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 5070% 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 patients 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.
药物对免疫系统的影响常常导致自身免疫性疾病等不良事件的发生。甲状腺是一个器官，其胚胎发育的特点是易受各种自身免疫作用的自发和诱导病变的影响。细胞分裂素诱导的甲状腺炎(在5070%的病例中发展为破坏性甲状腺炎)，免疫检查点抑制剂后甲状腺功能障碍(使用CTLA-4 + PD-1/PD-L1联合治疗可导致甲状腺功能减退率增加高达20%)。一些研究人员认为，锂治疗后可能会出现甲状腺功能障碍。作者强调，自身免疫机制对甲状腺疾病的易感性也有双相情感障碍和丙型肝炎的干扰素- α治疗。对于许多这些临床情况，国家和国际协会采纳了临床建议，并向医生介绍了在危险人群中纠正治疗的最佳筛选算法。免疫康复疗法(IRT)被广泛应用于多种疾病的治疗中。这些药物对甲状腺的影响在多发性硬化症、HIV感染和骨髓移植中得到了最充分的描述。IRT制剂对甲状腺的非特异性作用的特殊性可导致短暂性疾病或在IRT完成后的后期长期表现出来。这使得对一系列疾病的有针对性的诊断变得复杂，这意味着它增加了并发症发生和发展的风险，恶化了患者的生活质量和预后。在本文中，我们根据2019年发布的IRT，为读者回顾了欧洲甲状腺功能障碍临床指南。这些建议不仅适用于内分泌学家，也适用于风湿病学家、传染病专家、移植学家、全科医生和许多其他专业。早些时候，《临床与实验甲状腺学杂志》(Journal of Clinical and Experimental Thyroidology)已经对免疫介导的内分泌疾病进行了描述，该疾病在使用免疫反应控制点抑制剂治疗癌症患者中发展起来。这些内分泌疾病有其独特的特点，是研究甲状腺不良事件的兴趣所在。它们反映在临床建议中，并为内分泌学家关于现代药物对甲状腺的影响开辟了新的方面。
{"title":"Thyroid dysfunction following immune reconstitution therapy","authors":"G. Melnichenko, A. Glibka, Olga Y. Demicheva","doi":"10.14341/ket12225","DOIUrl":"https://doi.org/10.14341/ket12225","url":null,"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. \u0000Cytokinin-induced thyroiditis (in 5070% 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. \u0000Authors emphasize that predisposition to autoimmune mechanisms thyroid diseases also has bipolar affective disorder and treatment with interferon-alfa in hepatitis C. \u0000For 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. \u0000Immune 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 patients quality of life and prognosis. \u0000In 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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77570504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Rumyantsev, M. Degtyarev, Dali S. Dzeytova, A. Trukhin, K. Slashchuk, M. S. Sheremeta, S. Serzhenko, V. S. Yasuchenia, Y. I. Sirota
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.
甲状腺毒症的病因诊断(结节性和弥漫性甲状腺病理中甲状腺组织的破坏或功能活性增加)是确定该病理患者治疗的关键。闪烁显像是鉴别诊断甲状腺毒症病因、评估甲状腺功能状态的首选方法。根据不同的医学兴趣，甲状腺闪烁成像可以使用99mtc -高锝酸盐或放射性碘同位素(123i, 124i, 131i)进行。对于甲状腺摄取评估，使用99mtc -高锝酸盐放射性药物进行闪烁成像，该放射性药物不会被组织并迅速从甲状腺组织中排出。在甲状腺碘药代动力学研究的情况下，使用碘同位素(123 I, 131 I, 124 I)标记的放射性药物。审查包括原始图表，表格和图表。本文结合病史、实验室检查、超声(TIRADS)和FNA (Bethesda)结果，对甲状腺显像检查在现代诊断算法中的地位和作用进行了分析。此外，作者着重于现有的临床指南分析。一个优化算法的诊断和治疗弥漫性和/或结节性甲状腺病理与甲状腺毒症提出。
{"title":"Thyroid scintigraphy in diagnosis of nodular and diffuse thyroid pathology","authors":"P. Rumyantsev, M. Degtyarev, Dali S. Dzeytova, A. Trukhin, K. Slashchuk, M. S. Sheremeta, S. Serzhenko, V. S. Yasuchenia, Y. I. Sirota","doi":"10.14341/ket12240","DOIUrl":"https://doi.org/10.14341/ket12240","url":null,"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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"16 1","pages":"138-147"},"PeriodicalIF":0.0,"publicationDate":"2020-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79313944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinical decision support (CDS) systems are the medical technologies that go through their life cycle. Evaluation ofeffectiveness 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 ithad 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.
