Diffuse Nontoxic Goiter Research Articles

Prognostic factors for the development of obstetric and perinatal pathology in pregnant women under conditions of iodine deficiency

According to the World Health Organization (WHO), iodine deficiency is the main cause of mental retardation in children, and at the same time, it significantly affects the pathological course of pregnancy and childbirth. The problem is complicated by the fact that more than 100.000 children with cretinism are born annually in the world. In recent years, there has been a significant increase in endemic thyroid diseases in Ukraine, the main cause of which is insufficient iodine consumption. Iodine deficiency conditions are aggravated by socio‑economic, ecological and radiological factors, while at the same time mass and group iodine prophylaxis is carried out improperly on the state level. Objective. To determine prognostic factors for the development of obstetric and perinatal pathology in pregnant women under conditions of iodine deficiency. Materials and methods. To compile a diagnostic table of prognostic factors of the threat of miscarriage, the analysis has been performed of 185 cases of threatened abortion (111 in the first trimester, 56 in the second, 18 in the third) and 223 control observations (without the threat of miscarriage). A diagnosis was considered as confirmed if it was established using all applicable methods of examination of pregnant women. Results. The risk factors of the occurrence of perinatal pathology include hypothyroxinemia (DC=–2.5) and ioduria in pregnant women less than 100 mg/l (DC=–1.9). In the intranatal period, a negative impact is exerted by the lack of coordination and weakness of labor activity (DC=–8.1). Levels of thyroid‑stimulating hormone (TSH) in umbilical cord blood >10 mIU/ml (DC=–4.6) are the prognostically favorable factors for the postnatal adaptation of the newborn, especially TSH levels >20 mIU/ml (DC=–8.3). Conduction of iodine prophylaxis (DC=7.7) and ioduria in pregnant women 200—400 mg/l (DC=5.1) contribute to the improvement of perinatal outcomes. Conclusions. A retrospective review of the prognostic significance of the diagnostic table in 188 patients with diffuse nontoxic goiter revealed its sensitivity (76%) and specificity (68%). On the basis of the conducted research, we established risk factors for the development of obstetric and perinatal complications, and assessed their informativeness. The developed algorithm is represented by a diagnostic table for the prediction of complications of pregnancy, childbirth and adverse perinatal outcomes in women with endemic thyropathies.

APPLICATION EFFICIENCY OF THE TREATMENT IMPROVED METHOD OF ACUTE ODONTOGENIC PERIOSTITIS IN CHILDREN

The aim of our work – to establish the effectiveness of the improved method of treatmentof acute odontogenic periostitis in children suffering from diffuse non-toxic goiter.Materials and methods. 38 children aged 12-15 years with acute odontogenic periostitisagainst a background of diffuse non-toxic goiter were involved into the treatment andobservation. Pharmacological correction was applied in the complex of generallyaccepted treatment measures, in particular, the appointment of topical probiotic lozengesfor absorption «BioGaia Prodentis» and oral administration of the immunomodulatorydrug «Imupret» against a background of correction of the trace element supply of thechild’s body with the drug «Calcemin advance».The results. The high clinical effectiveness of the proposed method of treatment wasestablished, which was confirmed by the reduction of the treatment period to (5.3±0.26)days against (8.0±0.36) days with the generally accepted method of treatment (p<0.05)and the normalization of all protective components of oral fluid.Conclusion. The proposed method of treatment makes it possible to provide effectively thedental care to children with odontogenic inflammatory diseases, taking into account theetiopathogenetic mechanisms of the formation of the inflammatory process and preventingthe development of possible complications from the dento- maxillofacial system and thechild’s body as a whole.

Frequency and nature of thyroid pathology in children and adolescents with type 1 diabetes mellitus and its influence on sexual development

