия, 28 жағдайда- қалқанша артерия эмболизациясы жасалды. Қалқанша безінің гормоныоперациядан 1, 6, 12, 24 ай өткен соң талданды. Қалқанша безінің бастапқы көлеміне байланысты науқастар кіші топтарға бөлінді (45 см3 аз және 45 см3 артық). Сандық қатарлардың статистикалық талдауы Манн-Уитни әдісі бойынша, салыстырмалы мәндер- Фишердің екі жақты дәл тесті арқылы жүргізілді. Зерттеу нәтижелері. Операциядан кейінгі асқынулардың орташа саны анықталды, топта без экстирпациясы басым болды және артерия эмболизациясына ұшыраған науқастарда экстирпация болмайды. Керісінше, гипертиреоидтық жағдайдың қайталануының жиілігі соңғы топқа тән болды, мұнда ол 24 айлық бақылау кезеңінде 28,6% құрады. Субтотальды резекция кезінде тиісті көрсеткіш14,4% құрады, экстирпациядан кейін рецидив жағдайлары байқалмады. Экстирпация барлық науқастарда жалпы гипотиреоздың дамуына әкелді, басқа топтарда бұл жағдай жағдайлардың жартысында байқалды. Бездің бастапқы көлемінің 45 см3 артық болуы операциядан кейінгі гипотиреоз ауруының күрт өсуімен сипатталды. Қорытынды: Диффузиялық-токсикалық зобты хирургиялық емдеудің әртүрлі тәсілдерін қолдану периоперациялық асқынулардың (қалқанша безінің экстирпациясы кезіндегі артық) және кеш асқынулардың айырмашылықтарын береді. Кеш асқынулардың ішінде гипотиреоз басым, ол ауыстыру терапиясымен өтелуге жатады. Тиреотоксикоздың қайталану жиілігі емдеу тәсіліне және Қалқанша безінің бастапқы көлеміне екі есе тәуелді болады. ДТЖбезінің көлемі45 см3-ден жоғары хирургиялық емдеу кезінде рецидивтің алдын алу үшін ең ұтымдысы - экстирпация, Наука и здравоохранение, Выпуск 2 (23) 2021, Pages 103-110

SUMMARY Diffuse toxic goiter, as the most common cause of hyperthyroidism, is usually initially treated with thyrostatic drugs such as methimazole, followed by radioiodine therapy or surgery which may be indicated as definitive treatment. Radioactive iodine therapy has a known association with various histopathologic features including cytologic atypia, but herein we present a rare example of morphological thyrocyte changes induced by long-term pharmacological treatment with methimazole that mimicked thyroid malignancy in a pathohistological sample.

Diffuse toxic goiter is one of the commonest diseases of the thyroid. In the present article, etiology and pathogenesis of this disease are considered. Modern approaches to its diagnostics and treatment are described.

The features of calcium, phosphorus, parathyroid hormone, vitamin D indexes in patients with diffuse toxic goiter after thyroidectomy are presented. It is set that age, greater thyroid volume, decreased 25(ОН)D level before operation, decline of parathyroid hormone level after operation it is belonged to the basic parameters that influence on development of hypocalcemia in patients with diffuse toxic goiter after thyroidectomy. 25(ОН)D level below 20 ng/ml it follows to examine as to specific and sensible preoperated predictor of hypocalcemia development after thyroidectomy as well as hypoparathyroidism.

The goal of this investigation was to study the influence of metformin on the indices of thyroid hormones, carbohydrate and lipid metabolism in patients with diffuse toxic goiter and insulin resistance. The article presents the results of the study of 21 patients with diffuse toxic goiter. Treatment was conducted in two phases and each phase lasted for 3 months. During the first phase all patients received thyreostatic therapy with thyrozol, metformin was additionally prescribed in order to correct insulin resistance on the second phase. The obtained results are the evidence in favor of HOMA-IR index normalization by reducing glucose and fasting insulin, and slight increase in thyroid stimulating hormone and free thyroxine reduction within the referential standards against the background of combined treatment with thyrozol and metformin.

