Vol 14, No 3 (2018)

De Gustibus
Through years, across distances…
Gerasimov G.A.

Medicine is an ancient science. In the modern sense, the medical profession began to form after bloodletting as a universal way of restoring the balance of bodily juices was replaced by more scientific and less crippling methods. But in medical practice it often happens that new methods of diagnosis and treatment get along with very ancient ones, and some traditional approaches, that previously had no reliable justification, receive solid scientific support. This historic process closely resembles the flow of water in a river: fast in the rapids, slow along the shores and sedentary in quiet creeks, at the bottom of which one can find shabby garbage brought by floods. All this is in a circuit – something disappears in the abyss, and something suddenly floats to the surface. The scandal in the USA with the recall of a medicine made from desiccated and dried porcine thyroid gland reminded us that some concoctions, which have been known since the times of ancient Chinese medicine, and drugs that appeared relatively recently thanks to modern pharmacology can easily coexist in clinical practice. With one essential caveat: the quality of such concoctions should be controlled as carefully as the newest drugs. Modern technologies have allowed us to analyze the genome of the inhabitants of our internal organs, that constitute the human microbiome. This made it possible to rehabilitate the concept of dysbacteriosis (dysbiosis), which was previously considered anti-scientific. For example, intestinal bacteria are able to compete with the host organism for selenium and even capable of aggravating its deficiency, as well as modulating the bioavailability of iodothyronines. It is possible that intestinal dysbiosis may be one of the causes of thyroxine malabsorption. All these and much more in this column “De Gustibus”.

Clinical and experimental thyroidology. 2018;14(3):122-127
Clinical Guidelines
Review of American Thyroid Association guidelines for the diagnosis and management of thyroid disease during pregnancy and the postpartum
Fadeyev V.V.

Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period. The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research.

We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.

Clinical and experimental thyroidology. 2018;14(3):128-139
Review of literature
MicroRNAs – promising molecular markers for detecting cancer in thyroid nodules
Serdyukova O.S., Titov S.E., Malakhina E.S., Rymar O.D.

Thyroid nodules are one of the most common thyroid diseases. The prevalence of thyroid nodules is estimated to be 2–65% depending on the detection methods. Yet despite the high frequency of thyroid nodules only about 5–10% of such nodules are malignant. Fine needle aspiration cytology of the thyroid nodule is currently the primary diagnostic tool for determining the nature of a thyroid nodule. Now, the fine needle aspiration biopsy is the gold standard for diagnosing thyroid cancer but in 30% of cases the cytological conclusion is uncertain. Cytological research is not enough to diagnose benign and malignant tumors. The need to improve the effectiveness of fine needle aspiration biopsy findings led to the search for new diagnostic biomarkers and the creation of diagnostic panels on their basis for their application in the diagnosis of uncertain nodules. Determination of molecular markers in the thyroid aspirate will allow to differentiate benign and malignant tumors more accurately at the preoperative stage and reduce the number of inappropriate surgery. The review article presents the characteristics of MicroRNAs, allowing them to be used in preoperative diagnosis of thyroid nodules. Diagnostic panels based on gene mutations and MicroRNA expression demonstrating high sensitivity and specificity of these methods are also indicated. Analysis of literature indicates that molecular analysis of fine needle aspiration genetic material from thyroid nodal formations demonstrates great prospects of prognosis, diagnosis and treatment of thyroid cancer. However, there is no sufficient evidence to recommend or to prohibit of utilization this molecular testing during the cytological conclusion of indeterminate thyroid nodules. Molecular analysis (MicroRNA) is a perspective method for evaluation of thyroid nodal formations with indeterminate cytology, however, this method requires further study and improvement.

Clinical and experimental thyroidology. 2018;14(3):140-148
Original Studies
Assessment of iodine status among school age children and pregnant women of Belarus in 2017–2018
Mokhort T.V., Petrenko S.V., Leushev B.Y., Fedorenko E.V., Kolomiets N.D., Mokhort A.G.

Background. Despite the measures taken by the Government of Belarus, the problem of iodine deficiency among the population remains actual.

