Background Of Hypothyroidism Research Articles

CHANGES IN THE DENSITY AND COMPOSITION OF BONE TISSUE AND ALVEOLAR BONE ATROPHY IN RATS WITH HYPOTHIREOSIS AND CORRECTION WITH A COMPLEX OF MINERALS AND VITAMINS

Problem. For diseases of the thyroid gland, it is advisable to use hormone replacement therapy. However, numerous consequences of an overdose of L‑thyroxine drugs are known. The use of a preventive complex based on minerals, vitamins and quercetin can be an alternative to replacement therapy for correcting the consequences of disorders of the musculoskeletal system in thyroid diseases. Goal. The purpose of the work is an experimental study of the osteoprotective effectiveness of a complex of vitamins and minerals in rats with hypothyroidism. Method. In the experiment, 36 rats were used, which were divided into three groups: 12 intact, 12 animals that were simulated with hypothyroidism, and 12 rats that, against the background of hypothyroidism, were administered a preventive complex daily. The experiment on modeling hypothyroidism and its prevention lasted 4 months. Mandibles, lumbar vertebrae and femurs of rats of both sexes were isolated. Morphometric parameters were studied in vertebrae and femurs: density, content of mineral and organic components of bone tissue. The degree of atrophy of the alveolar process was determined in the jaws of the animals. Main results. Modeling hypothyroidism in rats caused a significant decrease in femoral bone density in males by 2.2% and in females by 1.7%, had no effect on lumbar vertebral density, and significantly increased alveolar process atrophy in males by 22.2% and in females by 15. 8%. The decrease in the density of the femur bone was due to a decrease in the content of the mineral component of bone tissue by 4.5–7.2%. The use of a preventive complex containing vitamins, minerals and quercetin led to an increase in the density of femurs to the level of healthy animals, increased the density of the lumbar vertebrae by 2.2–3.1%, and reduced atrophy of the alveolar process of the jaws in females by 21.5% and in males by 31.4%. Deterioration of the quality of bone tissue in thyroid insufficiency, as well as the osteotropic effectiveness of the prophylactic complex in conditions of hypothyroidism, were more pronounced in males. Conclusions. The conducted studies showed the development of dystrophic processes in the jaws and femurs of rats against the background of a deficiency of thyroid hormones and the positive effect of a complex of vitamins and minerals, which effectively stopped the atrophy of the alveolar process of the jaws and the decrease in the density of the femurs, and also increased the density of the lumbar vertebrae of rats with hypothyroidism.

Changes in the functional activity of the hypothalamic-pituitaryadrenal axis in rats of both sexes with Guerin’s carcinoma against the background of hypothyroidism

The hypothalamic-pituitary-adrenal axis (HPA) makes the body’s response to various stress factors, interacting with the thyroid and gonadal axis. The aim of our work was to study the effect by induced hypothyroidism on changes in the functioning of the HPA axis in rats with Guerin’s carcinoma of both sexes. Materials and methods. The experiment was performed in white outbred rats of both sexes. Hypothyroidism was induced in animals by medication for 30 days with Mercazolil, and then Guerin’s carcinoma was transplanted (the main group). The reference groups covered animals with the independent growth of Guerin’s carcinoma and with independent hypothyroidism, as well as intact animals (the normal conditions). On day 18 of the tumor growth, the animals were sacrificed, and, using standard ELISA kits, in the serum and the homogenates of the adrenal glands, the tumor and the perifocal zone, the level of cortisol was determined; in the homogenates of the hypothalamus we measured the concentration of CT-releasing hormone (CRH) and in the pituitary gland the concentration of ACTH. Results. Induced hypothyroidism both in males and females caused adrenal insufficiency. The growth of Guerin’s carcinoma increased the level of CT-releasing hormone in males by 9.6 times and cortisol in the adrenal glands in females and males by 1.3 times and 2.3 times (p<0.05), respectively. In the main group females and males we revealed a decrease in the level of CT-releasing hormone of the hypothalamus by an average of 1.4 times, ACTH in the pituitary gland by 1.5-1.8 times, but an increase in the cortisol concentration in blood and the adrenal glands only in males by an average of 1.5 times (p˂0.05). Only in males of the main group in the tumor and its perifocal zone, the content of cortisol increased by 5.9 times and 1.6 times (р˂0.05), respectively. Conclusion. The HPA axis has a gender-specific response to the growth of a malignant tumor, both in its independent growth variant and against the background of hypothyroidism, which in its independent variant causes adrenal insufficiency.