Objective — to assess the frequency and nature of thyroid gland pathology in children and adolescents with type 1 diabetes mellitus (DM 1) and to determine its impact on somatic and sexual development.
 Materials and methods. Investigation involved 117 children and adolescents with DM 1, aged from 9 to 18 years (54 boys and 63 girls), who were under observation in the clinic of the Institute of Children and Adolescents Health Care. All children underwent thyroid gland (TG) ultrasound examination. The assessments included physical and sexual development of patients, the state of carbohydrate metabolism according to the glycosylated hemoglobin (HbA1c) levels. Creation of the database and statistical processing of the results were carried out using the packages of Microsoft Excel and SPSS 17.0 statistical methods.
 Results and discussion. Thyropathies were diagnosed in 41.0 % of DM 1 patients (from the, 20.5 % had diffuse nontoxic goiter, 17.1 % autoimmune thyroiditis (AIT), 3.4 % nodules, cysts). AIT was mostly often determined in girls (22.2 %), and diffuse nontoxic goiter in boys (31.5 %). Among boys with harmonious physical development, 51.6 % had thyroid pathology. In case of sexual development abnormalities, almost half of girls (46.7 %) and a third of boys (33.3 %) had thyropathies. Thyropathies were significantly more often identified in adolescents with the DM 1 onset in childhood (71.4 %) and early puberty (80.0 %), duration of diabetes from 5 to 10 years (48.3 %), and suboptimal compensation (63.3 % in boys and 50.0 % in girls).
 Conclusions. The high frequency of thyroid pathology has been established among children and adolescents in whom DM 1 developed at the age of 4—5 years (71.4 %). It has been shown that the increased AIT risk exists in both girls and boys. A significant percentage of thyropathies among children in the early puberty period (80.0 %) was established. The obtained results confirmed the need for careful monitoring of the thyroid gland in children and adolescents with DM1, especially in the period of puberty.

THE PERIODONTAL TISSUE STATE IN CHILDREN OF THE JUVENILE AGE TAKING INTO CONSIDERATION THE GENERAL SOMATIC FACTOR

Dental morbidity in children, despite numerous preventive measures, remains very hightoday. The prevalence and severity of the clinical course of periodontal tissue diseasevary widely in Ukraine and other countries, and depends on age.Today, inflammatory diseases of periodontal tissues are considered as a reaction of theorganism to the imbalance between the microbial agent and the protective systems of theoral cavity under the influence of various exo- and endogenous factors. Microflora oftartar, plaque, dental calculus can actively interact with the tissue elements located underthe sulcus epithelium, thus triggering typical pathological processes.Objective – to determine the prevalence and intensity of periodontal tissue damages inchildren with comorbid diffuse non-toxic goitre (DNG).Materials and Methods. To determine the dynamics of changes in clinical parameterswith age, two age groups – 12 and 15 years, among them there were 180 children withDNG, and 80 somatically healthy children have been examined.Results. Examination of somatically healthy children showed the presence of periodontaltissue pathology in 62,00 % of children under examination at the age of 12 years andin 80,00 % of those at the age of 15 years (Fig.1). CCG dominated in the structure ofperiodontal diseases with detection rates ranging from 83,33 to 95,83 %.Conclusions. Regarding periodontal tissue damages by tartar as one of the leading factorsof inflammatory processes in gums and alveolar bone, the following should be noted:there is a low level of periodontal tissue damage in younger children and in somaticallyhealthy children of both ages. The incidence of hard dental deposits in adolescents withDNG is moderate, and high in case of DNG, grade II.

Thyroid homeostasis in obesity children

Background. Due to the rapid increase in the prevalence of childhood obesity in Europe in recent years, various initiatives and actions have been launched in response to this alarming tendency. Over the last decade, the question of the interaction between obesity and thyroid pathology has been the most controversial. The study was aimed to assess the state of thyroid supply in overweight children. Materials and methods. Out of 936 people, 160 people aged 7 to 18 years with overweight (OW) and obesity were selected for a detailed study. The levels of thyroid-stimulating hormone (TSH), free triiodothyronine, and thyroxine (fT3, fT4) in serum were determined by enzyme-linked immunosorbent assay. Results. More than half of the children who were selected for the study had both diffuse nontoxic goiter (DNG) both in boys and girls (51.4%) with a predominance of thyroid volume corresponding to the first degree of goiter. Only in a small number of children with OW and obesity (14 out of 105 people, 13.3%), TSH levels were shifted toward its increase (4.31–4.98μIU/ml), and when using TSH/fT4, 20 (11.5%) children showed signs of laboratory hypothyroidism with a slight predominance of hyperthyrotropinemia in boys (18.5%) compared to girls (15.6%). The frequency of TSH levels >3.0μIU/ml elevated with increasing age of patients from 12.9% among children aged 7–9 years to 16.6% in the group of patients aged 10–13 years and 15.1% in children aged 14–18 years without significant differences by gender. Children with OW and obesity were more likely to have higher TSH values than children with DNG and normal body weight. Conclusions. Diffuse nontoxic goiter is more common in children with OW and obesity (51.2%) than in children with normal body weight (21.7%). The assessment of the age of the functional state of the thyroid gland in these children did not reveal significant changes in peripheral thyroid hormones, but in 11.5% of people, TSH/fT4 ranged from 0.19 to 0.29 and 13.3% of people had signs of subclinical hypothyroidism. This indicates the need to monitor the functional state of the thyroid gland in overweight and obese children.

