This review describes the lesions of the endocrine system that occur as a result of immunotherapy of cancer. This phenomenon is associated with the inhibition by monoclonal antibodies of checkpoints, which do not allow the immune system to affect tumor cells: CTLA-4, PD-1 and PD-L1. Immunotherapy by this group of drugs allows to increase the life expectancy of patients with cancer, but it also leads to the development of autoimmune endocrinopathies (thyroiditis, adrenalitis, diabetes mellitus, hypophysitis), which often manifest by life-threatening conditions. In view of the above, the necessity to carry out regular monitoring of the function of target organs in patients receiving immunotherapy for malignant tumors is discussed. On the other hand, the phenomenon of developing the autoimmune endocrinopathies during therapy with immunological checkpoints inhibitors is of fundamental interest to endocrinologists. Iatrogenic lesions of the endocrine system are unique models of initiation of immune autoagression. Thus, the development of adrenalitis in patients receiving treatment with a PD-1 inhibitor suggests that the PD-1 is involved in the pathogenesis of autoimmune adrenal insufficiency in patients not receiving treatment with this drug. Thus, clarification of the role of PD-1 in the development of adrenalitis is required. The results of such investigations will allow to identify the risk groups for the development of autoimmune adrenal insufficiency and, accordingly, timely diagnosing it and beginning treatment.
{"title":"Lesions in endocrine glands as a complication of immunotherapy in the practice of oncologist","authors":"N. Nuralieva, E. Troshina, G. Melnichenko","doi":"10.14341/KET9875","DOIUrl":"https://doi.org/10.14341/KET9875","url":null,"abstract":"This review describes the lesions of the endocrine system that occur as a result of immunotherapy of cancer. This phenomenon is associated with the inhibition by monoclonal antibodies of checkpoints, which do not allow the immune system to affect tumor cells: CTLA-4, PD-1 and PD-L1. Immunotherapy by this group of drugs allows to increase the life expectancy of patients with cancer, but it also leads to the development of autoimmune endocrinopathies (thyroiditis, adrenalitis, diabetes mellitus, hypophysitis), which often manifest by life-threatening conditions. In view of the above, the necessity to carry out regular monitoring of the function of target organs in patients receiving immunotherapy for malignant tumors is discussed. \u0000On the other hand, the phenomenon of developing the autoimmune endocrinopathies during therapy with immunological checkpoints inhibitors is of fundamental interest to endocrinologists. Iatrogenic lesions of the endocrine system are unique models of initiation of immune autoagression. Thus, the development of adrenalitis in patients receiving treatment with a PD-1 inhibitor suggests that the PD-1 is involved in the pathogenesis of autoimmune adrenal insufficiency in patients not receiving treatment with this drug. Thus, clarification of the role of PD-1 in the development of adrenalitis is required. The results of such investigations will allow to identify the risk groups for the development of autoimmune adrenal insufficiency and, accordingly, timely diagnosing it and beginning treatment.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"299 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76478376","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 the basis of the linear no-threshold theory, the Chernobyl accident was predicted to result in an incidence increase of various malignancies. In fact, there has been no cancer increase proven to be a consequence of the radiation exposure after the accident except for thyroid carcinoma in people exposed at a young age. Prior to the accident, thyroid cancer had been rarely diagnosed in children and adolescents. The ability of screening to enhance the registered incidence of thyroid tumors is known. The screening after the accident detected not only small tumors but also large neglected ones, sometimes misclassified as aggressive radiogenic cancers, which contributed to the concept of their aggressive behavior and early metastasizing. This had consequences for the practice: some experts recommended a more radical surgical treatment of supposedly radiogenic thyroid cancers. Such recommendations are generally not in agreement with the international practice. In conclusion, the treatment of Chernobyl-related thyroid carcinoma should not be different from that of sporadic one.
