Vol 11, No 3 (2015)

De Gustibus
Kind word treatment
Gerasimov G.
Abstract

Should adult people be taught how to eat well, dress themselves and even what water to drink? Are health communication program really effective and what factors should be taken into account? All these in new column “De Gustibus”.

Clinical and experimental thyroidology. 2015;11(3):6-10
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Original Studies
P-­glycoprotein expression in experimental thyroid dysfunction
Shchul'kin A.V., Yakusheva E.N., Chernykh I.V., Vinogradov I.Y., Popova N.M.
Abstract

Aim.

To study an expression of P-glycoprotein in the liver, lean gut, kidneys, cerebral cortex at experimental dysfunction of the thyroid gland.

Materials and methods.

P-glycoprotein expression was investigated on Chinchilla rabbits by immunohistochemistry method. Serum blood levels of thyroid hormones (general T4, general T3, TTH) was investigated by radioimmune method.

Results.

It was revealed that in rabbits with experimental hyperthyroidism caused by 14-days subcutaneous admi-nistration of thyroxine expression of P-glycoprotein in the liver, lean gut and cerebral cortex was increased. It was shown that in rabbits with experimental hypothyroidism caused by resection of the thyroid gland or administration of thiamazol within 21 days expression of P-glycoprotein in the liver, lean gut and cerebral cortex was decreased.

Conclusion.

Correlation dependence between serum levels of general T4, general T3, TTH and an expression of a P-glycoprotein in the liver, lean gut and cerebral cortex was revealed.

Clinical and experimental thyroidology. 2015;11(3):11-16
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Restaging of differentiated thyroid carcinoma with SPECT/CT after radioiodine therapy
Karalkina M.A., Vasilenko E.I., Fomin D.K., Galushko D.A.
Abstract

Purpose.

The purpose of the study was to assess the diagnostic value of SPECT/CT data after radioiodine therapy in comparison with the data of soft tissue neck ultrasonography (US) and computed tomography (CT) in patients with differentiated thyroid carcinoma (DTC) and thus to investigate the role of SPECT/CT data in the restaging of DTC.

Material and methods.

We analyzed the results of 263 patients who were examined from November 2011 to April 2014, at the age of 10 to 78 years (190 female and 73 male). According to postoperative histological tests, 255 patients had papillary thyroid cancer and 38 patients had follicular thyroid cancer. Soft tissue neck US, CT of the chest without intravenous contrast and scintigraphy with 99mTc-pertechnetate in all patients were performed and then they were treated with radioiodine (dose, 3.0–5.5 GBq). Whole-body scintigraphy (WBS) and SPECT/CT were performed on the 3–5 day in all patients receiving radioiodine therapy.

Results.

After radioiodine therapy and SPECT/CT cancer stage diagnosed with US, CT, and scintigraphy was changed to N in 36.7% of patients, and cancer stage was changed to M in 11% of patients. The frequency of regio-nal cervical metastasis not detectable with US but suspected on WBS was 43.9%. In most cases, there were micrometastasis and lymph node metastases in the pre- and paratracheal areas, which were difficult to access by US.

Conclusion.

SPECT/CT after radioiodine therapy could improve the assessment of cancer stage and prognosis in patients with DTC.

Clinical and experimental thyroidology. 2015;11(3):17-23
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SNP Ser38Gly in the β-subunit of potassium channel gene KCNE1 and thyrotoxic cardiomyopathy in patients with Graves’ disease
Babenko A.Y., Savitskaya D.A., Kostareva A.A., Grineva E.N.
Abstract

The relevance of the research.

The risk factors of developing severe thyrotoxic cardiomyopathy (TCMP) are not certainly determined now. But it is essential to choose the optimal approach to care. Recent studies show that even patients of the same sex, with similar age, duration of thyrotoxicosis and hormones’ level differ in a severity of cardiomyopathy. So, scientists began to search for genetic risk predictors of the heart damage, caused by thyrotoxicosis. Among possible genetic predictors of thyrotoxicosis are single nucleotide polymorphisms in genes, that expression is regulated by thyroid hormones or genes, that are involved in developing of non-thyrotoxic cardiac pathology.

