Thyroid Patients Research Articles

Investigate the improvement of facial skin texture with the VISIA system after total thyroidectomy

BackgroundDuring clinical practice we have noticed that some patients with hyperthyroidism have finer skin with less wrinkles, pores, and spots after thyroidectomy, and the improvement can be observed within a few weeks after the operation. However, there is no evidence or study in the literature to proof this finding.Aim and objectiveThis study was designed to evaluate and quantify the skin characters of patients with hyperthyroidism before and after thyroidectomy.Material and methodsThis is a prospective study to include patients with hyperthyroidism who received total thyroidectomy between March 1st, 2018 and February 28th, 2019. The patients received blood test for T4 and TSH analysis and VISIA measurements for skin texture quantification, at the preoperative stage, three, and six months postoperatively. A total of 8 patients were included. Repeated measurement was used to determine the lab data and VISIA measurement changes before and after the operation. Mauchly’s sphericity test was performed to determine whether the violation of sphericity occurs, and the Greenhouse–Geisser correction was used when the violation of sphericity occurs.ResultsAll the patients were female and generally healthy without systemic medical disease except the hyperthyroidism. The T4 and TSH levels were not significantly different before and after the thyroidectomy. In terms of the skin character measurements, the wrinkles, texture, pores, UV spots, and brown spots were not improved after thyroidectomy. A trend of improvement in spots, red area, and porphyrin was noted, although not statistically significant.ConclusionsSurgical removal of the thyroid gland in patients with hyperthyroidism does not improve the skin quality and texture in examinations via the VISIA system.

The "vicious circle" of thyroid metabolism in patients with chronic kidney disease

Background. Decreased thyroid function is common in patients with chronic kidney disease. Under conditions of hypothyroidism, there is significant changes in lipid metabolism, nitrogen excretion function of the kidneys. THE AIM. To study the parameters of the functional state of the thyroid gland in patients with various stages of chronic kidney disease. Patients and methods . A one-stage cross-sectional study of patients with glomerulopathies without clinically significant diseases of the cardiovascular system with preserved EF (> 55 % according to Simpson) from April 2019 to March 2020 was carried out. The study included 270 patients. To identify subclinical hypothyroidism (SH), the TSH level was determined. Patients were divided into groups according to TSH level: low TSH, normal TSH, and subclinical hypothyroidism. In patients, the indicators of biochemical blood analysis, data from a complex laboratory functional examination of the kidneys were assessed. Results. The detection rate of SH in patients with different stages of CKD was 17.56 %. Patients with SH were significantly older than the group of patients with normal TSH levels (p=0.002). In the group of patients with subclinical hypothyroidism, anti-TPO antibodies were detected only in 9.6 % of patients. A correlation was found between GFR and free T3 in patients with 3B and 4 stages of CKD (r=0.3, p<0.05). In the group of patients with subclinical hypothyroidism, there was a decrease in total protein and albumin, an increase in daily proteinuria, a decrease in total calcium, increased inorganic phosphorus, chlorine, decreased renal transport of uric acid. Conclusion. Increased TSH levels are associated with advanced stages of CKD. The increase in TSH levels in patients with CKD is not associated with female sex and older age. In most patients with glomerulopathies, an increase in TSH levels is not an outcome of autoimmune thyroiditis. SH in CKD patients is associated with severe impairment of renal nitrogen excretion function, protein, and electrolyte metabolism.

To compare the effect of conventional radiotherapy versus concurrent chemoradiotherapy on the thyroid gland after external beam radiotherapy in head-and-neck carcinoma