{"title":"On the overdiagnosis and overtreatment of thyroid carcinoma after the Chernobyl accident","authors":"S. Jargin","doi":"10.14341/KET10086","DOIUrl":"https://doi.org/10.14341/KET10086","url":null,"abstract":"On the basis of the linear no-threshold theory, the Chernobyl accident was predicted to result in an incidence increase of various malignancies. In fact, there has been no cancer increase proven to be a consequence of the radiation exposure after the accident except for thyroid carcinoma in people exposed at a young age. Prior to the accident, thyroid cancer had been rarely diagnosed in children and adolescents. The ability of screening to enhance the registered incidence of thyroid tumors is known. The screening after the accident detected not only small tumors but also large neglected ones, sometimes misclassified as aggressive radiogenic cancers, which contributed to the concept of their aggressive behavior and early metastasizing. This had consequences for the practice: some experts recommended a more radical surgical treatment of supposedly radiogenic thyroid cancers. Such recommendations are generally not in agreement with the international practice. In conclusion, the treatment of Chernobyl-related thyroid carcinoma should not be different from that of sporadic one.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74696602","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}
Diabetes mellitus and primary hypothyroidism, in the outcome of chronic autoimmune thyroiditis, the two most common diseases in endocrinology and the practicing doctor are important not to forget about the possible association of these pathologies. This applies to patients with diabetes mellitus, both 1 and 2 types. However, the combination of these two pathologies is more common in type 1 diabetes, which is due to the autoimmune nature of these diseases. A clinical case of a patient with type 1 diabetes mellitus, which is on pump insulin therapy, is presented, which, in the background of previously selected therapy, during the last 2 months, episodes of hypoglycemia increased. In the course of the survey, primary subclinical hypothyroidism was identified, in the outcome of chronic autoimmune thyroiditis. Against the background of the achievement of euthyroidism, it was possible to achieve compensation of carbohydrate metabolism without correction of previously selected insulin therapy. The high incidence of thyroid dysfunction in patients with diabetes mellitus, and as a consequence, the deterioration in the compensation of carbohydrate metabolism, requires a systematic screening of thyroid disorders in the presence of diabetes mellitus.
{"title":"Features of carbohydrate metabolism in a patient with type 1 diabetes mellitus in subclinical hypothyroidism in the outcome of chronic autoimmune thyroiditis","authors":"M. S. Mikhina, E. Troshina, T. Nikonova","doi":"10.14341/KET9748","DOIUrl":"https://doi.org/10.14341/KET9748","url":null,"abstract":"Diabetes mellitus and primary hypothyroidism, in the outcome of chronic autoimmune thyroiditis, the two most common diseases in endocrinology and the practicing doctor are important not to forget about the possible association of these pathologies. This applies to patients with diabetes mellitus, both 1 and 2 types. However, the combination of these two pathologies is more common in type 1 diabetes, which is due to the autoimmune nature of these diseases. A clinical case of a patient with type 1 diabetes mellitus, which is on pump insulin therapy, is presented, which, in the background of previously selected therapy, during the last 2 months, episodes of hypoglycemia increased. In the course of the survey, primary subclinical hypothyroidism was identified, in the outcome of chronic autoimmune thyroiditis. Against the background of the achievement of euthyroidism, it was possible to achieve compensation of carbohydrate metabolism without correction of previously selected insulin therapy. The high incidence of thyroid dysfunction in patients with diabetes mellitus, and as a consequence, the deterioration in the compensation of carbohydrate metabolism, requires a systematic screening of thyroid disorders in the presence of diabetes mellitus.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86108595","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}
Endocrine ophthalmopathy (EOP) is a chronic disease characterized by progressive autoimmune inflammation of the soft retrobulbar tissues in thyroid dysfunction. The orbital fibroblasts with their unique morphofunctional properties are very important in the pathogenesis of the infiltrative process and fibrosis of the extraocular muscles and/or retrobulbar tissue. They, unlike other localization fibroblasts, have not mesodermal, but neuro-ectodermal origin. The review acquaints with the immunological aspects of the regulation of these cells in different activity phases of disease. Intercellular interaction with T-lymphocytes (CD40-CD154) leads to orbital fibroblasts activation with increased expression of pathological receptors for thyroid-stimulating hormone, as well as production of intercellular matrix components, adhesion molecules, growth factors, cytokines and prostaglandins. Detailed morphofunctional characteristics of the orbit fibroblast subpopulations and mechanisms regulating their transdifferentiation into adipocytes and myofibroblasts are given. The analysis of literature data on the effect of T-helper type 17 on the functional activity of Thy1+/Thy1- (CD90+/CD90-) orbital fibroblasts is presented. The importance of the further study of the orbital fibroblasts characteristics in EOP and their intercellular interaction with various immune cells was noted, which may be able to uncover new pathogenetic mechanisms of this pathology.
