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Background. Thyroid disease is the second most common endocrine disorder after diabetes in pregnancy. Thyroid hormones are crucial for the growth and maturation of many target tissues, especially the brain and skeleton. During critical periods in the first trimester of pregnancy, maternal thyroxine is essential for fetal development as it supplies thyroid hormone-dependent tissues. The purpose of the study was to research the features of the bioelectrical activity of the brain in pregnant women with thyroid pathology and determine the frequency of such changes. Materials and methods. The state of bioelectrical activity of the brain was evaluated by electroencephalography in 160 pregnant women with thyroid pathology. The biopotentials of the brain in the subjects were studied with software and hardware complex DX-NT32 (DX Complexes software, Kharkiv, Ukraine) and computer processing of electroencephalography data. Electrodes in the amount of 16 pieces were applied according to the international scheme 10/20 in the bipolar interpretation. Results. Specific changes in electroencephalograms characteristic of each type of thyroid pathology and dependent on its severity were revealed in pregnant women. Acquired disorders adversely affect the course of pregnancy and childbirth in women with thyroid pathology. Increased anxiety with depressive tendencies, reduced general activity, a feeling of depression, anxiety, and low mood were detected in women with thyroid disorders. The identified criteria make it possible to attribute these changes to the manifestations of a pathological neurotic state in conditions of maladaptation, which was confirmed by electroencephalography data. Conclusions. The detected disorders of spontaneous and evoked brain activity indicate the existence of a cerebral basis of psychological stress, which has a qualitative effect on electroencephalography. Acquired disorders negatively affect the course of pregnancy, childbirth, perinatal outcomes, and future development of the child.

Diseases of the thyroid gland occupy one of the central places in clinical endocrinology. The main components for the synthesis of thyroid hormones are iodine and the amino acid tyrosine. Studies conducted in the 21st century indicate a certain effect on the metabolism and function of the thyroid gland and other microelements and vitamins. We searched the PubMed and Scopus information databases for publications devoted to the study of the influence of trace elements selenium, zinc, vitamins A, C, E on the physiology and pathology of the thyroid gland, including sources up to 29.02.2024. Adequate intake of selenium, zinc, along with two other important microelements (iodine and iron), as well as vitamins A, C, E, contributes to normal metabolism of the thyroid gland. Maintaining a physiological balance of micronutrients and vitamins through a sensible diet or taking nutraceuticals is essential to preventing thyroid disease and maintaining overall health. Basal analysis of microelements and vitamins seems appropriate for better selection of patients in need of replacement therapy using nutraceuticals

Background. Thyroid disease is the second most common endocrine disorder after diabetes in pregnancy. Thyroid hormones are crucial for the growth and maturation of many target tissues, especially the brain and skeleton. During critical periods in the first trimester of pregnancy, maternal thyroxine is essential for fetal development as it supplies thyroid hormone-dependent tissues. The purpose of the study was to research the features of the bioelectrical activity of the brain in pregnant women with thyroid pathology and determine the frequency of such changes. Materials and methods. The state of bioelectrical activity of the brain was evaluated by electroencephalography in 160 pregnant women with thyroid pathology. The biopotentials of the brain in the subjects were studied with software and hardware complex DX-NT32 (DX Complexes software, Kharkiv, Ukraine) and computer processing of electroencephalography data. Electrodes in the amount of 16 pieces were applied according to the international scheme 10/20 in the bipolar interpretation. Results. Specific changes in electroencephalograms characteristic of each type of thyroid pathology and dependent on its severity were revealed in pregnant women. Acquired disorders adversely affect the course of pregnancy and childbirth in women with thyroid pathology. Increased anxiety with depressive tendencies, reduced general activity, a feeling of depression, anxiety, and low mood were detected in women with thyroid disorders. The identified criteria make it possible to attribute these changes to the manifestations of a pathological neurotic state in conditions of maladaptation, which was confirmed by electroencephalography data. Conclusions. The detected disorders of spontaneous and evoked brain activity indicate the existence of a cerebral basis of psychological stress, which has a qualitative effect on electroencephalography. Acquired disorders negatively affect the course of pregnancy, childbirth, perinatal outcomes, and future development of the child. [ABSTRACT FROM AUTHOR]

Rituximab is a chimeric (mouse and human) monoclonal antibody against B-lymphocytes (CD20). This drug is widely used in rheumatology in the treatment of rheumatoid arthritis, Sjogren’s syndrome, some systemic connective tissue diseases and vasculitis, as well as in hematology in lymphoproliferative diseases. Administration of rituximab leads to depletion of B-lymphocytes through various mechanisms, including antibody-dependent and complementdependent cytotoxic effects, as well as the regulation of apoptosis. Considering the mechanism of autoimmune damage in Graves’ disease, an autoimmune thyroid disease accompanied by thyrotoxicosis and endocrine ophthalmopathy (an autoimmune lesion of the accessory apparatus of the eye), the use of rituximab may be effective in these diseases. The review considers the currently available results of studies on the use of various doses of rituximab in these diseases.