Aim.

To investigate the possible association of the polymorphism Ser38Gly in KCNE1 gene with different manifestations of thyrotoxic cardiomyopathy, especially with atrial fibrillation and cardiac remodeling.

Materials and methods.

155 patients with thyrotoxicosis caused by Graves’ disease were enrolled. Genotyping was also made in 187 healthy blood donors – the control group. Genotyping was performed by real time polymerase chain reaction.

Results.

Our results show an interaction of the single nucleotide polymorphism Ser38Gly in KCNE1 gene with TCMP only in patients aged 45 and older. In this age group atrial fibrillation was significantly more prevalent in GG genotype carriers: 35.3% (GG) vs 13.9% (AG+AA) (p = 0.037). Also, there was a significant difference in systolic blood pressure (SBP) by KCNE1 codon 38 genotypes. SBP were significantly higher in allele G gomozygotes as compared to allele A carriers: 124.89 ± 15.14 mm Hg vs 131.35 ± 15.32 mm Hg (p = 0.012).

Conclusion.

The fact, that association of the polymorphism Ser38Gly with atrial fibrillation was shown only in group with patients older than 45 years, proves that its influence is of a lower value in comparison with “traditional” risk factors. There was no significant difference among genotypes in severity of TCMP and types of myocardial re-modeling.

Clinical and experimental thyroidology. 2015;11(3):24-33
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The prevalence of thyroid tumors in patients with acromegaly
Viktorovna K.O., Nikolaevna M.N., Yakovlevna R.L.
Abstract

Aim.

To study the incidence of thyroid tumors in patients with acromegaly in comparison with the control group (1:2,5).

Materials and methods.

The study included 125 patients with acromegaly: 85 women and 40 men. Mean age 51,31 [23;78]. The control group included of 324 people: 228 women and 96 men. Mean age group 49 [24;80]. All were performed ultrasound. If there is evidence in both groups performed FNA, followed by cytological examination. In patients with acromegaly were investigated levels of growth hormone and IGF-1, TSH and FT4. In the control group of TSH and FT4.

Results.

Thyroid diseases are comparable between the study groups by sex: nodular goiter frequently diagnosed in females, and mixed and diffuse goiters in males. Thyroid cancer has also been reported more often in men in both groups. However, it should be noted that the incidence of thyroid cancer in patients with acromegaly exceeded the figures of the control group 3,05 times, namely: nodular goiter 1.69 times (р = 0.05), diffuse goiter 2.32 times (р = 0.01), mixed goiter 5,96 times (р < 0.01). The incidence of thyroid cancer has exceeded the values of the control group 6,05 times. These results gave an odds ratio of 6.68 (95%CI 2.5 to 17.82), р = 0.0001. Dependencies between the level of IGF-1 (p = 0.84), disease duration (p = 0.69), age (p = 0.86) and the risk of developing cancer have been identified.

Conclusion.

The results indicate an increased risk of thyroid disease in patients with acromegaly in general and cancer in particular, that necessitates more frequent monitoring thyroid condition in patients with acromegaly, especially in males, independent of the level of IGF-1, the duration of the disease and age.

Clinical and experimental thyroidology. 2015;11(3):34-38
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Prevention of iodine deficiency in the Tyumen region: success or failure?
Suplotova L.A., Makarova O.B., Kovalzhina L.S., Sharuho G.V.
Abstract

Aim.

To evaluate the effectiveness of regional programs for the prevention of iodine deficiency in the Tyumen region and explore the awareness and behaviors of different groups of the population in matters of iodine prophylaxis in the conditions absence of federal law on universal salt iodization.

Materials and methods.

The results are presented of the realization of regional programs for the prevention of iodine deficiency in the Tyumen region for the period 1994–2014 years. As part of the medical monitoring examined 18,906 prepubertal children 8–12 years with the use of a unified system of identification of iodine deficiency. The results of sociological research are presented, as part of a public health monitoring conducted by surveying students (n = 744) and their parents (n = 677) on a representative sample.

Results.

