Vol 13, No 3 (2017)

De Gustibus
Lost in translation
Gerasimov G.A.

Along with globalization and the development of the Internet, new phenomenon have appeared and multiplied: international open access (OA) scientific journals in which manuscripts can be published for a fee.  It should be stipulated that the bulk of the OA journals are published by well-respected publishers conducting peer review of the manuscripts and producing high-quality content. Hpowever, according to some estimates, at least a quarter of OA journals are "predatory", ready to publish articles for money on the day they are submitted without any selection and review. Unfortunately, predatory journals can be considered "journals of the poor", in which researchers from countries with low per capita income have to publish their manuscripts. The most frequent authors of predatory scientific journals (34.7%) are Indians, followed by residents of other Asian countries (25.6%) and Africans (16.4%). For the Europeans and inhabitants of North America, these magazines are less popular: 8.8 and 9.2% respectively. What is not surprising: all self-respecting universities prohibit their employees from printing in questionable OA journals. As Russian researchers will feel ever-increasing pressure to publish manuscripts in international journals in English, the likelihood of getting into the claws of a predatory journals will increase. The author believes that gradually it is necessary to transform well-known Russian journals into officially bilingual ones, and then, perhaps, accept manuscripts only in English.

Clinical and experimental thyroidology. 2017;13(3):6-10
Editorial note
Repetition of the passed or new opportunities? Comments on Duntas L. New aspects of an old dilemma: treatment of hypothyroidism with L-thyroxine combined with L-triiodothyronine
Melnichenko G.A.

This article is for comments and comprehensive discussion on relatively published review “New aspects of an old dilemma: treatment of hypothyroidism with L-thyroxine combined with L-triiodothyronine” by L. Duntas.

Clinical and experimental thyroidology. 2017;13(3):11-13
Review of literature
New aspects of an old dilemma: treatment of hypothyroidism with L-thyroxine combined with L-triiodothyronine
Duntas L.H.

The current review summarizes the most recent developments in the field of combined treatment with LT4+LT3 in hypothyroidism. Though it was well established for the past 20 years that T3 combined with T4 was best able to achieve euthyroidism in hypothyroidectomized rats, several recent studies and meta-analyses did not demonstrate any increased benefit of combined treatment as compared with T4 monotherapy. Moreover, patients under combination treatment are more prone to experience adverse effects, such as tachycardia, nervousness and fatigue. Conversely, T4 monotherapy usually leads to lower FT3 and higher serum FT4 levels as compared to the LT4+LT3 regimen thus resulting in a FT3:FT4 ratio closer to that of healthy subjects. Today, T4 monotherapy constitutes first-line treatment of hypothyroidism according to both the ETA and ATA Guidelines. However, in many cases the guidelines are not followed, with patients often taking compounded desiccated thyroid hormones or various T3 preparations available on the web. Recently, single nucleotide polymorphisms (SNPs) in the deiodinase type 1 (DIO1) and type 2 (DIO2) genes and in the phosphodiesterase 8B gene have been associated with T3 decrease and thyroid dysfunction. The above observations point to the necessity for more research into the application of customized treatment as well as to the need for the long-awaited LT3-retard formulations or low-dose (about 5μg/tablet/capsule) LT3 preparations to be appropriately dosed with LT4 in the context of a personalized treatment strategy. The recent finding that SNPs in DIOs or in thyroid hormone transporter genes may affect serum T3 in tissues opens up the way to the genotyping of those thyroidectomized patients who complain of symptoms and have a lower FT3:FT4 ratio.

Clinical and experimental thyroidology. 2017;13(3):14-19
New opportunities in endocrine ophthalmopathy diagnostics (review)
Taskina E.S., Charinzeva S.V., Charinzev V.V., Serkin D.M.

Endocrine ophthalmopathy (EOP) is a progressive autoimmune disease that affects soft retrobulbar tissues in thyroid gland diseases. The statistical data on this disease are presented. The review presents both generally accepted and alternative approaches to the diagnosis of EOP different stages. Detailed clinical symptoms, main severity and activity score classifications of EOP, the required list of physical and instrumental examinations are given. We described the diagnostic value of computed tomography, magnetic resonance imaging, optical coherence tomography, Heidelberg Retina Tomography, radioisotope studies, triplex scanning of the major vessels of the eye, the Doppler mapping method, indocyanine-green angiography, as well as the histological examination of soft retrobulbar tissues biopsy in EOP. Generally accepted diagnostic methods of EOP have their disadvantages. Therefore, nowadays the promising direction is immunological, biochemical and genetic studies of EOP activity markers. The peculiarity of these methods in EOP diagnosis is an accuracy, possibility of multiple measurements, few side effects and a relatively low cost. Further studies of key mechanisms of the development of edema, leukocyte infiltration with subsequent formation of fibrosis of extraocular muscles and retrobulbar fiber in EOP is of significance, which may improve diagnostics of clinical complicated cases and initial stages of the disease.