{"title":"Morphofunctional characteristics and immunological regulation of the orbital fibroblasts function in endocrine ophthalmopathy","authors":"E. S. Taskina, S. V. Kharintseva","doi":"10.14341/KET10147","DOIUrl":"https://doi.org/10.14341/KET10147","url":null,"abstract":"Endocrine ophthalmopathy (EOP) is a chronic disease characterized by progressive autoimmune inflammation of the soft retrobulbar tissues in thyroid dysfunction. The orbital fibroblasts with their unique morphofunctional properties are very important in the pathogenesis of the infiltrative process and fibrosis of the extraocular muscles and/or retrobulbar tissue. They, unlike other localization fibroblasts, have not mesodermal, but neuro-ectodermal origin. The review acquaints with the immunological aspects of the regulation of these cells in different activity phases of disease. Intercellular interaction with T-lymphocytes (CD40-CD154) leads to orbital fibroblasts activation with increased expression of pathological receptors for thyroid-stimulating hormone, as well as production of intercellular matrix components, adhesion molecules, growth factors, cytokines and prostaglandins. Detailed morphofunctional characteristics of the orbit fibroblast subpopulations and mechanisms regulating their transdifferentiation into adipocytes and myofibroblasts are given. The analysis of literature data on the effect of T-helper type 17 on the functional activity of Thy1+/Thy1- (CD90+/CD90-) orbital fibroblasts is presented. The importance of the further study of the orbital fibroblasts characteristics in EOP and their intercellular interaction with various immune cells was noted, which may be able to uncover new pathogenetic mechanisms of this pathology.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84136346","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 past few years have been actively discussing the role of individual macro- and micronutrients as factors regulating the functional activity of organs and systems and reducing the risk of developing a number of diseases, including thyroid diseases. Selenium is one of the most important and intensively studied at present microelements. According to several studies, its low plasma level is associated with an increased risk of developing autoimmune thyroid diseases. In animal experiments, it was shown that a combined deficiency of selenium and iodine leads to more pronounced hypothyroidism than iodine deficiency alone. Some authors believe that cretinism in the newborn is a consequence of the combined deficiency of these two elements in the mother. It is also important that the optimal level of selenium is necessary both to initiate an immune response and to regulate an excessive immune response, as well as chronic inflammation. The review article discusses the relationship between selenium and thyroid pathology, discusses the role of selenium in the physiology of the thyroid gland and in the development of autoimmune diseases. The biochemical aspects of the pathogenesis of thyroid disease are presented.
{"title":"The role of selenium in the pathogenesis of thyroid disease","authors":"E. Troshina, E. S. Senyushkina, M. A. Terekhova","doi":"10.14341/ket10157","DOIUrl":"https://doi.org/10.14341/ket10157","url":null,"abstract":"The past few years have been actively discussing the role of individual macro- and micronutrients as factors regulating the functional activity of organs and systems and reducing the risk of developing a number of diseases, including thyroid diseases. \u0000Selenium is one of the most important and intensively studied at present microelements. According to several studies, its low plasma level is associated with an increased risk of developing autoimmune thyroid diseases. In animal experiments, it was shown that a combined deficiency of selenium and iodine leads to more pronounced hypothyroidism than iodine deficiency alone. Some authors believe that cretinism in the newborn is a consequence of the combined deficiency of these two elements in the mother. It is also important that the optimal level of selenium is necessary both to initiate an immune response and to regulate an excessive immune response, as well as chronic inflammation. \u0000The review article discusses the relationship between selenium and thyroid pathology, discusses the role of selenium in the physiology of the thyroid gland and in the development of autoimmune diseases. The biochemical aspects of the pathogenesis of thyroid disease are presented.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76832784","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}
T. Mokhort, S. Petrenko, B. Leushev, E. Fedorenko, N. Kolomiets, A. Mokhort
Background. Despite the measures taken by the Government of Belarus, the problem of iodine deficiency among the population remains actual. Aims. To determine iodine sufficiency in children and pregnant women living in Belarus. Materials and methods. The study included 873 schoolchildren aged 9–12 years of both sexes, of which 650 children were in regular schools, and the remaining children in boarding schools. A separate group consisted of 700 practically healthy pregnant women (during gestation from 16 to 36 weeks). Questioning, determination of urinary iodine concentration and thyroid volume with ultrasound was carried out. Results. Urine iodine median was 191 µg/L in the 873 children in 16 regions of Belarus. Thyroid volume corresponds to the normative values in children. According to the survey, 81% of households used iodized salt, constantly – 46%. Indicator of iodine sufficiency of 700 pregnant women (median urinary iodine concentration was 121 µg /l) is a non-optimal for this population group. Conclusions. Currently adequate iodine supplementation in school age children has been achieved. The prevalence of thyroid gland diseases caused by iodine deficiency in children decreased significantly. In pregnant women iodine supply is still insufficient.