Postoperative hypoparathyroidism is one of frequent specific complications after thyroid surgery that occupies the special place, having regard to severity of manifestation and complicated prevention. A research aim is to assess frequency of hypocalcemia after thyroidectomy concerning different thyroid pathology. Materials and methods. 50 patients with a multinodular goiter (MNG), 50 patients with diffuse toxic goiter (DTG) and 50 patients with thyroid cancer (TC) were under observation. All patients underwent thyroidectomy with the further assessment of thyroid hormones. Results. Thyroidectomy in patients with TC and DTG is accompanied by more expressed transitory hypoparathyroidism as compared to an analogical operation in patients with MNG. A postoperative hypoparathyroidism more often develops after thyroidectomy in patients with TC and DTG as compared to the patients with MNG. Conclusions. The risk of development of hypoparathyroidism after thyroidectomy is highest in patients with TC, less pronounced – in patients with DTG and MNG., Одним из наиболее частых специфических осложнений после операций на щитовидной железе (ЩЖ) является послеоперационный гипопаратиреоз, который занимает особенное место, принимая во внимание тяжесть проявления и сложности профилактики. Цель работы – установить частоту гипокальциемии после тиреоидэктомии по поводу различной патологии ЩЖ. Материалы и методы. В исследование было включено 50 больных многоузловым зобом (МУЗ), 50 больных диффузным токсическим зобом (ДТЗ) и 50 больных папиллярным раком ЩЖ (РЩЖ). Всем больным было проведено оперативное вмешательство на ЩЖ – тиреоидэктомия с дальнейшим назначением заместительной или супрессивной дозы препаратов тиреоидных гормонов. Результаты. Тиреоидэктомия у пациентов с РЩЖ и ДТЗ сопровождается более выраженным транзиторным гипопаратиреозом по сравнению с аналогичной операцией у больных с МУЗ. Послеоперационный гипопаратиреоз чаще развивается после тиреоидэктомии у больных РЩЖ и ДТЗ в сравнении с больными с МУЗ. Выводы. Риск развития гипопаратиреоза после тиреоидэктомии наиболее высокий у больных РЩЖ, меньший – у пациентов с ДТЗ и МУЗ., Одним із найчастiших специфічних ускладнень після операцій на щитоподібній залозі (ЩЗ) є післяопераційний гіпопаратиреоз, який займає особливе місце, зважаючи на тяжкість прояву і складності профілактики. Мета роботи – встановити частоту гіпокальціємії після тиреоїдектомії з приводу різної патології ЩЗ. Матеріали та методи. У дослідження було включено 50 хворих на багатовузловий зоб (БВЗ), 50 хворих на дифузний токсичний зоб (ДТЗ) і 50 хворих на папілярний рак ЩЗ (РЩЗ). Всім хворим було проведено оперативне втручання на ЩЗ – тиреоїдектомія з подальшим призначенням замісної чи супресивної дози препаратів тиреоїдних гормонів. Результати. Тиреоїдектомія у пацієнтів з РЩЗ і ДТЗ супроводжується більш виразним транзиторним гіпопаратиреозом в порівнянні з аналогічною операцією у хворих на БВЗ. Післяопераційний гіпопаратиреоз частіше розвивається після тиреоїдектомії у хворих на РЩЗ і ДТЗ у порівнянні з хворими на БВЗ. Висновок. Ризик розвитку гіпопаратиреозу після тиреоїдектомії найбільш високий у хворих на РЩЗ, менший – у пацієнтів з ДТЗ і БВЗ. Ключові слова: рак щитоподібної залози, дифузний токсичний зоб, багатовузловий зоб, тиреоїдектомія, паратгормон, кальцій.

Postoperative hypoparathyroidism is one of frequent specific complications after thyroid surgery that occupies the special place, having regard to severity of manifestation and complicated prevention. A research aim is to assess frequency of hypocalcemia after thyroidectomy concerning different thyroid pathology. Materials and methods. 50 patients with a multinodular goiter (MNG), 50 patients with diffuse toxic goiter (DTG) and 50 patients with thyroid cancer (TC) were under observation. All patients underwent thyroidectomy with the further assessment of thyroid hormones. Results. Thyroidectomy in patients with TC and DTG is accompanied by more expressed transitory hypoparathyroidism as compared to an analogical operation in patients with MNG. A postoperative hypoparathyroidism more often develops after thyroidectomy in patients with TC and DTG as compared to the patients with MNG. Conclusions. The risk of development of hypoparathyroidism after thyroidectomy is highest in patients with TC, less pronounced – in patients with DTG and MNG., Одним из наиболее частых специфических осложнений после операций на щитовидной железе (ЩЖ) является послеоперационный гипопаратиреоз, который занимает особенное место, принимая во внимание тяжесть проявления и сложности профилактики. Цель работы – установить частоту гипокальциемии после тиреоидэктомии по поводу различной патологии ЩЖ. Материалы и методы. В исследование было включено 50 больных многоузловым зобом (МУЗ), 50 больных диффузным токсическим зобом (ДТЗ) и 50 больных папиллярным раком ЩЖ (РЩЖ). Всем больным было проведено оперативное вмешательство на ЩЖ – тиреоидэктомия с дальнейшим назначением заместительной или супрессивной дозы препаратов тиреоидных гормонов. Результаты. Тиреоидэктомия у пациентов с РЩЖ и ДТЗ сопровождается более выраженным транзиторным гипопаратиреозом по сравнению с аналогичной операцией у больных с МУЗ. Послеоперационный гипопаратиреоз чаще развивается после тиреоидэктомии у больных РЩЖ и ДТЗ в сравнении с больными с МУЗ. Выводы. Риск развития гипопаратиреоза после тиреоидэктомии наиболее высокий у больных РЩЖ, меньший – у пациентов с ДТЗ и МУЗ., Одним із найчастiших специфічних ускладнень після операцій на щитоподібній залозі (ЩЗ) є післяопераційний гіпопаратиреоз, який займає особливе місце, зважаючи на тяжкість прояву і складності профілактики. Мета роботи – встановити частоту гіпокальціємії після тиреоїдектомії з приводу різної патології ЩЗ. Матеріали та методи. У дослідження було включено 50 хворих на багатовузловий зоб (БВЗ), 50 хворих на дифузний токсичний зоб (ДТЗ) і 50 хворих на папілярний рак ЩЗ (РЩЗ). Всім хворим було проведено оперативне втручання на ЩЗ – тиреоїдектомія з подальшим призначенням замісної чи супресивної дози препаратів тиреоїдних гормонів. Результати. Тиреоїдектомія у пацієнтів з РЩЗ і ДТЗ супроводжується більш виразним транзиторним гіпопаратиреозом в порівнянні з аналогічною операцією у хворих на БВЗ. Післяопераційний гіпопаратиреоз частіше розвивається після тиреоїдектомії у хворих на РЩЗ і ДТЗ у порівнянні з хворими на БВЗ. Висновок. Ризик розвитку гіпопаратиреозу після тиреоїдектомії найбільш високий у хворих на РЩЗ, менший – у пацієнтів з ДТЗ і БВЗ. Ключові слова: рак щитоподібної залози, дифузний токсичний зоб, багатовузловий зоб, тиреоїдектомія, паратгормон, кальцій.

