Concomitant Thyroid Pathology Research Articles

The associations of cytokines and gens polymorphisms of β-adrenoceptors in patients with heart failure and some thyroid pathology (literature review and own observations).

Aim: To analyze the role of cytokines in the progression of heart failure (HF) in patients with concomitant pathology of the thyroid gland. Materials and Methods: The systematization of literature data on the role of cytokines in the progression of HF in patients with concomitant thyroid pathology (TP) was carried out. The results of our own research were presented. Conclusions: The final chapter in the history of the role of cytokines in the progression of HF has not yet been written. Further studies, including genetic ones, are necessary. The patients with HF have higher levels of TNFβ and IL-6, and a lower concentration of IL-4, compared to the control group. Patients with a fatal outcome of the disease, in contrast to those who survived for two years, have an increased level of TNFβ. In patients with concomitant TP, who had repeated hospitalization, a lower level was registered, compared to that under conditions of a more favorable course of heart failure. Concentrations of cytokines in the blood of patients with HF are associated with gene polymorphisms of the β-adrenoreceptor system: the C-allele of the Gly389A polymorphism of the β1-adrenoceptor gene leads to a decrease in the risk of increasing TNFα; IL-1α increases in the presence of the A-allele of the Ser49Gly polymorphism of this gene. In patients with HF and concomitant thyroid pathology, the risk of IL-6 growth increases in homozygous (C) patients for the Ser275 polymorphism of the β3 subunit of the G-protein.

Papillary thyroid carcinoma coexisting with benign thyroid and parathyroid pathology: clinical and pathomorphological features

Background. Papillary thyroid carcinoma (PTC) is the most frequent malignant neoplasm originating from follicular cells of thyroid gland. PTC is often coexisting with other benign thyroid pathology such as chronic lymphocytic thyroiditis, follicular thyroid adenoma, toxic thyroid adenoma, Graves’ disease, non-toxic multinodular goiter. PTC can be diagnosed in patients undergoing surgical treatment for hyperparathyroidism. However, the clinical and pathomorphological features of PTC in the presence of other benign thyroid or parathyroid pathology, as well as possible differences in surgical tactics, remain relevant as evidenced by previously published reports. The purpose of the study is to assess the prevalence and determine the differences in the clinical and pathomorphological parameters of PTC in the presence of benign thyroid and parathyroid pathology. Materials and methods. There were identified 91 patients with PTC, who underwent surgical treatment at the clinical bases of the Department of Surgery of the NSC “Institute of Biology and Medicine” of Taras Shevchenko National University of Kyiv. Results. In the studied PTC cohort, 31 (35 %) patients were without coexisted benign thyroid pathology and 60 (35 %) patients had it (PTC/coexisted). A statistically significantly higher number of mitoses per 10 high power fields in the PTC group were identified in 3 (10 %) patients, as compared to the absence of this pathohistological parameter in the PTC/coexisted (p = 0.037). Further analysis of these 3 cases showed that 4 mitotic figures were found in one PTC, and one mitotic figure in the other two cases per 10 high power fields (400×). Conclusions. Papillary thyroid carcinoma in patients with other benign thyroid pathology is associated with lower biological aggressiveness than PTC without comorbidity as evidenced by a lower frequency of mitotic figures per 10 high power fields. The presence of concomitant benign thyroid pathology can be considered as a favorable prognostic factor for patients with PTC.

Preoperative parathyroid localization. Relevance of MIBI SPECT-CT in adverse scenarios

PurposeSelective parathyroidectomy, the treatment of choice for primary hyperparathyroidism, requires precise preoperative localization. Our purpose was to compare the accuracy and concordance of pre-surgical MIBI parathyroid scintigraphy and ultrasonography, as well as to assess the relevance of hybrid acquisition (SPECT/CT) in compromised circumstances: low-weight or ectopic adenomas, coexisting thyroid disease and re-interventions. MethodsThe study included 223 patients with primary hyperparathyroidism operated in a single Surgical Unit from August 2016 to March 2021. Preoperative ultrasonography and double-phase MIBI were performed with early SPECT/CT acquisition. A minimally invasive surgical approach was initially attempted, except in patients with concomitant thyroid surgery or multiglandular parathyroid disease. ResultsSelective parathyroidectomy was accomplished in 179 patients (80.2%); cervicotomy and/or thoracoscopy in 44. Removal of the parathyroid lesion was achieved in 211 patients (94.6%), corresponding 204 (96.7%) to adenomas (37 ectopic). The cure rate was 94.2%. Preoperative MIBI SPECT/CT showed higher sensitivity and accuracy (84%; 80%) compared to ultrasound (72%; 71%), being more precise in defining the exact anatomical location (75.8% vs 68.7%). These differences reached statistical significance in ectopic glands. The existence of concomitant thyroid pathology did not decrease the sensitivity of SPECT/CT (84.2%). Mean parathyroid weight was 692.2mg (95%CI: 443.5-941) in MIBI-negative cases and 1145.9mg (95%CI: 983.6-1308.3) in MIBI-positive (p=0.001). Re-intervention was successful in the 8 patients with previous surgery. ConclusionMIBI SPECT/CT presents greater sensitivity, accuracy and anatomical precision than ultrasound for preoperative parathyroid localization, even in the case of ectopic glands or coexisting thyroid pathology. The weight of the pathological gland is a significantly limiting factor.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

