Vol 15, No 3 (2019)

De Gustibus
Memories of the future
Gerasimov G.A.

With bated breath we follow the fate of the long-suffering law “On the prevention of diseases caused by iodine deficiency”. What can be expected in terms of improving public health after the adoption and successful implementation of this bill, which provides for the enrichment with iodine of edible salt of extra, higher and first varieties, grinding No. 0 and No. 1? In addition, in the production of bakery products, the recipe of which contains edible salt, the use of iodized salt will become mandatory. According to the experience of many near and far countries, within 2–3 years from the start of the program of mandatory salt iodization, one can expect a significant (at times) reduction in the incidence of endemic goiter. This trend will not exhaust itself in subsequent years. In the medium term (after about 10 years), a decrease (by half or more) in the incidence of thyrotoxicosis can also be expected in Russia. However, in the short term (5–7 years), a transient increase in the incidence of thyrotoxicosis in people over 60 years of age is possible, which can be considered a kind of “payment” for the previous iodine deficiency. The trend towards an increase in the incidence of subclinical and, possibly, manifest hypothyroidism may continue, but this will not be a consequence of an increase in iodine supply. Optimization of iodine intake against the background of mandatory salt iodization should reduce the frequency of transient disorders of thyroid function in newborns and, possibly, congenital hypothyroidism.

Clinical and experimental thyroidology. 2019;15(3):90-95
Review of literature
Overview of foreign clinical guidelines for the use of fine-needle aspiration biopsy of thyroid nodules
Petrov V.G., Nelaeva A.A., Molozhavenko E.V., Ivashina E.G.

Fine-needle aspiration biopsy (FNA) is the most accurate and cost-effective method for evaluating thyroid nodules. FNA results are useful for stratifying the risk of malignant neoplasms and provide key information to determine the appropriateness of an operation. However, we should keep in mind that FNA is an invasive diagnostic method, so there is a possibility of complications. There is a likelihood of nondiagnostic, false positive and false negative results that can lead to a late or unnecessary operation. We see a growing incidence of thyroid nodules, associated mainly with the increased availability of ultrasound diagnostic of this organ. So the leading organizations involved in the development of clinical guidelines for diagnostics and treatment of thyroid pathologies suggest limiting the conduct of FNA. The use of this method in some cases is not necessary and at times can be even dangerous to a patient. When making clinical decisions, sonographic patterns of thyroid nodules and individual anamnestic and clinical factors of the patient should be considered. For small thyroid nodules, the FNA in most cases is not necessary. It is more rational to make a decision based on sonographic patterns rather than be guided by a threshold node size of > 1 cm. The specific sonographic patterns of malignancy are: presence of calcifications, irregular margins, hypoechoic nodule, taller-than-wide shape, metastases to the cervical lymph nodes, and extrathyroidal extension. The totality of these signs is useful for stratifying the risk of malignancy of the thyroid nodules and deciding on the need for FNA.

Clinical and experimental thyroidology. 2019;15(3):96-109
The role of autophagy in the thyroid tumors development, connection with the AKT/m-TOR signaling pathway activation
Spirina L.V., Chizhevskaya S.Y., Kondakova I.V., Tarasenko N.V.

Autophagy is an important intracellular process that supports cell death and survival. Oncogenesis is associated with a change in the AKT/mTOR signaling pathway status. At the same time, the existence of protective autophagy, as one of the mechanisms of disease progression and the formation of resistance to treatment, has been proven. The review describes the significant mechanisms of the autophagy development, its association with AKT/mTOR signaling pathway. A molecule mTOR in TORC1 complex is associated with the oncogenesis, it provides the proliferation of transformed cells, apoptosis inhibition, and to the development of autophagy.

The participation of this phenomenon at all stages of carcinogenesis, influencing on the main signal kinases: AKT, mTOR, is noted. It is shown that in most cases this mechanism is responsible for the progression of the disease and the development of resistance to treatment. The development of thyroid cancer associated with the BRAF mutation and with the activation of the RET oncoprotein, as well as with the formation of radio-resistant forms of the disease is associated with molecular peculiarities of autophagy. Given the inconsistency of this phenomenon regarding their influence on the processes of oncogenesis, its role in the development of thyroid cancer is still unknown.

