Vol 5, No 1 (2009)

Cover Page
Articles
Are there any Perspectives for Radioiodine Treatment in Patients with Hyperthyroidism in Russia?
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Abstract
В последние 60 лет радиойодтерапия тиреотоксикоза получила широкое распространение и является методом выбора радикального лечения в США и Европе. Она позволяет быстро и с минимальными затратами оказать эффективную помощь пациентам в устранении симптомов тиреотоксикоза. Поскольку 131I не имеет доказанного тератогенного эффекта, возможно назначение его больным репродуктивного возраста (исключая беременность). Доза на гонады при радиойодтерапии не превышает 2 cГр, что намного ниже, чем при выполнении рутинной рентгенографии поясничного отдела позвоночника, внутривенной урографии или ирригоскопии с барием, и тем более при компьютерной томографии (КТ) абдоминальной области. Риск развития радиационно-индуцированной опухоли намного ниже при применении 131I по сравнению с большинством рентгенодиагностических исследований или интервенционными радиологическими процедурами, проводимыми под рентгеновским контролем. Это подтверждают отдаленные результаты многолетнего опыта лечения 131I сотен тысяч больных с гипертиреозом. Согласно общепринятому мнению специалистов по радиационной гигиене, риски развития рака щитовидной железы (РЩЖ), лейкозов, любого другого рака и генетических или эмбриональных дефектов достоверно ниже таких же рисков эндогенного возникновения тех же заболеваний.
Clinical and experimental thyroidology. 2009;5(1):3-7
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Management of Diagnostics and Treatment in Patients with Thyroid Disorders in North-Western Region of Russia
., ., ., ., ., ., ., ., ., .
Abstract
Для того чтобы добиться значительных результатов в лечении заболеваний щитовидной железы (ЩЖ), впрочем, как и любой другой патологии, мало создать центр, оборудованный современной аппаратурой, операционной с наличием лекарственных препаратов и имеющий высококвалифицированных специалистов, хотя мы полностью согласны со статьей И.И. Дедова и соавт. (2008), о целесообразности введения специальности “эндокринная хирургия” и подготовки хирургов соответствующего профиля. Необходимо создать и внедрить систему, обеспечивающую современный уровень диагностики и лечебной помощи на всех уровнях, все звенья которой работали бы как единый механизм, начиная с населенного пункта, где проживает больной. Каковы же основные задачи, которые приходится решать тем, кто работает по нашей специальности? Диагностика и лечение пациентов с заболеваниями ЩЖ в настоящее время – наиболее алгоритмизованные разделы медицины.
Clinical and experimental thyroidology. 2009;5(1):8-12
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Novosti mirovoy tireoidologii
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Abstract
Clinical and experimental thyroidology. 2009;5(1):13-16
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Do we need Reference Ranges for Thyroid Volume for Children in Clinical Practice?
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Abstract
История применения ультразвукового исследования в тиреоидологии насчитывает уже более 40 лет. Японские исследователи K.Yamakawa и S.Natio (1966) впервые описали способ определения объема ЩЖ с помощью ультразвука [1]. С этого момента был проведен ряд исследований, посвященных разработке и совершенствованию метода для определения объема ЩЖ [2–4]. J. Brun (1981) предложил метод, использующий модель ротационного эллипсоида, который основан на измерении высоты, ширины и толщины каждой доли с последующим вычислением объема по формуле эллипсоида. Исследования на трупах позволили ввести поправочный коэффициент 0,479 и оптимизировать формулу расчета [3]. Убедившись в объективности и воспроизводимости метода, ученые всего мира сосредоточили свои усилия на решении следующей проблемы: разработка нормативов объема ЩЖ в различных возрастных группах.
Clinical and experimental thyroidology. 2009;5(1):17-19
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Comparison of Thyroid Hormones Consumption in Russia and European Countries
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Abstract
Hypothyroidism is one of the most common endocrine diseases. The prevalence of hypothyroidism in adults is estimated to be 1–2% for overt hypothyroidism and 7–10% for subclinical hypothyroidism, especially in elder women. Considering high prevalence of hypothyroidism and negative consequences of nontreated hypothyroidism for health, we conducted the work which aim was the assessment of consumption of thyroid hormones in Russia in comparison with the countries of Europe. The aim of this analysis, in turn, is the approximate estimation of hypodiagnostics of hypothyroidism in our country.
Clinical and experimental thyroidology. 2009;5(1):20-25
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Endothelium-related Cardiovascular Risk Factors in Subclinical Hypothyroidism
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Abstract
The aim of the study was to evaluate the endothelial function in patients with subclinical hypothyroidism. 39 patients and a control group of 14 matched persons group were included in cross-sectional research. In subclinical hypothyroid patients endothelium-dependent vasodilatation significantly decreased, while endothelin-1 and PAI-1 levels increased. Levels of total cholesterol and low-density lipoproteins were significantly higher in patients with subclinical hypothyroidism than in control group, and their positive correlation with TSH was revealed. These findings allow us to make a conclusion on presence of endothelial dysfunction and atherogenic dislipoproteinemia in patients with subclinical hypothyroidism.
Clinical and experimental thyroidology. 2009;5(1):26-29
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Heart rate Variability and Efficiency Assessment of Graves' Disease Radioiodine Therapy
., ., ., .