THE ROLE OF PROINFLAMMATORY CYTOKINES INTERLEUKIN 1-Β AND TUMOR NECROSIS FACTOR-Α IN DIAGNOSTICS OF PUBERTAL MENORRHAGES AGAINST THYROID PATHOLOGY

Introduction. During puberty, the reproductive system is vulnerable to the influence of any adverse factors that lead to a disorder of its functional state and to menstrual disorders in particular. Among the numerous factors that provoke menstrual dysfunction is the pathology of the thyroid gland.Cytokines are known to be involved in all aspects of innate and acquired immunity, including the activation of growth and differentiation of immunocompetent cells, inflammation and restoration of the function of the affected organ. Cytokines are characterized by the action of preventing the interaction of cells of the immune, hematopoietic, endocrine and nervous systems. Cytokines of the first generation are conditionally distinguished, which are produced by cells of nonspecific anti-infective protection. The main pro-inflammatory cytokines are IL-1β, IL-2, IL-6, interferons, TNF-α and others. The main factor of inflammatory reactions is multifunctional IL-1β. Tumor necrosis factor-alpha (TNF-α) is a pro-inflammatory cytokine, one of the central regulators of factors and mechanisms of innate resistance. It has many biogenic effects, most of which are similar to the action of IL-1β.Considering the above exactly IL-1β and TNF-α to study their concentration in the blood of adolescent girls with pubertal menorrhagia has been the basis of immunological studies.The aim of the study. Assessment of cytokine status in girls of pubertal age against the background of concomitant thyroid pathology.Material and methods. We examined 70 adolescent girls with pubertal menorrhagia who were treated in the gynecological department of the Chernivtsi Regional Perinatal Center. The girls were divided into two groups: I (main) included 30 adolescent girls diagnosed with pubertal menorrhagia on the background of concomitant thyroid pathology, II group (comparison) - 40 adolescent girls diagnosed with pubertal menorrhagia. Control group III - 25 practically healthy adolescent girls. Pro-inflammatory cytokines, namely interleukin 1-beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) were studied once, after inclusion of patients in the study, by enzyme-linked immunosorbent assay based on a solid-phase ‘sandwich’ variant using mono- and polyclonal antibodies to IL-1β and TNF-α. The tubes with the serum samples were closed with lids and stored in the freezer until analysis at -20 °C.Statistical processing of the material was carried out using the computer program STATISTICA and Microsoft Exel Windows, StatSoft® Inc.The design of the study and all methods used in this study were reviewed and approved by the Bioethics Committee of the Higher Educational Institution “Bukovinian State Medical University” (protocol No. 1, dated 24.01.2011). Research work “Prevention, diagnostics and treatment of perinatal and reproductive system disorders of women and adolescent girls” (№ 201110Н state registration number 0111U006499. Term of realization: 02.2011-12.2015.)Results of the study. The obtained results of the study of the cytokine cascade showed that upon admission to inpatient treatment and examination in the blood of adolescent girls with pubertal menorrhagia without concomitant pathology, the concentration of IL-β increases significantly (by 60.61%) and a tendency to increase (4.09 times) the concentration of TNF-α in the peripheral blood of the examined patients is formed. However, the results of clinical and laboratory examinations obtained during admission for inpatient examination and treatment of adolescent girls with pubertal menorrhagia associated with thyroid pathology showed that patients have a steady tendency to decrease the concentration of IL-1β by 6.96% and TNF-α - by 1.48 times. It was found that the pathology of the thyroid gland contributes to the inhibition of immunocompetent cells production of IL-1β by 1.66 times, TNF-α by 6.04 times.Conclusion. Pathology of the thyroid gland leads to a decrease in immunoregulatory function due to a decrease in the concentration of some important proinflammatory cytokines (IL-1β and TNF-α).