The objective of this study was to establish the relationship between the levels of thyroid hormones and characteristics of bone tissue according to radiological and laboratory methods. To assess the influence of thyroid hormone levels on the bone tissue, there was performed a comparative study of four groups of patients aged 19 to 49 years. The main study groups consisted of 34 patients with diffuse toxic goiter (DTG) and 42 patients with overt primary hypothyroidism. A comparison group included 23 patients with diffuse nontoxic goiter and preserved functional state of the thyroid gland (indicators of thyroid-stimulating hormone (TSH) and fT4 were not statistically significantly different from the control group data). The control group is presented by 20 apparently healthy persons. It was found that excessive production of thyroid hormone with a pronounced inhibition of TSH (0.08 ± 0.03 µIU/ml) in patients with DTG, as well as reduced thyroid function with higher levels of TSH (8.24 ± 3.16 µIU/ml) in patients with overt hypothyroidism, lead to disturbances in the system of bone metabolism: in thyrotoxicosis — increase with the predominance of resorption, and in hypothyroidism — decrease of bone remodeling. Ultrasonic densitometry has shown a statistically significant decrease of bone density values and increased incidence of osteopenia and osteoporosis compared to apparently healthy individuals. The development of hyperthyroidism in the age under 30 increases the risk of osteopenic syndrome in patients with DTG. The incidence of osteopenic syndrome in patients with overt hypothyroidism does not depend on age.

The article contains an analysis of the clinical case of Graves disease in the elderly. The features of thyrotoxic disorders in the elderly, the reasons for their development are presented. It describes characteristic manifestations of diffuse toxic goiter in geriatric patients, pathogenesis, diagnosis and treatment principles.

In recent years, the surgical treatment of DTG includes extirpation of the thyroid gland that can lead to the development of postoperative hypocalcemia, which causes of development are under study. Up to now, there are no clear recommendations for prophylaxis of postoperative hypocalcemia. In this connection, it is actually to carry out additional research to explore the methods of prophylaxis of postoperative hypocalcemia. The study involved 57 patients with diffuse toxic goiter, who had extirpation of the thyroid gland in period from 2010 until 2015. According to results of the performed study, it has been shown that prophylactic administration of preparations of calcium and vitamin D reduces the risk of postoperative hypocalcemia for patients with vitamin D deficiency.

To analyze long-term outcomes of Graves' disease management.There were 428 patients for the periods 2000-2004 and 2005-2010. Patients were called for examination and thyroid status control. 2 groups were compared: group 1 of 203 patients and group 2 of 225 patients.It was found that after subtotal resection by original technique (patent 1802309 of the Russian Federation, MPK 5 G01N1, 1/28) in group 1 euthyroid state was observed in more than half (59.4%) of patients, hypothyroidism - 30.3% and recurrence - in 10.3% 10 years postoperatively. At the same time most of patients of group 2 (71.6%) after predominant thyroidectomy had hypothyroidism, euthyroid state was only in 24%. Postoperative recurrent diffuse toxic goiter incidence was 4.7%.The dynamics of postoperative thyroid status depending on type of surgery and follow-up was presented.Авторами проанализированы отдаленные результаты лечения 428 пациентов, оперированных по поводу болезни Грейвса в 2000-2004 и 2005-2010 гг. Больные были вызваны для прохождения обследования и контроля тиреоидного статуса. Выделены две группы: 1-я группа - 203 пациента, 2-я группа - 225 пациентов. Установлено, что в 1-й группе через 10 лет после операции в объеме субтотальной резекции по методике нашей клиники (патент 1802309 РФ, МПК 5 G01N1, 1/28) эутиреоз наблюдался более чем у половины (59,4%) пациентов, гипотиреоз - у 30,3% и рецидив заболевания - у 10,3%, в то время как во 2-й группе с преобладанием тиреоидэктомий большинство (71,6%) пациентов находились в состоянии гипотиреоза, эутиреоидный статус отмечен в 24% наблюдений. Частота послеоперационного рецидива диффузного токсического зоба до 4,7%. Показана динамика тиреоидного статуса оперированных пациентов в зависимости от объема операции и длительности наблюдения.