Influence by hypothyroidism on the level of sex hormones in blood and their intracrine content in the tumor in rats with Guerin’s carcinoma

The aim of our research work was to study the level of sex steroids in blood, the tumor and the perifocal zone in rats of both sexes with Guerin’s carcinoma against the background of hypothyroidism. Materials and methods. The experiment was performed in 110 outbred rats of both sexes. Hypothyroidism was induced in animals for 30 days with Mercazolil medication, and then Guerin’s carcinoma was transplanted (the main group). The reference groups included animals with an independent growth of Guerin’s carcinoma and with independent hypothyroidism, as well as intact animals (the norm). On the 18th day of the tumor growth, the animals were sacrificed, and, using standard RIA kits, in the serum, the tumor homogenates and the perifocal zone, the levels of estradiol (E2), testosterone (T) and progesterone (P4) were determined. Results. In comparison with intact animals, hypothyroidism caused an increase in the blood content of E2 in animals of both sexes by 2.2-2.4 times and T by 1.4-16 times, and P4 by 1.7 times only in females, but recorded was a decrease therein in males by 2.4 times. The growth of Guerin’s carcinoma resulted in a 2.5-5.5-fold decrease in E2 in blood of the animals of both sexes, an increase in T by 2.1 times and P4 by 3 times in the females, but a decrease in T by 2.6 times without changing P4 in the males. In the main group, in the animals of both sexes, similarly to the processes in hypothyroidism, the level of E2 and P4 increased by 1.4-1.6 times, and in females also T by 4.4 times, compared with the intact animals. Conclusion. Hypothyroidism and the growth of Guerin’s carcinoma changed E2 in different directions in animals of both sexes the level of sex hormones in blood and shifted the steroid balance in the tumor and its perifocal zone. In the females of the main group, the saturation of the tumor with estrogens, androgens and progesterone decreased, while in the males, on the contrary, the concentration of steroids increased.

Disorders in connections of the hypothalamic-pituitarygonadal axis in rats with Guerin’s carcinoma against the background of induced hypothyroidism

Aims: to study the content of regulatory peptides in the hypothalamus and pituitary gland, as well as sex steroids in the gonads in rats of both sexes with Guerin’s carcinoma against the background of hypothyroidism. Materials and methods. Our experiment was performed in white outbred rats of both sexes with induced hypothyroidism, against the background of which Guerin’s carcinoma was transplanted. In 1% homogenates of the pituitary and the hypothalamus and in 10% homogenates of the gonads in the animals from the main and reference groups, the levels of GnRH (Casabio, China) were determined by the ELISA method using standard kits, and the content of LH, FSH, estradiol (E2), testosterone (T) and progesterone (P4) by the RIA method (Immunotech, Czech Republic). Statistical analysis of the results was performed using the Statistica 10.0 software package. Results. In females of the main group, the level of GnRH in the hypothalamus increased by 1.6 times, but the content of LH and FSH in the pituitary gland decreased, while in males the content of GnRH decreased by 1.4 times and FSH by 1.6 times compared with the intact animals. In the gonads of females of the main group, the content of E2 and T decreased by 1.3 times, but the level of P4 increased by 4.7 times, while in males the T production decreased by 7.1 times. Hypothyroidism, against the background of which Guerin’s carcinoma developed, had a significant effect both on the central links of the HPG axis and the peripheral ones, producing an additional hormonal imbalance in sex steroids

Changes in pathophysiology of tumor growth and functional activity of the hypothalamic-pituitary-thyroid axis in rats of both sexes with the development of Guerin's carcinoma on the background of hypothyroidism

Purpose of the study. Was to analyze changes in pathophysiological parameters of transplantable tumor growth and functional activity of the hypothalamic-pituitary-thyroid axis (HPT) in rats of both sexes with Guerin's carcinoma in presence of induced hypothyroidism.Materials and methods. The dynamics of tumor growth and average life span were assessed in white alley rats of both sexes with Guerins carcinoma transplanted subcutaneously on the background of thyreostatic induced hypothyroidism. RIA (radioimmune assay) and ELISA (enzyme-linked immunosorbent assay) methods were used to determine levels of thyroid hormones in the blood and thyroid and tumor samples, and thyrotropin-releasing hormone (TRH) in the hypothalamus, as well as TSH in the pituitary gland. The experiment included 2 control groups: animals of both sexes with hypothyroidism (control group 1, number of rodents = 15) and animals with subcutaneously transplanted Guerin's carcinoma without hypothyroidism (control group 2, number of rodents = 15).Results. Hypothyroidism in female rats inhibited the tumor growth and improved median survival by 1.8 times (p < 0.05). No such effect was observed in males of the main group. Levels of regulatory peptides of the hypothalamus and pituitary gland declined in females of the main group, while levels of TSH in the pituitary gland in males increased, despite a decrease in TRH by 3.5 times. TSH levels decreased in the thyroid and blood of animals of both sexes; however, a decrease in levels of total and free circulating thyroxine (T4 and FT4) by 1.6 times and by 2.8 times was found in the tumor, respectively; samples of Guerin's carcinoma in males of the main group remained saturated with T4 and FT4 as well as and in control group rodents without induced hypothyroidism.Conclusions. The gender differences in the pathophysiology of the tumor development in presence of hypothyroidism, as well as changes in the functional activity of the HPT axis in experimental animals revealed in this study can probably be associated with sex hormones, which requires further study of the hypothalamic-pituitary-gonadal (HPG) axis and steroid hormones in peripheral organs and tumor samples.

