Vol 14, No 1 (2018)

De Gustibus
The cognitive dissonance
Gerasimov G.A.

The first 1000 days of life (the period between conception and the second birthday) is a window of opportunity for brain development, a unique period when the foundations for optimal growth and development of the nervous system are laid throughout the entire life. Previously it was believed that the main factor that negatively affects the psychomotor development of a child is maternal hypothyroidism in the early stages of pregnancy. However, numerous experimental and epidemiological studies have shown that the development of the nervous system of the fetus is disrupted when a woman has isolated hypothyroxinemia in early pregnancy. The cause of neuropsychiatric disorders in this case is the inadequate availability of maternal thyroxin for the developing brain. Universal salt iodization and fortification of flour with folic acid and iron is a reliable means of preventing micronutrient deficiency in the first 1000 days of life. It is important that this prevention begins before conception and lasts until the end of the neurogenesis period. However, in practice, effective mass methods of prevention are ignored in favor of certain “individual” approaches, the possibilities of which are severely limited.

Clinical and experimental thyroidology. 2018;14(1):6-10
Original Studies
Yersinia infections and Graves’ disease
Khamnueva L.Y., Goma T.V., Klimov V.T.

Background. The most common thyroid disease, accompanied by thyrotoxicosis syndrome, is Graves' disease (GD). Information about the role of Yersinia in the development of this disease is contradictory.

Aims. To study the significance of Yersinia (Y.) enterocolitica and Y. pseudotuberculosis in the development of Graves' disease.

Materials and methods. 78 patients with GD. Identification of antibodies to Y. was carried out by the following methods: 1. agglutination test (AT) with suspensions of live virulent cultures Y. pseudotuberculosis, Y. enterocolitica O:3 and O:9; 2. indirect hemagglutination test (IHET) with the use of erythrocyte diagnosticum; 3. determination of IgA and IgG antibodies against pathogenicity factors of Y. enterocolitica strains by immunoblotting (30 patients with GD).

Results. Diagnostically significant titers of antibodies to Y. pseudotuberculosis and Y. enterocolitica were obtained in all patients with GD by AT. The greatest total thyroid volume determined by ultrasound investigation (p = 0.010) and the maximum duration of the disease (p = 0.040) were determined in the group of patients with the maximum antibody titer. No significant relation was found between the titer of antibodies to Yersinia and the levels of thyroid hormones stimulating the thyroid antibodies.The test for detection of IgA antibodies by immunoblotting was negative in 30 patients with GD (9 patients with a titer of antibodies by AT 1:800 – 1:1600, 17 – 1:400, 4 – 1:200). In all cases with the maximum antibody titer in AT, the positive IgG antibodies to the antigens YopM (Yop2a), YopH (Yop2b), V-antigen, YopD were found. The GD duration in patients with negative titers of antibodies by the immunoblotting test was less than with the positive one (p = 0.010). The privative clinical and anamnestic data and negative results by IHET confirmed the absence of active and/or transferred Yersinia infections in all the examined patients with GD.

Conclusions. The cross-reacting antibodies to the antigens of Y. enterocolitica are determined in the serum of GD patients by AT and immunoblotting. The diagnostic titer of these antibodies is more often detected in patients with greater GD duration and larger volume of the thyroid gland. The absence of a link between the titer of these antibodies and the levels of thyroid hormones, the antibodies to the thyrotropin receptors of pituitary, as well as negative results by IHET with a diagnosticum that does not contain outer membrane proteins of pathogenic Yersinia, deny the trigger role of Yersinia infections as an initiating factor in the development of GD.

Clinical and experimental thyroidology. 2018;14(1):11-18
The predictors of “hidden” central neck lymph node metastasis in patients with differentiated thyroid cancer
Solodkiy V.A., Fomin D.K., Galushko D.A., Asmaryan H.G.

Background. The regional lymph node metastasis in differentiated thyroid cancer (DTC) is still very high: 50–60%, especially in papillary form. Averagely, after central neck lymph node dissection (CNLD), in 30–40% cases “hidden” metastasis in lymph nodes of VI zone of neck were revealed. But they were not indicated by preoperative diagnostic procedures: ultrasound (US) and computer tomogpraphy (CT).

Aims. To define the factors associated with the increased risk of lymph node metastasis for specification of indications to CNLD performance.

Materials and methods. The study covers 105 patients with clinical stages of DTC T1-2N0M0, who received a thyroidectomy (TE) with preventive bilateral CNLD in RSCRR since 2012 till 2017. Patients older than 45 y.o. prevailed (66 patients (62.9%)). Data processing was carried out in a Microsoft Access database, a one-factor dispersion analysis was used for the analysis of the quantitative signs, and a c-square criterion was used for the qualitative ones.