Iodine nutrition use was normalization through 3 years against the background of the realization regional program of iodine prophylaxis since 1997 in the Tyumen region, as evidenced by normalization of urinary iodine excretion in prepubertal children. The median urinary iodine in prepubertal children significantly increased from baseline 71.4 mg/l to 142 mg/l in 2009, and as a result decreased the frequency of goiter in children 8–10 years from 87% to 8%, which corresponds to mild endemic goiter region. It noted a lack of awareness of parents of iodine deficiency in the area of residence (54.8% informed their parents of schoolchildren); indicator is linked to gender, age (p < 0.01), education (p < 0.001), and where do you live respondents (p < 0.001). Knowledge of the existence and availability of prevention of iodine deficiency showed 75% of parents and 46.6% of students. Regular use of iodized salt in the home diet (“always used” and “often iodized salt than non-iodised”) 57.4% of parents say. To identify various models of preventive behaviors of parents of schoolchildren in the prevention of iodine deficiency calculated parameters characterizing the connection between awareness and preventive behaviors. It is noted that the high awareness of the respondents does not guarantee the daily implementation of preventive practices.

Conclusions.

These models have a preventive behavior relationship with socio-demographic characteristics of the population that must be considered in the formation of a regional strategy for the prevention of iodine deficiency among the population forming the motivation for daily preventive action (systematic consumer choice iodized salt).

Clinical and experimental thyroidology. 2015;11(3):39-46
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Neonatal gipertireotropinemiya – an indicator of the severity of iodine deficiency in the population?
Suplotova L.A., Makarova O.B., Kovalzhina L.S.
Abstract

Aims.

Rate the severity of iodine deficiency and the effectiveness of iodine prophylaxis in the Tyumen region on the basis of the criterion of neonatal hyperthyreotropinemy than 5 mU/l for the period from 1994–2014 and to determine the significance of the indicator as the monitoring of iodine deficiency in the population.

Materials and methods.

Analysis of screening for congenital hypothyroidism in the period from 1994–2014’s was performed in Tyumen region as an example of the region with implemented a program of prevention of iodine deficiency. Consider the views pregnant women and mothers of children of school age in the prevention of iodine deficiency by the survey.

Results.

In the process of implementation of regional programs for the prevention of iodine deficiency was a significant reduction in the incidence of neonatal TSH above 5 mU/l from 44.7% in 1995 to 5% in 2013. Pregnant women use of drugs iodine on group prevention iodine deficiency unequal conditions with a population for sources of iodine, so there is open the question of objective criteria neonatal TSH > 5 mU/l, as an indicator of the severity of iodine deficiency in the territory. Correlation analysis of the severity indicators of iodine deficiency showed that in the region with implementing a program of iodine prophylaxis in group of pregnant women, indicator iodine deficiency – neonatal TSH > 5 mU/l can be used to assess the severity of iodine deficiency in a population of pregnant women only. Revealed low awareness of pregnant women (61%) and mothers of pupils (66%) of the problem of iodine deficiency. Awareness about the means of prevention is higher. For example, 78% of respondents noted “the use of iodized salt”. An important feature observed in the prevention of iodine deficiency are different models of behavior: pregnant women under medical supervision implement prevention group using drugs iodine, and women in the status of “parent” does not have this preventive practice. The proportion of respondents using iodized salt was not significantly different.

Conclusions.

Therefore, pregnant (lactating) women and their newborn babies within the group prophylaxis have an advantage over children, students and their parents in the prevention of iodine deficiency in the territory endemic for iodine.

Clinical and experimental thyroidology. 2015;11(3):47-53
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Impact of Preoperative Detection of Sodium-Iodide Symporter Expression Level on Differentiated Thyroid Cancer (DTC) Prognosis
Boriskova M.E., Semenov D.Y., Farafonova U.V., Koloskova L.E., Pankova P.A., Smolina E.N.
Abstract

Nowadays it is of utmost importance to forecast a cancer progression, in particular, thyroid cancer in order to make a decision about the optimal treatment tactics.

Aim.

To evaluate the possibility of preoperative detection of membrane located NIS expression level by flow cytofluorometry (FC) method in fine needle aspiration biopsy (FNAB) material as a marker of unfavourable prognosis of DTC.

Materials and methods.