Abstract
Time of the transformation to the euthyroid condition after radioiodine therapy of Grave’s disease is individual and deviates from weeks to months, what requires frequent hormones control. The aim of this study was the assessment of possibility to use HRV parameters in dynamic control after the radioiodine therapy. 77 patients were examined with 114 fT4 measurement and HRV parameters recording (before radioiodine administration and in 1, 3, 6, 12 months after). From HRV parameters two were chosen as characterizing the closest correlation with fT4 and relatively independent from each other. The whole sample was divided into the teaching set (86 measurements) and the test set (28 measurements). The decision rule was found by support vector machine in the teaching set asf(HR,SDNN) = 0.995 lg(HR) – 0.104 lg(SDNN) – 1.703, where f is the indicator of the thyroid gland function, HR – heart rate during 5-minute ECG recording; SDNN – standard deviation of RR intervals; 0.995 , 0.104 and 1.703 – correcting coefficients. If f > 0, the thyrotoxicosis takes place in a patient. If f < 0 – there is no thyrotoxicosis. The analysis of diagnostic method precision in testing set gave the following results: diagnostic sensitivity was 71%, the diagnostic specificity 79%. This method can predict thyrotoxicosis elimination or relapse with high possibility. Its use can optimize thyroid function control and refuse from fixed time hormone measurement.
Clinical and experimental thyroidology. 2009;5(1):30-34
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Photodynamic Vvisualisation of Paratyroid Glands – Results of Clinical use Eng
., ., ., ., ., ., ., ., .
Abstract
The purpose: an approbation of intraoperative photodynamic identification of healthy and adenomatous parathyroid glands using 5-aminolevulinic acid (5-ALA) at thyroid and parathyroid operations.Materials and methods: intraoperative photodynamic identification using 5-ALA was performed in 25 patients with various thyroid and parathyroid diseases. 2–3 hours before the surgery the patients have received 1,5 g of 5-ALA per os. In 10 cases video-assisted operations were performed. In 3 cases at primary hyperparathyroidism video-assisted parathyroidectomy was used. In other cases the operative intervention was carried out using conventional technique. The operative wound surface was exposed to blue light of the light source KARL STORZ D-Light C (wavelength –380–440 nm) and the endoscope with the system of filters. During preand postoperative period we have been registering basic clinical parameters, including parathyroid hormone level and the level of ionized calcium monitoring before operation, in 24, 48 hours and 1 month after operation. Results: the parathyroid glands were identified in 23 of 25 patients. There were no cases of allergic reactions and other side effects of 5-ALA introduction.Conclusion: intraoperative parathyroid glands identification by the way of registration of their fluorescence at peroral administration of 5-aminolevulinic acid is possible for the overwhelming majority of patients.
Clinical and experimental thyroidology. 2009;5(1):35-40
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First Experimental Results in Electrochemical Lysis of Thyroid Nodules
., ., ., ., .
Abstract
Electrochemical lysis is investigated to be used in miniinvasive treatment of thyroid nodules. Histological operative preparations of thyroid nodules (n = 20) helped to work out a model of electrochemical lysis optimal regimens. The results of this experiment were verified by usage of experimental animals.
Clinical and experimental thyroidology. 2009;5(1):41-46
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Association of PTPN22 Haplotypes with Hashimotos Thyroiditis in Population of Novosibirsk
., ., ., ., ., ., ., ., .
Abstract
The single nucleotide polymorphism (SNP) C1858T within the PTPN22 gene was recently associated with autoimmune thyroid disease (AITD). The purpose of this study was to examine the joint association of this polymorphism with the AITD. Materials and methods: In this association study 358 subjects were genotyped for the C1858T polymorphism PTPN22 gene. The study population included 215 patients with both autoimmune thyroid diseases (AITD): 108 Novosibirsk patients with Graves' disease (GD) and 107 Hashimotos thyroiditis (HT), and 143 healthy controls. Results. No differences in genotype frequencies were observed between GD and controls for the C1858T polymorphism PTPN22 gene in population of Novosibirsk. The PTPN22 1858 T-allele frequency was strongly increased in patients with HT 24,3% versus controls 12.9%; χ2 = 10.8, (р = 0.001, OR = 2.16, 95% CI 1.36–3.44). The T-allele frequency was 24.7% in women with HT and 12,1% in the control group; χ2 = 7.62, р = 0.006. The T-allele were associated with the increased risk for HT in women (odds ratio OR = 2.39 95% CI 1.27-4.89). Conclusion: The PTPN22 gene is a joint susceptibility locus for HT.
Clinical and experimental thyroidology. 2009;5(1):47-52
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Clinicoradiologic Relationships in Case of Grave's Orbitopathy
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Abstract
Purpose. To evaluate the relationship of clinical and radiologic findings in improving of diagnostics and amendment of the outcome.Material and methods. 52 patients (104 orbial cavities) in the age of 18–61 years were examined. Patients with the clinical symptoms of Grave’s orbitopathy were examined using ophthalmological evaluation and MSCT-visualization of orbial cavities.Results. The most significant MSCT-parameters for the determination of severity are: prolapse of orbital fat (р = 0.0009), protrusion of eye bulb (р = 0.001), apical inspissations (р = 0.019), density of RBCmin (р = 0.004), size of external terminal membrane (р = 0.001), size of LRM (р = 0.002), size of MRM (р = 0.006), length of optic nerve (р = 0.0001), diameter of optic nerve in 1 cm from the macula (р = 0.01), width of lacrimal gland (р = 0.0002).Conclusions. There is significant relationship between clinical and radiologic (MSCT) features. It lets develop the protocolof examination for diagnostics and treatment of Grave’s orbitopathy.
Clinical and experimental thyroidology. 2009;5(1):53-57
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