Throughout history, people have reacted differently to various physical abnormalities that develop in the absence of treatment and progression of diseases of the endocrine system. From antiquity until relatively recently, some manifestations of endocrine pathology caused fear and horror, while others, on the contrary, were considered ideals of beauty. But, thanks to the improvement of diagnostic and treatment methods, it is now increasingly rare to find gross long-term consequences of diseases, the owners of which a century ago would have been doomed to a difficult and not always long life. All this remains on the pages of history and in the works of masters, which can be an excellent tool for young professionals.

Objective. To reveal the incidence of various morphological types and degrees of the anemia severity in patients with diffuse toxic goiter. Materials and methods. Data of medical histories of 157 patients, operated for diffuse toxic goiter in 2012 yr were analyzed. In accordance to hematological indices estimated there were outlined two Groups of patients: Group I – 98 patients with diffuse toxic goiter and mild anemia, average age (39.4 ± 1.4) yrs old, 57 (58.2%) women and 41 (41.8%) men, and Group II – 59 patients with diffuse toxic goiter and middle degree of the anemia severity, average age (41.1 ± 1.7) yrs old, 48 (81.4%) women and 11 (18.6%) men. Levels of hemoglobin, hematocrit, quantity and average volume of erythrocytes, average content of hemoglobin in one erythrocyte, average concentration of hemoglobin in the erythrocytes were determined in the blood analysis. Results. Microcytic type of anemia was noted in 89.8% of patients with anemia of middle degree of severity, while a normocytic one – in 10.2%; in mild anemia – in 87.8 and 12.2% patients, accordingly. Hypochromic and normochromic types of anemia with equal rate were revealed in mild anemia and anemia of middle degree of severity: hypochromic – in 94.9%, normochromic – in 5.1% patients. Conclusion. Diffuse toxic goiter is characterized by more frequent development of mild (62.4%), microcytic (88.5%), hyperchromic (94.9%) anemia, caused by iron deficiency.

Copyright of Journal of Modern Laboratory Medicine is the property of Journal of Modern Laboratory Medicine Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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.

