Vol 15, No 2 (2019)

De Gustibus
Salt iodization decreased the risk of thyrotoxicosis in Denmark by the halve
Zimmermann M.

The status of iodine nutrition is a key factor in determining the prevalence of thyroid disorders in adults. The study under discussion provides data on the change in the incidence of nosological subtypes of overt thyrotoxicosis and hypothyroidism in adults during an increase in iodine intake after the introduction of mandatory salt iodization in Denmark. The authors carefully studied the case histories of all new patients with thyrotoxicosis and hypothyroidism registered in 2014–2016 in an open cohort of the population of Northern Jutland (n = 309,434), in which a moderate iodine deficiency has historically been observed and compared with incidence rates in 1997–1998 years before introduction of mandatory salt iodization began 2001. Over this period of time, iodine intake almost doubled. At the same time, the incidence rate of confirmed overt thyrotoxicosis significantly decreased: from the initial rate of 97.5 cases per 100,000 people per year in 1997–2000 to 48.8 cases per 100,000 people per year in 2014–2016. This result was due to a significant decrease in the incidence of multinodular toxic goiter, toxic adenoma and Graves’ disease in all age groups in both women and men. Moreover, the overall incidence of primary overt hypothyroidism has not changed.

Clinical and experimental thyroidology. 2019;15(2):38-41
Editorial comments for the reprinted article by prof. M.B. Zimmerman “Salt iodization decreased the risk of thyrotoxicosis in Denmark by the halve”, doi: 10.14341/ket10379
Gerasimov G.A.


Clinical and experimental thyroidology. 2019;15(2):42-43
Original Studies
Effects of selenium in patients with autoimmune thyroiditis
Shabalina E.A., Fadeyev V.V.

Background: In the last decades, a number of clinical studies have been conducted where both the positive and neutral effects of Se on thyroid autoimmunity have been demonstrated.

Aims: The aim of our study was to assess the effects of selenmethionine among euthyroid patients with elevated TPO-Ab (TPO > 100 IU/ml) and patients with subclinical hypothyroidism and elevated TPO-Ab.

Materials and methods: 40 euthyroid patients with elevated TPO-Ab and 11 patients with subclinical hypothyroidism plus elevated TPO-Ab were included in our study. Patients of both categories were randomized to recieve Se 200 μg/day or to the dynamic observation. TSH, f. T4, f. T3, AT-TPO were measured at baseline and every 3 months of follow-up. The volume and echogenicity of the thyroid were also evaluated every 3 month of follow-up period (12 month).

Results: There were no significant difference between the groups on the dynamics of TSH, f. T3, f. T4, AT-TPO titers, volume and the echogenicity of the thyroid gland during the whole observational period among euthyroid patients with elevated TPO-Ab. Among the patients with subclinical hypothyroidism there were also no significant difference between the groups on the dynamics of f. T3, f. T4, AT-TPO titers, volume and the echogenicity of the thyroid gland during the whole observational period. But by the 12 month of the follow-up there were significantly more euthyroid patients in Se group compare to dynamic observation group.

Conclusions: Our study, failed to show possitive effects of Se supplementation on thyroid autoimmunity.

Clinical and experimental thyroidology. 2019;15(2):44-54
Review of literature
Оn the need to introduce the TI-RADS classification in Russia
Fisenko E.P., Sencha A.N., Katrich A.N., Sych Y.P., Tsvetkova N.V., Borsukov A.V., Kostromina E.V.

