Vol 10, No 3 (2014)

De Gustibus
De Gustibus. Should we treat them or live them in peace?
Gerasimov G.A.

There are certain conditions, such as prediabetes, subclinical hypothyroidism or "low T syndrome" with questionable clinical significance. Should we treat these conditions or ...?

Clinical and experimental thyroidology. 2014;10(3):4-7
Editorial note
Russian Association of Endocrinologists clinical practice guidelines for thyrotoxicosis diagnosis and treatment
Troshina E.A., Sviridenko N.Y., Vanushko V.E., Rumyantsev P.O., Fadeyev V.V., Petunina N.A.
Clinical practice recommendations are dedicated to the management of patients with Graves' disease and multinodular toxic goiter.
Clinical and experimental thyroidology. 2014;10(3):8-19
Comments to the European Thyroid Association guidelines for the management of subclinical hypothyroidism in pregnancy and in children
Fadeyev V.V.
The article is dedicated to the discussion about European Thyroid Association guidelines for the management of subclinical hypothyroidism in pregnancy and in children.
Clinical and experimental thyroidology. 2014;10(3):20-26
News of the world thyroidology
World thyroidology news
Manuylova Y.A., Shvedova A.E.

The article is to overview papers:

  1. Effect of vitamin C on the absorption of levothyroxine in patients with hypothyroidism and gastritis.
  2. Management of neonates born to women with Graves’ disease: a cohort study.
  3. A prospective, randomized trial of intravenous glucocorticoids therapy with different protocols for patients with Graves’ ophthalmopathy.
  4. Glucocorticoid regimens for prevention of Graves’ ophthalmopathy progression following radioiodine treatment: systematic review and meta-analysis.
  5. Smoking induces overexpression of immediate early genes in active Graves’ ophthalmopathy.
  6. Obesity and the risk of papillary thyroid cancer: A pooled analysis of three case-control studies.
  7. Differentiation of postpartum Graves’ thyrotoxicosis from postpartum destructive thyrotoxicosis using antithyrotropin receptor antibodies and thyroid blood flow.
  8. Follow-up of newborns of mothers with Graves’ disease.
  9. Severity of birth defects after propylthiouracil exposure in early pregnancy.
  10. The attitude toward hypothyroid- ism during early gestation: time for a change of mind?
  11. Effect of iodine restriction on thyroid function in subclinical hypothyroid patients in an iodine-replete area: A long period observa- tion in a large-scale cohort.
  12. Subclinical hypothyroidism and risk for incident ischemic stroke among postmenopausal women.
  13. Hashimoto’s thyroiditis pathology and risk for thyroid cancer.
  14. Anxiety and depression are more prevalent in patients with Graves’ disease than in patients with nodular goitre.
  15. The TRHR gene is associated with hypothalamo-pituitary sensitivity to levothyroxine.
Clinical and experimental thyroidology. 2014;10(3):28-35
Original Studies
BRAF mutation in papillary thyroid microcarcinoma – additional marker of risk stratification
Semyonov D.Y., Boriskova M.E., Zaraisky M.I., Farafonova U.V., Bikov M.A.


Papillary thyroid microcarcinoma (PTMC) is heterogeneous group of tumor less than 1 cm in the diameter. The volume of surgical treatment stay unstable because unclear biological potential of PTMC.


The aim of our study was to assess the utility of BRAF gene mutation as preoperative additional marker of risk stratification.

Materials and methods

We include 44 patient who were operated in general surgery department Pavlov State Medical University from 2001 to 2013. In all 44 cases BRAF gene mutation was detected and compared with clinic-morphological features (multifocality, invasive growth, lymph node metastasis, recurrence) retrospectively


In our study the frequency of BRAF gene mutation was 68.2%. On multivariate regression analysis the presence of bilateral tumoural foci, lymph node metastasis and the presence of capsular invasion were significantly related to BRAF positive gene status.


Thus, appropriate volume for the BRAF positive PTMC is thyroidectomy with central compartment lymph node dissection.

Clinical and experimental thyroidology. 2014;10(3):36-40
Potential of the drug-regulation iodide uptake in patients for prevention of radioiodine-refractory papillary thyroid cancer
Fomin D.K., Cholak P.M., Nazarov A.A., Zacepina N.V.


To evaluate the efficacy and feasibility of retinoic acid derivatives and lithium salts for radioiodine-refractory prevention in patients with differentiated thyroid cancer during multistage radioiodine therapy.

