Showing papers in "Clinical and experimental thyroidology in 2020"

Overview of foreign clinical guidelines for the use of fine-needle aspiration biopsy of thyroid nodules

Abstract: 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.

Awareness of the population in Russian Federation about iodine deficiency, its effects and methods for prevention of iodine deficiency disorders.

Abstract: 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.

The role of autophagy in the thyroid tumors development, connection with the AKT/m-TOR signaling pathway activation

Abstract: 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.

Thyroid scintigraphy in diagnosis of nodular and diffuse thyroid pathology

Abstract: Diagnosis of the causes of thyrotoxicosis (destruction or increased functional activity of the thyroid tissue in nodular and diffuse thyroid pathology) is a key point in determining the management of patients with this pathology. Scintigraphy is the method of choice in differential diagnosis of the causes of thyrotoxicosis assessing the functional state of the thyroid gland. According to variable medical interest, thyroid scintigraphy can be performed using 99 mTc-pertechnetate or radioactive iodine isotopes ( 123 I, 124 I, 131 I). For thyroid uptake evaluation used scintigraphy with 99 mTc-pertechnetate radiopharmaceutical, which is not organificates and quickly excretes from thyroid tissue. In case of thyroid iodine pharmacokinetics investigation radiopharmaceuticals labeled by iodine isotopes ( 123 I, 131 I, 124 I) are used. The review includes original scintigrams, tables and diagrams. Article shows thyroid scintigraphy informativity analysis, evaluates the place and role of the thyroid scintigraphy examinations in modern diagnostic algorithms taking into account the history of the disease, laboratory tests, ultrasound (TIRADS) and result of FNA (Bethesda). Additionally authors focused on existing clinical guidelines analysis. An optimized algorithm for the diagnosis and treatment of diffuse and/or nodular thyroid pathology associated with thyrotoxicosis is proposed.

Thyroid dysfunction following immune reconstitution therapy

Abstract: Medication effects on the immune system often lead to the development of adverse events such as autoimmune diseases. The thyroid gland is organ whose embryonic development features are predisposed spontaneous and induced lesions with various autoimmune effects. Cytokinin-induced thyroiditis (in 50–70% of cases proceeds as a destructive thyroiditis), thyroid dysfunction following immune checkpoint inhibitors (using the combined treatment CTLA-4 + PD-1/PD-L1 leads to an increase hypothyroidism rates up to 20%). Some researchers presume that can develop thyroid dysfunction following treatment lithium. Authors emphasize that predisposition to autoimmune mechanisms thyroid diseases also has bipolar affective disorder and treatment with interferon-alfa in hepatitis C. For many of these clinical situations, national and international associations adopted clinical recommendations and physicians have been introduced to optimal screening algorithm of correcting treatment in risk groups. Immune rehabilitation therapy (IRT) is actively used in the treatment of many diseases. The effect of these drugs on the thyroid gland is most fully described for multiple sclerosis, HIV infection and bone marrow transplantation. The peculiarity of the non-specific effect of IRT preparations on the thyroid gland can lead to transient disorders or manifest in the late long-term period after completion of the IRT. This complicates the targeted diagnosis of a whole range of diseases, which means it increases the risk of development and progression of complications, worsens the patient’s quality of life and prognosis. In this article we reviewed for our readers European clinical guidelines for thyroid dysfunction, following IRT, published in 2019. The recommendations are relevant not only for Endocrinologists, but also for Rheumatologists, Infectious disease specialists, Transplantologists, GP and many other specialties. Earlier, in the Journal of Clinical and Experimental Thyroidology a description was already made for immuno-mediated endocrinopathies, developing in the treatment of cancer patients with inhibitors of immune response control points. These endocrinopathies have their own distinctive features and are of interest in the study of adverse events from the thyroid gland. They are reflected in clinical recommendations and open up new aspects for the Endocrinologists about the effect of modern drugs on the thyroid gland.

По материалам клинических рекомендаций Европейской Тиреоидной Ассоциации по диагностике и лечению тиреотоксикоза при болезни Грейвса 2018 года