Surgical management of primary hyperparathyroidism

Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia due to inappropriate parathyroid hormone (PTH) secretion mostly caused by a single adenoma. Clinical manifestations vary and include bone loss (osteopenia, osteoporosis), kidney stones, asthenia and psychiatric disorders. In 80 % of cases PHPT is asymptomatic. Secondary causes of elevated PTH such as renal insufficiency and/or vitamin D deficiency should be excluded, and 24-hour calciuria should be measured to rule out familial hyocalciuric hypercalcemia. Surgery requires radiological tests: a cervical ultrasound to exclude concomitant thyroid pathology and a functional examination (Sestamibi scintigraphy or F-choline PET scan). Management should be discussed in a multidisciplinary team. Treatment is surgical and can also be offered to asymptomatic patients.

Primary Hyperparathyroidism: Is Image Localization Alone Sufficient to Ensure Long-Term Cure in Unifocal Disease?

Advances in imaging have facilitated precise preoperative localization and focused resection of hyperfunctional parathyroids in primary hyperparathyroidism (PHPT). Combining imaging techniques or a "dual" approach, when concordant, improves adenoma-localizing accuracy above individual modalities. This study sought to assess biochemical cure and failure rates (persistence or recurrence) of surgery directed by dual imaging alone in PHPT. This observational, single-center analysis comprised 31 patients diagnosed with PHPT and imaged with both ultrasound (USG) of theneck and sestamibi scintigraphy. The extent of surgery was based solely on inter-modality concurrence for adenoma localization; imaging-concordant patients underwent focused parathyroidectomy, whereas discordant patients necessitated neck exploration (with extent altered according to scintigraphic lesion lateralization). No intraoperative localizing adjuncts were used. Twenty-three patients had concordant imaging, of which 19 underwent focused exploration, with sensitivity and positive predictive value (PPV) for dual imaging of 100% and 95.7%, respectively. The overall sensitivity and PPV were 92.9% and 89.7% for USG aloneand 100% and 93.6% for scintigraphy, respectively. The mean age and prevalence of thyroid disease were significantly higher in the discordant group. All patients achieved postoperative normocalcemia. There were no cases of persistent or recurrent hyperparathyroidism on follow-up. In the imaging-concordant setting, focused surgery may be safely performed with the omission of other adjuncts for localization. Older age and concomitant thyroid pathology predispose to discordant imaging and are risk factors for surgical failure when attempting an image-directed approach. Neck exploration is an alternative in these patients with excellent cure rates and acceptable morbidity.

Prediction of unfavorable course of heart failure in patients with concomitant thyroid pathology

The aim — to determine the predictors of unfavorable course of heart failure (HF) with account of thyroid status of patients.
 Materials and methods. A comprehensive examination involved 381 patients with HF, developed against the background of coronary heart disease (CHD) after infarction cardiosclerosis. All patients were hospitalized in Cardiology department due to HF decompensation. From them, 57.22 % had comorbid thyroid pathology (TP): 92 (24.15 %) non­toxic goiter (NG) and 126 (33.07 %) autoimmune thyroiditis (AIT). 142 patients (37.3 %) were diagnosed with low triiodothyronine syndrome (LT3S), and 26 (6.82 %) were diagnosed with subclinical hypothyroidism. The results of the study were processed using the statistical package of IBM®SPSS® Statistics, 20.0 and MedCalc, 16.4 (free version). To identify adverse factors for the course of HF in patients with concomitant TP in comparison with patients without this comorbidity, a regression analysis of Cox (proportional risk model (Cox proportional hazards model)) was used. Kaplan­Meyer graphs were constructed.
 Results. The prognostic factor was calculated based on the data of Cox’s regression analysis. With account of β-coefficients of the variables included in the model, the Cox regression equation was developed, which determines the probability of rehospitalization (RH) of HF patients within 24 months. During the ROC analysis it was found that the RH risk in patients with HF due to decompensation of the disease increases when reaching the optimal distribution point for the value of HR > 0.104 (sensitivity — 51.61 %, specificity — 96.47 %, p < 0.0001). The RH risk chance ratio for 2 years was 21.60 (6.34 — 73.63), χ2 = 31.543; p = 0.0001). Repeated ROC analysis revealed that in patients with HF in combination with TP, the risk of RH due to decompensation of the disease increases when reaching the optimal distribution point for the value of HR > 0.043 (sensitivity — 80.77 %, specificity — 74.00 %, p < 0.0001). GHG risk chance ratio for 2 years = 11.95 (3.74 — 38.21), χ2 = 18.35; p = 0.0001). The use of ROC­analysis in the group of patients with CH without TP did not allow to establish a probable prognostic value of the HR index. The model of predicting the adverse course of HF in patients with TP was tested on a separate group of 66 patients with HF against the background of coronary heart disease, which was not included in the development of Cox prognostic regression model. These groups did not differ in age, sex, TP and RH frequency. The sensitivity of the specified value of the coefficient was 86.36 %, specificity = 78.57 %. The prognostic value of the positive result was 86.4 %.
 Conclusions. The cumulative rehospitalization risk in patients with HF against the background of coronary heart disease with concomitant TP is higher compared to patients without this comorbid pathology. The risk is highest in patients with concomitant emergency situations. The high risk of unfavorable HF course in patients with comorbid TP was stipulated by presence of the low triiodothyronine syndrome. According to Cox regression analysis, the following predictors that cause an unfavorable HF course in patients with concomitant TP were defined: levels of low­density lipoprotein cholesterol, interleukin­4 and free triiodothyronine. The risk of unfavorable HF course increases with the value of the hazard ratio: for the regression model > 0.043 (OR = 11.960).