Aims. To determine iodine sufficiency in children and pregnant women living in Belarus.

Materials and methods. The study included 873 schoolchildren aged 9–12 years of both sexes, of which 650 children were in regular schools, and the remaining children in boarding schools. A separate group consisted of 700 practically healthy pregnant women (during gestation from 16 to 36 weeks). Questioning, determination of urinary iodine concentration and thyroid volume with ultrasound was carried out.

Results. Urine iodine median was 191 µg/L in the 873 children in 16 regions of Belarus. Thyroid volume corresponds to the normative values in children. According to the survey, 81% of households used iodized salt, constantly – 46%. Indicator of iodine sufficiency of 700 pregnant women (median urinary iodine concentration was 121 µg /l) is a non-optimal for this population group.

Conclusions. Currently adequate iodine supplementation in school age children has been achieved. The prevalence of thyroid gland diseases caused by iodine deficiency in children decreased significantly. In pregnant women iodine supply is still insufficient.

Clinical and experimental thyroidology. 2018;14(3):149-155
Case Report
Polyneuropathy on the background of thyrotoxicosis with thiamazole drug treatment
Oblaukhova V.I., Svetlana D.N., Mustafina S.V.

The article is devoted to the clinical case of the development of toxic polyneuropathy in patients receiving thiamazole 25 mg per day in a 43-year-old patient with manifest thyrotoxicosis, which is clinically manifested by severe pain in the muscles of the upper and lower extremities; muscle weakness in the upper limbs. The patient, prescribed by a neurologist, was treated with carbamazepine-retard 400 mg per day for 1 month, and the attending physician decided to replace tiamazole with propylthiouracil 300 mg per day, followed by dose adjustment. The patient categorically refuses surgical treatment or treatment with radioactive iodine. The diagnosis of toxic polyneuropathy was confirmed during the differential diagnosis with inflammatory diseases of the joints and muscles, polyneuropathy on the background of thyrotoxicosis. In the outcome of the treatment, all neurological symptoms were stopped. The observation time on the occasion of polyneuropathy was 1 month, the total time of observation of the patient at the time of publication was 5 years. This clinical case demonstrates the possibility of the development of toxic polyneuropathy in patients receiving thiamazole in the treatment of thyrotoxicosis. Given the low frequency of this complication in clinical practice, it is necessary to draw additional attention of clinicians to this case and recommend including this condition in the differential diagnosis of polyneuropathy.

Clinical and experimental thyroidology. 2018;14(3):156-161
TSH-secreting pituitary adenoma in combination with primary hypothyroidism in the outcome of Hashimoto’s disease: diagnostic difficulties
Tkachuk A.V., Grebennikova T.A., Lapshina A.M., Vladimirova V.P., Belaya Z.E., Melnichenko G.A.

Despite the fact that pituitary adenomas are among the most frequent brain tumours, TSH-secreting pituitary adenomas (thyrotropinomas) are less than 1% of all adenomas. Due to the increase in the free fractions of thyroid hormones at normal or elevated TSH levels, the majority of patients with these pituitary adenomas have a long anamnesis of thyrotoxicosis which requires a differential diagnosis with thyroid pathology (Graves’ disease, toxic adenoma, autonomously functioning thyroid nodules). The diagnosis of the thyrotropinoma is quite challenging for clinicians. This article describes the case of a combination of the thyrotropinoma with primary hypothyroidism as a result of the Hashimoto’s disease. A feature of this article is the absence of a typical clinical picture of thyrotoxicosis in combination with an evaluated level of TSH on the background of constantly increasing substitution therapy for primary hypothyroidism. The picture of space-occupying lesion according to MRI of the brain allowed to suspect hormone-active pituitary adenoma (macroadenoma). As a result of surgical treatment (endonasal transsphenoidal adenomectomy), the level of TSH and free thyroid hormone levels were normalized in the postoperative period. The diagnosis of TSH-secreting pituitary adenoma was confirmed by histological and immunohistochemical analysis of postoperative material.

Clinical and experimental thyroidology. 2018;14(3):162-168

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