An active discussion of TI-RADS modifications (Thyroid Imaging Reporting And Diagnostic System) classification continues in the world professional medical community. This system of thyroid nodules stratification on the malignancy signs is intended primarily to select thyroid nodules for a fine needle aspiration biopsy. The classification should be uniform for all medical institutions of our country, easy to use and understandable by various medical specialists. This article presents a modification of TI-RADS prepared for discussion in the professional communities of Russia. Some “major” ultrasound features of malignancy (with specificity >95%) and additional or “minor” features (with specificity >90%) of thyroid nodules are pointed out to emphasise the need of fine needle biopsy. After comparison of diagnostic parameters of proposed TI-RADS and European TIRADS (EU-TIRADS), both systems showed comparable specificity of 93%, while sensitivity of proposed TI-RADS was slightly higher than for EU-TIRADS, with 94.2% and 91.0%, respectively. This discrepancy may be related to “minor” features of malignancy which were taken into consideration.

Clinical and experimental thyroidology. 2019;15(2):55-63
Secondary hypothyroidism in adults: diagnosis and treatment
Kienia T.A., Morgunova T.B., Fadeyev V.V.

Secondary hypothyroidism is a rare disease. There is a number of questions and difficulties in diagnosis and management of this condition. There are two forms of secondary hypothyroidism: congenital (casuistic seldom) and acquired. The main causes of secondary hypothyroidism in adults are tumors of the hypothalamic-pituitary region and the state after surgical and radiation effects on this area. Hormonally active and inactive pituitary macroadenomas cause the development of acquired secondary hypothyroidism in more than 50% of cases. The development of secondary hypothyroidism is possible years after the radiotherapy of brain tumors. As well as in case of primary hypothyroidism, the clinical manifestations of secondary hypothyroidism are non-specific. Diagnosis and management of this pathology is often complicated by its combination with the deficiency of other tropic hormones. The diagnosis of secondary hypothyroidism is based on anamnestic data and laboratory tests - the simultaneous determination of the levels of fT4 and TSH. The level of fT4 today is also used as the main marker of the adequacy of the dose of L-T4 in the treatment of secondary hypothyroidism. The results of recent studies help us to optimize replacement therapy in secondary hypothyroidism. However, the use of additional biochemical markers to assess the adequacy of replacement therapy remains unexplored.

Clinical and experimental thyroidology. 2019;15(2):64-72
Iodine status of the population in Russia and the world: what do we have for 2019?
Alferova V.I., Mustafina S.V., Rymar O.D.

The article presents the most relevant data of the world literature on the problem of iodine status. The problem of iodine deficiency still remains unresolved on the territory of the former Soviet Union (the median urinary iodine was 29.1 μg/l in Abkhazia, and almost 30% of the examined had the level of ioduria below standard values in Kazakhstan), although some countries have been successful in dealing with iodine deficiency (the median urinary iodine is 191 μg/l in Belarus, 169 μg/l in Ukraine). On the rest of the Eurasian continent, the picture is also different: among the total mass of countries with normal median urinary iodine, there are territories with both iodine deficiency (the median of ioduria ranges from 80 to 138 μg/l in the UK, the median of ioduria is 63 μg/l in France) and its excessive consumption (the median of ioduria is 330.0 μg/l in China). On the territory of America, in 2016, the elimination of iodine deficiency was announced (the median of ioduria ranged from 123 μg/l (Argentina) to 415 μg/l (Colombia)), and Haiti was the only country with a fixed iodine deficiency – 84 μg/l. Research data from different years in the following regions of the Russian Federation are presented: Moscow (the median of ioduria 67.0 μg/l), St. Petersburg (66.0–86.0 μg/l), Tyumen region (106.9 μg/l), Novosibirsk region (93.0 μg/l), Republic of Bashkortostan (70.3 μg/l), Republic of Dagestan (65.8 μg/l), Kemerovo region (90.0 μg/l), Saratov region (59.0–106.0 μg/l), Tomsk region (94 μg/l), Far Eastern region (58.0–74 μg/l), Chelyabinsk region (92.0–164.5 μg/l), Chuvash Republic (72.0 μg/l), Perm region (100.0 μg/l). Almost throughout the Russian Federation, iodine deficiency of mild severity was noted.

Clinical and experimental thyroidology. 2019;15(2):73-82

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