Preoperative parathyroid localization. Relevance of MIBI SPECT-CT in adverse scenarios

PurposeSelective parathyroidectomy, the treatment of choice for primary hyperparathyroidism, requires precise preoperative localization. Our purpose was to compare the accuracy and concordance of pre-surgical MIBI parathyroid scintigraphy and ultrasonography, as well as to assess the relevance of hybrid acquisition (SPECT/CT) in compromised circumstances: low-weight or ectopic adenomas, coexisting thyroid disease and re-interventions. MethodsThe study included 223 patients with primary hyperparathyroidism operated in a single Surgical Unit from August 2016 to March 2021. Preoperative ultrasonography and double-phase MIBI were performed with early SPECT/CT acquisition. A minimally invasive surgical approach was initially attempted, except in patients with concomitant thyroid surgery or multiglandular parathyroid disease. ResultsSelective parathyroidectomy was accomplished in 179 patients (80.2%); cervicotomy and/or thoracoscopy in 44. Removal of the parathyroid lesion was achieved in 211 patients (94.6%), corresponding 204 (96.7%) to adenomas (37 ectopic). The cure rate was 94.2%. Preoperative MIBI SPECT/CT showed higher sensitivity and accuracy (84%; 80%) compared to ultrasound (72%; 71%), being more precise in defining the exact anatomical location (75.8% vs 68.7%). These differences reached statistical significance in ectopic glands. The existence of concomitant thyroid pathology did not decrease the sensitivity of SPECT/CT (84.2%). Mean parathyroid weight was 692.2mg (95%CI: 443.5-941) in MIBI-negative cases and 1145.9mg (95%CI: 983.6-1308.3) in MIBI-positive (p=0.001). Re-intervention was successful in the 8 patients with previous surgery. ConclusionMIBI SPECT/CT presents greater sensitivity, accuracy and anatomical precision than ultrasound for preoperative parathyroid localization, even in the case of ectopic glands or coexisting thyroid pathology. The weight of the pathological gland is a significantly limiting factor.

The Diagnostic Value of Contrast Enhanced Ultrasound for Localization of Parathyroid Lesions in Primary Hyperparathyroidism: Comparison With Color Doppler Ultrasound: Comparison With Color Doppler Ultrasound.

Preoperative localization of pathological parathyroid glands with imaging is essential for focused unilateral neck exploration and minimally invasive techniques. Recently published studies suggested that contrast-enhanced ultrasonography (CEUS) had high accuracy in the localization of hyperfunctioning parathyroid glands, with a general increase in the sensitivity as compared to conventional sonography. The purpose of this study was to determine the usefulness of CEUS in the localization of parathyroid lesions relating to surgical and histopathological data, in comparison to color Doppler ultrasound (CDUS), in the same series of patients. Records of 142 patients who underwent parathyroidectomy were retrospectively examined comparing imaging and intraoperative/histopathologic findings. The overall sensitivity of CEUS was 77.6% compared with 74.6% for CDUS, although no significative differences were found (P= .516). Conversely, CDUS has shown higher sensitivity than CEUS in the group of patients with associated thyroid pathology but there was no statistical difference (P= .529). The sensitivity for detection of multiple adenomas was the same for both procedures. We found no significative superior sensitivity of CEUS also in case of concomitant thyroid pathology and multiple glands disease.