{"title":"Assessment of iodine status among school age children and pregnant women of Belarus in 2017–2018","authors":"T. Mokhort, S. Petrenko, B. Leushev, E. Fedorenko, N. Kolomiets, A. Mokhort","doi":"10.14341/KET9732","DOIUrl":"https://doi.org/10.14341/KET9732","url":null,"abstract":"Background. Despite the measures taken by the Government of Belarus, the problem of iodine deficiency among the population remains actual. \u0000Aims. To determine iodine sufficiency in children and pregnant women living in Belarus. \u0000Materials and methods. The study included 873 schoolchildren aged 9–12 years of both sexes, of which 650 children were in regular schools, and the remaining children in boarding schools. A separate group consisted of 700 practically healthy pregnant women (during gestation from 16 to 36 weeks). Questioning, determination of urinary iodine concentration and thyroid volume with ultrasound was carried out. \u0000Results. Urine iodine median was 191 µg/L in the 873 children in 16 regions of Belarus. Thyroid volume corresponds to the normative values in children. According to the survey, 81% of households used iodized salt, constantly – 46%. Indicator of iodine sufficiency of 700 pregnant women (median urinary iodine concentration was 121 µg /l) is a non-optimal for this population group. \u0000Conclusions. Currently adequate iodine supplementation in school age children has been achieved. The prevalence of thyroid gland diseases caused by iodine deficiency in children decreased significantly. In pregnant women iodine supply is still insufficient.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75807761","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}
Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period. The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research. We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.
{"title":"Review of American Thyroid Association guidelines for the diagnosis and management of thyroid disease during pregnancy and the postpartum","authors":"V. Fadeyev","doi":"10.14341/KET9794","DOIUrl":"https://doi.org/10.14341/KET9794","url":null,"abstract":"Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period. The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research. \u0000We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78761930","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}
Medicine is an ancient science. In the modern sense, the medical profession began to form after bloodletting as a universal way of restoring the balance of bodily juices was replaced by more scientific and less crippling methods. But in medical practice it often happens that new methods of diagnosis and treatment get along with very ancient ones, and some traditional approaches, that previously had no reliable justification, receive solid scientific support. This historic process closely resembles the flow of water in a river: fast in the rapids, slow along the shores and sedentary in quiet creeks, at the bottom of which one can find shabby garbage brought by floods. All this is in a circuit – something disappears in the abyss, and something suddenly floats to the surface. The scandal in the USA with the recall of a medicine made from desiccated and dried porcine thyroid gland reminded us that some concoctions, which have been known since the times of ancient Chinese medicine, and drugs that appeared relatively recently thanks to modern pharmacology can easily coexist in clinical practice. With one essential caveat: the quality of such concoctions should be controlled as carefully as the newest drugs. Modern technologies have allowed us to analyze the genome of the inhabitants of our internal organs, that constitute the human microbiome. This made it possible to rehabilitate the concept of dysbacteriosis (dysbiosis), which was previously considered anti-scientific. For example, intestinal bacteria are able to compete with the host organism for selenium and even capable of aggravating its deficiency, as well as modulating the bioavailability of iodothyronines. It is possible that intestinal dysbiosis may be one of the causes of thyroxine malabsorption. All these and much more in this column “De Gustibus”.