Analysis of the anamnestic data, of laboratory parameters and instrumental findings in 189 patients with toxic goiter, who had been operated on because of the lack of the disease remission, showed that during the period from 1970 to 2010, the number of relapses of hyperthyroidism after conservative surgery had increased seven times. The conclusion suggests further search for criteria of prognosing the results of surgical management

A total of 60 patients given substitution treatment with levothyroxin for diffuse toxic goiter were examined within 3-7 years after iodine radiotherapy. The patients showing different TSH levels were allocated to three groups: (group 1: low normal TSH level: 0.4-2.25 mcIU/ml; group 2: high normal TSH level: 2.6-4.0 mcIU/ml; group 3, decompensated hypothyroidism: above 4.0 mcIU/ml but lower than 10 mcIU/ml). The quality of life was assessed with the use of the abridged version of the SF-36 questionnaire and the psychoemotional status based on the Beck depression inventory and the Spilberg-Khanin test. The patients presenting with compensated hypothyroidism showed better characteristics of the quality of life compared with the patients of other groups. Moreover, they were less frequently subjected to anxiety and depressive disorders. It is concluded that replacement therapy with levothyroxin designed to maintain the TSH level within the low normal values ensures a higher quality of life and lower incidence of depressive disorders than in the patients having TSH levels closer to the upper normal limit.

The features of calcium, phosphorus, parathyroid hormone, vitamin D indexes in patients with diffuse toxic goiter after thyroidectomy are presented. It is set that age, greater thyroid volume, decreased 25(ОН)D level before operation, decline of parathyroid hormone level after operation it is belonged to the basic parameters that influence on development of hypocalcemia in patients with diffuse toxic goiter after thyroidectomy. 25(ОН)D level below 20 ng/ml it follows to examine as to specific and sensible preoperated predictor of hypocalcemia development after thyroidectomy as well as hypoparathyroidism., В статье установлены особенности показателей кальция, фосфора, паратгормона и витамина D у больных диффузным токсическим зобом после тиреоидэктомии. Показано, что возраст больных, объем щитовидной железы, более низкий уровень 25(ОН)D перед операцией, снижение уровня паратгормона после операции принадлежат к основным параметрам, которые влияют на развитие гипокальциемии у больных диффузным токсическим зобом после тиреоидэктомии. Уровень 25(ОН)D ниже 20 нг/мл следует рассматривать как специфический и чувствительный дооперационный предиктор развития гипокальциемии после тиреоидэктомии, а также стойкого гипопаратиреоза. Предикторами послеоперационного развития указанных состояний также можно считать уровень паратгормона после операции ниже 10 пг/мл., У статті встановлено особливості показників кальцію, фосфору, паратгормону та вітаміну D у хворих на дифузний токсичний зоб після тиреоїдектомії. Встановлено, що вік хворих, більший об’єм щитоподібної залози, більш низький рівень 25(ОН)D до операції, зниження рівня паратгормону після операції належать до основних параметрів, які впливають на розвиток гіпокальціємії у хворих на дифузний токсичний зоб після тиреоїдектомії. Рівень 25(ОН)D нижче від 20 нг/мл слід розглядати як специфічний і чутливий доопераційний предиктор розвитку гіпокальціємії після тиреоїдектомії, а також стійкого гіпопаратиреозу. Предикторами розвитку зазначених станів можна вважати рівень паратгормону після операції нижче від 10 пг/мл.

Diffuse toxic goiter (DTG) is an autoimmune disease, which is based on a congenital defect in the immune system. As a result of stimulating the synthesis of antibodies directed to the TSH receptor. Goiter forms gradually and then hyperthyroidism develops. For the last decades it has been pointed out a steady increase in the number of new cases of diffuse toxic goiter and drastic reduction of likelihood of remission. To some extent the spectrum of thyroid disease and the nature of the disease depend on the level of iodine provision in the particular region. Active iodine preventive measures were implemented among the population in Saint-Petersburg for the last decades. So the median urinary iodine increased from 105 (1999) to 148 mg/l (2010). Probably the growth of the iodine intake in Saint- Petersburg reduces the incidence of DTG remission and thus optimization of the treatment in these patients seems to be relevant and requires further study.

Objective: The aim of this study was to compare the B mode ultrasonography findings of thyroid gland and peak systolic velocity of inferior thyroid artery by color Doppler application, in patients with diffuse toxic goiter at the time of diagnosis and 6-8 months after radioiodine 131-I therapy.Patients and Methods: This was a prospective observational study conducted in National Institute of Nuclear Medicine & Allied Sciences (NINMAS) between June 2015 and October 2016. Forty consecutive diagnosed diffuse toxic goiter patients were selected at the time of diagnosis prior to radioiodine therapy. An ultrasonography evaluation of thyroid gland (measurement of anterior posterior diameter for convenience) and measurement of peak systolic velocity of inferior thyroid artery in both sides of thyroid gland were performed before and after 131-I therapy (6-8 months). The examination was performed in thyroid division of NINMAS by advanced ultrasound machine with a linear transducer (5-12 MHz). The patients were divided into two groups. Group A-diffuse toxic goiter prior to radioiodine therapy and group B- same patients 6-8 months after radioiodine therapy.Results: A reduction in the anterior –posterior diameter of the thyroid gland was observed from pre to post treatment evaluation, performed at 6 and or 8 months after radioiodine therapy. Color Doppler showed increased parenchymal vascularity at the time of diagnosis which gradually declined after radioiodine therapy. Thyroid blood flow, as assessed by PSV of ITA, was significantly higher in Group A than in Group B respectively (70.5 ± 15.5 cm/ sec versus 22.2 ± 12.9 cm/sec). PSV was measured in 10 healthy euthyroid adults & their PSV ranged 13-20 cm/Sec. Parenchymal vascularity of the thyroid gland was higher in hyperthyroid patients than in euthyroid patients.Conclusion: Assessment of thyroid gland by B-mode ultrasound and blood flow by color Doppler study (CDS) is an effective marker in the initial diagnosis of diffuse toxic goiter.Bangladesh J. Nuclear Med. 20(1): 41-44, January 2017