Background. The role of selenium deficiency in the pathogenesis of thyropathies is actively discussed in the last decade, as well as the advisability and efficiency of using selenium-containing drugs in their treatment. There are extremely little data on the presence/absence of selenium deficiency in the general population of Ukraine and in patients with thyroid pathology in particular to date. Therefore, the question of expedient use of selenium-containing drugs is of great interest to both scientists and practitioners. The purpose was to study the attitude of Ukrainian endocrinologists towards the use of selenium-containing drugs in the treatment of thyroid pathology, and to investigate selenium content in the blood serum of patients with diffuse toxic goiter during antithyroid therapy in combination with prolonged use of these drugs. Materials and methods. The questionnaire was sent online to 100 endocrinologists from different regions of Ukraine, it included 6 questions: 1. Do you know about the role of selenium deficiency in the development of thyroid pathology? 2. Do you prescribe selenium drugs to patients with thyroid pathology? 3. In which thyroid pathology do you usually prescribe selenium drugs? 4. Which doses of selenium do you prefer? 5. What duration of treatment with selenium-containing drugs do you recommend? 6. Do you control the level of selenium before and after the course of therapy with selenium drugs? The study of selenium content in the blood of patients with thyropathies before and after treatment with selenium drugs was also continued in the clinic of the State Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine” during 2018–2019 to evaluate their effectiveness and the time needed to eliminate selenium deficiency. The group of examined patients consisted of 35 persons: 34 women and 1 man (mean age of 48.2 ± 5.2 years) suffering from diffuse toxic goiter. According to the anamnesis, the disease duration ranged from 6 months to 5 years (2.8 ± 2.0 years on average). At the time of the examination, all the patients were in a state of euthyroidism. The determination of selenium was performed by a fluorometric method using the Hitachi MPF-4 spectrofluorimeter with the required sensitivity (approximately 0.0004 µg/ml of selenium) and an insignificant measurement error (2 %). Results. It was determined that 98 % of doctors were informed of the role of selenium deficiency in the development of thyroid pathology, but 33 % of them said that they would like to have more information. The awareness of doctors does not affect the frequency of selenium-containing drug prescriptions. Selenium-containing drugs are prescribed in thyropathies by 47 % of respondents, 35 % prescribe them sometimes, and 18 % do not prescribe at all. The doctors mainly prescribe selenium drugs in autoimmune thyroiditis with euthyroidism or subclinical hypothyroidism (77 %), in diffuse euthyroid goiter (10 %), in diffuse toxic goiter (7 %), in thyroid-associated ophthalmopathy (5 %), and in multinodular nontoxic goiter (6 %). It was found that most doctors (55 %) prescribe selenium-containing drugs at a dose of 50 to 100 µg per day, 30 % of respondents usually prescribe 100 to 200 µg per day, and only 15 % of doctors prescribe 200 µg or more. The duration of treatment course preferred by doctors is 3 months (70 %), 12 % of respondents prescribe selenium-containing drugs for 1 month, and 18 % — for 6 months. Selenium content in the blood of patients before/after the course of treatment is determined always only by 5 % of respondents, sometimes — by 6 % of respondents, and 89 % of them do not determine it at all. When studying selenium content in the blood serum of patients with diffuse toxic goiter, its level was 17.80 ± 2.59 µg/l in the study group; median — 13 µg/l (with a norm of 80–100 µg/l). All the patients were prescribed selenium-containing drugs at a daily dose of 200 μg, followed by a control study of selenium in the blood 3 and 6 months after continuous treatment. Selenium levels increased significantly to 63.88 ± 6.61 μg/l (median of 58.5 µg/l) 3 months after treatment. When controlling this indicator after 6 months, the level was 75.02 ± 9.78 µg/l (median of 78 µg/l) that was significantly higher than baseline values. Thus, a three-month course of using selenium-containing drugs (with a daily dose of 200 µg) may not be sufficient to restore the normal levels of selenium in patients with diffuse toxic goiter and selenium deficiency, requiring the continued treatment for another three months with individual control of selenium levels, or prescription of higher daily doses of the drug. Conclusions. The number of endocrinologists who know about the role of selenium deficiency in the development of thyroid pathology is 98 %, at the same time 33 % of respondents are wishing to have more information about the advisability of prescription and efficiency of selenium-containing drugs. Selenium-containing drugs are prescribed in thyroid diseases by 47 % of doctors, of these, by 77 % — only in autoimmune thyroiditis. Only 5 % of doctors prescribe selenium-containing drugs in thyroid-associated ophthalmopathy. Preference is given to the use of small doses of selenium-containing drugs (55 %) with the treatment duration no more than 3 months (70 % of respondents). The level of selenium before/after the course of selenium-containing therapy is not determined by 89 % of the respondents. In patients with selenium deficiency (17.80 ± 2.59 µg/l; median — 13 µg/l) after regular use of selenium-containing drugs (200 µg of selenium per day) for 3 months, the level of selenium in the blood increases significantly to 63.88 ± 6.61 µg/l; the median of 58.5 µg/l, but does not reach the lower limit of normal. Only 6 months after regular intake of selenium-containing drugs (daily dose of 200 µg), the level of selenium in the blood is normalized to 75.02 ± 9.78 µg/l; median of 78 µg/l, thus approaching the lower limit of normal.

Detection of liver dysfunction in patients with diffuse toxic goiter (DTG) at an early stage allows for correcting it in time with appropriate therapy; therefore, diagnosing hepatobiliary system lesions in these patients is an important medical issue. We examined 62 patients, divided into two groups depending on the duration of the disease. The first group included patients with a disease duration of up to two years, the second group - patients with a disease duration of more than two years. The study and comparison of laboratory and multiparametric ultrasound criteria of liver and thyroid dysfunction were performed. Analysis of ultrasound signs of hepatobiliary system lesions in patients in the two groups showed that they were more common in the second group. There is a correlation between the stiffness of the parenchyma of the thyroid gland and liver and the duration of the disease, the level of free thyroxine (T4f), and antibodies to thyroid-stimulating hormone receptors (ArTTG). Increased liver stiffness was more common in patients with ArTTG levels above 20 IU/ml, and the degree of F1 fibrosis was higher at T4f greater than 50 pmol/l. To assess the condition of a patient with DTG and the need to correct treatment tactics, it is advisable to use the criteria of multiparametric ultrasound examination of the hepatobiliary system and thyroid gland. [ABSTRACT FROM AUTHOR]