Clinical and experimental thyroidology. 2019;15(3):110-117
Original Studies
Awareness of the population in Russian Federation about iodine deficiency, its effects and methods for prevention of iodine deficiency disorders.
Terekhov P.A., Rybakova A.A., Terekhova M.A., Troshina E.A.

Background: Throughout all territory of Russian Federation has been confirmed absence of iodine deficiency of varying severity. Chronic iodine deficiency leads to irreversible defects in the intellectual and physical development of children, thyroid gland diseases, including such severe manifestations as functional autonomy and iodine-induced thyrotoxicosis and reproductive disorders.

Aims: To assess the awareness of Russians about the effect of iodine deficiency on health and the need to use iodized salt in food.

Materials and methods: During November 2019 we conducted an anonymous online survey about iodine deficiency and methods of its prevention. The participants of this survey were 9309 Russians of different age categories. We asked each respondent six questions regarding their knowledge about the importance of iodine for the body and its supply sources. This study is one-staged, uncontrolled, full-designed, and conducted using “Google Forms” (Google LLC, 2019). As a result, we summarized data on the awareness of Russians about iodine deficiency disorders and methods for its prevention.

Results: 60.4% of respondents is using iodized salt, while the number of respondents who consider prevention with iodized salt to be unhealthy (or have lack knowledge of its effects) is related to the number of respondents who do not use iodized salt. We get that in Volga region only 50% of population is using iodized salt (the lowest level), while 62.83% of the European South inhabitants is using iodized salt. In the rest of Russian Federation, this indicator varies from 52 to 57%. There is a low awareness of the population about prevention of iodine deficiency disorders and as a result myth about the dangers of universal salt iodization are widespread in Russian Federation.

Conclusions: Awareness of Russians about prevention of iodine deficiency disorders still remains at a low level, and it is directly affecting the success of ongoing prevention programs.

Clinical and experimental thyroidology. 2019;15(3):118-123
Case Report
Review of the clinical case of a patient with microcarcinoma of the thyroid gland
Melnichenko G.A., Mokrysheva N.G., Katamadze N.N.

Before us is the story of young woman who actively monitored the condition of the thyroid gland, due to the accidental detection of antibodies to the thyroid tissue. After the detection of a tumor (7 mm), hemi thyroidectomy was conducted. For two years after the operation she has been under the care of oncologist and endocrinologist. However, despite explanations about a good prognosis of the disease, she is extremely alarmed and unjustifiably often conducts laboratory tests, ignoring the fact that both the reference range and the evaluation methods are different. It should be said that similar problems exist in all countries (Nedman C. et al., 2017) – fear of relapse of the disease worries the vast majority of patients even years after it’s been diagnosed. People are concerned not only about the risks of thyroid cancer recurrence, but also about the risks of development of other cancers, the risks of being not able to get access to skilled care. The obvious task of a doctor is to correct a pattern of patient behavior that increases anxiety.

Clinical and experimental thyroidology. 2019;15(3):124-128
Erratum: Effects of selenium in patients with autoimmune thyroiditis (Clinical and experimental thyroidology. 2019;15(2). doi: 10.14341/ket10299)
Shabalina E.A., Fadeyev V.V.

An erratum on “Effects of selenium in patients with autoimmune thyroiditis” by Elena A. Shabalina, Valentin V. Fadeyev (2019). Clinical and experimental thyroidology. 15(2). doi: 10.14341/ket10299.

In Figure 1, entitled “Study design”, an error was made at the TSH level: 0.4–10.0 mU/L. The correct values are as follows: TSH 4.0–10.0 mU/L.

The editorial board apologize for this error and state that this does not change the scientific conclusions of the article in any way.

The original article has been updated.

Clinical and experimental thyroidology. 2019;15(3):129-129

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