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.
{"title":"Secondary hypothyroidism in adults: diagnosis and treatment","authors":"Tatiana A. Kienia, T. Morgunova, V. Fadeyev","doi":"10.14341/KET10303","DOIUrl":"https://doi.org/10.14341/KET10303","url":null,"abstract":"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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"154 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77705900","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}
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.
{"title":"Salt iodization decreased the risk of thyrotoxicosis in Denmark by the halve","authors":"M. Zimmermann, Циммерман Майкл Брюс","doi":"10.14341/ket10379","DOIUrl":"https://doi.org/10.14341/ket10379","url":null,"abstract":"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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87430050","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}
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.
{"title":"Iodine status of the population in Russia and the world: what do we have for 2019?","authors":"V. I. Alferova, S. Mustafina, O. Rymar","doi":"10.14341/ket10353","DOIUrl":"https://doi.org/10.14341/ket10353","url":null,"abstract":"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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82930023","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}
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.
{"title":"Effects of selenium in patients with autoimmune thyroiditis","authors":"E. A. Shabalina, V. Fadeyev","doi":"10.14341/KET10299","DOIUrl":"https://doi.org/10.14341/KET10299","url":null,"abstract":"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. \u0000Aims: 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. \u0000Materials 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). \u0000Results: 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. \u0000Conclusions: Our study, failed to show possitive effects of Se supplementation on thyroid autoimmunity.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89647391","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}
E. Fisenko, A. Sencha, A. N. Katrich, Yulia P. Sych, N. Tsvetkova, A. Borsukov, E. Kostromina
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.
{"title":"Оn the need to introduce the TI-RADS classification in Russia","authors":"E. Fisenko, A. Sencha, A. N. Katrich, Yulia P. Sych, N. Tsvetkova, A. Borsukov, E. Kostromina","doi":"10.14341/KET10115","DOIUrl":"https://doi.org/10.14341/KET10115","url":null,"abstract":"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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90843116","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}
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.
{"title":"Never have been and here again…","authors":"G. Gerasimov","doi":"10.14341/KET10281","DOIUrl":"https://doi.org/10.14341/KET10281","url":null,"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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88541201","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}
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.
{"title":"Causes of treatment failure in primary hypothyroidism","authors":"Y. Manuylova, T. Morgunova, V. Fadeyev","doi":"10.14341/KET10163","DOIUrl":"https://doi.org/10.14341/KET10163","url":null,"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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82132204","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}
Lewis E. Braverman, Professor of Medicine in the Section of Endocrinology, passed away peacefully on Monday, June 10, 2019.
内分泌科医学教授Lewis E. Braverman于2019年6月10日星期一安详去世。
{"title":"In Memoriam: Lewis E. Braverman (1929–2019)","authors":"G. Melnichenko","doi":"10.14341/KET10330","DOIUrl":"https://doi.org/10.14341/KET10330","url":null,"abstract":"Lewis E. Braverman, Professor of Medicine in the Section of Endocrinology, passed away peacefully on Monday, June 10, 2019.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75735557","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. Yanevskaya, T. Karonova, I. Sleptsov, M. E. Boriskova, A. R. Bakhtiyarova, E. V. Ivanova, K. Pogosian, U. Farafonova, A. Andreeva, U. Tsoi, E. Grineva
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.
背景:原发性甲状旁腺功能亢进(PHPT)是一种以一个或多个甲状旁腺分泌甲状旁腺激素(PTH)为特征的疾病。在过去50年中，该病的无症状形式在发达国家变得更为普遍。目的:评价近年来出现的PHPT临床表现，明确有症状和无症状PHPT患者的临床和实验室特征。材料和方法:我们回顾了2011-2018年间在俄罗斯圣彼得堡三家医疗中心收治的449名患者的病历。分析患者的记忆、人体测量数据、实验室(PTH、血清总钙和电离钙、磷、碱性磷酸酶、24小时尿钙水平、25(OH)D)和仪器(超声、显像、CT/MRI扫描、DXA)检查。结果:患者平均年龄59岁，女性占93.1%，F:M比为13.5:1。在310例(69%)患者中发现了PHPT的症状形式，而139例无症状。4.2%的患者有PHPT作为MEN综合征的一部分。几乎一半的男性患有尿石症，45%的女性患有骨质疏松症。64.4%的病例存在心血管疾病。25(OH)D水平仅在20%的病例中检测到，无症状患者更高(32.2和18.6 ng/ml, p = 0.003)。37例(8.2%)患者被诊断为正常钙血症型PHPT，其特征不仅包括正常钙血症和较低的PHT水平，而且还包括较小的腺瘤大小(p = 0.01)和术后低钙血症综合征。结论:研究结果表明，症状性PHPT在俄罗斯人群中更为普遍，影响其临床表现的性别差异较大，且该患者人群中心血管疾病的发生率较高。PHPT作为男性综合征的一部分在4.2%的病例中被检测到，需要进行分子基因检测。四分之一的患者出现正常血钙水平的PHPT伴术后低血钙。作为PHPT患者术前准备的一部分，25(OH)D水平的罕见测定增加了对维生素D补充和减少其缺乏的强制性评估的必要性。
{"title":"Primary hyperparathyroidism: clinical forms and their features. Retrospective study","authors":"L. Yanevskaya, T. Karonova, I. Sleptsov, M. E. Boriskova, A. R. Bakhtiyarova, E. V. Ivanova, K. Pogosian, U. Farafonova, A. Andreeva, U. Tsoi, E. Grineva","doi":"10.14341/KET10213","DOIUrl":"https://doi.org/10.14341/KET10213","url":null,"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.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75177721","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}
On June 14, 2018, at the age of 85, Maria Bronstein, a remarkable pathologist, died. The entire professional life of M. Bronstein was associated with the Endocrinology Research Centre (the Institute of Experimental Endocrinology and Chemistry of Hormones of the Russian Academy of Medical Sciences).
{"title":"In memory of Maria I. Bronstein","authors":"L. Rozhinskaya","doi":"10.14341/KET10168","DOIUrl":"https://doi.org/10.14341/KET10168","url":null,"abstract":"On June 14, 2018, at the age of 85, Maria Bronstein, a remarkable pathologist, died. The entire professional life of M. Bronstein was associated with the Endocrinology Research Centre (the Institute of Experimental Endocrinology and Chemistry of Hormones of the Russian Academy of Medical Sciences).","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81806683","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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