Objective: to study the functional state of the thyroid gland in newborns from mothers with diffuse toxic goiter, depending on the level of antibodies to thyroid stimulating hormone receptors (AB-rTSH).Materials and methods: 68 newborns from 67 mothers with diffuse toxic goiter were examined. The control group included 49 newborns from 49 mothers without thyroid pathology. To assess the functional state of the thyroid gland of newborns, we determined the levels of thyroid stimulating hormone, free thyroxine (fT4), and AB-rTSH in cord blood and calculated the TSH/fT4 coefficient, which allows us to differentiate congenital hypothyroidism from neonatal thyrotoxicosis. On the 4-7th day of life, all newborns underwent ultrasound examination (ultrasound) of the thyroid gland.Results: newborns from mothers with diffuse toxic goiter had lower growth-weight indices in comparison with the same indices of the control group and they often showed thyroid hyperplasia. It was shown that the increased content of AB-rTSH in the blood serum of pregnant women with diffuse toxic goiter and in the umbilical cord blood of newborns can contribute to the development of neonatal thyrotoxicosis, detected in 16.2 % of newborns.Conclusions: increased levels of AB-rTSH in the blood serum of mothers with DTG, especially in the second half of pregnancy, and in the umbilical cord blood of newborns affect the formation of thyroid hyperplasia in newborns and contribute to the development of neonatal thyrotoxicosis.

Rationale: Evaluation of the cardiovascular system in patients with common thyroid disorders could be of interest from the perspective to identify new risk factors for cardiovascular events. Whether cardiovascular abnormalities associated with thyrotoxicosis would be reversible after its treatment, needs elucidation.Aim: To assess the degree of restoration and prerequisites for reversion of the signs and symptoms of cardiac injury in the long term after conservative and surgical cure of thyrotoxicosis in patients with diffuse toxic goiter (DTG).Materials and methods: This was an open longitudinal retrospective study performed in the Regional Center for Endocrine Surgery, Chelyabinsk Municipal Clinical Hospital No. 1 in 124 patients with past history of DTG. By the time of examination, all patients were in a stable clinical and laboratory remission after the withdrawal thyrostatic agents or were in controlled post-operative hypothyroidism for 1.5 to 5 years after surgery for DTG. The mean age of the conservatively treated patients (n=62) was 39.9±1.31 years (19 to 55 years). The mean age of the patients that had been treated surgically (n=62; subtotal thyroid resection) was 41.1±1.4 years (21 to 56 years). We compared with patients' complaints, electrocardiographic and echocardiographic parameters by the time of examination with the corresponding data at the time of the primary referral.Results: In the long term after the elimination of thyrotoxicosis, 56.5% (35/62) of the patients who had underwent surgery, were complaining of dyspnea, 54.8% (34/62) of palpitations, and 50% (31/62) of cardialgias (p

Objective: Graves' disease (GD) is a common autoimmune disorder with variable outcomes. We aim to study the clinical manifestations and treatment outcome of GD in the post-iodization scenario. Material and Methods: The present study was designed as a cross-sectional study, in which a total of 180 patients with GD (127 males and 53 females) attending our center were reviewed retrospectively. The demographic data, modes of treatment, comorbidities, remission, and recurrence rates were determined for the patients. All patients were initially treated with anti-thyroid drugs (ATDs), with the subsequent management depending on the course of the disease. Results: The mean (±SD) age at diagnosis was 38.30 (10.73) years and the lag period between the onset of symptoms and the diagnosis was 5.12 (2.69) months, with the male patients having a significantly shorter duration of illness compared to females (4.36 vs. 5.44 months; P=0.015). Majority of the patients presented with the typical symptoms and signs associated with hyperthyroidism and/or goiter, although the atypical presentations were not uncommon. ATDs were the most preferred treatment modality employed to achieve clinical and biochemical remission. The mean duration of achieving euthyroidism and the normalization of TSH levels were 3.31±1.51 and 7.45±3.35 months, respectively. On follow-up at three months, 46.1% of the patients were euthyroid, with normalization of the TSH levels in 15.6% of them. Failure to achieve early remission/disease control was significantly higher in males (p=0.003) and smokers (p=0.036). Among the 72 patients who completed medical therapy, 49 patients achieved remission, of whom 20 patients relapsed with a first-year relapse rate of 20.4%. Disease relapse was significantly associated with higher initial 99 mTechnetium (99mTc) uptake (p=0.022) and higher grade of goiter (p=0.026) at presentation. The logistic regression analysis revealed male gender (p=0.048) and orbitopathy (p=0.036) as the independent risk factors predicting relapse of the GD. Conclusion: Graves' disease manifests with varied clinical manifestations, including the atypical ones, warranting careful clinical assessment to ensure an accurate diagnosis. Gender and orbitopathy are the independent risk factors predicting the relapse of the disease. [ABSTRACT FROM AUTHOR]