{"title":"Efficacy of clinical decision support systems: methods and estimates","authors":"O. Rebrova","doi":"10.14341/ket12377","DOIUrl":"https://doi.org/10.14341/ket12377","url":null,"abstract":"Clinical decision support (CDS) systems are the medical technologies that go through their life cycle. Evaluation ofeffectiveness 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 ithad 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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87484856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
Elena A. Shabalina, Valentin V. Fadeyev(2019)对“硒对自身免疫性甲状腺炎患者的影响”的更正。临床及实验甲状腺学。15(2)。doi: 10.14341 / ket10299。在名为“研究设计”的图1中，在TSH水平为0.4-10.0 mU/L时进行了误差。正确值为:TSH 4.0 ~ 10.0 mU/L。编辑委员会为这个错误道歉，并声明这不会以任何方式改变文章的科学结论。原文已更新。
{"title":"Erratum: Effects of selenium in patients with autoimmune thyroiditis (Clinical and experimental thyroidology. 2019;15(2). doi: 10.14341/ket10299)","authors":"E. A. Shabalina, V. Fadeyev","doi":"10.14341/ket12298","DOIUrl":"https://doi.org/10.14341/ket12298","url":null,"abstract":"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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"93 1","pages":"129-129"},"PeriodicalIF":0.0,"publicationDate":"2020-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76564949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Petr A. Terekhov, A. Rybakova, M. A. Terekhova, E. Troshina
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.
{"title":"Awareness of the population in Russian Federation about iodine deficiency, its effects and methods for prevention of iodine deficiency disorders.","authors":"Petr A. Terekhov, A. Rybakova, M. A. Terekhova, E. Troshina","doi":"10.14341/ket12239","DOIUrl":"https://doi.org/10.14341/ket12239","url":null,"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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"21 1","pages":"118-123"},"PeriodicalIF":0.0,"publicationDate":"2020-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88938309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
在我们面前的是一个年轻女子的故事，她主动监测甲状腺的状况，由于意外检测到甲状腺组织的抗体。发现肿瘤(7mm)后，行半甲状腺切除术。手术后的两年里，她一直在肿瘤科医生和内分泌科医生的照顾下。然而，尽管有关于疾病预后良好的解释，她还是非常惊慌，不合理地经常进行实验室检查，忽视了参考范围和评估方法不同的事实。应该说，类似的问题在所有国家都存在(Nedman C. et al.， 2017)——即使在确诊多年后，绝大多数患者仍然担心疾病复发。人们不仅担心甲状腺癌复发的风险，还担心其他癌症发展的风险，以及无法获得专业护理的风险。医生的明显任务是纠正病人增加焦虑的行为模式。
{"title":"Review of the clinical case of a patient with microcarcinoma of the thyroid gland","authors":"G. Melnichenko, N. Mokrysheva, Nino N. Katamadze","doi":"10.14341/ket12255","DOIUrl":"https://doi.org/10.14341/ket12255","url":null,"abstract":"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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"26 1","pages":"124-128"},"PeriodicalIF":0.0,"publicationDate":"2020-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80833518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Petrov, A. Nelaeva, E. Molozhavenko, E. Ivashina
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.
{"title":"Overview of foreign clinical guidelines for the use of fine-needle aspiration biopsy of thyroid nodules","authors":"V. Petrov, A. Nelaeva, E. Molozhavenko, E. Ivashina","doi":"10.14341/ket10382","DOIUrl":"https://doi.org/10.14341/ket10382","url":null,"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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"16 1","pages":"96-109"},"PeriodicalIF":0.0,"publicationDate":"2020-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86590672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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 23 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 (57 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.
{"title":"Memories of the future","authors":"G. Gerasimov","doi":"10.14341/ket12250","DOIUrl":"https://doi.org/10.14341/ket12250","url":null,"abstract":"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 23 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 (57 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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"422 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88350063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Spirina, S. Chizhevskaya, I. Kondakova, N. Tarasenko
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.
{"title":"The role of autophagy in the thyroid tumors development, connection with the AKT/m-TOR signaling pathway activation","authors":"L. Spirina, S. Chizhevskaya, I. Kondakova, N. Tarasenko","doi":"10.14341/probl10138","DOIUrl":"https://doi.org/10.14341/probl10138","url":null,"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. \u0000The 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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85375554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"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","authors":"G. Gerasimov","doi":"10.14341/ket10380","DOIUrl":"https://doi.org/10.14341/ket10380","url":null,"abstract":"<jats:p>.</jats:p>","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73515995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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