Vol 15, No 1 (2019)

De Gustibus
Never have been and here again…
Gerasimov G.A.
Abstract

The discussion in this column is not about legislation but about issues that are closer to the readership. What products mainly provide for the need of the human body in iodine in Russia and other (near and far) countries of the world? For example, is there such a substance as an “optimal thyroid diet” and how can it be achieved both by healthy people and patients with thyroid disorders? Unlike North America, Australia and New Zealand, the Scandinavian and some other European countries, dairy products are not the main sources of iodine in the diet of the Russian population. There are not so many of these sources, let alone their availability and price. Even the high iodine content in feijoa is proven fake. And what will happen to our “thyroid” diet, when, finally, Russia will adopt a law on mandatory salt iodization? If everything goes as planned, in a few years, bakery products will become the main source of iodine in our diet, and the daily intake of iodine due to the use of iodized salt in baking will increase by an average of 80–100 mcg per day. Then the dream of an “optimal thyroid diet” will come true even without expensive seafood and amazing feijoa.

Clinical and experimental thyroidology. 2019;15(1):6-11
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Review of literature
Causes of treatment failure in primary hypothyroidism
Manuylova Y.A., Morgunova T.B., Fadeyev V.V.
Abstract

Primary hypothyroidism is one of the most common endocrine diseases. Levothyroxine is the treatment of choice due to its efficacy, good tolerance, simplicity of a dose titration, low cost and long elimination half-life. Replacement therapy for hypothyroidism is simple and convenient, but from 30 to 60% of patients are in a state of decompensation. Over- or underreplacement with L-T4 may lead to serious adverse events such as decreased performance and mood, deterioration of health and quality of life, developing of cardiovascular diseases, cardiac arrhythmias and bone fractures. The most common reasons for failure to compensate for the disease are improper administration of the drug (after eating, drinking coffee and milk immediately after levothyroxine), non-compliance with storage conditions (use after the expiration date, excessive heat), insufficient patient adherence to treatment (skipping the drug), the effect of other medicines drugs (calcium, iron preparations, proton pump inhibitors, etc.), diseases of the gastrointestinal tract (atrophic gastritis, celiac disease). Given many factors influencing the achievement and maintenance of compensation for hypothyroidism, it is necessary to determine and, if possible, eliminate the main factor leading to decompensation before the dose adjustment.

Clinical and experimental thyroidology. 2019;15(1):12-18
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Original Studies
Primary hyperparathyroidism: clinical forms and their features. Retrospective study
Yanevskaya L.G., Karonova T.L., Sleptsov I.V., Boriskova M.E., Bakhtiyarova A.R., Ivanova E.V., Pogosian K.A., Farafonova U.V., Andreeva A.T., Tsoi U.A., Grineva E.N.
Abstract

Background: Primary hyperparathyroidism (PHPT) is a disease characterized by autonomous production of parathyroid hormone (PTH) from one or more parathyroid glands. Over the past 50 years asymptomatic form of the disease have become more prevalent in developed countries.

Aims: To evaluate the clinical forms of PHPT presented in recent years and to specify the clinical and laboratory features in patients with symptomatic and asymptomatic forms of the disease.

Materials and methods: We reviewed medical records of 449 patients admitted to three Medical Centers (Saint-Petersburg, Russia) between 2011–2018. Anamnesis, anthropometric data, laboratory (PTH, serum total calcium and ionized calcium, phosphorus, alkaline phosphatase, 24-h calciuria level, 25(OH)D) and instrumental (ultrasonography, scintigraphy, CT/MRI scan, DXA) tests were analyzed.

Results: Patients’ average age was 59 years, with 93.1% women, and an F:M ratio of 13.5:1. Symptomatic form of PHPT was identified in 310 patients (69%), while 139 were asymptomatic. 4.2% of patients had PHPT as part of MEN syndrome. Almost half of the male population had urolithiasis and 45% of women had osteoporosis. Cardiovascular diseases were present in 64.4% of cases. 25(OH)D level was determined only in 20% of cases and was higher in asymptomatic patients (32.2 & 18.6 ng/ml, p = 0.003). Normocalcemic form of PHPT was diagnosed in 37 patients (8.2%) and was characterized not only by normocalcemia and lower PHT level, but also by smaller adenoma size (p = 0.01) and hypocalcemic syndrome after surgery.

Conclusions: Study results showed that symptomatic PHPT is more prevalent in the Russian population, that there are gender distinctions affecting the clinical presentation, and that the frequency of cardiovascular disease is high in this patient population. PHPT as part of MEN syndrome was detected in 4.2% of cases and required molecular genetic testing. Normocalcemic form of PHPT with postoperative hypocalcemia was present in every fourth patient. Rare determination of 25(OH)D level imposes the need of mandatory assessment of vitamin D supplementation and the reduction of its deficiency as part of the preoperative preparation of PHPT patients.

Clinical and experimental thyroidology. 2019;15(1):19-29
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Short messages
In Memoriam: Lewis E. Braverman (1929–2019)
Melnichenko G.A.
Abstract

Lewis E. Braverman, Professor of Medicine in the Section of Endocrinology, passed away peacefully on Monday, June 10, 2019.

Clinical and experimental thyroidology. 2019;15(1):30-31
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