The research was of prospective character. 43 patients with DTC who underwent medical treatment  in general surgery department of St.Petersburg State Medical University named after Pavlov in the period 2009–2010 were enrolled in the study. Level of NIS expression in FNAB material analysed preoperatively and expression was accessed quantitavely by FC method. According to the results of routine histology examination: 28 patients needed radioiodine ablation (RIA). During 48 months of observation recurrences were detected in 10 cases. All recurrences were of local character. Not a single patient from the group without RIA had recurrence.

Results.

FC method of NIS detection in FNAB material is technically possible and the results obtained are in line with immunohistochemical method. When studying the level of membrane located NIS expression in DTC it was found that the mean level in the group without RIA and disease recurrence is 6.5% with maximum up to 11.6 %. The lowest mean level of NIS expression was in patients group with recurrence of DTC after RIA (p = 0.00083). We proved that crutial for recurrence of DTC after RIA were decreased level of membrane located NIS expression less than 1%. That means that when NIS level is detected to be less than 1% a patient can be considered to belong to a high-risk group and more aggressive surgical tactics must be used to decrease the risk of recurrence.

Conclusion.

It is possible to use FC method of detecting NIS expression level on preoperative stage in FNAB material. If it is detected that NIS expression level is lower than 1%, these patients belong to high-risk group and for this group thyroidectomy and central compartment lymph node dissection are recommended.

 

Clinical and experimental thyroidology. 2015;11(3):54-59
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Percutaneous larynx ultrasonography for evaluation of vocal cords mobility after thyroid and parathyroid operations
Makarin V.A., Uspenskaya A.A., Timofeeva N.I., Sleptsov I.V., Semenov A.A., Chernikov R.A., Chinchuk I.K., Karelina Y.V., Novokshonov K.Y., Fedorov E.A., Malugov Y.N., Rusakov V.F., Davidova M.O., Malkov V.A., Pridvigkina T.S., Valdina E.A., Fedotov Y.N., Bubnov A.N.
Abstract

The amount of thyroid and parathyroid surgeries increases annually. Contemporary diagnostics of such a severe complication, as larynx paresis, remains nowadays actual. The main diagnostic procedure for larynx paresis is endoscopic laryngoscopy, though it has several disadvantages: this is an invasive procedure, causing discomfort to the patients, it requires local anesthesia, which may lead to allergy; some patients can’t endure this procedure because of the anatomical features. All these factors force to find out a similar and at the same time effective diagnostic procedure for revealing disturbances of vocal cords mobility.

This work represents the experience of implementation of 1252 percutaneous ultrasound examination of the vocal cords. We showed the diagnostic efficiency and convenience of this method at the endocrine surgical department.

Aim.

To evaluate a possibility of percutaneous ultrasound examination for detection of vocal cords mobility after thyroid and parathyroid surgery comparing with the laryngoscopy.

Materials and methods.

The first stage of the work included 809 patients, who were subjected to percutaneous larynx ultrasound check-up. During the second stage 443 patients were examined before and after operative treatment by means of larynx ultrasound and endoscopic laryngoscopy.

Results.

It is possible to visualize vocal cords in 85.9% of patients: in case of female patients it is possible to visualize vocal cords in 90.6%, and in men in 27.9% (c2 = 183.6; p < 0.001). The visualization of vocal cords is feasible in 97.4% of patients under 40 years and in 57.1% in patients over 80 years (c2 = 42.4; p < 0.001). Diagnostic efficiency of ultrasound visualization of vocal cords abnormality appeared to be 91.4%.The sensitivity of the method reached 62.5%, specificity 95.3%. Diagnostic efficiency of ultrasound visualization of vocal cords paresis reached 97.7%. The increase of this index is caused by sensitivity growth, which was 88.2%. Specificity grew also upto 98.5%.

Dependence of diagnostic efficiency of ultrasound examination of vocal cords abnormality and patients’ age was statistically significant (c2 = 6.3; p < 0.05).

Conclusions.

Percutaneous ultrasound examination of vocal cords is effective and convenient method of control over larynx function in patients after thyroid and parathyroid surgery.

Clinical and experimental thyroidology. 2015;11(3):60-67
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