Содержание витаминов и микроэлементов у подростков с диффузным нетоксическим зобом с учетом потребления продуктов питания

У подростков с диффузным нетоксическим зобом (ДНЗ), проживающих в условиях легкого йодного дефицита, путем анкетирования проведен анализ рациона питания и его влияния на содержание витаминов и микроэлементов. Установлено, что недостаток в питании продуктов животного происхождения (рыбы и мяса) сопровождается снижением уровня витаминов В1, В2 и Е. У подростков с ДНЗ, использующих при приготовлении пищи йодированную соль, определяли более высокие показатели селена и витамина А. Среди них реже диагностировали зоб II–III степени.Для профилактики и лечения ДНЗ у детей и подростков, проживающих в условиях легкого йододефицита, необходимо включение в рацион питания продуктов животного происхождения, морепродуктов, а также обязательное использование йодированной соли. В случае выявления сочетанного дефицита йода, селена и витаминов, особенно при отсутствии полноценного питания, необходимо сочетанное назначение препаратов калия йодида, селена, витаминов А и группы В.

Features of physical and sexual development in school-aged children with psychosomatic disorders

Background. Monitoring of physical and sexual development indicators using standards appropriate to age and sex, especially in children with chronic diseases is the most important element of management of children and adolescents with various pathologies because it allows managing the treatment process and improving it timely. Unfortunately, these issues have not been studied enough today. The purpose of the work is to determine the influence of somatic and mental diseases on the physical and sexual development impairments in school-age children. Materials and methods. Nine hundred and thirty-five patients aged 10–17 years (boys — 441, girls — 494) with the following pathology were examined: diabetes mellitus type 1, diffuse nontoxic goiter (DNG) with various menstrual disorders (girls with abnormal uterine bleeding), and girls with hypomenorrhea syndrome (HMS), mental disorders (functional and organic), systemic connective tissue dysplasia, secondary cardiomyopathy, juvenile idiopathic arthritis (JIA), systemic lupus erythematosus (SLE). The comparison group enrolled healthy children of the same age. Results. The presence of type 1 diabetes mellitus, diffuse nontoxic goiter were proved to negatively affect the somatosexual development of school-age children and contribute to the formation of disharmonious physical development (in 32.4 % of patients with diabetes mellitus 1 and 56.6 % of adolescents with DNG) and sexual maturation. It was established that 52.4 % of girls with gynecological pathology presented with harmonious physical development. Against the background of disharmony of physical development, girls are more likely to develop menstrual irregularities such as HMS. Harmonious physical development is registered in 50.8 % of patients with JIA. 67.25 % of people with JIA have normal growth rates. Exceedance of normal and lower values are observed in girls (p < 0.05). At the stages of puberty, the most common deviations in growth and body weight were observed in early puberty (100 %), the least often — in late puberty (42.8 %). In 56.8 % of patients with SLE, harmonious physical development was registered. The most common were as follows: overweight (33.3 %), decreased growth rate (17.6 %), and weight deficit (11.7 %). Based on the frequency of SLE, it was determined that the most vulnerable were puberty (91.0 %) and prepuberty (87.5 %). The onset of SLE in late puberty occurred in 26.3 % of cases. In patients with secondary cardiomyopathies and systemic connective tissue dysplasia, no significant statistical differences in age-related parameters were found. Most patients with mental disorders had a harmonious physical development (93.6 %). Among the violations of the latter, the deficit of body weight was most often determined (19.5 %).

Role of Fine Needle Aspiration Cytology (FNAC) in Surgical Intervention of Thyroid Lesions: in Correlation with Thyroid Hormone Profile