Morphological changes of the exocrine part of the pancreas under immobilization stress on the background of hypothyrosis

Annotation. Stress is a condition that causes the body's cells to use large amounts of energy to acclimate to abnormal environmental conditions. Hypothyroidism affects almost all organs and systems of the body, in particular, the pancreas. The goal of our research is to study the effect of chronic immobilization stress against the background of hypothyroidism on the tissue structure of the exocrine part of the pancreas. The experimental rats were divided into three groups: I – intact animals (10), II – animals with immobilization stress (10), III – animals with hypothyroidism and immobilization stress (10). Hypothyroidism was modeled by daily per os injection using a probe of the pharmacopoeial mercazolil thyreostatics at a dose of 25 mg/kg during the 21 day. Acute immobilization stress was modeled by tying experimental rats in a supine position in 4 limbs without restriction of head mobility for 3 hours. Histological studies were carried out according to generally accepted methods. Histological preparations were studied using a SEO SСAN light microscope and photo-documented using a Vision CCD Camera with a system of image output from histological preparations. In the 1st control group, the pancreas had a general structure plan of a parenchyme in organ. In the II group, remodeling of the exocrine part of the pancreas, slight disturbances in the structure of the acini, blood vessels, and moderate edema of the connective tissue were observed, compared to the control group of animals. In the III group, more significant changes of the gland were revealed, compared to the II experimental group, manifested by swelling and growth of connective tissue, changes in the shape of the acini, violation and loss of polarity of exocrinocytes, blood-filling of vessels. Thus, under conditions of simulated chronic stress, slight changes in the parenchyma of the gland were detected, and during chronic immobilization stress against the background of hypothyroidism, alterative changes of the gland were detected, compared to the II experimental group.

Hypothyroidism And Gestational Diabetes Mellitus: Is There A Relationship?

Background and Objective — Subclinical gestational hypothyroidism (SGH) and gestational diabetes mellitus (GDM) constitute two most common endocrine pathologies encountered during pregnancy. SGH and GDM have common pathophysiological mechanisms, being interrelated pathological conditions that are capable of complicating the course of pregnancy, labor and the postpartum period both on the part of the mother and on the part of the fetus. We aimed to analyze the relationship between these pathologies and to assess the risk of developing GDM against the background of hypothyroidism. Materials and Methods — the study included 200 pregnant women observed at the Perinatal Center of the Maternity Hospital the Bauman State Clinical Hospital No. 29 during 2018-2020. The main group consisted of 133 women who visited the perinatal center for hypothyroidism (both SGH and primary hypothyroidism, detected prior to pregnancy); the control group comprised 67 women without endocrine pathology. Both groups were comparable in terms of age, height, weight, and the number of pregnancies in the anamneses. The main group received levothyroxine sodium therapy with the achievement of the target trimester-specific level of thyroid-stimulating hormone (TSH). The criteria for the diagnosis of SGH were the TSH level above 2.5 μIU/mL in combination with an enlarged titer of antithyroid antibodies and/or a burdened medical history of thyroid pathology, or the TSH level above 4.0 μIU/mL in the absence of antithyroid antibodies [1]. The diagnosis of GDM was established on the basis of fasting hyperglycemia (≥5.1 mmol/L), or based on the results of an oral glucose tolerance test (OGTT) with 75 g of glucose: fasting glucose level of ≥5.1 mmol/L; the concentration 1 hour after glucose intake ≥10.0 mmol/L; the content 2 hours after glucose intake ≥8.5 mmol/l) [2]. In both groups, the frequency of developing GDM, the timing of diagnosis, and the need for insulin therapy were evaluated. Statistical data processing was carried out using the StatTech v. 2.1.0 software. Quantitative indicators were assessed for compliance with the normal distribution via Shapiro-Wilk criterion or Kolmogorov-Smirnov criterion. Intergroup comparison was performed using Mann-Whitney U test or Pearson’s chi-squared test. Results — We discovered that among women with a burdened family history of thyroid pathology and diabetes mellitus, as well as with thyroid pathology prior to pregnancy, the prevalence of hypothyroidism was higher. The presence of thyroid pathology in the anamnesis of pregnant women was associated with an earlier diagnosis of hypothyroidism. We revealed a significant difference in the prevalence of GDM between two groups of subjects. The chances of detecting GDM in the hypothyroidism group were 8.6 times higher than in the euthyroidism group. The threshold level of TSH for the first trimester, predicting the development of GDM, was identified. The sensitivity and specificity of the model were 71.4% and 63.1%, respectively. Conclusion — Hypofunction of the thyroid and GDM are interrelated endocrine pathologies. In the presence of hypothyroidism (both primary and SGH), GDM develops significantly more often. The level of TSH in the first trimester ≥2.7 μIU/mL amplifies the chance of developing GDM by over 8 times; hence, it could be considered a signal for timely prevention and detection of this pathology.