Особливості перебігу цукрового діабету 2-го типу у поєднанні з гіпотиреозом

Вступ. Останні десятиліття характеризуються значним збільшенням частоти захворювань органів ендокринної системи зі зміною структури, насамперед випадків поліендокринопатій, особливе місце серед яких займають поєднання цукрового діабету (ЦД) і тиреопатій. Збільшення частоти поєднання ЦД 2-го типу з гіпотиреозом впливає на особливості клінічного перебігу такої патології, залишається актуальною проблемою сучасної медичної науки. Мета дослідження: вивчення частоти гіпотиреозу у хворих на ЦД 2-го типу та встановлення клінічних особливостей перебігу ЦД 2-го типу у поєднанні з гіпотиреозом. Матеріали і методи. Проведено обстеження 179 хворих на ЦД у поєднанні з первинним гіпотиреозом, у тому числі 64 хворих на ЦД 1-го типу і 115 хворих на ЦД 2-го типу. Групу порівняння становили 62 хворі на ЦД без гіпотиреозу (з них 27 — із ЦД 1-го типу, 35 — із ЦД 2-го типу). Функціональний стан щитоподібної залози (ЩЗ) оцінювали за допомогою визначення базальних концентрацій тиреотропного гормона і вільної фракції тироксину. Результати. Встановлено, що пацієнти із ЦД 2-го типу та гіпотиреозом належали до більш старшої вікової категорії, ніж пацієнти з ЦД 1-го типу та гіпотиреозом. Так, вік пацієнтів у групі хворих на ЦД 1-го типу з гіпотиреозом становив 35,3 ± 9,5 року та у групі хворих на ЦД 2-го типу з гіпотиреозом — 47,6 ± 11,0 року. В усіх групах хворих відсоток жінок був значно вищим за чоловіків. Виявлено вірогідні відмінності щодо показника амплітуди глікемії — його збільшення у хворих на ЦД 1-го типу з гіпотиреозом. При поєднанні ЦД 2-го типу з гіпотиреозом показники ліпідного обміну були вищими, ніж при ЦД 2-го типу без тиреоїдної патології. Це підтверджує вплив гіпотиреозу на ліпідний обмін та обумовлює підвищення ризику прогресування серцево-судинних ускладнень за наявності двох захворювань. Висновки. Серед обстежених хворих гіпотиреоз траплявся у 2,4 раза частіше при ЦД 2-го типу, ніж при ЦД 1-го типу, що свідчить про більше число чинників ризику розвитку супутньої автоімунної патології за умов метаболічних порушень при ЦД 2-го типу. Інсулінорезистентність та гіперінсулінемія, що відзначаються при ЦД 2-го типу, сприяють проліферативним процесам, у тому числі й у тканині ЩЗ, а більш старший вік хворих на ЦД 2-го типу сприяє прогресуванню інволютивних змін і подальшому розвитку гіпофункції ЩЗ. Рекомендується обов’язкове комплексне обстеження хворих на ЦД 2-го типу щодо наявності супутньої тиреоїдної патології.

Peculiarities of influence of risk factors and cardiometabolic disorders on the course of hypertension with comorbid complications

Objective — to determine the clinical features of the influence of risk factors and cardiometabolic disorders on the course of arterial hypertension (AH) with comorbid complications. Materials and methods. The study included the results of a survey of 580 patients (according to case histories) — 260 (44.8 %) female and 320 (55.2 %) male aged 20 to 88 years (mean age 59.34 ± 8.48) with AH stage II — III, who were examined and treated in the clinic of the State Institution «National Institute of Therapy. L. T. Malaya of National Academy of Medical Sciences of Ukraine” (Kharkiv). All patients had their blood pressure, body weight, height measured, fat and muscle tissue ratios evaluated, and physical activity was determined using pedometers. The indicators of distribution of adipose tissue were calculated: the percentage of fat deposits (PFD), body fat mass (BFM), fat mass index (FMI) according to known formulas. Indicators of carbohydrate, lipid and purine metabolism were evaluated. Results. The severity of the AH was associated with a lower percentage of alcohol consumption (p = 0.012), higher blood pressure levels (p < 0.001), higher functional class of chronic heart failure (CHF) (p < 0.001), more frequent detection of fasting hyperglycemia in patients (p < 0.001), the development of type 2 DM (p < 0.001) and diabetic nephropathy (p < 0.001). The markers of visceral obesity (PBF, BFM and FMI) correlated significantly with a low level of daily physical activity (p ≤ 0.002), a higher degree of AH (p ≤ 0.001), a higher functional class of CHF (p ≤ 0.001), with the presence of left ventricular hypertrophy (p < 0.001), the development of concomitant type 2 DM (p ≤ 0.001). It should be noted that in contrast to BMI, higher rates of PBF, BFM and FMI were more likely to correlate with older age, history of smoking and excessive alcohol consumption as well as the presence of concomitant thyroid pathology. Assessment of the lipid profile showed a significant correlation between BMI, BFM, FMI and the level of triglycerides (TG), very low­density lipoprotein cholesterol and with high­density lipoprotein cholesterol (HDL­C). The presence of visceral obesity was strongly correlated with triglyceride­glucose index (TyG index) (p ≤ 0,001). According to the results of the factor analysis, the severity of AH in the examined patients is primarily due to metabolic disorders associated with disorders of lipid metabolism and the development of varying degrees of insulin resistance, which in male is most strongly correlated with TG levels (r = 0.899), atherogenic index of plasma (r = 0.872), TyG index (r = 0.788), in female — with HDL­C (r = –0.770), atherogenic coefficient (r = 0.768), TG (r = 0.749). In contrast to the population of female, for male with AH there is the additional most important component of the indicators was estimated that characterizes the presence of comorbid chronic diseases of the pancreas (r = 0.754) on the background of a history of alcohol abuse (r = 0.627) and/or comorbid non­alcoholic fatty liver disease (r = 0.558). Conclusions. The severity of GC in the examined patients is primarily due to metabolic disorders associated with disorders of lipid metabolism and the development of varying degrees of insulin resistance on the background of visceral obesity.

