Vol 13, No 2 (2017)

De Gustibus
Russia – the land of contrasts
Gerasimov G.A.

Few people drew attention to the fact that somehow imperceptibly 20 years have passed since the official revival of the iodine prevention program in the post-Soviet Russia. In his regular column, the author goes into memories, talks about the current situation with iodine nutrition and tries to answer the age-old Russian question “What should be done?”.

Clinical and experimental thyroidology. 2017;13(2):6-12
Editorial note
Just in case…
Fadeyev V.V.

The article discusses the problems of modern clinical, laboratory and visual diagnostics, in particular the problem of reference ranges, high prevalence of clinically insignificant abnormalities with the increasing risk of detection when the tests are performing without clinical indications. The article also discusses psychological problems that are caused by conducting studies without clinical evidence.

Clinical and experimental thyroidology. 2017;13(2):13-30
Review of literature
Amiodarone-induced thyrotoxicosis: state of the art
Lebedeva E.A., Iablonskaia I.A., Bulgakova S.V.

The review presents recent data on the pathogenesis, diagnosis and treatment of amiodarone-induced thyrotoxicosis (AIT), which is a frequent complication of amiodarone (Am) therapy. Changes in secretion and metabolism of thyroid hormones are described under the influence of short-term and long-term therapy. The development of AIT leads to worsening of arrhythmias, aggravation of circulatory insufficiency, deterioration of the patient’s condition. Two types of AIT are distinguished, as well as mixed form. Diagnostic criteria of AIT type 1 and AIT type 2 are described. The most informative test for differential diagnosis between first and second types of AIT and mixed forms is ultrasound examination of the thyroid gland with Doppler blood flow evaluation and radionuclide scanning with 99 mTc-sestaMIBI. Medical management is determined by the type of AIT, the state of cardiovascular system and the risk of recurrent arrhythmias. Pharmacological management of AIT depends on it’s type and comprises the use of anti-thyroid medications or glucocorticoids. The possibility of continuing antiarrhythmic amiodarone therapy in patients who underwent AIT is discussed. In patients with AIT type 1 and mixed form drug cancellation is required, if this is not possible – radical treatment of thyrotoxicosis (radioiodine therapy, thyroidectomy) is applied. AIT type 2 is a self-limiting process with life-threatening arrhythmias, and amiodarone therapy can be continued. The effectiveness of radioiodine therapy for radical treatment of AIT type 1 and type 2 is shown in spite of low radioiodine capture. However, this issue requires further investigation and discussion. Plasmapheresis and thyroidectomy are used for rapid restoration of euthyroidfunction in severe patients.

Clinical and experimental thyroidology. 2017;13(2):31-38
Original Studies
Comparison of some indicators of the thyroid gland functional activity in simultaneous testing of capillary and venous blood
Olkhovik A.Y., Sadovnikov P.S., Vasiliev A.V., Denisov D.G., Emanuel V.L.

Background. In clinical practice it is often impossible to draw blood from peripheral veins for laboratory testing. At the same time the problem of comparison of venous and capillary blood parameters is still insufficiently studied.

Aims. To compare 5 laboratory indicators of the thyroid gland function – FT3 (free T3), FT4 (free T4), TgAb (thyroglobulin antibodies), TPOAb (thyroid peroxidase antibodies), and TSH – in order to assess deviations of these parameters in venous against capillary blood.

Materials and methods. The study enrolled 22 clinically healthy patients of both sexes who had their venous and capillary blood samples simultaneously collected in compliance with pre-analytical rules. The tests were performed within three hours of sample collection on the analyzer Roche Cobas e601. Mean values were calculated for all parameters using a 95% confidence interval based on bootstrap. Differences between paired values of venous and capillary blood parameters were calculated and expressed in relative units (%). Wilcoxon test and correlation analysis were used to compare dependent samples.