EFFECT OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS AND PARACETAMOL ON THE FUNCTIONAL STATE OF THE THYROID GLAND IN EXPERIMENTAL OSTEOARTHRITIS WITH HYPOTHYROIDISM

The question of the effect of NSAIDs on the functional state of the thyroid gland arises due to the existence of conflicting studies on the various effects of drugs, in particular NSAIDs on thyroid hormones in the serum. It is known that drugs can affect the hormonal activity of the thyroid gland in various ways, in particular through the induction of cytochromes, direct influence on the synthesis and secretion of hormones or their metabolism, clearance and uptake by tissues, antagonism with transport proteins. The aim of the study was to investigate the effects of NSAIDs and paracetamol on the functional state of the thyroid gland in osteoarthritis with hypothyroidism. The study was performed on 80 nonlinear white rats with reconstituted osteoarthritis and hypothyroidism. To address the question posed about the effect of NSAIDs and paracetamol on the functional state of the thyroid gland, which was determined by the level of hormones TSH, T3 and T4, each of the studied drugs was administered in two doses. Doses were chosen based on calculations based on average and maximum human doses, using a species sensitivity factor, and taking into account data from the literature. Interpretation of the results obtained was based on the known fact that clinical laboratory diagnosis of hypothyroidism is characterized by increased concentration of TSH and decreased content of free T4, while the concentration of free T3 remains within the normal range or sometimes decreases. The conducted study revealed that analgesic drugs exhibit a variety of effects on thyroid function in conditions of comorbid pathology, which depends on both the drug itself and its dose. The authors have identified drugs that can adversely affect hormone concentration in a dose-dependent manner. Thus, ibuprofen (7 mg/kg), meloxicam (12 mg/kg) and nimesulide (100 mg/kg) reduced the TSH level and increased the serum T4 level in rats, which aggravated hypothyroidism. It was proved that pharmacotherapy of osteoarthritis against the background of hypothyroidism should take into account the effect of analgesics on the hormones of TSH, T3 and T4, which should be kept in mind while correcting the functional activity of the thyroid gland.

Paradoxical Low Flow Low Gradient Severe Aortic Stenosis—An Under-Recognized Entity

Some patients with severe aortic stenosis (AS), due to restrictive cardiac physiology, paradoxically have relatively low flow and low gradients across stenotic aortic valves despite preserved left ventricular (LV) systolic function. It results in symptoms and reduced quality of life and carries a high mortality. Whilst this form of severe AS, termed paradoxical low flow low gradient (pLFLG), is well reported, patients with this diagnosis experience inappropriate barriers to aortic valve replacement (AVR), the only efficacious treatment. We present the case of an 88-year-old female with 12 months of exertional dyspnoea on a background of hypothyroidism and hypercholesterolemia. Transthoracic echocardiogram (TTE) revealed LV hypertrophy, with a small LV cavity size and reduced stroke volume, yet normal systolic function. A heavily calcified aortic valve was identified with severe aortic stenosis, based on valve area, yet with incongruous mean transvalvular gradient of 25 mmHg (severe ≥ 50 mmHg). Following exclusion of other differential diagnoses, her symptoms were attributed to paradoxical LFLG severe AS. She was however declined definitive transcatheter aortic valve implantation (TAVI) due to her paradoxically low mean aortic gradient. Following further deterioration in her symptoms and supportive quantification of poor exercise performance, she was ultimately re-referred, accepted, and underwent TAVI. Following her AVR, the patient experiences significant improvement in both symptoms and quality of life after only one month. Paradoxical LFLG severe AS remains a well-documented yet under recognized disease. It carries high morbidity and mortality if untreated, yet is significantly less likely to be referred and accepted for intervention. With its prevalence expected to rise with an ageing population, this case serves as a timely reminder for clinicians to address the under recognition of important pathology.

Risk factors and prognosis of metabolic syndrome in perimenopausal women with hypothyroidism

One of the main problems is that the metabolic syndrome (MS) is not clinically manifested until thesignificant carbohydrate and lipid metabolism violations, that initiate a pathological range of symptoms, leading to cardiovascular disease, diabetes mellitus, non-alcoholic steatohepatosis, impairment of reproductive function and other diseases. Conco­mitant endocrine disorders create a background on which dyshormonal and metabolic factors are superimposed. Therefore, an urgent and important task is the correct, and most importantly timely, interpretation of existing risk factors for metabolic disorders in women of perimenopausal age with concomitant hypothyroidism (HT), purposed on their correction to prevent or slowdown the development of complications.Aim — to develop a mathematical model for assessing the prognostic value of risk factors for investigation ofMSdevelopment and progression in perimenopausal women with HT.Materials and methods. 146 perimenopausal women with HT were examined to predict the MS development. Multiple regression analysis was used to construct prognostic model of MS risk.Results. With the help of logistic regression analysis, the following significant multicollinear risk factors for MS have been identified: triglycerides, thyroid-stimulating hormone, vitamin D, and waist circumference. A correlation matrix with the calculation of regression coefficients and coefficient of determination was constructed, and mathematical model was created to determine the coefficient of the MSprogression. The developed mathematical model for predicting of MSdevelopment had a high predictive accuracy, which confirms the compliance of the predicted results with the theoretically expected. The probability that patients will develop MS with a previously predicted risk of MS was 96.1 % (p < 0.05).Conclusions. The developed mathematical model of the predictionof metabolic syndromedevelopment against the background of hypothyroidism is highly informative and allows to determine in advance the contingent of women with high probability of MS development for the timely implementation of appropriate preventive measures.