The objectve of the study is to present a rare observation of thyrotoxic hypokalemic periodic paralysis in a Caucasian male. The article presents a clinical observation of 44-year-old man suffering from diffuse toxic goiter. The course of the disease was complicated by the development of attacks of periodic hypokalemic paralysis. The patient was repeatedly hospitalized to the neurological departments of different city hospitals with diagnosis of cerebrovascular disorders. Thyrotoxicosis as the cause of periodic paralysis was diagnosed in five months after the disease onset. Due to the risk of progression of thyrotoxic complications and worsening of neurological pathology, the patient underwent thyroidectomy. There were no complications. Working capacity restored on the 12thday. Attacks of muscle weakness were not observed. Replacement therapy with 100 mg of levothyroxine per day was prescribed. Parameters of potassium, total calcium were normal.Conclusion. A rare observation of genetically determined manifestations of diffuse toxic goiter – a thyrotoxic hypokalemic periodic paralysis is presented. Surgical treatment allowed to radically cure thyrotoxicosis and to eliminate episodes of paralysis, to return the patient’s workability.

Against the background of concomitant endocrine diseases of diabetes mellitus and diffuse toxic goiter, it significantly complicates the treatment of patients with purulent surgical diseases of soft tissues. The aim of our study was to study the features of the clinical course of purulent surgical diseases of soft tissues against the background of diabetes mellitus and with a combination of diffuse toxic goiter. Group I - patients with purulent surgical diseases of soft tissues on the background of diabetes mellitus. II - a group of patients with purulent surgical diseases of soft tissues against the background of a combination of diabetes mellitus and diffuse toxic goiter. Results and discussion. Purulent-necrotic diseases of soft tissues against the background of a combined disease of diabetes mellitus and diffuse toxic goiter revealed the following features of the course of the wound process: all indicators of intoxication of the body, the timing of cleansing and wound healing tended to normalize at a slower pace than group I, retreating by 2 days. In this case, the average bed days were 10±1.4 days, when in group I patients these indicators were equal to 8±1.5 days. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Endocrinology / Mìžnarodnij Endokrinologìčnij Žurnal is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of International Journal of Endocrinology / Mìžnarodnij Endokrinologìčnij Žurnal is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Relevance. Diffuse toxic goiter (DTG) is an autoimmune thyroid disease, which is based on the excessive secretion of autoantibodies to thyroid-stimulating hormone receptor (TRAb). Over the last decades, high relapse rate of thyrotoxicosis is observed after withdrawal of conservative therapy. At the same time, there are no reliable criteria to predict the efficiency of drug therapy. It is widely discussedin literature that singlenucleotide polymorphism (SNP) at cytokine-encoding genesnot only confers susceptibility to the DTG, but also has impact on the features ofclinical course of the disease .The aim of this study was to determine whether the SNPs in -572C/G (rs1800796) of IL6 or -1112C/Т (rs1800925) of IL13 genes can influence thedevelopment and clinical course of the diffuse toxic goiter (DTG).Materials and methods. We examined 270 patients with diffuse toxic goiter and 200 healthy persons (reference subjects)with the help of molecular genetic analysis of polymorphic variants of the gene encoding the Pro-inflammatory cytokines. Identification of C-572G of IL6 gene and C-1112T of IL13gene was performed using the PCR method followed by the restriction analysis.Results. We determined that the carriage of -572G allele of the rs1800796 in IL6 gene isassociated with the growth of recurrence risk of thyrotoxicosis and the absence of remission of DTGin 1.3 times (р=0.031, OR=1.3, 95 %, CI 0.98–1.76) and the carriage of CC genotype of the rs1800925 in IL13 – in 2.3 times (р=0.026, OR=2.3, 95 %, CI 1.09–4.82) respectively. The obtained results allowed to revealnew genetic markers of an adverse course in patients with diffuse toxic goiter, Saint Petersburg residents.

The article presents the modern views and data on the risk factors, mechanisms of development, clinical features and complications of diffuse toxic goiter during the pregnancy, labor, in the postpartum period and in newborns. Information about the modern approaches to the diagnosis, treatment and prevention of this disease has been investigated that makes it possible to recommend it for the implementation in the clinical practice.

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.