Results. A statistically significant increase in capillary against venous samples was shown for FT3 (mean deviation 3.11; p < 0.001), FT4 (3.89%, p < 0.001), TgAb (2.73%; p = 0.041) and TPOAb (6.75%; p < 0.001), and a decrease – for TSH (-4.3%; p < 0.001). A 5%-deviation is in most cases clinically insignificant for diagnosis and choosing a treatment. All the capillary blood parameters under study strongly correlate (r > 0.75) with the same parameters of the venous blood: r = 0.971 for FT3; r = 0.993 for FT4; r = 0.958 for TgAb; r = 0.836 for TPOAb; r = 0.995 for TSH.

Conclusions. Thus, FT3, FT4 and TSH can be determined in the capillary blood without affecting accuracy and precision of clinical evaluation, while for TgAb and TPOAb these deviations may be significant only when the results are in upper borderline values.

Clinical and experimental thyroidology. 2017;13(2):39-44
Correlation of hormonal and cytokines regulation in case of autoimmune thyroiditis
Zdor V.V.

Background. Studied immune aspects of the pathogenesis of autoimmune thyroiditis (AIT), which occupies the first place among human autoimmune pathologies. Treatment of the disease is based on thyroid hormones (TH) replacement therapy. TH are today considered to be super antigens in autoimmune inflammation of the thyroid gland.

Aims. On the basis of complex assessment of hormonal and immunological markers (TSH, TH, Treg, the Th1-, Th2-, Th17-marker cytokines) with a research of possible interrelations of their indicators at patients with various clinical options of a current of AIT initially and against the background of replacement therapy of TH to define differences in functional activity of various types of immunocompetent cages depending on weight of inflammatory process for forecasting of a further clinical current of AIT, optimization of protocols of therapy and timely correction of strategy of treatment.

Methods. In a prospective study, patients with AIT were evaluated for serum levels of cytokines and their receptors before initiating TH replacement therapy and on treatment by means of the ELISA modern methods with immuneсhemiluminescence and electroсhemiluminescence ways of detection.

Results. Patients suffering from AIT showed an excess production of Th1-, Th2-, Th17- and Tregs marker cytokines with a deficiency of TGF-β1, closely connected with autoimmune hypothyroidism severity. Under pressure of TH therapy the indices of most cytokines decreased or improved, with the exception of IL-6, IL-8, IL-2, IFN-g, TNF-α. The greatest variations from the normal range were recorded in the complicated hypothyroidism.

Conclusions. High serum TNF-α level in the onset of the disease is an important marker for the unfavourable AIT course and a predictor of hormone replacement therapy in case of its subclinical course. Safety indexes of functional thyroid epithelium are systemic levels of IL-8 and IL-22, their dynamic reduction in blood serum is an adverse factor, indicating a progressive loss of functionally active thyroid tissue and a possible increase of hypothyroidism in case of subclinical AIT course. If specific gravity and magnitudes of IL-1α, IL-6 and IFN-γ exceed manifold they can be considered to be predictors of AIT clinical course severity and autoimmune inflammation in the thyroid.

Clinical and experimental thyroidology. 2017;13(2):45-56
Letters to the Editor
“Pattern approach” or search for new templates. Respond to the article “Evaluating of significance of thyroglobulin (Tg) level in blood as a biomarker of iodine deficiency disorders severity in Uzbekistan”
Mel'nichenko G.A., Makolina N.P., Mikhina M.S., Platonova N.M., Troshina E.A.

Science will never stop in its search for new solutions. The process of investigating and predicting by scientific theories — is the process of identifying and managing patterns (sets of repetitive models, stable combinations and sequences).

Over the years, the problem of iodine deficiency remains important for global health. Despite all the measures have been taken to eliminate this disease, now it is not possible to optimize iodine deficiency diagnosis and treatment all over the world. So, previously published in Clinical and experimental thyroidology journal article “Evaluating of significance of thyroglobulin (Tg) level in blood as a biomarker of iodine deficiency disorders severity in Uzbekistan” is incredibly relevant and undoubtedly requires detailed analysis. The analysis and comments to provided research is the subject of current article.

Clinical and experimental thyroidology. 2017;13(2):57-61

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