{"title":"Through years, across distances…","authors":"G. Gerasimov","doi":"10.14341/ket10002","DOIUrl":"https://doi.org/10.14341/ket10002","url":null,"abstract":"Medicine is an ancient science. In the modern sense, the medical profession began to form after bloodletting as a universal way of restoring the balance of bodily juices was replaced by more scientific and less crippling methods. But in medical practice it often happens that new methods of diagnosis and treatment get along with very ancient ones, and some traditional approaches, that previously had no reliable justification, receive solid scientific support. This historic process closely resembles the flow of water in a river: fast in the rapids, slow along the shores and sedentary in quiet creeks, at the bottom of which one can find shabby garbage brought by floods. All this is in a circuit – something disappears in the abyss, and something suddenly floats to the surface. The scandal in the USA with the recall of a medicine made from desiccated and dried porcine thyroid gland reminded us that some concoctions, which have been known since the times of ancient Chinese medicine, and drugs that appeared relatively recently thanks to modern pharmacology can easily coexist in clinical practice. With one essential caveat: the quality of such concoctions should be controlled as carefully as the newest drugs. Modern technologies have allowed us to analyze the genome of the inhabitants of our internal organs, that constitute the human microbiome. This made it possible to rehabilitate the concept of dysbacteriosis (dysbiosis), which was previously considered anti-scientific. For example, intestinal bacteria are able to compete with the host organism for selenium and even capable of aggravating its deficiency, as well as modulating the bioavailability of iodothyronines. It is possible that intestinal dysbiosis may be one of the causes of thyroxine malabsorption. All these and much more in this column “De Gustibus”.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86371905","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}
A. V. Tkachuk, T. Grebennikova, A. M. Lapshina, V. P. Vladimirova, Z. Belaya, G. Melnichenko
Despite the fact that pituitary adenomas are among the most frequent brain tumours, TSH-secreting pituitary adenomas (thyrotropinomas) are less than 1% of all adenomas. Due to the increase in the free fractions of thyroid hormones at normal or elevated TSH levels, the majority of patients with these pituitary adenomas have a long anamnesis of thyrotoxicosis which requires a differential diagnosis with thyroid pathology (Graves’ disease, toxic adenoma, autonomously functioning thyroid nodules). The diagnosis of the thyrotropinoma is quite challenging for clinicians. This article describes the case of a combination of the thyrotropinoma with primary hypothyroidism as a result of the Hashimoto’s disease. A feature of this article is the absence of a typical clinical picture of thyrotoxicosis in combination with an evaluated level of TSH on the background of constantly increasing substitution therapy for primary hypothyroidism. The picture of space-occupying lesion according to MRI of the brain allowed to suspect hormone-active pituitary adenoma (macroadenoma). As a result of surgical treatment (endonasal transsphenoidal adenomectomy), the level of TSH and free thyroid hormone levels were normalized in the postoperative period. The diagnosis of TSH-secreting pituitary adenoma was confirmed by histological and immunohistochemical analysis of postoperative material.
