Vol 10, No 2 (2014)

Articles
De Gustibus POCO SALE, MA IODATE
Герасимов Г.А.

Abstract

Наверняка каждый из нас хоть раз в жизни говорил или по крайней мере думал: “Эх, мне бы твои проблемы!” Однако, произнося эти слова, мы вовсе не были готовы обменять чьи-то сложные и запутанные проблемы на понятные и легко решаемые. Скорее наоборот. Соединяя теорию с практикой, американские социологи Хорст Риттель и Мелвин Уэббер в ставшей классической статье, опубликованной в 1973 г., разделили проблемы человечества на два типа: “злые” и “прирученные”

Clinical and experimental thyroidology. 2014;10(2):4-9
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Ultrasound Evaluation of Thyroid Gland Volume in Schoolchildren 7-11 years from West Kazakhstan
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Abstract

Objective: to determine thyroid volume by ultrasound in schoolchildren aged 7 to 11 years, from oil and gas areas of West Kazakhstan. Materials and Methods. During the period from May to December 2013 cross-sectional study was conducted on schoolchildren living in the oil and gas and clean areas of West Kazakhstan. A total of 815 schoolchildren aged 7-11 years who met the study criteria were included in the study. Anthropometry was measured before the ultrasound, then the expert radiologist conducted measurement of thyroid volume using a portable ultrasound machine according to recommendations of WHO. Urinary iodine was tested in 10% of students selected randomly. Results. The prevalence of goiter in our sample using the 97th percentile of the volume recommended by WHO / ICCIDD (2007) was 24.7 ± 1.50% (49.8% girls and 51.2% boys). Average thyroid volume measured by ultrasound in the oil and gas regions was 4.43 ± 1.66 ml, in a safe area of 2.9 ± 1.24 ml. The difference in thyroid volume was statistically significant p <0.0001. The difference in thyroid volume between boys compared areas was statistically significant ( p <0.0001): 4.62 ± 1.75 ml and 2.78 ± 0.93 ml; between girls 4.23 ± 1.53 ml and 3.05 ± 1.52 ml, respectively ( p <0.0001).Mean volume thyroid does not correlate with the age of the participants, but weakly correlated with BMI ( r = 0.3; p <0.0001). Median and 97th percentile thyroid volumes of our subjects were higher than the reference values reported to WHO. Median urinary iodine (UI) was 193 mg/l. Conclusion. Thyroid size of schoolchildren in west region of Kazakhstan is higher than the reference values reported to WHO. The high prevalence of goiter in the areas of oil and gas on of versus iodine-replete conditions available to the regional populations according to urinary iodine (UI) suggests the influence of other goitrogenic factors in the region and requires further study.
Clinical and experimental thyroidology. 2014;10(2):10-15
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The Relationship between TSH Values and Cardiovascular Risk Factors in Patients with Autoimmune Thyroiditis and Subclinical Hypothyroidism
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Abstract

The study aimed to investigate the relationship between TSH values and the presence of cardiovascular and some metabolic disorders in 186 patients with autoimmune thyroiditis without hyper" and overt hypothyroidism. Results. In the ROC analysis, a level of TSH ≥ 4.47 mu/L was found to predict diastolic dysfunction of the right and / or left ventricles with 70.8 [48.9; 87.3] % sensitivity and 69.1 [55.2; 80.8] % specificity (AUC: 0.678 [0.563; 0.778], p = 0.036). The level of TSH ≥ 5.25 mu/L predicted the presence of anemia with 54.8 [39.7; 70.1] % sensitivity and 54,8 [44.2; 65.2] % specificity (AUC: 0.603 [0.516; 0.688], p = 0.068) as well as some other cardiovascular and meta" bolic abnormalities. Conclusion. Among the patients with subclinical hypothyroidism (SCH), the level of TSH over 5.25 mu/L might be considered a predictive marker for increased risk of SCH associated disorders.
Clinical and experimental thyroidology. 2014;10(2):16-21
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The Contribution of the Common Single-nucleotide Polymorphisms of β1-Adrenoreceptor Gene to Cardiovascular Alteration in Patients with Thyrotoxicosis
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Abstract

The detection of a genetic organization of common diseases is one of the first key direction in modern medicine. In thyrotoxicosis, identification of genetic predictors, defining remission and the risk of cardiovascular complications is of a great importance. We gave attention to the second of above mentioned aspects. Candidates for genetic prediction are the genes regulated by triiodothyronine and playing a key role in changing of the myocardial contractility and arrhythmogenesis. There are SNPs of the β1-adrenergic receptor (ADRB1) gene among them: polymorphism in the 389 codon (Gly389Arg) and polymorphism in codon 49 (Ser49Gly). The investigation goal was to determine whether the deleterious effects on cardiovascular system of the thyroid hormones excess in people with thyrothoxicosis were modified by polymorphic variants of ADRB1 gene. So we investigated the possible link of these two SNPs with clinicopathologic findings, echocardiographic parameters and the changes during therapy in 165 patients with a thyrotoxicosis caused by Gravesdisease without any nonthyrotoxic cardiovascular disorders. The data analysis demonstrates that both Gly389Arg and Ser49Gly polymorphisms have very moderate influence on the risk of atrial arrhythmias, left ventricular hypertrophy and its type (concentric or eccentric). Genotype Gly389Gly (Gly389Arg polymorphism) or genotype Gly49Gly (Ser49Gly polymorphism) carriers have tendency to the lowest risk of cardiovascular complications during thyrohoxicosis, but no statistically significant effects were revealed.
Clinical and experimental thyroidology. 2014;10(2):22-31
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Evaluation of the Results of Repeated FNA in Patients with Nodular Colloid Goiter
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Abstract