Abstract: Background: Fine needle aspiration cytology (FNAC) of the Thyroid is over half a century old and has been shown to be superior to clinical, radionucleotide or thyroid ultrasound assessment alone. It is the most accurate, cost-effective, and simplest screening test for rapid diagnosis of thyroid nodules. Evaluation of both cytomorphological pattern and thyroid hormone profile aids in early detection of various thyroid diseases there by reducing surgical intervention. Aims and Objectives: To correlate role of thyroid hormone profile (T3, T4 and TSH) with cytology results, in various thyroid disorders like diffuse nontoxic goiter, diagnosis of solitary/dominant thyroid nodule and thyroid malignancy. To evaluate the clinical correlation with Euthyroid, Hypo and Hyperthyroid picture in various disorders. To calculate the percentage of surgical intervention for various thyroid disorders in view of thyroid profile in correlation with FNAC findings. Material and methods: All patients who underwent thyroid FNAC from July 2017 to June 2018 have been included in the study only if Thyroid profile has been done. The various lesions have been categorised as Euthyroid, Hypothyroid and Hyperthyroid as per the hormone analysis results. The FNAC findings have been reported as per the Bethesda System and classified as per the latest WHO guidelines. Results: predominantly affected gender was females (91.25%), most common affected age group was 41-50 years (30%), 88.75% were euthyroid patients, most common benign lesion on FNAC was nodular goiter (33.75%), malignant lesion was papillary thyroid carcinoma (18.75%), thyroid profile in various thyroid lesions were euthyroid.

The influence of thyroid pathology on the course of periodontal disease in children and ways to correct it (Review)

Iodine deficiency diseases constitute an important medical and social problem, since a significant part of the territory of Ukraine is characterized by biogeochemical indicators of low iodine content in the environment, which is the cause of hypothyroidism development. At the same time, there are many other factors that can trigger the thyroid disorders in children. Epidemiological studies carried out in the Carpathian region have shown that iodine deficiency of varying degrees is specific to this area. Professor M.M. Kovalev's in-depth study of the causes of goitre in Bukovyna showed that along with iodine deficiency, macro- and micronutrient deficiencies associated with certain regions play an important role. Iodine deficiency promotes goitrogenesis and decreases the secretory capacity of the thyroid gland. As a result of reduced intrathyroid iodine in the gland, diiodothyrosine synthesis decreases and monoiodothyrosine increases, the hormone ratio increases due to an increase in the more biologically active triiodothyronine. This compensates for the euthyroid state against the background iodine deficiency. An adaptive manifestation of iodine deficiency is goitre, considered being the main sign of iodine deficiency; as iodine deficiency or thyroid hormone requirements increase, goiter size increases and more severe forms of thyroopathology develop. Iodine deficiency is common in many countries of the world. The analysis of the research data has shown the multifactorial nature of the etiology and pathogenesis of periodontal diseases in children, as well as the significant impact of thyroid disorders on the condition of the human dentition. In this regard, the study of cause-effect relationships between the initial manifestations of thyroid pathology and periodontal tissue changes in children seems relevant and promising in terms of improving methods of diagnosis, prevention and treatment. Keywords: periodontium, diffuse non-toxic goitre, children.

Состояние моторно-эвакуаторной функции желудка у детей с диффузным нетоксическим зобом

Актуальность. Доказано, что почти в 2,5 раза чаще патологией органов пищеварения страдают школьники с болезнями щитовидной железы, в том числе с диффузным нетоксическим зобом (ДНЗ). Цель: изучить особенности моторно-эвакуаторной функции желудка у детей с диффузным нетоксическим зобом. Материалы и методы. Основную группу составили дети с зобом (89 человек), группу сравнения — дети (84 человека) без отклонений со стороны щитовидной железы. Проводилось многоплановое анкетирование, ультрасонографическое исследование щитовидной железы и функциональное ультрасонографическое исследование желудка. Результаты. Распространенность зоба среди детей Буковины составила 53,3 %. Частота функциональных расстройств органов пищеварения у детей обеих групп составляла 27,55 ± 2,17 %: у детей с ДНЗ — 33,9 ± 2,3 %, у детей без ДНЗ — 21,4 ± 1,3 %, p < 0,05. Нарушения моторно-эвакуаторной функции желудка установлены у 12 детей с ДНЗ (11,6 %) и 6 (8,5 %) детей без ДНЗ. Чаще всего эти нарушения регистрировались у детей с функциональной диспепсией. Выводы. Установлена достоверно более высокая частота функциональных расстройств пищеварительной системы у детей с диффузным нетоксическим зобом, в том числе нарушений моторно-эвакуаторной функции желудка. Санация соматической патологии позволит уменьшить частоту неблагоприятного течения ДНЗ у детей и подростков.