Clinical and experimental thyroidology. 2017;13(3):20-28
Original Studies
Aspects of endocrine ophthalmopathy surgical treatment by ENT specialist
Kochetkov P.A.

Background: Endocrine ophthalmopathy is a complex pathology in endocrinology and ophthalmology. It is multidisciplinary question, located at the junction of endocrinology and ophthalmology. Currently, the treatment of endocrine ophthalmopathy there are not many surgical approaches which differ in their effectiveness and safety. One of the most popular methods is transethmoid orbit decompression to the removal of the medial wall of the orbit and medial part of the orbital bottom. In addition, we can say unequivocally that this method slows down the progression of the disease, thereby improving visual acuity and quality of life.

Aim: To assess the possibilities of endocrine ophthalmopathy surgical treatment – transethmoidal orbital decompression, according to reduce of exophthalmos.

Methods: 64 patients with endocrine ophthalmopathy were included in the study with ineffective drug treatment, the surgical treatment of which was conducted from 2006 to 2016. Transethmoidal orbital decompression was performed on 90 orbits.

Results: All patients in the postoperative period showed persistent positive dynamics, expressed in decreasing exophthalmos and improving the quality of life due to the disappearance of the cosmetic defect. However, in all patients, we observed varying degrees of transient or persistent postoperative diplopia. None of the patients had orbital infectious complications or other clinically significant infections of the nasal cavity and paranasal sinuses.

Conclusion: In our study, the high clinical efficacy of transethmoidal orbit decompression with respect to the regression of exophthalmos was demonstrated. Exophthalmos on average decreased in all patients by 5.1 mm, and the level of postoperative diplopia was less than 20% of cases.

Clinical and experimental thyroidology. 2017;13(3):29-35
Side effects of statins in patient with compensated hypothyroidism and SLCO1B1 *5 (c.521T>C) polymorphism
Strongin L.G., Lugovaya L.A., Nekrasova T.A., Koroleva T.V., Tarasova N.I., Novitskaya A.B., Ledentsova O.V., Vasileva Y.S.

Aim: to assess the influence of compensated hypothyroidism and SLCO1B1 *5 (c.521T>C) gene polymorphism on the clinical and laboratory signs of the muscle damage during statin therapy.

Methods: assessment of symptoms and markers of the muscle damage and SLCO1B1 *5 (c.521T>C) genotyping were performed in 33 patients with primary hypothyroidism taking statins, in 31 patients taking statins without hypothyroidism and in 33 patients with primary hypothyroidism without statins taking.

Results: muscle pain was observed more often in the group of the patients with compensated hypothyroidism on the background of statins taking compared with other groups (45,5, 16,1 and 30,3 %, respectively, p=0,048). Only in this group the pain was associated with increased levels of creatine- kinase (171,0±108,12 and 110,0±43,81U/L, in the presence and absence of the pain, p=0,049), LDH (369,5±66,22 and 305,6±41,98 U/L, р=0,007), myoglobin titer (90,7±109,89 and 41,1±28,56, р=0,005), and more frequent occurrence of TC and CC genotypes of SLCO1B1*5 (c.521T>C) (68,4 и 28,6%, р=0,0027).

Conclusions: the patients with compensated hypothyroidism have a higher risk of statin-induced myopathy increasing if the TC heterozygotes or CC homozygotes of SLCO1B1 *5 (c.521T>C) gene are present, which requires thorough monitoring of clinical and biochemical muscle damage signs in case of its detection.

Clinical and experimental thyroidology. 2017;13(3):36-44
Clinical Guidelines
Review of American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis.
Fadeyev V.V.

Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves’ hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves’ disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves’ orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves’ hyperthyroidism with antithyroid drugs, the management of pregnant hyperthyroid patients, and the preparation of patients for thyroid surgery. The sections on less common causes of thyrotoxicosis have been expanded. One hundred twenty-four evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.

Clinical and experimental thyroidology. 2017;13(3):45-56

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