Objective — to study Adaptol efficiency in patients with diffuse toxic goiter (DTG) of varying severity with deviations in the emotional sphere without expressed psychoorganic disorders, as well as impact of the drug on the efficiency of main thyrostatic therapy that allows to expand the range of indications for the use of the drug in the practice of endocrinologists. Materials and methods. We observed 25 patients with thyrotoxicosis in a state of drug subcompensation (17 — with the overt one, which developed as a result of DTG, and 8 — with subclinical one), who received Adaptol in combination treatment for two months (group I). Another 20 patients with similar pathology formed the control group (group II). Patients in the control group did not differ statistically significantly by the age, sex, duration and severity of DTG from those of the main group. Results. The analysis of the findings indicates that in the first (main) group of patients with DTG (with additional administration of Adaptol), there is a more significant effect of treatment compared with patients in the control group. Additional use of Adaptol helped to reduce the daily dose of thyrostatics in patients with DTG that reduces the risk of complications of the therapy. If the average daily dose of thiamazole/carbimazole at the beginning of treatment in the examined groups of patients did not differ, then after 2 months of treatment, the mean dose of thyrostatics in the first group was 24.3 ± 2.1 mg, in the control group — 31.8 ± 2.4 mg (p < 0.05). During therapy with Adaptol, there was a decrease (p < 0.05) in the content of malondialdehyde, as well as increase in the activity of antioxidant defense enzymes: superoxide dismutase (p < 0.05) and glutathione peroxidase (p < 0.05). Conclusions. After 2 months of Adaptol therapy, according to the Hamilton scale, patients of the main group hadn’t anxiety states (5.6 ± 1.2 points; p < 0.05), whereas in the control group, there were symptoms of anxiety (14.8 ± 2.7 points; p < 0.05). Adaptol has a positive therapeutic effect on both the oxidant and antioxidant systems that manifests by inhibition of lipid peroxidation and activation of compensatory processes. In view of the research, application of Adaptol must take the proper place in the schemes of treatment for DTG and to expand its possibilities in case of both mild and long-term course of the disease.

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.

Background: The course of pregnancy and delivery in patients with diffuse toxic goiter (DTG) is often complicated by preeclampsia, fetoplacental insufficiency, placental abruption and associated with higher maternal and perinatal mortality. Aim: To study particulars of fetoplacental complex functioning in DTG. Materials and methods: We assessed pregnant patients with DTG (n = 92) and their newborns (n = 94). By the time of delivery, 86 of patients were clinically and biochemically euthyroid. Functions of fetoplacental complex (by levels of placental lactogen, α-fetoprotein, estriol, progesterone and cortisol) were assessed by radioimmune and immunoenzyme assays. Fetometrical parameters of fetuses were studied by ultrasound method. Complex assessment of placentas was done by light and electronic microscopy. Results: Eighty seven (94,6%) patients with DTG had combined complications of pregnancy. The most frequent were: the threat of termination of pregnancy, in 68 (73.9%) of cases, low placenta placement, in 23 (25%), anemia, in 56 (60.9%), pre-eclampsia, in 56 (60.9%). In 59 of patients (64.1%), fetoplacental insufficiency was diagnosed, with predominance of strain or exhaustion reactions. Critical status of fetoplacental complex was found in pregnant patients with uncontrolled DTG and duration of control of less than 20 weeks, as well as in pregnant patients with DTG relapses. The values of main hormones (placental lactogen, α-fetoprotein and progesterone) were below 10th percentile.According to the results of the ultrasound assessments, fetuses from mothers with DTG during gestation demonstrated decrease of the majority or percentile parameters, such as biparietal cranial size, fetal femoral length, abdomen diameter, that was especially prominent in the groups with relapsing DTG.Eighty eight of 94 newborns (93.6%) were born full-term. In total, every third baby (29.3%) had some degree of intrauterine developmental delay at birth. Among the cases with controlled DTG in mothers, there were 21.2% of such babies, whereas among those with DTG relapses, 40%. There was an association between the length of DTG control during pregnancy and mass and body parameters of newborns: the shorter was duration of DTG control during gestation, the higher was the risk of low birth weight fetuses (р < 0.05).Histological assessment of placentas from DTG patients showed changes of endothelial microlandscape with sprouting of cell plasmolemma, blood cell adhesion and fibrin deposition. In 86% of placentas there were stasis, sludge formation and thrombosis in cord vessels.Conclusion: Pregnancy starting during uncontrolled DTG is typically associated with primary placental insufficiency that is morphologically characterized by profound metabolic abnormalities (stromal fibrosis, immaturity of the villous tree, blood flow abnormalities and ischemia). Morphological and functional placental abnormalities correlated with duration of uncontrolled DTG and lead to high rate of intrauterine developmental delay.