Цинк та соматостатевий розвиток підлітків

Вивчена вікова динаміка вмісту цинку (Zn) у хлопців пубертатного віку та його зміни при затримці росту та статевого розвитку. Мета дослідження: поглиблення існуючих уявлень щодо впливу дефіциту Zn на формування порушень фізичного та статевого розвитку в підлітків. Матеріали та методи. У 70 хлопців-­підлітків 10–17 років оцінено вміст Zn з урахуванням характеру соматостатевого розвитку, наявності дифузного нетоксичного зоба (ДНЗ). Підлітки розподілені на групи: 1) 20 хлопців 10–17 років із нормальним об’ємом щитоподібної залози, нормальним фізичним та статевим розвитком; 2) 17 хлопців 14–17 років із нормальним статевим розвитком та ДНЗ; 3) 15 хлопців 14–17 років із затримкою статевого розвитку (ЗСР) та нормальним об’ємом щитоподібної залози; 4) 18 хлопців 14–17 років із ДНЗ та ЗСР. Результати. Найбільший рівень Zn визначали у період власне пубертату при фізіологічному його перебігу ((16,52; 14,27–18,66) ммоль/л), що вірогідно більше, ніж у препубертатному віці ((13,53; 12,77–16,41) ммоль/л; p < 0,05) та в період пізнього пубертату ((12,59; 10,22–16,07) ммоль/л; p < 0,05). У хлопців із ЗСР ((14,41; 12,67–15,83) ммоль/л) та низьким зростом ((12,53; 8,80–15,46) ммоль/л) діагностовано зменшення рівня Zn, особливо в разі наявності в них ДНЗ ((10,03; 8,51–13,76) ммоль/л). Під час регресійного та факторного аналізу вивчено характер взаємозв’язку між антропометричними показниками, ступенем розвиненості вторинних статевих ознак і рівнем Zn, функціональним станом статевої та тиреоїдної системи. Визначена необхідність проведення вторинної профілактики та корекції дефіциту Zn із застосуванням «Цинкіту» у вигляді моно- або комплексної терапії. Висновки. Протягом пубертату змінюються показники Zn із максимальним його рівнем у період власне пубертату. Затримка росту та статевого розвитку відбувається на тлі зменшення концентрації Zn у крові. Найменший рівень Zn притаманний підліткам із ДНЗ та ЗСР. Вивчено характер взаємозв’язку між антропометричними показниками, ступенем розвиненості вторинних статевих ознак із Zn, функціональним станом статевої та тиреоїдної системи. Обґрунтовано доцільність застосування «Цинкіту» при проведенні вторинної профілактики та лікування дефіциту Zn у підлітків із порушенням соматостатевого розвитку.

Вплив дифузного нетоксичного зоба на розвиток плацентарної недостатності, перебіг гестації та пологів

Актуальність. При захворюваннях щитоподібної залози (ЩЗ), особливо за умов хронічного дефіциту йоду, спостерігаються суттєві порушення у функціонуванні системи «мати — плацента — плід», що призводить до ускладнень вагітності, пологів із загрозою здоров’ю потомства. Мета. Вивчення впливу йодиду калію в поєднанні з натрію селенітом і цитофлавіном у жінок із дифузним нетоксичним зобом (ДНЗ) для корекції порушень у системі «мати — плацента — плід» під час вагітності. Матеріали та методи. Для оцінки стану вагітних за період 2012–2017 рр. обстежено 159 вагітних жінок і їхніх новонароджених, які сформували дві групи. До першої групи увійшло 79 вагітних із ДНЗ, які через різні причини не отримували йодиду калію та інші препарати. Другу групу сформували 80 жінок із ДНЗ, які отримували йодид калію (200 мкг/добу) в поєднанні з натрію селенітом і цитофлавіном. Результати. Хронічна фетоплацентарна недостатність зареєстрована в 21,1 % випадків, причому встановлено вірогідну відмінність у її частоті в обох групах обстежуваних жінок: 27,9 % у першій групі та 14,3 % у другій групі. Рівень тиреотропного гормону (ТТГ) новонароджених, які народилися від жінок першої і другої груп, вірогідно не відрізнявся та не перевищував нормальних показників (4,72 ± 1,22 мМО/л і 2,73 ± 1,01 мМО/л відповідно). Концентрація ТТГ у крові новонароджених другої групи була на 42,2 % нижчою, ніж у новонароджених першої групи. Висновки. Про сприятливий вплив прийому йодиду калію в поєднанні з натрію селенітом і цитофлавіном під час гестації на розвиток плода свідчить статистично значуще зменшення частоти внутрішньоутробних ускладнень у другій групі в порівнянні з першою групою дослідження: хронічної фетоплацентарної недостатності (14,3 і 27,9 % відповідно; р < 0,05) і хронічної внутрішньоутробної гіпотрофії плода (13,8 і 28,6 % відповідно; р < 0,05).