The aim of the investigation was to assess the time course of structural-and-functional and spatiogeometric changes following drug correction of euthyroidism in patients with diffuse toxic goiter and to determine prospects for restoring the cardiac functional reserve after elimination of thyrotoxicosis. The geometric parameters of the left ventricle (LV) and the readings of tissue Doppler echocardiography and exercise tests were compared in 27 female patients (mean age 53.3±9.2 years) who had thyrotoxicosis and 6 months after thyrosole-induced normalization of thyroid-stimulating and thyroid hormone. There were significant increases in myocardial mass and peak systolic and diastolic mitral ring motion rates and an increasing trend for LV linear sizes after correction of euthyroidism. Despite the fact that there were no significant differences in the majority of LV geometric parameters, with euthyroidism achievement, the cardiac functional reserve doubled as compared with the baseline values (105.7±11.4 and 57.8±14.7 W, respectively; p < 0.001), but remained below the control level (148.7±11.7 W; p < 0.05), which may contribute to the development of heart failure in future under certain conditions.

Patients with thyroid autoimmune diseases have lower blood level of vitamin D by comparison to a general population. However, there are few studies examining vitamin D status in patients with diffuse toxic goiter depending on the degree of disease compensation.A research aim was determination of vitamin D blood level in patients with diffuse toxic goiter, and also his possible influence on disease progression.Materials and methods. In cross-sectional study there were involved 57 women with diffuse toxic goiter of different degree of disease compensation. The first group was formed by women with diffuse toxic goiter in the state of protracted (over 6-9 months) thyrotoxicosis compensation (n=23). The second group was entered by 34 patients in the state of sub- and decompensation of diffuse toxic goiter. 25 practically healthy women without thyroid dysfunction and increase level of thyrotropin receptor antibodies were examined during the same period.Results and discussion. Vitamin D level (14.9±1.8 ng/ml) was significantly lower in patients with diffuse toxic goiter in sub- and decompensation state in comparison to the group of women with diffuse toxic goiter in the state of stabile thyrotoxicosis compensation (21.2±2.4 ng/ml) and control group (23.9±2.7 ng/ml). The results of correlation analysis revealed the presence in patients with diffuse toxic goiter in the sub- and decompensation thyrotoxicosis state significant negative connection between vitamin D range and level of thyrotropin receptor antibodies (r= –0.47; р, У пациентов с аутоиммунными заболеваниями щитовидной железы (ЩЖ) наблюдается более низкое содержание витамина D в сравнении с общей популяцией. В то же время отсутствуют работы, в которых проведен сравнительный анализ между содержанием витамина D у пациентов с диффузным токсическим зобом (ДТЗ) в зависимости от состояния компенсации заболевания.Цель работы – определить содержание витамина D у пациенток с ДТЗ, а также его возможное влияние на течение заболевания.Материалы и методы. В одномоментном перекрестном исследовании обследованы 57 женщин с ДТЗ в различной степени компенсации заболевания. Первую группу составили женщины с ДТЗ в состоянии длительной (более 6–9 мес) компенсации тиреотоксикоза (n=23). Во вторую группу вошли 34 пациентки в состоянии суб- и декомпенсации ДТЗ. 25 практически здоровых женщин без нарушения функции ЩЖ и повышенного титра антител к рецептору ТТГ были обследованы в течение такого же периода.Результаты и обсуждение. Содержание витамина D (14,9±1,8 нг/мл) оказалось достоверно ниже у пациенток с ДТЗ, которые находились в состоянии суб- и декомпенсации в сравнении с группой женщин с ДТЗ в состоянии стабильной компенсации тиреотоксикоза (21,2±2,4 нг/мл) и контрольной группой (23,9±2,7 нг/мл). Результаты корреляционного анализа свидетельствуют о наличии у пациенток с ДТЗ в состоянии суб- и декомпенсации тиреотоксикоза значимой отрицательной связи между содержанием витамина D и уровнем антител к рецептору ТТГ (r= –0,47; р, У пацієнтів з автоімунними захворюваннями щитоподібної залози (ЩЗ) спостерігається нижчий вміст вітаміну D порівняно із загальною популяцією. Однак відсутні роботи, в яких проведено порівняльний аналіз між вмістом вітаміну D у пацієнтів з дифузним токсичним зобом (ДТЗ) залежно від стану компенсації захворювання.Мета роботи – визначення вмісту вітаміну D у пацієнток із ДТЗ, а також його можливого впливу на перебіг захворювання.Матеріали та методи. В одномоментному перехресному дослідженні обстежено 57 жінок із ДТЗ різного ступеня компенсації захворювання. Першу групу сформували жінки з ДТЗ у стані тривалої (понад 6–9 міс) компенсації тиреотоксикозу (n=23). До другої групи ввійшли 34 пацієнтки в стані суб- і декомпенсації ДТЗ. 25 практично здорових жінок без порушення функції ЩЗ і підвищеного титру антитіл до рецептора ТТГ були обстежені протягом цього ж періоду.Результати та обговорення. Вміст вітаміну D (14,9±1,8 нг/мл) виявився достовірно нижчим у пацієнток із ДТЗ, які перебували в стані суб- і декомпенсації на час обстеження, порівняно з групою жінок із ДТЗ у стані стабільної компенсації тиреотоксикозу (21,2±2,4 нг/мл) та контрольною групою (23,9±2,7 нг/мл). Результати кореляційного аналізу свідчать про наявність у пацієнток із ДТЗ у стані суб- і декомпенсації тиреотоксикозу значущого зворотного зв’язку між вмістом вітаміну D і рівнем антитіл до рецептора ТТГ (r= –0,47; р