Introduction: Radiotherapy-induced hypothyroidism has remained underestimated and under reported ailment, because of noninclusion of routine assessment of thyroid function test in baseline workup and during follow-up protocol, which results in failure to detect and treat a reversible cause of morbidity in significant proportion of surviving patients. Greater magnitude and duration of thyroid-stimulating hormone elevation increase the probability of progression to clinical hypothyroidism and therefore increase the potential benefit of treatment of subclinical hypothyroidism. Hence, recognizing subclinical hypothyroidism at an early stage can prevent clinical hypothyroidism and its associated morbidities. Aims and Objectives: The aim of the present prospective study was to evaluate the functional and anatomical changes in thyroid glands in patients with head-and-neck cancer treated with conventional radiotherapy (external beam radiotherapy) and concurrent chemoradiotherapy and to assess the necessity of inclusion of routine thyroid function test in the workup and follow-up protocol of these patients. Materials and Methods: A total of 98 patients were randomly allocated in two arms. In arm I, 50 patients received concurrent chemoradiotherapy and in arm II, 48 patients underwent radical conventional radiotherapy alone. Baseline thyroid function test and ultrasonography of neck along with thoroughly clinical evaluation were done for every patient and these investigations were repeated in the middle of radiotherapy treatment (after 17 #), at the end of radiotherapy treatment, 3 months after completion of radiotherapy, and after that, at every 3rd-month follow-up to determine late changes in thyroid function test and echotexture. Results: In arm I, total 60% patients developed acute hyperthyroidism while in arm II, 68.75% patients developed acute hyperthyroidism. A total of 18.36% patients were found to have subclinical hypothyroidism. At the 9th month of follow-up, 55 out of 98 patients (56.12%) developed hypothyroidism. Among 55 patients, 37 were having clinical hypothyroidism while 18 patients were having subclinical hypothyroidism (P ≤ 0.0001). Maximum number of patients, i.e. 26/98 (47.27%) developing hypothyroidism were between 51 and 60 years of age group. Addition of surgery and chemotherapy had shown no difference in thyroid dysfunction. Patients with clinical hypothyroidism required medical management while patients with subclinical hypothyroidism were kept on close monitoring. Conclusion: Recognizing hypothyroidism (clinical or subclinical) early and treating it timely can prevent associated complications which are often ignored. Hence, thyroid function tests should be done routinely that is before starting of radiotherapy, on completion of radiotherapy, and during follow-up as well.

Thyroid-stimulating hormone, leptin and insulin resistance in patients with obesity after bariatric surgery

BACKGROUND: The function of the thyroid gland effects on obesity and comorbidities. It has been proven for bariatric surgery to be the most effective in obesity treatment.
 AIM: to evaluate the dynamics of body weight, thyroid status, leptin and insulin resistance in obese patients after bariatric surgery.
 MATERIALS AND METHODS: 74 obese patients were observed after bariatric surgery (sleeve gastrectomy 42, gastric bypass - 32); initial body mass index (BMI), thyroid stimulating hormone, free T4, fasting plasma leptin, insulin and glucose were estimated; the insulin resistance index HOMA-IR was calculated. The dynamics of body weight was estimated by BMI and the excess BMI loss (% EBMIL). After 3 years of follow-up, 48 patients were examined.
 RESULTS: Subclinical hypothyroidism (SH) was detected in 36.5% of patients with high degrees of obesity. A correlation was found between BMI and TSH level (R=0.5; p=0.01). HOMA-IR was increased in most patients with obesity of the II and III degree (4.81.9 ng / ml). In the SH group, the leptin level was significantly higher than in the group with a normal TSH level of 43.07.3 ng / ml and 33.24.6 ng / ml (p=0.004). Among patients with initial SH, spontaneous reduction of TSH levels occurred in 45% patients 3 years after surgery.
 CONCLUSIONS: Postoperatively, the BMI decrease was associated with the decrease of TSH, leptin and HOMA-IR. The data obtained may reflect the effect of adipose tissue on the functional state of the thyroid gland in patients with high degrees of obesity after bariatric surgery. This seems to be extremely important for maintaining body weight.

Evaluation of the Stiffness of Thyroid Parenchyma With Shear Wave Elastography Using a Free-Region of Interest Technique in Graves Disease.