Assessment of the state of the oxidant-antioxidant system and lipid peroxidation in patients with chronic pancreatitis combined with hypothyroidism

Changes in oxidative-antioxidant homeostasis is one of the pathogenetic links in the onset and progression of many nosologies, including chronic pancreatitis (CP) and hypothyroidism (HТ), however, data on the development of oxidative stress (OS) with a combination of CP and HP are insufficient, therefore, determining the role of these systems with a comorbid course of these pathologies is an urgent issue of our time.The aim of the work is to study the state of the oxidative and antioxidant system in patients with CP and CP combined with HT.Material and methods. 96 people were examined, including 26 patients with chronic pancreatitis (group 1), 24 patients with hypothyroidism (group 2), 26 patients with chronic pancreatitis on the background of hypothyroidism (group 3), 20 almost healthy individuals (group 4). Evaluation of the oxidative-antioxidant system and lipid peroxidation was assessed by determining the content of malonic aldehyde in blood plasma (MA pl.) And erythrocytes (MA er.), The level of reduced glutathione, glutathione peroxidase (GP) and glutathione-S-trans-ion (GT). Enzyme activity was calculated per 1 g of hemoglobin (HB).Research results. The analysis of the obtained results revealed clear patterns of changes in the state of the oxidative-antioxidant system and lipid peroxidation in patients with chronic pancreatitis on the background of hypothyroidism. Namely, violation of lipid peroxidation in patients with comorbid pathology, accompanied by an increase in the content of MA er. by 44.87% and the content of MA in blood plasma by 46.42%; oxidative-antioxidant system: decrease in HF in the blood by 51,61%, combined of a compensatory increase in BP - by 48.03% and HT - by 34.76%.Conclusion. Under the conditions of comorbidity of CP and HT, there is a violation of the oxidative-antioxidant system and the state of lipid peroxidation, which is characterized by a significant increase in MA in erythrocytes and MA in plasma against a decrease in glutathione and which complicates the course of the underlying disease, its diagnosis and treatment.

Peculiarities of calcium-phosphorus homeostasis of the oral fluid in young patients with primary hypothyroidism, having generalized periodontitis

The problem of hormonal imbalance in periodontal diseases, as well as the importance of endocrine diseases in its development, plays a significant role. In the professional literature there are data that thyroid disease is a risk factor for the occurrence and further progression of periodontal diseases. The processes of bone modeling and remodeling and its mineralization are closely related to calcium metabolism. The biochemical manifestation of osteoporotic processes in the alveolar bone in generalized periodontitis is a violation of calcium-phosphorus homeostasis against the background of altered markers of bone metabolism. The aim of our investigation was to study the calcium-phosphorus homeostasis of the oral fluid in patients with primary hypothyroidism and persons without endocrine pathology, with generalized periodontitis. Since in the structure of periodontal diseases in the study groups generalized periodontitis of the initial-I and II degree had the largest percentage, biochemical studies were performed in this sample of patients. The first group included 50 people with generalized periodontitis against the background of primary hypothyroidism: 25 patients – with generalized periodontitis of the initial-I degree and 25 patients with generalized periodontitis of the II degree of development. The second group included 50 patients with generalized periodontitis without endocrinological pathology (25 patients with GP of the initial-I degree and 25 patients with GP of the II degree of development). In young people with generalized periodontitis, against the background of hypothyroidism, there were observed negative changes in calcium-phosphorus homeostasis of the oral fluid: there was a tendency to the decrease of calcium content in the oral fluid with the development of inflammatory-dystrophic process in the periodontium, on the contrary, phosphorus level has increased. Negative dynamics of calcium-phosphorus molar coefficient was found in patients with hypofunction of the thyroid gland. Thus, the analysis of research results shows that in young people with periodontal diseases and hypothyroidism there is a pathological change in metabolic processes, increased excretion of mineral components, especially calcium. Periodontal pathology against the background of hypothyroidism is characterized by the development of a chronic inflammatory process together with a pronounced decrease in calcium-phosphorus homeostasis of the oral fluid.

Predicting the risk of severe menopausal syndrome in perimenopausal women with hypothyroidism

Background. Every year the number of menopausal women increases. At this age, the prevalence of hypothyroidism (HT) reaches its peak. The problem of menopausal syndrome (MS) is relevant for patients with HT, concomitant endocrine disorders create a background for combination with dyshormonal factors. The purpose of the study: to propose an approach to predicting the risk of severe MS in perimenopausal women with HT according to the developed algorithm and mathematical model. Materials and methods. To predict the development of MS, 146 perimenopausal women with autoimmune HT were surveyed. Using multiple regression analysis, a prognostic model of the risk of severe MS was created. Results. Logistic regression analysis revealed the following most significant multicollinear risk factors for MS: smoking, alcohol consumption, adverse environmental conditions, physical activity, history of stress and anxiety, thyroid disease. A correlation matrix with calculation of regression coefficients and coefficient of determination was constructed, a mathematical model was created to determine the risk factor for the progression of MS. The predicted value of the risk factor for severe MS with a high degree of probability was determined in 72 (49.32%) women, with an average probability— in 58 (39.73%), and with a low probability— in 16 women (10.95%) with HT. The correspondence of the predicted results with the theoretically expected ones in the high-risk group was recorded in 104.37%, in the average-risk— in 94.73%, and in the low-risk— in 89.65% of cases. Conclusions. The developed algorithm and mathematical model for predicting severe MS on the background of HT are highly informative and allow determining in advance the group of women at high risk of severe MS for the timely implementation of appropriate preventive measures.