Частота і структура захворювань щитоподібної залози у дітей і підлітків за даними звертання

Актуальність. Захворювання щитоподібної залози (ЩЗ) у дітей і підлітків є актуальною проблемою ендокринології. Мета дослідження — вивчити частоту і структуру захворювань ЩЗ у дітей і підлітків за даними звертання за період 2012–2016 рр. Матеріали та методи. Під наглядом у відділі дитячої ендокринології Республіканського спеціалізованого науково-практичного медичного центру ендокринології МОЗ РУз за період з 2012 по 2016 р. перебувало 213 дітей і підлітків із різними захворюваннями ЩЗ. Результати. Більшу частину хворих, які зверталися по медичну допомогу, становили пацієнти із уродженим гіпотиреозом — 94 випадки (44,1 %), далі — вузловий зоб — 35 спостережень (16,4 %), дифузний токсичний зоб — 30 пацієнтів (14,0 %), а також дифузний нетоксичний зоб I–II ст. — 19 (8,9 %), автоімунний тирео­їдит — 14 (6,5 %), багатовузловий зоб — 15 (7,0 %), гострий гнійний струміт — 2 (0,9 %), папілярна аденокарцинома — 2 (1,0 %). Пацієнтам найчастіше виконувалася тотальна тиреоїдектомія — 14 (34 %) спостережень, геміструмектомія — 10 (24 %), розширена резекція частки — 6 (14,5 %). Висновки. Частота ускладнень основних захворювань у дітей і підлітків становила: затримка скелетного розвитку — 17,8 %, затримка фізичного, статевого, розумового, мовного розвитку — 25,8 %, затримка фізичного, розумового розвитку — 20,4 %, затримка фізичного, статевого розвит­ку — 15,6 %, затримка фізичного розвитку — 14,5 %.

The Influence of Diffuse Nontoxic Goiter on the State of Protective Mechanisms of the Oral Cavity in Children.

Immunopathogenesis of inflammatory and dystrophic diseases of the tissues of the oral cavity is characterized by cellular and humoral factors of specific and nonspecific resistance, the functioning of which is determined by the overall somatic state.This study aimed to study the features of protective mechanisms of the oral cavity due to orthodontic pathology, pathology of periodontal tissues, and odontogenic inflammatory process in children with diffuse nontoxic goiter.Eighty children with diffuse nontoxic goiter aged 12-15 years with different dental status were examined. Evaluation of local immunity of the oral cavity was carried out by determining the content of sIgA, IgA, IgG, lysozyme activity, and levels of IL-1β, IL-4 by enzyme immunoassay.Immunological studies have shown that in children with diffuse nontoxic goiter, the activity of lysozyme in the oral fluid is decreased. The level of sIgА is also reduced by about 20%. Besides, there is an increase in the content of IgG and a growing trend in the level of IgА. The content of IL-1β and IL-4 in such children fluctuates more compared to somatically healthy children.In conclusion, a violation of the local protective mechanisms of the oral cavity is observed in children with diffuse nontoxic goiter. Also, the increase in the severity of dental pathology leads to increased tension of local protective and compensatory reactions.

Diffusive non-toxic goiter and purbatic course in girls

Objective of the study. To study the peculiarities of the puberty course in girls with diffuse non-toxic goiter (DNG) and justify an individual approach to prevention of its disorders.Materials and methods. Compares the features of the puberty course and state of the thyroid system in girls with DNG (main group), which was first diagnosed at 9–13 years in the prepubertal period (n = 51) and early puberty (n = 58). The comparison group consisted of 107 peers with a normal thyroid volume, harmonious physical development and physiological course of puberty. An ultrasound of the thyroid gland was performed; thyroid stimulating hormone (TSH) value, free fractions of thyroxine (fT4) and free triiodothyronine (fT3) in blood were determined, TSH/fT4 ratios and fT3/fT4 ratios were calculated in conventional units. Sexual development and puberty course were also studied.Results. An individual analysis of sexual development during the initial examination allowed us to determine its normal character in 90.0% girls with disabilities, 6.4% recorded an acceleration of its pace for 1–2 years, and only 2 girls (1.8%) 13 years old were diagnosed with a slowdown pace of puberty. Two (1.8%) 10-year old girls had inverted puberty. It was found that an earlier onset of puberty occurs with an increase in TSH and fT3 levels against the background of normal fT4. Dynamics of observation showed an increase of patients with signs of thyroid failure, which was accompanied by a delay in sexual development in 11.1% and menstrual dysfunction in 28.0% girls.Conclusion. Girls with DNG identified in pre- and early puberty increase the risk of delayed sexual development and menstrual dysfunction, which is the rationale for therapy aimed at correcting and preventing the progression of thyroid dysfunction. The feasibility of using potassium iodide and/or L-thyroxine in order to prevent violations of the puberty course in girls with DNG is substantiated