Abstract: Graves’ disease (GD) is a systemic autoimmune disorder characterized by the infiltration of thyroid antigen-specific T-cells into thyroid-stimulating hormone receptor (TSH-R)-expressing tissues. Stimulatory autoantibodies (Ab) in GD activate the TSH-R leading to thyroid hyperplasia and unregulated thyroid hormone production and secretion. Diagnosis of GD is straightforward in a patient with biochemically confirmed thyrotoxicosis, positive TSH-R-Ab, a hypervascular and hypoechoic thyroid gland (ultrasound), and associated orbitopathy. In GD, measurement of TSH-R-Ab is recommended for an accurate diagnosis/differential diagnosis, prior to stopping antithyroid drug (ATD) treatment and during pregnancy. Graves’ hyperthyroidism is treated by decreasing thyroid hormone synthesis with the use of ATD, or by reducing the amount of thyroid tissue with radioactive iodine (RAI) treatment or total thyroidectomy. Patients with newly diagnosed Graves’ hyperthyroidism are usually medically treated for 12–18 months with methimazole (MMI) as the preferred drug. In children with GD, a 24- to 36-month course of MMI is recommended. Patients with persistently high TSH-R-Ab at 12–18 months can continue MMI treatment, repeating the TSH-R-Ab measurement after an additional 12 months, or opt for therapy with RAI or thyroidectomy. Women treated with MMI should be switched to propylthiouracil when planning pregnancy and during the first trimester of pregnancy. If a patient relapses after completing a course of ATD, definitive treatment is recommended; however, continued long-term low-dose MMI can be considered. Thyroidectomy should be performed by an experienced high-volume thyroid surgeon. RAI is contraindicated in Graves’ patients with active/severe orbitopathy, and steroid prophylaxis is warranted in Graves’ patients with mild/active orbitopathy receiving RAI.

Efficacy of clinical decision support systems: methods and estimates

Abstract: Clinical decision support (CDS) systems are the medical technologies that go through their life cycle. Evaluation of effectiveness and safety should be carried out at its various stages – at the development, in clinical trials, licensing, clinical and economic analysis, health technologies assessment. To date, the effectiveness and safety of CDS systems vary and are ambiguous – there are both successes and failures. Hundreds of clinical trials are carried out, and more than a hundred of systematic reviews are published. When evaluating the efficacy and safety of CDS systems, two types of outcomes are usually estimated: indicators of medical care (volume, time, costs, etc.), and patient outcomes (clinical and surrogate). A slight increase in physicians’ adherence to clinical guidelines has been observed, but it had very small influence on surrogate outcomes, and there is no effect on clinical patient outcomes. A slight increase in risk with respect to patient outcomes was found in only a few studies. However, the methodological quality of the evidence is very low. In this regard, a few products based on artificial intelligence have so far approached the licensing phase. The field of CDS systems is developing, but not yet sufficiently studied, and there is a long way to real successes ahead. Meanwhile, there is a wide gap between the postulated and empirically demonstrated benefits of CDS systems.

Показатели функции щитовидной железы у женщин фертильного возраста из Казахстанской части Приаралья

Abstract: Background : The Aral crisis consider as one of the largest ecological catastrophes on the planet. TheKazakhstan part of the Aral Sea regiondeclared an environmental disaster zone. The constantly changing unfavorable environmental situation contributed to higher number of thyroid pathology and initiates the study of this problem in women of reproductive age in the AralSea area. Aims: To study thyroid function in women of reproductive age living in ecologically unfavorable territories of Kazakhstan part of the Aral Sea region. Materials and methods: The survey was conducted within scientific and technical program: “Integrated approaches in managing the health status of the population of the Aral Sea region” 2014–2016 years, performed by Ministry of Health and Social Development of the Republic of Kazakhstan. The study was cross-sectional, observational, uncontrolled and multicenter.Study included the representative sample of 2205 women of reproductive age from 18 to 49 years old living in the Aral Sea region.The levels ofTSH,FT4and AntiTPOweredetermined by the laboratory of collective use of KSMU on the Evolis Robotized System using“Tiroid-ELISA-TTG,0.23-3.4µIU/ml”, “Thyroid–ELISAfreeT4,10-23.2pmol/l”,“Tiroid ELISA – atTPO,<30EDU/ml”testsystems. Results: A huge number of women from environmental disadvantaged areas of the Kazakhstan part of the Aral Sea region have TSH values exceeding reference of 3.4 μI/ml. The frequency of SH was 0.2%;0.9%,0.2% in the different study areas at TTG values≥10.0 μIU/ml and freeT4 from 10to23.2 pmol/l. The frequency of MH was 2.4%;2.7%,2.5% in the studied areas at TSH values ≥10.0μIU/ml and FreeT4<10.0 pmol/l, Thus, the data obtained on the prevalence of reduced thyroid function in women living in the studied areas of the Aral Sea ecological disaster can be considered as comparative. About3%of women of reproductive age neededon replacement therapy for hypothyroidism. Thelargest number of women with elevated AT-TPO identified in the zone of the ecological crisis. Almost same number of women with hypothyroidism was revealed among AT-TPO hosts in all studied zones. Conclusions: Women of reproductive age living in ecologically unfavorable territories havea high, comparable frequency of manifest hypothyroidism in the three studied zones of the Kazakhstan part of the Aral Sea region of the Republic of Kazakhstan.