Особливості перебігу патології шлунково-кишкового тракту у хворих на гастроезофагеальну рефлюксну хворобу на тлі гіпотиреозу

The article identifies the features of the pathology of the gastrointestinal tract in patients with gastroesophageal reflux disease on the background of hypothyroidism. The frequency of gastroesophageal reflux disease and the severity of this disease increase with age and the presence of comorbid pathology. In the elderly, the frequency of the typical esophageal manifestations decreases, and the erosive esophagitis with atypical symptoms is more common. The growing number of cases of combined thyroid dysfunction with gastropathology requires in-depth study of the reasons for the relationship between these processes. Pathological changes in the gastrointestinal tract in these patients make their condition severer, contributing to the development and progression of metabolic disorders. An important aggravating effect on the regulatory mechanisms of esophageal kinetics has a pathological functioning of the thyroid gland on the background of iodine deficiency. Results and discussion. In patients with gastroesophageal reflux disease with hypothyroidism, all changes in gastric and duodenal function are associated with a decrease in the acid-forming function of the gastric mucosa, due to its atrophy, decreased tone and contractility of the stomach. This in turn leads to a slowing of gastric and duodenal evacuation, dysfunction of the closing capacity of the cardia and, as a consequence, the development of duodenogastroesophageal reflux. The esophageal contents are not so pronounced, so patients with non-erosive forms of esophagitis predominate (46.2%) against 16% of patients in the second group (patients with gastroesophageal reflux disease). At the same time, erosive forms predominate among patients in the control group with predominant acid reflux. It should be noted that there is a clear relationship between the frequency of erosive changes in the esophageal mucosa and the duration of the disease. Thus, among patients of the main group with a 5-year history of the disease, the number of erosive forms of gastroesophageal reflux disease was minimal. The number of erosive changes in the esophageal mucosa increased sharply in patients with a 10-year history and reached its maximum after 15 years from the onset of the disease. Conclusion. The delay in gastric evacuation is more pronounced in patients with gastroesophageal reflux disease on the background of hypothyroidism. It can be explained by a decrease in gastric motility and the presence of duodenostasis. The slowing of gastric evacuation was more pronounced in patients with gastroesophageal reflux disease on the background of reduced thyroid function. In patients with gastroesophageal reflux disease on the background of hypothyroidism there is an alkaline duodenogastroesophageal reflux as a consequence of reduced acid-forming function of the gastric mucosa and reduced contractility of the stomach and duodenum

Особливості патернів копінгу при психоендокринному синдромі на тлі дисфункцій щитоподібної залози

На базі Українського науково-практичного центру ендокринної хірургії, трансплантації ендокринних органів і тканин МОЗ України обстежено 200 хворих із діагнозами гіпо- й гіпертиреозу у стані терапевтичної компенсації ендокринної дисфункції та з проявами психоендокринного синдрому. З метою встановлення й порівняння патернів копінгу нозогенного стресу за психоендокринного синдрому на тлі гіпо- й гіпертиреозу використано структуроване психодіагностичне інтерв’ю на основі копінг-тесту Лазаруса. Установлено, що хворими на гіпотиреоз стратегії «дистанціювання» (54 особи), «самоконтроль» (26 осіб), «утеча–уникнення» (67 осіб) та «планування вирішення проблеми» (23 особи) використовувались частіше, ніж хворими на гіпертиреоз. Натомість у обстежених із гіпертиреозом стратегії «конфронтація» (77 осіб), «пошук соціальної підтримки» (34 особи) та «позитивне переоцінювання» (43 особи) були представлені частіше, ніж у осіб із гіпотиреозом.

Неспецифічний захист й особливості автоімунних процесів у пацієнток із зовнішнім генітальним ендометріозом на тлі гіпотиреозу