Assessment of the periodontal tissue state in the dynamics of treatment of chronic catarrhal gingivitis in children suffering from diffuse nontoxic goiter

Assessment of the periodontal tissue state in the dynamics of treatment of chronic catarrhal gingivitis in children suffering from diffuse nontoxic goiter

Diagnostic possibilities for autoimmune thyroiditis using non-invasive determination of intrathyroid iodine concentration in children

Sixty-seven children (55 girls and 12 boys) aged 5-16 years were examined. Autoimmune thyroiditis (AT) was diagnosed in 28 and diffuse nontoxic goiter (DNG) in 39. The diseases were diagnosed on the basis of case history, results of examination and palpation of the thyroid, ultrasonic findings, presence of antibodies to thyroglobulin (in AT) or their absence (in DNG), and the microsomal fraction detected by enzyme immunoassay using Boehringer Mannheim kits. AT diagnosis was confirmed cytomorphologically in all patients. Intrathyroid stable iodine (ISI) was measured by a Russian noninvasive x-ray fluorescent analyzer. ISI concentration was notably decreased in children with autoimmune thyroiditis confirmed by cytomorphological methods: below the threshold level of the method in 46%) cases and 120±10 mcg/g in 54%). This confirms a high informative value of the proposed method in this disease. Measurements of ISI in children with enlarged thyroid helps differentiate the hypertrophic form of AT from DNG: ISI concentration under 200 mcg/g is characteristic of AT, while in DNG the concentration of ISI in Moscow children is 500±40 mcg/g (M±m).

Features of the pregnancy course and state of the feto-placental complex in women with thyroid pathology

Pregnancy with thyroid pathology is a special situation that needs to be solved jointly by the gynecologist and endocrinologist. Endocrine disorders are often combined with somatic pathologythat poses additional difficulties in the tactics of pregnancy monitoring and delivery. Changes in pregnant woman with thyroid pathology differ from changes in physiological pregnancy. Objective — to determine the peculiarities of feto-placental complex functioning in patients with thyroid pathology. Materials and methods. Under observation, there were 85 women in the period from 6 to 40 weeks of gestation. The first group included 23 patients with diffuse nontoxic goiter (DNG), the second — 20 pregnant women with Graves’ disease, the third group — with hypothyroidism (n = 22). The control group consisted of 20 pregnant women without any endocrine pathology. Results and discussion. In terms of thyroid hormo­nes in women with Graves’ disease, there was a decrease in TSH levels with a higher level of free thyroxin, but in the second and third trimester, these indices did not differ from the normal against the background of treatment. The inherent disorders of homeostasis in women with thyroid diseases, even under compensa­ted conditions, lead to the development of complicati­ons of pregnancy and child­birth, among which the most frequent is the threat of interruption (77.2 %) and gestosis (63.6 %). The most pronounced complications were observed in groups of women with hypothyroi­dism and Graves’ disease. Conclusions. Clinical and laboratory signs of feto­placental insufficiency were established in 86.4 % of pregnant women with hypothyroidismaccording to the criteria of modern ultrasound and functional methods, 55 % with Graves’ disease, and 39.1 % with DNG. De­­compensated form of placental insufficiency was found predominantly in women with hypothyroidism, and reached 31.8 % of cases.