The aim of the research was to study the risk factors which favor formation of structural and functional disorders of osseous tissue at thyrotoxicosis and to estimate diagnostic value of x-ray morphometric examination and ultrasound densitometry at early identification of osteoporotic processes. We examined 170 females of reproductive age and at menopausal period, first of all with diagnosis of diffuse toxic goiter. All these women were divided into three subgroups depending on the intensity of their osteoporotic changes (the patients with diffuse toxic goiter without evidence of changes in bone tissue; the patients with diffuse toxic goiter and osteopenia; and the patients with diffuse toxic goiter and osteoporosis). A control group included the healthy women of the both age groups which were divided into the same subgroups. It has been established that radiographic method which is used to reveal osteoporotic changes in women of different age groups with diffuse toxic goiter (including determination of indexes of the vertebrae deformation such as Rokhlin index, Scharmazanova index, metacarpal index) allows evaluate the condition of the bone tissue on the first stage of examination. Nevertheless, this method doesn’t pertain to the most highly informative techniques. The evaluation of mineral density indexes of bone tissue by ultrasound osseous densitometry is more modern and informative method. The present study revealed that osteopenia and osteoporosis are associated with loss of the density of the heel bone in females of the both age groups, either in case of presence of diffuse toxic goiter or without it. Nevertheless the percentage share of the density loss depends both on age and presence of diffuse toxic goiter. In reproductive age the mineral density of the bone tissue in osteopenia is not complicated with diffuse toxic goiter but in osteoporosis the fact of presence of thyroid pathology additionally impact the bone structure. Loss of density of the heel bone in menopausal women shows the same tendency as in the women of reproductive age. It has been proved that decrease in density of the heel bone up to stage of osteopenia does not depend on the diagnosed diffuse toxic goiter. Meanwhile, the more serious changes in density connected with the degree of osteoporosis have no correlation with the diffuse toxic goiter, and are observed in the age group of menopausal women. The diffuse toxic goiter balances these age differences in the mentioned parameter: both in reproductive period and in menopausal period the loss of density in osteoporosis is of approximately 35 %. So identification of primary impairment of mineral density of the bone tissue is likely to help in prevention of the development of the further destruction in bone tissue which is connected with thyroid status. It may be supposed that normalizing of the thyroid state may stop the process of destruction in the bone tissue. It has been revealed that in the groups of patients with osteopenia and osteoporosis the reduced mineral density of the bone tissue is associated with certain statistically significant differences in bone density in the women of both subgroups (with diffuse toxic goiter and without it) as well as in the velocity of ultrasound transmission and changes of wide-band ultrasound reduction. The revealed data indicate the changes in quantity, sizes and dimensional orientation of bone trabecules in the examined bone in the above mentioned patients being observed. The analysis of mineral density of the bone tissue by T-score parameter allowed reveal certain age differences among the groups with no thyroid pathology but with osteoporosis.

The dynamics of structural and functional state of thyroid gland was studied, as well as the levels of antithyroid antibodies in patients with diffuse toxic goiter (DTG) during long-term treatment with thyrostatic agents. Objective of the study — to perform the analysis of changes in the levels of thyrotropin receptor antibodies (TRAbs), antibodies to thyreoproxidase (ATPO) at DTG manifestation and during long-term drug therapy, as well as to determine TRAbs levels in relapsing course of disease. Materials and methods. 112 patients with DTG were examined. The duration of the disease at the examination beginning was from 1 month to 15 years. All patients were divided into two groups depending on the DTG duration: the first group consisted of 46 patients with disease duration up to 1 year (3.96 months in average), the second one consisted of 66 patients with disease duration more than 1 year (3.32 years in average). This distribution was specified by desire to study the dynamics of antithyroid antibody levels at disease manifestation and during long-term course of autoimmune process. Results. On the background of thyrostatic therapy, the number of patients with focal thyroid gland formations increased. When analyzing the levels of antithyroid antibodies at baseline, it was revealed that ATPO level in both groups of patients with DTG significantly exceeded the performance of the control group (group1 — 283.33 ± 86.61 U/ml vs 35.65 ± 4.90 U/ml; group 2 — 207.34 ± 42.52 U/ml vs 35.65 ± ± 4.90 U/ml) and did not depend on disease duration and preliminary treatment duration. In 6 months of treatment, the level of ATPO in both groups was not decreased. The study of TRAbs dynamics during thyrostatic therapy revealed that in patients of the first and second groups, the decrease of TRAbs level was noted only 6–12 months after the start of thyrostatic therapy (group 1 — from 17.19 ± 2.17 IU/l to 6.95 ± 2.39 IU/l, p < 0.05; group 2 — from 14.20 ± 2.04 IU/l to 5.81 ± 2.26 IU/l, p < 0.05). In 24 months of treatment, the recurrence of thyrotoxicosis has been detected in 24 patients (21.4 %). The study of TRAbs levels in patients with relapsing course of the disease revealed their significant increase (24.27 ± 2.86 IU/l vs 12.28 ± 3.57 IU/l). In 6 months of thyrostatic therapy, the levels of TRAbs in patients with relapses do not significantly decreased and were significantly higher than similar rates in patients with DTG in remission (17.22 ± 3.37 IU/l vs 4.64 ± 1.99 IU/l). Conclusions. In patients with DTG, TRAbs level decreases in only 6–12 months after the beginning of thyrostatic therapy. The patients with relapsing course of the disease have significantly larger sizes of goiter, as well as the levels of TRAbs, which in 6 months of continuous treatment far exceeded the normal values and indicators of patients with remission.