Results. The “hidden” metastasizes are founded by 32 (30.5%) patients. Multifocality is registered in 29 (27.6%) cases, lack of the tumor node capsule is registered in 65 (61.9%) and an invasion of the thyroid gland capsule is registered in 38 (36.2%) patients. Background diseases of the thyroid gland (TG) have 69 (65.7%) patients. According to the multifactorial analysis reliable independent predictors of the “hidden” metastasis of central neck lymph nodes were invasion of the anatomic capsule of TG (р = 0.003), age of patients ≤45 y.o. (р = 0.005), nonincapsulated form of tumor (р = 0.007).

Conclusion. Use of TE in combination with CNLD allowed to restage at 46.7% of patients due to TG capsule invasion (28.6%) and “hidden” metastasis in VI group lymph nodes (30.5%) identification.

Clinical and experimental thyroidology. 2018;14(1):19-24
Surgical tactics optimization for treatment of BRAF positive papillary thyroid cancer
Boriskova M.E., Farafonova U.V., Pankova P.A., Bikov M.A., Ramazanova E.A.

Backgraund. Papillary thyroid cancer (PTC) has a favorable course and low mortality rates. However, the incidence of morbidity and mortality continues to increase, especially in the high-risk group. BRAF mutation is a marker of the PTC aggressive course.

Aims. Тo study the relationship between surgical treatment tactics and the BRAF positive PTC prognosis.

Materials and methods. Our prospective study included 80 patients with BRAF positive PTC, operated from 2009 to 2016 y. Surgical tactics were determined by existing clinical guidelines. To the patients with BRAF positive thyroid cancer it is proposed to perform thyroidectomy with central compartment lymph node dissection. BRAF status was determined by the PCR method in fine needle aspiration biopsy material (FNAB).

Results. Recurrence was detected in 7 of the 18 patients of the hemi/thyroidectomy group. Among 62 patients from the group of thyroidectomy with central compartment lymph node dissection recurrence was detected only in 3 cases. The mean recurrence time also differed significantly, and in the group of patients with (hemi)thyroidectomy without central compartment lymph node dissection is detected earlier (53 months and 59.61 months). Also, organ-preserving operations without central compartment lymph node dissection in BRAF positive tumor has worse result, regardless of T stage.

Conclusions. In the presence of BRAF-positive PTC thyroidectomy with central compartment lymph node dissection is indicated.

Clinical and experimental thyroidology. 2018;14(1):25-33
Case Report
Combination of medullary thyroid cancer and renal cell carcinoma in one patient
Dolinskaya Y.A., Shevchenko S.P., Maksimov V.N., Voropaeva E.N., Rymar O.D.

Patients who received treatment for the first malignant neoplasm remain in the group at increased risk of developing a second primary tumor throughout their later life. A rare case of medullary thyroid cancer and renal cell carcinoma of the kidney is described in one patient. Medullary thyroid cancer is an orphan disease. The patient and his first-line relatives underwent molecular-genetic testing, the presence of a hereditary form of medullary cancer was excluded. During the observation, malignant kidney formation was detected, and surgical treatment was performed. The patient because of treatment and surveillance does not have data for the progression of thyroid cancer and kidney cancer, compensation for concomitant diseases has been achieved. When observing patients with medullary thyroid cancer, it is necessary to use the existing modern diagnostic arsenal, including positron emission tomography, since patients remain in the group at increased risk of disease progression and development of the second tumor throughout the entire subsequent life. In addition, this case clearly illustrates the need for a routine study of calcitonin as a diagnostic marker for the progression of medullary thyroid cancer.

Clinical and experimental thyroidology. 2018;14(1):34-38
Thyroid hormone resistance syndrom: difficulties in differential diagnosis
Ruyatkina L.A., Molchanova A.A., Ruyatkina A.S., Rozhinskaya L.Y.

Thyroid hormone resistance syndrome (RTH) is a rare disorder characterized by reduced peripheral tissue responses to thyroid hormones (TH) and elevated levels of circulating free thyroid hormones. Resistance to thyroid hormone is caused by mutations of the thyroid hormone receptor beta (THRB) gene. In this article, we present case of 26-years-old women who presented with unclear signs and symptoms. Thyroid morphology and function were evaluated with standard ultrasound of the thyroid, scintigraphy and cytological specimen obtained by FNAB. The features of the basic assessment of thyroid status with an emphasis on the concept of “±feedback” of thyroid-stimulating hormone (TSH) and TH. A differential diagnosis of TSH-secreting pituitary adenoma and RTH was discussed. Heterozygous mutation p.P453T in the THRB gene was detected. Thus, the given clinical case demonstrates the necessity of the thorough examination of patients in identifying disorders of the principle of “±feedback”. The observation in dynamics is recommended.

Clinical and experimental thyroidology. 2018;14(1):39-46

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