CHARACTERISTICS OF LOCAL PROTECTIVE MECHANISMS OF THE ORAL LIQUID OF CHILDREN WITH DIFFUSIVE NON-TOXIC DAMAGE

Introduction. Immunopathogenesis of inflammatory and dystrophic diseases of oral tissue sisrealized through cellular and humoral factors of specific and nonspecific resistance, the functioning of which is determined by the over all somatic state of the child's body.Aim of study. Study the features of local defense mechanisms of the oral cavity in the pathology of periodontal tissues and the odontogenic inflammatory processin children with diffuse non-toxic goiter.Materials and methods. 65 children with a diffuse non toxic goiter aged 12-15 years with different dental status were examined: healthy; patients with chronic catarrhal gingivitis; patients with odontogen icinflammatory processes. Control group sconsisted of somatically healthy children with similar dental diseases of the same age. Local oral immunity was evaluated by determining the content of sIgA, IgA, IgG by simple radial diffusion in agar according to G. Manchini (1963) using monospecific standard antisera against the immunoglobulin classes studied, lysozymeactivityby G. Gorin (1971) in modification A. P. Levitskyand A.A. Zhiginoi (1974) and levels of IL-1β, IL-4 bythe method of enzyme immunoassay.Results. Immunological studies have shown that in children with diffuse nontoxic goiter, a decrease in lysozyme activity in the oral fluid is observed both in the studied dental pathology and in healthy oral tissues. The level of sIgA also decreases by about 20%. There is an increase in the IgG content and a tendency toward an increase in the IgA level, which indicates an increase in the local immunity of the oral cavity in children with diffuse non-toxic goiter. The content of IL-1β and IL-4 in these children varies more than in somatically healthy children.Conclusion. 1. In children with diffuse non toxic goiter, there is a violation of local oral defense mechanisms, which are characterized by a decrease in sIgA, an increase in IgA and IgG, a decrease in lysozyme activity and an imbalance in pro- and anti-inflammatory cytokines. 2. An increase in the severity of dental pathology leads to an increase in the tension of local defense-compensatory reactions.

INFLUENCE OF DIFFUSE NON-TOXIC GOITER ON THE PROBABILITY OF INCREASING THE CHANCES OF COMPLICATIONS DURING PREGNANCY AND CHILDBIRTH

Diffuse nontoxic goiter is the most common form of thyroid pathology among women, which is often found during pregnancy.The aim of the study. Evaluate the probability increase the chances of complications during pregnancy and childbirth in women with diffuse non-toxic goiter.Materials and methods. A retrospective analysis of the history of labor was conducted to assess the relationship between the presence of diffuse non-toxic goiter and the occurrence of complications during pregnancy and childbirth. The estimated probability of complications in women with diffuse nontoxic goiter without disturbance functions of the thyroid gland and hypothyroidism of the thyroid gland.Results of the research. In women with diffuse non-toxic goiter, compared with persons without goiter, statistically significantly more often, there are complications during pregnancy and childbirth, accordingly, increases the chance of threat spontaneous abortion (2.77; 95% CI 2.02-3.79) and threat of preterm labor (3.44; 95% CI 2.02-5.85), occurrence of placental dysfunction (6.51; 95% CI 4.80-8.84), growth retardation of the fetus (4.65; 95% CI 2.51-8.61), preeclampsia (1.65; 95% CI 1.05-2.58), iron deficiency anemia (2.55; 95% CI 1.85-3.52), preterm labor (3.71; 95% CI 1.93-7.12), untimely discharge of amniotic fluid (1.84; 95% CI 1.36-2.49) and anomalies of labor activity (3.16; 95% CI 2.15-4.66). In women with diffuse nontoxic goiter without thyroid disturbance, in comparison with women without goiter, the chance of occurrence of placental dysfunction (4.83; 95% CI 3.45-6.77), fetal growth retardation (3.09; 95% CI 1.55-6.15), iron deficiency anemia (1.82; 95% CI 1.26-2.63), anomalies of labor activity (2.13; 95% CI 1.37-3.31), untimely discharge of amniotic fluid (1.64; 95% CI 1.16-2.31). In women with diffuse nontoxic goiter and subclinical hypothyroidism the chance of a threat of abortion (6.78; 95% CI 4.56-10.08) and preterm labor (6.53 95% CI 3.66-11.63), premature delivery (6.88; 95% CI 3.43-13.81), placental dysfunction (11.17; 95% CI 7.30-17.11), growth retardation (7.39; 95% CI 3.79-14.41), preeclampsia (2.20; 95% CI 1.29-3.74), anemia (4.10; 95% CI 2.77 -6.08),untimely withdrawal of amniotic fluid (2.20; 95% CI 1.50-3.23), anomalies of labor (5.24; 95% CI 3.35-8.19) and caesarean section (1.93; 95% CI 1.20-3.12).Conclusion. The presence of diffuse non-toxic goiter in pregnant women increases the chance of complications during pregnancy and in childbirth. The most probable chance of occurrence of complications during pregnancy and childbirth is the presence of diffuse non-toxic goiter on the background of subclinical hypothyroidism.