Materials and methods

The retrospective analysis was performed using the diagnostic and treatment results of 40 patients with differentiated thyroid cancer that underwent 131I therapy, which on the basis of posttherapy whole-body scan had direct indications for subsequent course of radioiodine therapy. The patients were divided into two groups:

  1. the control group (20 patients), which conducted a second course of radioiodine therapy on the standard template and without special training$
  2. the main group (20 patients), who were administered Sedalia (900 mg per day for 8 days, p.o.) and isotretinoin (1.2 mg/kg body weight for 60 days, p.o.) to prevention of the 131I resistance.

To evaluate the effectiveness of a repeated course of radioiodine therapy following parameters were used: the thyroglobulin (Tg) and antibodies to thyroglobulin (Tg-Ab) level in the serum, the posttherapy whole body scan in combination with SPECT-CT.


We have found, that radioactive iodine treatment was effective in 75% of the main group and 90% of patients in the control group. The remission was observed in 10% and 40% in the main and control group, respectively. The partial regression was considered as Tg and TG-Ab reduction, and was observed more in the study group. The resistance to 131I therapy was found in 20% and 10% in the main and control group, respectively, which was based on the fact of permanent Tg/Tg-Ab serum level and absence of the pathological foci iodine uptake on the whole-body scans. The disease progress was found in one patient in the main group.


The use of retinoic acid derivatives and lithium salts, in an effort to prevent the resistance to 131I-theraphy pretend to be unjustified, because it does not lead to significant improvement in long-term results and reduce the number of 131I-resistance.

Clinical and experimental thyroidology. 2014;10(3):41-44
Thyroid disorders after radiation therapy in childhood
Bobrova E.I., Fadeyev V.V., Sotnikov V.M., Pavlova M.G., Sych Y.P., Semochkin S.V., Parkhomenko R.A., Mazerkina N.A., Zheludkova O.G.


The aim of our study was to analyze thyroid status in adults after treatment for malignancies in childhood and its relationship with dose and type of radiotherapy.

Material and methods

Thyroid function (TSH, free T4, anti-TPO), thyroid ultrasound and FNA (in case of thyroid nodules more than 1 cm) were evaluated in 106 adults with a history of radiotherapy for brain tumors (BT), acute lymphoblastic leukemia (ALL) and Hodgkin's lymphoma (HL) in childhood and compared with that in healthy controls (n = 33).

  • Group 1 (cranial irradiation 18 Gy): 11 men and 17 women (median age 21.7 ± 4.2 yrs (range 15–30)), 14.6 ± 4 years after treatment for ALL.
  • Group 2 (craniospinal irradiation 35 Gy + boost to the tumor 55 Gy): 28 men and 20 women (median age 19.48 ± 2.76 yrs (range 15 – 26), 7.84 ± 4.68 years after treatment for brain tumors (BT).
  • Group 3 (local irradiation of cervix and mediastinum mean dose 30.9 ± 9.17 Gy): 13 men and 16 women (median age 28.2 ± 6.31 yrs (range 17 – 44), 11.37 ± 7.25 years after treatment for HL.


Maximal incidence of hypothyroidism was in the group 2 – 58.3% (35.4% – primary, 4.2% – central, 18.8% – mixed). Prevalence of hypothyroidism in groups 1 (9.09%) and 3 (17.24%) doesn't significantly differ from controls. Thyroid volume was lower (mean 4.58±2.39 ml) in group 2 (p<0.001) in compare with other groups and control. TSH was higher (mean 3.72±2.51 MEd/l) in the same group in compare with group 1 and control (p=0.001). Incidence of thyroid nodules (10.34% – group 1; 8.3% – group 2; 20.7% – group 3) doesn't significantly differ between groups and controls (p=0.277).


These data indicate that treatment of cancer in childhood is associated with development of thyroid abnormality later during the life, and there is a possible link between craniospinal irradiation and incidence of hypo-thyroidism.

Clinical and experimental thyroidology. 2014;10(3):45-52
Letters to the Editor
To the article of Vasilyev D.A. and authors: "Ways of the sonoelastography diagnostic significance improving in the differential diagnosis of thyroid nodules"
Borsukov A.V.
In a brief review in the format "review of equals" the conclusions of the article of Vasilyev D.A. et al. were analyzed in position with evidence-based medicine. Fundamental errors in the method of compression sonoelastography of thyroid are listed.
Clinical and experimental thyroidology. 2014;10(3):53-54

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