Article is devoted to the relevance of the application of needle aspiration (FNA), as well as the feasibility of re (FNA) in patients with initially benign thyroid nodules. The study involved 120 patients who underwent FNA, the results of which were diagnosed nodular colloid goiter. During repeated FNA of patients with benign thyroid cytologic diagnosis changed in 16.6% of patients ( n = 20), and the conclusion from benign to “suspicious for malignancy” occurred in one patient (0.8%). Long-term observation of patients with initially benign conclusion leads to an increased number of repeat FNAs that not only beneficial in terms of funding, but uninformative, as the percentage identified of malignancies statistically insignificant. The above observation showed that the use of re-FNA in patients with proven benign thyroid nodules impractical even when data are available for the growth of the nodules and the change in concentration of TSH and regardless of age.
Clinical and experimental thyroidology. 2014;10(2):32-37
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Results of Surgical Treatment of Papillary Thyroid Cancer
., ., ., ., ., ., ., ., ., ., ., ., ., ., .

Abstract

Thyroid papillary cancer, one of the most frequent malignant tumors, aroused growing interest during last years due to continuous increase in number of such patients. This article is devoted to the closest results of surgical stage of treatment of patients with thyroid papillary cancer and to the analysis of complications after thyroid surgery. Material and Methods. This work is based on the analysis of results of treatment of 1156 patients with thyroid papillary cancer, who were operated during the period 2007 and 2012 at the Department of Endocrine Surgery of SPCC FGBI “NMSC named after N.I. Pirogov” of MH of RF. The diagnoses were confirmed by histological method. Results. Hemithyroidectomy was performed only in patients with rather favourable forms of thyroid papillary cancer - typical, follicular and sclerosing. Patients with more aggressive forms - tall cell and columnar!cell - were subjected to thyroidectomy. There is increase of complications with thyroid surgery expansion - hypoparathyroidism from 7.6% after thyroidectomy without lymphodissection to 13.3% after thyroidectomy with central and lateral lymphodissection, and paresis of lower laryngeal nerve from 5.1% to 6.5%. Postoperative bleeding that required repeated operative intervention was registered in 3/1156 (0.3%) of patients. There were no lethal complications after thyroid surgery. Among operated 1156 patients cancer recurrence was detected in 29 patients (2.5%).
Clinical and experimental thyroidology. 2014;10(2):38-42
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Predictors of Postoperative Hypocalcemia after Thyroidectomy for Nontoxic Multinodular Goiter
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Abstract

The aim of this prospective study was to determine the main factors influencing the development of postoperative hypocalcemia in patients with Gravesdisease after thyroidectomy. Assess whether patients with BG likely to develop postoperative hypocalcemia than those who performed thyroidectomy about nontoxiс multinodular goiter. In this study were prospectively included 54 patients with Gravesdisease, which from October 2011 to May 2013 was performed thyroidectomy. Additionally, as a control group from the database included 48 patients with nontoxiс multinodular goiter, who underwent thyroidectomy in the same time. All patients attended deficit/insufficiency of vitamin D (25(OH)D were 20/30 ng/ml). Patients were divided into 2 groups according to the postoperative calcium concentrations corrected for albumin in the blood: Group 1 - patients with postoperative levels of calcium in the blood of 2.0 mmol/l or less; Group 2 - Patients with blood calcium levels above 2.0 mmol/l. Thus, when patients Gravesdisease Group 1 disease duration was significantly higher concentration of 25(OH)D and postoperative parathyroid hormone was significantly lower compared to the 2nd group. According to logistic regression analysis, postoperative PTH level below 10 pg/ml was the main predictors of postoperative hypocalcemia ( p < 0,001). Patients with Gravesdisease increasingly requiring the appointment of calcium after the operation, they are demonstrating a significant clinical signs of hypocalcemia than patients with nontoxiс multinodular goiter after thyroidectomy.
Clinical and experimental thyroidology. 2014;10(2):43-48
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Methods of Estimation the Reliability and Increasing the Informativeness of the Laboratory Results (Analysis of the Laboratory Case of Measurement the Indicators of Thyroid Function)
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Abstract

The goal of the study was to demonstrate the multilevel laboratory quality management system and point at the methods of estimating the reliability and increasing the amount of information content of the laboratory results (on the example of the laboratory case). Results. The article examines the stages of laboratory quality management which has helped to estimate the reliability of the results of determining Free T3, Free T4 and TSH. The measurement results are presented by the expanded uncertainty and the evaluation of the dynamics. Conclusion. Compliance with mandatory measures for laboratory quality management system enables laboratories to obtain reliable results and calculate the parameters that are able to increase the amount of information content of laboratory tests in clinical decision making.
Clinical and experimental thyroidology. 2014;10(2):49-56
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