Association of gene polymorphism with menorrhagia combined with thyroid pathology

Purpose of the study: to establish the frequency of alleles and genotypes of GP IIIa gene polymorphism in adolescent girls with uterine bleeding that is concomitant thyroid pathology and conduct a thorough genetic analysis of patients.Materials and methods. 70 teenage girls with puberty menorrhagia were surveyed. Study groups: I (main) – 30 teenage girls with puberty menorrhagia against the background of thyroid gland pathology, II group (comparison) – 40 teenage girls diagnosed with puberty menorrhagia. Control group consist of 25 almost healthy teenage girls. GP IIIa gene polymorphism (PLA1/PLA2) was studied once using PCR polymerase chain reaction.Results. A1/A2 polymorphism of the GP IIIa gene in adolescent girls with menorrhagia against the background of thyroid pathology indicates the likely prevailing frequency of individuals with “favorable” A1 allele over such with A2A2 genotype with and without pathology: in 12.3 and 9 times respectively. In adolescents without concomitant pathology A1A1 genotype was observed 11.7% more frequently than those with thyroid disease and 15.0% more often than in the control group. Distribution of genotypes of the GP IIIa gene polymorphous locus corresponded to the expected Hardy-Weinberg population balance, both in general and separately in the surveyed groups.Conclusions. In adolescents with menorrhagia without thyroid pathology A1A1 genotype occur 11.7% more frequently than in girls with thyroid diseases and 15.0% more often than in the control group. Relative frequency of A1A2- genotype is 9.2% in girls with menorrhagia and thyroid pathology, and A2A2 genotype by 2.5% over such in adolescents of comparison groups. Thus, risk factors for uterine bleeding with existing thyroid pathology in adolescent girls may depend on gene polymorphism.

Relationship between glycemic metabolism and hypothyroidism in patients with type 2 diabetes mellitus

The purpose of the work is to study the prevalence of hypothyroidism in patients with type 2 diabetes mellitus and to establish the clinical features of type 2 diabetes in combination with hypothyroidism. Materials and methods. Examination of 181 patients with diabetes in combination with primary hypo­thyroi­dism was performed, of which 65 with type 1 diabetes and 116 with type 2 diabetes. The comparison groups consisted of 64 patients with diabetes without hypothyroidism, including 28 with type 1 diabetes, 36 with type 2 diabetes. The functional state of the thyroid gland was assessed by determining the basal concentrations of thyroid-stimulating hormone and the free thyroxine. Results and discussion. Patients with type 2 diabetes and hypothyroidism had belonged to an older age group than patients with type 1 diabetes and hypothyroidism (mean age was (47.8 ± 11.4) and (35.4 ± 9.6) respectively). In all groups of patients the proportion of women significantly exceeded that of men. There were statistically significant differences in the degree of glycemia, namely, an increase in patients with type 1 diabetes with hypothyroidism. In the case of combination of type 2 diabetes with hypothyroidism, lipid metabolism was higher than in type 2 diabetes without thyroid pathology. This confirms the effect of hypothyroidism on lipid metabolism and lead to increased risk of progression of cardiovascular complications in the presence of two diseases. Conclusions. Among the examined patients, hypothyroidism occurred 2.5 times more often in type 2 diabetes compared to type 1 diabetes, which indicates a greater presence of risk factors for concomitant autoimmune pathology in metabolic disorders associated with type 2 diabetes. Mandatory comprehensive examination of patients with type 2 diabetes for concomitant thyroid pathology is recommended.