Background: Iodine supplementation with salt as a carrier was introduced in Sri Lanka in 1995. Literature from elsewhere suggest that there is an increase in hyperthyroidism after the initiation of such programmes.Objectives: To identify weather iodination precipitated an exacerbation of hyperthyroidism in the Central Province of Sri LankaMethods: Four-hundred-and-eight consecutive patients with hyperthyroidism seen over a period of thirty one years in a General Surgical Clinic at Teaching Hospital, Peradeniya were reviewed.Results: The prevalence of secondary hyperthyroidism increased after iodination. No change in the demography and presentation of simple diffuse toxic goiter was observed.Conclusions: Physicians must be aware of this increased incidence of hyperthyroidism after iodination and need to be vigilant of the need to control it, in view of its complications.

A patient presenting with diffuse toxic goiter and concomitant Buschke's scleroderma is described.

Endocrine ophthalmopathy (EO), or orbitopathy, is currently considered as a genetically determined independent autoimmune disease [38, 39]. At the same time, there is a close relationship between EO and autoimmune diseases of the thyroid gland (thyroid gland). In approximately 90% of cases, EO develops in patients with diffuse toxic goiter (DTZ), in 5% in patients with Hashimoto's autoimmune thyroiditis; in 5-10% of patients with EO, thyroid diseases are not detected [66]. The average age of patients with EA at the 1st visit to the doctor is 45-50 years and corresponds to the age of patients with DTZ; in children, EO develops rarely and proceeds, as a rule, in a mild form [51]. Smoking is considered a risk factor for the development of EO: among 85 EO patients, 53 (62%) smokers were found, and only 23% of the patients with DTZ without EO smoked [61, 66].

As a result of determination of urinary iodine excretion in 36 patients with diffuse toxic goiter in iodine deficient region was marked decline of urinary iodine excretion that depends on severity of thyrotoxicosis at the beginning of disease. As a result of treatment by standard therapy (antithyroid drugs, beta-blockers) was defined with decreasing rates of hyperthyroidism urinary iodine excretion increased significantly. It can serve as the index of correct dose of antithyroid drugs., Исследование показателей йодурии у 36 больных диффузным токсическим зобом, проживающих в йододефицитном регионе, показало, что в начале заболевания отмечается снижение йодурии, которое зависит от тяжести тиреотоксикоза. В результате лечения стандартной терапией (тиреостатики, бета-блокаторы) с уменьшением проявлений тиреотоксикоза экскреция йода с мочой значительно возрастает, что может служить показателем адекватности дозы тиреостатиков.

As a result of determination of urinary iodine excretion in 36 patients with diffuse toxic goiter in iodine deficient region was marked decline of urinary iodine excretion that depends on severity of thyrotoxicosis at the beginning of disease. As a result of treatment by standard therapy (antithyroid drugs, beta-blockers) was defined with decreasing rates of hyperthyroidism urinary iodine excretion increased significantly. It can serve as the index of correct dose of antithyroid drugs., Исследование показателей йодурии у 36 больных диффузным токсическим зобом, проживающих в йододефицитном регионе, показало, что в начале заболевания отмечается снижение йодурии, которое зависит от тяжести тиреотоксикоза. В результате лечения стандартной терапией (тиреостатики, бета-блокаторы) с уменьшением проявлений тиреотоксикоза экскреция йода с мочой значительно возрастает, что может служить показателем адекватности дозы тиреостатиков.

The results of investigating the absorption spectra of blood plasma in the visible and infrared parts of spectra obtained using the techniques of spherical photometer and spectrophotometric complex "Specord IR75" are presented. The possibility of using these spectra for diagnoses the cases of diffuse toxic goiter and nodular goiter and control of treatment process in postsurgical period in the cases of thyroid gland surgery is estimated.

The results of absorption spectra of blood plasma in the ultraviolet and visible areas of the spectrum using the technique of spherical photometer. Possibilities of using these spectra to detect the diseases - diffuse toxic goiter and nodular euthyroid goiter and to control the surgical treatment of this pathology.

The effect of α-lipoic acid on functional liver changes of patients with a diffuse toxic goiter during the month was studied. Positive influence on the indices of aminotranferases, bilirubine, alkaline phosphatase, total protein and also reduction of oxidative stress and decreased of endogenous intoxication level were shown that allows to recommend lipoic acid as as an adjuvant in the treatment of patients with diffuse toxic goiter., Изучение влияния α-липоевой кислоты на функциональные изменения печени у больных диффузионным токсическим зобом в течение месяца. Выявлено положительное влияние на показатели трансаминаз, билирубина, щелочной фосфатазы, общего белка, а также уменьшение окислительного стресса и снижение уровня эндогенной интоксикации, что позволяет рекомендовать липоевую кислоту в качестве вспомагательного средства в лечении больных диффузным токсическим зобом.