Мета — проаналізувати стан неспецифічного захисту й особливості автоімунних процесів у пацієнток із зовнішнім генітальним ендометріозом (ЗГЕ) на тлі гіпотиреозу. Матеріал і методи. До дослідження увійшли 110 пацієнток із ЗГЕ на тлі гіпофункції щитоподібної залози (ЩЗ), яким у Державній науковій установі «Науково-практичний центр профілактичної і клінічної медицини» Державного управління справами (ДНУ «НПЦ КПМ» ДУС) проводили загальноклінічне передопераційне обстеження, пальпацію та УЗД ЩЗ, рутинні гінекологічні обстеження — огляд у дзеркалах, бімануальне дослідження. Для з’ясування характеру порушень імунного статусу на системному рівні досліджували показники клітинного та гуморального імунітету: вміст субпопуляцій Т-лімфоцитів, В-лімфоцитів (CD3, CD4, CD8, CD20, CD16); прозапальних і протизапальних цитокінів — інтерлейкінів IL‑1β, IL‑6, IL‑8, IL‑10, чинника некрозу пухлин α (TNF-α); імуноглобулінів (IgG, IgM, IgA); антитіл до фосфоліпідів (IgG, IgM). Визначення вмісту цитокінів, інтерлейкінів, Ig у крові проводили імуноферментним методом. Результати. За поєднання ЗГЕ та гіпотиреозу відбуваються виражені імунні зсуви — пригнічення клітинного (зниження вмісту CD3, CD4, CD8, збільшення CD16 Т-лімфоцитів) та активація гуморального (збільшення вмісту CD20 В-лімфоцитів, IgA і IgG) імунітету. Виявлено негативний середньої сили кореляційний зв’язок між показниками тиреотропного гормону (ТТГ) і CD3 (r= –0,59; t=5,1), між ТТГ і CD4 (r= –0,59; t=4,14), між ТТГ і CD8 (r=–0,51; t=4,98); прямий середньої сили зв’язок між ТТГ і CD16 (r=0,69; t=5,57), між ТТГ та IgA (r=0,61; t=4,82), між ТТГ та IgG (r=0,54; t=5,81), між ТТГ і CD20 (r=0,43; t=4,17). У жінок із ЗГЕ та гіпотиреозом знижується вміст TNF-α(в 1,3 раза), IL‑6 (в 1,5 раза), IL‑8 (в 1,7 раза); підвищуються рівні IL-l (в 1,5 раза) і IL‑10 (в 1,4 раза), а також виявляються автоімунні порушення, які супроводжуються підвищенням вмісту антифосфоліпідних IgG (в 1,5 раза), антитіл до нативної (двоспіральної) ДНК IgG (в 1,2 раза) та зниженням рівня антифосфоліпідних IgM (в 1,5 раза). Висновки. За поєднання ЗГЕ та гіпотиреозу відбуваються виражені імунні зсуви: пригнічення клітинного та активація гуморального імунітету — зниження вмісту CD3, CD4, CD8 і збільшення рівнів CD16 Т-лімфоцитів, CD20 В-лімфоцитів, IgA, IgG. Доведено наявність кореляційного зв’язку між рівнем ТТГ у крові та імунними показниками — негативного із CD3, CD4, CD8 і позитивного із CD16, CD20, IgA та IgG. У жінок із ЗГЕ та гіпотиреозом знижуються рівні TNF-α, IL‑6, IL‑8, підвищується вміст IL-l, IL‑10 і мають місце автоімунні порушення, що супроводжуються підвищенням показників антифосфоліпідних IgG, антитіл до нативної (двоспіральної) ДНК IgG і зниженням рівня антифосфоліпідних IgM, що свідчить про посилення автоімунних процесів у таких жінок.

CHANGES OF MORPHOFUNCTIONAL STATE OF THYROID GLAND IN HYPOTHYROID RATS IN CONDITIONS OF INFLUENCE LONG-TERM STRESS

Relevance. The chronic stress influences on increasing of frequency of thyroid pathology together with other factors (decreased iodine intake in food, harmful factors of external environment, high technogenic loading, depravation of general ecological state, violation of structure of nutrition). The changes of hypothalamus-hypophysis-thyroid gland axis at stress is not enough agreed because of influence stressful factors with different character and duration.
 Objective is study of influence of chronic emotional painful stress (CS) on the changes of morphofunctional state of thyroid gland (TG) on the background of experimental hypothyroidism (EH).
 Materials and methods. Experiments were performed on 48 white laboratory sex matured male rats. Animals were divided on four groups: the fist – intact animals; the second – animals with EH; the third – animals under influence of CS; the fourth – animals with EH under action of CS. The EH was modeled by everyday addition of mercazolilum (dose 10mg/kg) to drinking water during 15 days. The CS was modeled by 1 hour per day during 30 days. The functional activity of TG was estimated by the concentration of thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxin (T4) in blood plasma and calculation of thyroid index (TI). The morphological state of TG was studied by light and electron microscopy. The statistical analysis of results was processed using Student’s test with Bonferroni-Holm correction in program Statistica 6.0. The differences were statistical significant at р<0,05. 
 Results. The long-term influence of stress factors caused significant decreasing of level of thyroid hormones in blood plasma in comparison to intact animals. The data of light and electron microscopy of TG of rats under influence of CS confirm biochemical changes and detect signs of decreasing of secretory function. On the background of action of mercazolilum the long-term stress caused to more substantial changes of functional state of TG (significant increasing of level of TSH, decreasing of content of T4 and TI) in comparison to data of animals with EH. The structural features of TG of animals with EH under influence of CS indicate on suppression of function.
 Conclusions. Decreasing of synthesis of hormones by TG in rats at conditions of CS was detected. The long-term action of stress on background of hypothyroidism causes to more substantial depravation of thyroid profile.

Biopharmaceutical analysis of the interaction of L-thyroxin, diclofenac sodium and chondroitin sulphate as components of pharmacotherapy of osteoarthritis manifestations resulted from hypothyroidism.