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.

Using Minnesota Multiphasic Personality Inventory, we have examined 50 pregnant women with diffuse toxic goiter of first and the second stage in the second trimester of pregnancy, before and after combined therapy. Studies show changes in psychoemotional state, psychological maladjustment, which require timely diagnosis and is effectively corrected by means of therapeutic regimen using glutargin and citoflavin.

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 changes in cardiovascular system take one of the leading places in the clinic of diffuse toxic goiter (DTG) and can define prognosis for a disease. Endotoxin (ET) can be the inductor of a systemic inflammation in patients with DTG and aggravate its clinical course. From there, the purpose of this work was to study humoral and cellular antiendotoxin immunity and C-reactive protein (CRP) level in patients with heart pathology. The level of antiendotoxin antibodies and CRP were studied by enzyme-linked immunosorbent assay. As an antigen, we used ET of the Gram-negative Escheriсhia coli K30 (09:K30:P12), isolated from bacterial biomass by method of water phenol extraction and additionally purified from RNA admixtures using cetavlon processing (Serva, Германия). Receptors to ET were determined by flow lase cytometry using a two-color immunofluorescence analysis using a monoclonal anti-CD14-PE IOTest® (CD14) and conjugate of lipopolysaccharide Escherichia coli K235 with fluorescein isothiocyanate (ET-P). For the study we allocated 3 groups of patients. The first group included 11 patients with DTG who do not have heart disease, the second group consisted of 47 patients with DTG and endocrine cardiomyopathy complicated by arrhythmia, and the third group — 13 patients with DTG and concomitant ischemic heart disease (IHD). Control group consisted of 33 apparently healthy subjects. It is found that in all patients with DTG and heart pathology, a possible reduction of anti-ET-sIgA, anti-ET-IgM and anti-ET-IG is observed in comparison with the control group. This is accompanied by an increase in CRP levels in these groups, especially in patients with DTG and IHD, in whom its level was significantly higher than in patients with DTG and without heart disease. Analysis of literature data and our results confirm the hypothesis that extravasation of the excess amount of ET into the bloodstream depletes reserves of synthesis of specific antibodies, assists enhance of the systemic inflammatory response and the emergence of typical cardiac pathology in examined patients, which makes the course of the underlying disease difficult.

Introduction. Graves disease (GD) managements are varying. More then 40% GD patients undergo surgery in Russia. Materials and Methods. In the Centre 2920 GD patients were operated on. They made 11.7% of 24934 Thyroid (T) surgical cases during 1974-2009. This study includes 357 males (M) and 2527 females (F) observed 2-30 years after Dunhill-Drachinskaya operations (leaving 2-4 g. of some T upper pole) or thyroidectomy. Long-term results of treatment have been evaluated 2-30 years later in 336 (94.1%) males and 119 (99%) females. Statistic analysis of the data was performed using “Statistica” software. Results. Average age made 46.2 ± 2.5 years. M (43.2 ± 1.5) were significantly (p 0.05) younger then F (47.3 ± 1.8). Age of GD beginning was about 39. Duration of diseases of M was much shorter (2.1 ± 0.9) then F (7.2 ± 1.9). Cardiac fibrillation happened in 32.1% of M, 13.7% - in F, exophthalmia - in 44.4% of M, in 24.8% of F (P 0.05). Deterioration of libido and potency has observed in 40.6% and 48.9% of M (39.1 ± 0.4). Plasmapheresis was applied in 9.4% of M, 5.8% - of F. Thyroid has neck location in 55.0% of M, 62.0% - of F. T more often extended behind of sternum and trachea in M. The indication for operations: recurrent and complicated hyperthyroidism (47.0%); compression syndrome (27.0%); allergy (7.0%); oncological risk, pregnancy (19.0%). Postoperative unilateral RLN palsy was found at 0.9%, temporary hypoparathyroidism - at 1.7%. T remnant function was stabilized per the first 12-18 months. In 2-5 years later euthyroid condition observed in 63.4%, postoperative hypothyroidism - at 29.8%, subclinical hypothyroidism - at 5.4%, the relapse of thyrotoxicosis - at 1.36%. Conclusion. Clinical manifestations of M and F GD have essential differences with more aggressive course in M. Relapses of GD are rare after Dunhill-Drachinskaya T resection. Aggressive course of GD in M demands early surgical treatment.

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