The effect of α-lipoic acid on functional liver changes of patients with a diffuse toxic goiter during the month was studied. Positive influence on the indices of aminotranferases, bilirubine, alkaline phosphatase, total protein and also reduction of oxidative stress and decreased of endogenous intoxication level were shown that allows to recommend lipoic acid as as an adjuvant in the treatment of patients with diffuse toxic goiter., Изучение влияния α-липоевой кислоты на функциональные изменения печени у больных диффузионным токсическим зобом в течение месяца. Выявлено положительное влияние на показатели трансаминаз, билирубина, щелочной фосфатазы, общего белка, а также уменьшение окислительного стресса и снижение уровня эндогенной интоксикации, что позволяет рекомендовать липоевую кислоту в качестве вспомагательного средства в лечении больных диффузным токсическим зобом.

A 7- to 8-cm diffuse toxic goiter with associated symptoms of hyperthyroidism developed in a 38-year-old black female undergoing regular hemodialysis for renal failure. Our treatment of choice was an ablative dose of radioactive iodine in the form of sodium iodide (Na-131I). To our knowledge, this is only the 4th documented case of hyperthyroidism in a patient with renal failure. Detailed monitoring of 131I radioactivity in the blood, thyroid gland and the dialysate demonstrated that there was no radiation hazard to personnel involved in the patient management.

The article is devoted to the review of genetic markers of diffuse toxic goiter (graves' disease).

The specific features of the clinical course of pregnancy were studied in 46 females with diffuse toxic goiter. It was set that pregnancy at a diffuse toxic goiter is complicated by high-frequency of threat of breaking to pregnancy, placental insufficiency, by high-frequency of anomalies of childbirth. The presence of diffuse toxic goiter for pregnant predetermines high-frequency of early toxicosis (52,2%) and threat of abortion (47,8%). High-frequency of threat of breaking to pregnancy for women at a diffuse toxic goiter predetermines anomalous localization of placenta. Basic condition of successful delivery for women with a diffuse toxic goiter is achievement of the stable euthytoid state., С целью изучения течения беременности, родов и состояния новорожденных у женщин с диффузным токсическим зобом наблюдали 46 беременных. Установлено, что течение беременности при диффузном токсическом зобе осложняется высокой частотой угрозы прерывания беременности, фето-плацентарной недостаточности, а роды — высокой частотой аномалий родовой деятельности. Наличие диффузного токсического зоба у беременных предопределяет высокую частоту раннего токсикоза (52,2%) и угрозы выкидыша (47,8%). Декомпенсация диффузного токсического зоба обусловливает высокую частоту аномальной локализации плаценты, что, в свою очередь, провоцирует угрозу прерывания беременности. Основным условием успешного родоразрешения у женщин с диффузным токсическим зобом является достижение стойкого эутиреоидного состояния.

After the accident at the Chernobyl nuclear power plant in 1986, information appeared in the press about a significant increase in thyroid neoplasms. We analyzed our own data on the features of thyroid pathology in individuals exposed to radioactive radiation.

Probability of relapse development of diffuse toxic goiter during the nearest two years after treatment is determined by its results and stressogenic capacity level, which is defined by Holmes and Rage method. As long as satisfactory treatment results and level of stressogenic capacity are above 300 points, the risk of diffuse toxic goiter relapse run to 68,5%

The patients with autoimmune thyroiditis and various functional states of thyroid gland, and diffuse toxic goiter with pronounced thyrotoxicosis were studied for neurospecific enolase and enolase-specific autoantibodies levels in blood serum. Increased concentrations of neurospecific enolase and specific autoantibodies were revealed in all groups of the patients. A conclusion was drawn that nervous system may be involved into pathological process during development of thyropaties.

The results of treatment of 86 patients - the indigenous inhabitants of the northern region of Saudi Arabia with newly diagnosed diffuse nontoxic goiter. Peculiarities of diagnostics, treatment and therapy of diffuse toxic goiter in this ethnic group were studied. We revealed the prevalence of goiter grade II and III. Treatment, that was most effective in reducing the volume of the thyroid, was a combination of potassium iodide (150-200 mg daily) and L-thyroxine in individually selected dose. This treatment resulted in a reduction in the size of 34% of goiter. Potassium iodide monotherapy did not result in a statistically significant reduction in the volume of the thyroid gland.

Despite major advances in molecular biology, the etiology of Graves’ disease remains unknown and the treatment of Graves’ disease is best described as empirical. Until a better understanding is achieved of the genetic or triggering events that result in autoimmune stimulation of the thyroid gland, physicians have to choose among imperfect treatment methods (1). In a survey of physicians at the American Thyroid Association, with a limited number of surgeons participating, only one percent chose surgery as a first treatment option for diffuse toxic goiter or Graves’ disease (2). More than two thirds elected radioablation as the preferred method of treatment for their patients. Medical treatment with antithyroid drugs was reserved for the patient with a small goiter, and mild to moderate hyperthyroidism in the absence of high antibody titers; or in cases where radioablation could not be used. One might think that for patients with Graves’ disease, surgery should be reserved for those patients who are no longer candidates for medical or radioablative treatment methods. A better understanding of the advantages and disadvantages of current surgical techniques employed in the treatment of Graves’ disease would assist in the choice of the best selective treatment in Graves’ disease.