The article deals with the issue of the biopharmaceutical interaction of L-thyroxin, diclofenac sodium and chondroitin sulfate as components of pharmacotherapy of osteoarthritis manifestations with concomitant hypothyroidism. It is known that functional insufficiency of the thyroid gland has a negative effect on all types of metabolism and in particular on the condition of the bone and cartilage tissue, leading to the development of osteoarthritis. Existing pharmacotherapeutic approaches to the medical treatment of this pathology require the use of basic hormone replacement therapy for the correction of thyroid insufficiency, and NSAIDs as drugs for the symptomatic treatment of osteoarthritis. However, to date, questions of the biopharmaceutical interaction of L-thyroxin and diclofenac sodium are not covered, and the prevention of osteoarthritis against the background of hypothyroidism with the help of chondroitin sulfate and its interaction with the components of pharmacotherapy has not been sufficiently studied. Based on the conducted research, it was established that, proceeding from the theoretical analysis of the physicochemical and chemical properties of these drugs, predominantly reversible acid-base interactions are assumed. The probability of strong and irreversible physicochemical reactions is very low and the physical mixtures of these drugs are not subject to negative interactions which can lead to profound destructive changes on the part of the dosage forms. Since L-thyroxin, diclofenac sodium and chondroitin sulfate are absorbed mainly by simple diffusion, have different transport mechanisms through biological membranes, have different degrees of binding to plasma proteins and various enzyme systems involved in their metabolism and excretion, pharmacokinetic interactions between them are excluded. At the level of pharmacological interaction, the combined and unidirectional effects of the combination of active substances L-thyroxin, diclofenac sodium and chondroitin sulfate are expected, in particular, in degenerative-dystrophic disorders due to functional insufficiency of the thyroid gland, for restoration of the structure of cartilage tissue and for a complex etiotropic and symptomatic treatment of osteoarthritis and related states.

An autoimmune cause of confusion in a patient with a background of hypothyroidism.

SummaryA 68-year-old previously independent woman presented multiple times to hospital over the course of 3 months with a history of intermittent weakness, vacant episodes, word finding difficulty and reduced cognition. She was initially diagnosed with a TIA, and later with a traumatic subarachnoid haemorrhage following a fall; however, despite resolution of the haemorrhage, symptoms were ongoing and continued to worsen. Confusion screen blood tests showed no cause for the ongoing symptoms. More specialised investigations, such as brain imaging, cerebrospinal fluid analysis, electroencephalogram and serology also gave no clear diagnosis. The patient had a background of hypothyroidism, with plasma thyroid function tests throughout showing normal free thyroxine and a mildly raised thyroid-stimulating hormone (TSH). However plasma anti-thyroid peroxidise (TPO) antibody titres were very high. After discussion with specialists, it was felt she may have a rare and poorly understood condition known as Hashimoto’s encephalopathy (HE). After a trial with steroids, her symptoms dramatically improved and she was able to live independently again, something which would have been impossible at presentation.Learning points:In cases of subacute onset confusion where most other diagnoses have already been excluded, testing for anti-thyroid antibodies can identify patients potentially suffering from HE.In these patients, and under the guidance of specialists, a trial of steroids can dramatically improve patient’s symptoms.The majority of patients are euthyroid at the time of presentation, and so normal thyroid function tests should not prevent anti-thyroid antibodies being tested for.Due to high titres of anti-thyroid antibodies being found in a small percentage of the healthy population, HE should be treated as a diagnosis of exclusion, particularly as treatment with steroids may potentially worsen the outcome in other causes of confusion, such as infection.

SUN-435 SIADH Precipitated by Pneumonia in a Background of Hypothyroidism and SSRI Use

Introduction: Hyponatremia is serum sodium levels below 135 meq/L. SIADH is a disorder of impaired water excretion caused by the inability to suppress the secretion of ADH leading to hyponatremia. Important causes of hyponatremia are heart failure, cirrhosis, diuretic induced, hypothyroids, cortisol deficiency and SIADH. Causes of SIADH are CNS disorders, malignancies, surgery, pulmonary disease (particularly pneumonia), hormone deficiency (both hypopituitarism, hypothyroidsm), HIV, drugs- esp. SSRIs. Clinical Case: 74 y/o F with past medical history of Diabetes, HTN, hypothyroidism, depression and chronic compensated hyponatremia under carvedilol, losartan, levothyroxine, citalopram, presented to ER with SOB with wheezing. Patient was admitted for pneumonia and treated with azithromycin and ceftriaxone. In Day 2, he developed intractable nausea and vomiting despite zofran and phenargan. IV NS was started. Patient developed hyponatremia, Na of 126 mEq/L, serum osmolality 240, Urine osm 457 mOsm/, TSH was 41 mIU/L. Levothyroxine was increased to 175 mcg. Fluid & Citalopram was stopped. Na was closely monitored. Over the next few days, patient and Na levels slowly improved with fluid restriction and Na tablets. Conclusion: Not all hyponatremia is SIADH while SIADH is a cause of hyponatremia. The diagnosis is often confusing. SIADH should be suspected in any patient with serum Na <135 mmol/L, serum osmolality <280 mOsm, and a inappropriate and relatively high urine osmolality (compared to serum osmolality). SIADH is more common in patients above age 65 years. Finding out the cause and fluid restriction is the mainstay of treatment in SIADH. Exception to this is brain surgeries & Sub Arachnoid Hemorrhage where there may be ongoing cerebral salt wasting and, fluid restriction can be deleterious as it can cause cerebral vasospasm. However for most cases of non-SIADH hyponatremia, Sodium chloride, (oral tablet or isotonic saline) is the therapy. Other ways to treat hyponatremia would be treating the underlying cause, restricting water intake or vasopressin receptor antagonist. For severe case (with seizure and severe neurological abnormalities) of any hyponatremia, intravenous hypertonic saline is the choice.