Treatment of uterine bleeding in pubertal girls without application of hormonal therapy on the background of related thyroid pathology

Pubertal uterine bleeding occupies an important place in the structure of gynecological pathology since, in the years, it can lead to persistent and irreversible changes in the process of formation of the reproductive system.The purpose of the work is to investigate the effectiveness of non-hormonal therapy in the treatment of uterine bleeding in adolescent girls against the background of concomitant thyroid pathology.Material and methods. Thirty adolescent girls with pubertal uterine bleeding were examined and treated against the background of concomitant thyroid pathology, which were treated in the gynecological department of the city clinical maternity hospital No. 1 in Chernivtsi. All examined patients also underwent a comprehensive examination to determine the level of hormones in the blood serum and to determine individual indicators of hemostasis.Results. It was established that the complex therapy used in adolescent girls suffering from pubertal uterine bleeding against the background of thyroid pathology is effective, as indicated by the positive feedback mechanism, namely the release of follicle-stimulating hormone in response to an increase in the level of estradiol in peripheral blood.Conclusion. The comprehensive treatment technique developed and used by us in adolescent girls with uterine bleeding with concomitant thyroid pathology contributes to the gradual normalization of the level of sex and thyroid hormones in the blood serum, shortens the treatment period in the hospital, and helps to normalize the overall hormonal profile of the examined girls with concomitant thyroid pathology.

Pre-operative imaging workup for surgical intervention in primary hyperparathyroidism: A tertiary referral center experience

PurposePreoperative imaging in patients with primary hyperparathyroidism provides important localization information, allowing the surgeon to perform a focused surgery. However there are no evidence-based guidelines suggesting which preoperative imaging should be used, resulting in a risk of excessive prescription of exams and waste of economic resources. The main purpose of this study was to describe our experience on the performance of various imaging techniques for the preoperative localization of abnormal parathyroid gland/s, with a focus on the sensitivity and specificity of each technique. Secondly, we carried out an analysis of the cost utility of each technique in order to determine the most clinical and cost-effective combination of localization studies. Materials and methodsRecords of 336 patients who underwent parathyroidectomy were retrospectively examined comparing imaging and intraoperative/histopathologic findings to evaluate the accuracy in parathyroid detection of each imaging technique. Costs were determined by regional health system reimbursement. ResultsWe found that the sensitivity of color Doppler US was significantly higher than SPECT (p 0,023), while the sensitivity of 4D-CT was significantly better than US (p 0,029) and SPECT (p 0,0002). ConclusionsIn experienced hands color Doppler US is a highly sensitive technique especially in patients with no thyroid diseases. In patients with concomitant thyroid pathology, the combination of US and 4D-CT represents a reliable localization technique.

Evaluation of the performance of ultrasonography and 99mTc-sestamibi scintigraphy for primary hyperparathyroidism surgery

IntroductionMinimally invasive surgery has become the standard surgical attitude in primary hyperparathyroidism. It requires precise preoperative lesion localization. The aim of the present study was to evaluate the performance of ultrasonography and 99mTc-sestamibi scintigraphy in minimally invasive surgery for primary hyperparathyroidism. Materials and methodsA retrospective study included all patients managed surgically for primary hyperparathyroidism between January 2008 and November 2017 in the University Hospital of Brest (France). Two hundred and seventy-three patients underwent ultrasonography and 99mTc-sestamibi scintigraphy. Results determined intrinsic (sensitivity and specificity) and extrinsic (positive and negative predictive values) performance on per-patient and per-gland analysis. Demographic, preoperative, interventional and cure data were compared according to ultrasonography and scintigraphy results, distinguishing 3 patient groups: concordant n=156, discordant n=99, negative n=18. ResultsOn per-gland analysis, sensitivity was 70% for ultrasound, 74% for 99mTc-sestamibi scintigraphy and 81% for associated ultrasound-scintigraphy; positive predictive values were 89%, 91% and 96%, respectively. Gland volume and concomitant thyroid pathology rates differed significantly (both p=0.003) between the 3 imaging results groups. ConclusionThe performance of associated ultrasound-99mTc-sestamibi-scintigraphy provided a positive predictive value of 96%. Combining the two techniques reduced surgical morbidity.