This study focuses on improving the results of surgical treatment of patients with diffuse toxic goiter way jus tify the selection of thyroid residue and thyroid status in predicting longterm periods. The basis of the study is the immediate and longterm results of surgical treatment of 138 patients suffering from diffuse toxic goi ter. As a result of the research, with a modern point of clinical and statistical analysis proved the effective ness of fascial subtotal resection of the thyroid gland in patients with diffuse toxic goiter (Graves' disease). The dependence of disorders of the thyroid is remainded of its volume, autoimmune changes and limitations of the operation. The quality of life of patients in the late postoperative period is studied. The tactics of sur gical treatment of patients with diffuse toxic goiter, aimed at the prevention of postoperative recurrence of hyperthyroidism and hypothyroidism on the basis of prediction of the functional state of the thyroid residue in the longterm period, is proposed. Detected optimal sizes of thyroid balance after subtotal resection of the thyroid gland in patients with diffuse toxic goiter permit to objectify the technique of intervention.

The article presents the results of treatment of 54 patients — the indigenous inhabitants of the northern re-gion of Saudi Arabia with newly diagnosed diffuse toxic goiter (Graves' disease). Peculiarities of the diagnosis,treatment and therapy of Graves' disease in this ethnic group are present. The authors have identified a combi-nation of Graves' disease with other autoimmune diseases and the high rate of relapse, despite adequate medi-cation thyrostatic therapy. Shows the results use of I131 in patients with Graves' disease.

The combination of pathology of the adrenal glands and thyroid gland is very rare and, as a rule, is characterized by adrenal insufficiency and hypothyroidism / Schmidt syndrome), which develop in type II autoimmune polyglandular syndrome. There is a single description of low-krenin aldosteronism due to thyroid cancer. In the available literature, we have not found information about the combination of primary hyperaldosteronism and diffuse toxic goiter.

The relationship between changes in glucose tolerance with treatment of hyperthyroidism and various factors that might be relevant to carbohydrate metabolism were investigated in 64 hyperthyroid patients with abnormal glucose tolerance, including 35 cases with fasting plasma glucose (FPG) levels of 140 mg/dl or more. All patients had diffuse toxic goiter. After correction of the hyperthyroidism, glucose intolerance improved in almost all cases, even in cases with fasting hyperglycemia, but diabetes mellitus in patients with FPG above 140 mg/dl and/or delta IRI/delta PG X 30' during a 50-g oral glucose tolerance test below 0.10, persisted. Patients who showed diabetic glucose tolerance even after remission from thyroid dysfunction had significantly lower delta IRI/delta PG X 30' values and a higher incidence of family histories of diabetes mellitus than those not showing diabetic glucose tolerance. There were no significant differences in serum T3 and T4 levels between these two groups of patients. The findings suggest that predisposition to diabetes may be an important factor in persistent glucose intolerance in the hyperthyroidism of Graves' disease. The FPG and delta IRI/delta PG X 30' values may be useful in predicting which patients with hyperthyroidism will have permanent diabetes.

The results of this study would indicate: 1. 1. That a much larger percentage of recurrence of goiter than was formerly suspected is found in the group of nodular goiters. 2. 2. That the number of cases of true recurrences and “continuing goiter” is on the increase, due to the fact that this disease is being treated more generally by the profession as a whole, and that fewer cases are being handled by surgeons who have made a particular study of this disease. 3. 3. That an unreasonably large percentage of the cases of diffuse toxic goiter coming to second operation are not recurrent, but are cases of “continuing goiter,” due chiefly to an inadequate operation plus insufficient post-operative follow-up care.

A patient received 2 doses of radioiodine for a diffuse toxic goiter in 1956. Twelve years later at the age of 64 she was operated on for an anaplastic cancer arising in the right lobe of the thyroid. Other thyroid neoplasms following the therapeutic use of radioiodine have also been reported although the incidence may still be within the range of statistical coincidence. There is a definite risk of later malignant change after external radiation to the thyroid in infants and children. The risk in adults seems to be smaller, and the latent period is longer. The experimental and clinical evidence indicate some caution in the therapeutic use of radioiodine.

The purpose of this work was to clinically evaluate the efficacy of lithium electrophoresis in some thyroid diseases. We examined 28 patients with primary toxic diffuse goiter aged from 20 to 54 years (2 men and 26 women). Seventeen patients had mild thyrotoxicosis, nine had moderate, and two had severe thyrotoxicosis. Diffuse increase of thyroid gland of I-II degree was found in 22 patients, III - in 6 patients. thyrogenic ophthalmopathy of I-II degree was observed in 6 patients. Conservative antithyroid therapy was required in 23 patients, and 5 patients underwent strumulectomy.

Anti-thyroid drugs are widely used to treat diffuse toxic goiter (Graves' disease). Of the two drugs currently available in the United States, propylthiouracil is prescribed far more often than is methimazole (Tapazole). However, compared with propylthiouracil, methimazole can be given as a single daily dose, is cheaper, and, at low doses, is associated with less major toxicity; for these reasons, methimazole should be used for the routine management of Graves' disease when anti-thyroid drugs are selected as primary therapy. On the other hand, because of certain pharmacologic factors, propylthiouracil should be used in selected situations, particularly in patients with "thyroid storm" and in pregnant or lactating women.

Excerpt Endocrine exophthalmos can occur with or without evident hyperthyroidism, or may develop only after therapeutically induced remission of the thyrotoxicosis. The cause of the disorder has no...