{"title":"TSH-secreting pituitary adenoma in combination with primary hypothyroidism in the outcome of Hashimoto’s disease: diagnostic difficulties","authors":"A. V. Tkachuk, T. Grebennikova, A. M. Lapshina, V. P. Vladimirova, Z. Belaya, G. Melnichenko","doi":"10.14341/ket10021","DOIUrl":"https://doi.org/10.14341/ket10021","url":null,"abstract":"Despite the fact that pituitary adenomas are among the most frequent brain tumours, TSH-secreting pituitary adenomas (thyrotropinomas) are less than 1% of all adenomas. Due to the increase in the free fractions of thyroid hormones at normal or elevated TSH levels, the majority of patients with these pituitary adenomas have a long anamnesis of thyrotoxicosis which requires a differential diagnosis with thyroid pathology (Graves’ disease, toxic adenoma, autonomously functioning thyroid nodules). The diagnosis of the thyrotropinoma is quite challenging for clinicians. This article describes the case of a combination of the thyrotropinoma with primary hypothyroidism as a result of the Hashimoto’s disease. A feature of this article is the absence of a typical clinical picture of thyrotoxicosis in combination with an evaluated level of TSH on the background of constantly increasing substitution therapy for primary hypothyroidism. The picture of space-occupying lesion according to MRI of the brain allowed to suspect hormone-active pituitary adenoma (macroadenoma). As a result of surgical treatment (endonasal transsphenoidal adenomectomy), the level of TSH and free thyroid hormone levels were normalized in the postoperative period. The diagnosis of TSH-secreting pituitary adenoma was confirmed by histological and immunohistochemical analysis of postoperative material.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"71 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83343820","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}
O. S. Serdyukova, S. Titov, E. S. Malakhina, O. Rymar
Thyroid nodules are one of the most common thyroid diseases. The prevalence of thyroid nodules is estimated to be 2–65% depending on the detection methods. Yet despite the high frequency of thyroid nodules only about 5–10% of such nodules are malignant. Fine needle aspiration cytology of the thyroid nodule is currently the primary diagnostic tool for determining the nature of a thyroid nodule. Now, the fine needle aspiration biopsy is the gold standard for diagnosing thyroid cancer but in 30% of cases the cytological conclusion is uncertain. Cytological research is not enough to diagnose benign and malignant tumors. The need to improve the effectiveness of fine needle aspiration biopsy findings led to the search for new diagnostic biomarkers and the creation of diagnostic panels on their basis for their application in the diagnosis of uncertain nodules. Determination of molecular markers in the thyroid aspirate will allow to differentiate benign and malignant tumors more accurately at the preoperative stage and reduce the number of inappropriate surgery. The review article presents the characteristics of MicroRNAs, allowing them to be used in preoperative diagnosis of thyroid nodules. Diagnostic panels based on gene mutations and MicroRNA expression demonstrating high sensitivity and specificity of these methods are also indicated. Analysis of literature indicates that molecular analysis of fine needle aspiration genetic material from thyroid nodal formations demonstrates great prospects of prognosis, diagnosis and treatment of thyroid cancer. However, there is no sufficient evidence to recommend or to prohibit of utilization this molecular testing during the cytological conclusion of indeterminate thyroid nodules. Molecular analysis (MicroRNA) is a perspective method for evaluation of thyroid nodal formations with indeterminate cytology, however, this method requires further study and improvement.
{"title":"MicroRNAs – promising molecular markers for detecting cancer in thyroid nodules","authors":"O. S. Serdyukova, S. Titov, E. S. Malakhina, O. Rymar","doi":"10.14341/KET9774","DOIUrl":"https://doi.org/10.14341/KET9774","url":null,"abstract":"Thyroid nodules are one of the most common thyroid diseases. The prevalence of thyroid nodules is estimated to be 2–65% depending on the detection methods. Yet despite the high frequency of thyroid nodules only about 5–10% of such nodules are malignant. Fine needle aspiration cytology of the thyroid nodule is currently the primary diagnostic tool for determining the nature of a thyroid nodule. Now, the fine needle aspiration biopsy is the gold standard for diagnosing thyroid cancer but in 30% of cases the cytological conclusion is uncertain. Cytological research is not enough to diagnose benign and malignant tumors. The need to improve the effectiveness of fine needle aspiration biopsy findings led to the search for new diagnostic biomarkers and the creation of diagnostic panels on their basis for their application in the diagnosis of uncertain nodules. Determination of molecular markers in the thyroid aspirate will allow to differentiate benign and malignant tumors more accurately at the preoperative stage and reduce the number of inappropriate surgery. The review article presents the characteristics of MicroRNAs, allowing them to be used in preoperative diagnosis of thyroid nodules. Diagnostic panels based on gene mutations and MicroRNA expression demonstrating high sensitivity and specificity of these methods are also indicated. Analysis of literature indicates that molecular analysis of fine needle aspiration genetic material from thyroid nodal formations demonstrates great prospects of prognosis, diagnosis and treatment of thyroid cancer. However, there is no sufficient evidence to recommend or to prohibit of utilization this molecular testing during the cytological conclusion of indeterminate thyroid nodules. Molecular analysis (MicroRNA) is a perspective method for evaluation of thyroid nodal formations with indeterminate cytology, however, this method requires further study and improvement.","PeriodicalId":10284,"journal":{"name":"Clinical and experimental thyroidology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86100535","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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