Factors Influencing the Sensitivity of Ultrasound and Gamma Location of the Parathyroid Adenoma

IntroductionThe treatment of choice for primary hyperparathyroidism (PHPT) when there is proper preoperative localization of the adenoma is minimally invasive parathyroidectomy. However, imaging techniques are not always able to provide the exact location. The objective is to identify potential factors that might influence the sensitivity and concordance of ultrasound (US) and 99mTc-methoxy-isonitrile parathyroid scintigraphy (MIBI-PS) and the actual location of the adenoma. MethodsWe reviewed the data of patients who underwent parathyroidectomies for PHPT. All patients had undergone ultrasound and 99mTc-MIBI scintigraphy as a preoperative location study. Multiple endocrine neoplasms, other hyperplasias and non-cervical ectopic adenomas were excluded. The sensitivity, PPV and concordance have been estimated for the location of the gland in both tests compared with the intraoperative location, using a multivariable analysis of the factors that might influence their localization capacity. Results139 patients (82% women) have been analysed. The US sensitivity was 56.7%, concordance (Kappa index) 0.387 and PPV 96.3%. The MIBI-PS sensitivity was 81.6%, the concordance (Kappa index) 0.669 and the PPV 97.4%. The factor that improved localization of the glands by US in the multivariable analysis was the absence of a concomitant thyroid pathology. The factor that improved the MIBI-PS results was a gland weight greater than 600 mg. ConclusionsUS sensitivity improves when there is no concomitant thyroid pathology. MIBI-PS sensitivity improves when the gland weight is greater than 600 mg.

Factores que condicionan la sensibilidad de la ecografía y la gammagrafía en la localización del adenoma paratiroideo

IntroductionThe treatment of choice for primary hyperparathyroidism (PHPT) when there is proper preoperative localization of the adenoma is minimally invasive parathyroidectomy. However, imaging techniques are not always able to provide the exact location. The objective is to identify potential factors that might influence the sensitivity and concordance of ultrasound (US) and 99mTc-methoxy-isonitrile parathyroid scintigraphy (MIBI-PS) and the actual location of the adenoma. MethodsWe reviewed the data of patients who underwent parathyroidectomies for PHPT. All patients had undergone ultrasound and 99mTc-MIBI scintigraphy as a preoperative location study. Multiple endocrine neoplasms, other hyperplasias and non-cervical ectopic adenomas were excluded. The sensitivity, PPV and concordance have been estimated for the location of the gland in both tests compared with the intraoperative location, using a multivariable analysis of the factors that might influence their localization capacity. Results139 patients (82% women) have been analysed. The US sensitivity was 56.7%, concordance (Kappa index) 0.387 and PPV 96.3%. The MIBI-PS sensitivity was 81.6%, the concordance (Kappa index) 0.669 and the PPV 97.4%. The factor that improved localization of the glands by US in the multivariable analysis was the absence of a concomitant thyroid pathology. The factor that improved the MIBI-PS results was a gland weight greater than 600mg. ConclusionsUS sensitivity improves when there is no concomitant thyroid pathology. MIBI-PS sensitivity improves when the gland weight is greater than 600mg.

Efficacy of Scintigraphy, Ultrasound and Both Scintigraphy and Ultrasonography in Preoperative Detection and Localization of Primary Hyperparathyroidism.

Objective: The aim of our study was to evaluate the efficacy of preoperative dual-phase 99mTc-methoxyisobutylnitrile (MIBI) parathyroid scintigraphy (PS), and ultrasound (US) in primary hyperparathyroidism (pHPT) diagnosis and compare the results with the surgical findings.Methods: Forty-five patients were enrolled in this study. Preoperative serum parathyroid hormone (PTH) levels, calcium (Ca), phosphate (P), and alkaline phosphatase (AP) levels were measured. All parathyroid patients were evaluated by ultrasonography, dual phase 99mTc-MIBI. Surgical findings were used as a reference standard.Results: Of the 45 patients included in this study, 30 were females (66.7%) with an age range between 30 years and 70 years (mean age 41± 13). The sensitivity and specificity of 99mTc-MIBI scintigraphy was 97.4% and 71.4%, respectively, while the sensitivity of ultrasound was 94.4% and specificity 44.4%. The sensitivity, specificity, and accuracy of combined scintigraphy and ultrasound was higher-97.4%, 83.3%, and 95.6%, respectively.Conclusions: The combination of MIBI and US appears promising for localizing parathyroid pathology in patients with primary hyperparathyroidism. The concordance rate is high together with a lower chance of missing concomitant thyroid pathology, which might alter the surgical approach.