The first aim was to evaluate the stiffness of thyroid parenchyma with shear wave elastography (SWE) in patients with Graves disease (GD) and compare the elastographic values with those of asymptomatic volunteers. The second aim was to evaluate whether there was a correlation between SWE values and grayscale ultrasound (US) and laboratory parameters. In this prospective study, the thyroid gland parenchyma of 50 patients whose clinical and laboratory findings were indicative for GD and 54 asymptomatic participants with normal laboratory values was examined by SWE. Grayscale US images of the thyroid and submandibular gland were recorded. The volume of the thyroid gland was measured. Elastographic measurements were performed with a free region of interest. The quantitative SWE values (meters per second and kilopascals) of the patient and control groups were compared. A correlation analysis between the SWE values and grayscale US and laboratory parameters was performed. The median (range) SWE values of the thyroid gland in patients with GD were significantly higher than those of the control group [17.34 (12.58-56.15) versus 12.05 (7.72-23.67) kPa and 2.28 (1.83-4.12) versus 1.92 (1.55-2.61) m/s; P < .001 for both comparisons]. When 14.5 kPa or 2.115 m/s was designated as the cutoff value, GD could be diagnosed with a high sensitivity and specificity. We showed a negative weak correlation between the SWE values and parenchymal echogenicity in the GD group. Shear wave elastography can be used as an effective imaging method with high sensitivity and specificity rates in the diagnosis of GD.

Effect of lithium carbonate on the function of the thyroid gland: mechanism of action and clinical implications.

Lithium carbonate, a drug known for more than 100 years, has been successfully used as a psychiatric medication. Currently, it is a commonly used drug to treat patients with unipolar and bipolar depression, and for the prophylaxis of bipolar disorders and acute mania. Lithium salts may cause the development of goiter, hypothyroidism, or rarely hyperthyroidism. The present review examined the current state of knowledge on the effect of lithium carbonate on the thyroid gland. The Pubmed database and Google Scholar were searched for articles related to the effects of lithium therapy on the thyroid gland function published up to February 2020. Studies that examined the mechanism of action of lithium at the molecular level, including pharmacokinetics, and focused on its effects on the thyroid gland were included. Lithium as a mood-stabilizing drug has a complex mechanism of action. Because of the active transport of Na+/I- ions, lithium, despite its concentration gradient, is accumulated in the thyroid gland at a concentration 3 - 4 times higher than that in the plasma. It can inhibit the formation of colloid in thyrocytes, change the structure of thyroglobulin, weaken the iodination of tyrosines, and disrupt their coupling. In addition, it reduces the clearance of free thyroxine in the serum, thereby indirectly reducing the activity of 5-deiodinase type 1 and 2 and reducing the deiodination of these hormones in the liver. Taken together, this review provides recommendations for monitoring the thyroid gland in patients who require long-term lithium therapy. Prior to the initiation of lithium therapy, thyroid ultrasound should be performed, and the levels of thyroid hormones (fT3 and fT4), TSH, and antithyroid peroxidase and antithyroglobulin antibodies should be measured. If the patient shows normal thyroid function, TSH level measurement and thyroid ultrasound should be performed at 6- to 12-month intervals for long term.

Antibody-labeled Gold Nanoparticles Based Immunosensor for the Detection of Thyroxine Hormone.

Immunosensors are used to provide simple, quick and effective ways to detect analytes for the diagnosis of a number of diseases. This work reports on a novel optical immunosensor based on thyroxine antibody labeled gold nanoparticles (anti-T4/C-AuNPs) for the sensitive detection of the thyroxine (T4) hormone. T4 hormone is a reliable diagnostic biomarker present in the human blood serum that is necessary for normal neural development and cellular metabolism. The free T4 hormone, a major key player of the total biologically active T4 hormone, in serum regulates the patient's thyroid function. The immunosensor was synthesized by using amine functionalized cysteamine capped gold nanoparticles (C-AuNPs) of size 36 nm approximately. The T4 specific antibody (anti-T4) was covalently attached to C-AuNP by EDC-NHS (1-ethyl-3-(-3-dimethylaminopropyl) carbodiimide hydrochloride and N-hydroxysuccinimide) cross-linking chemistry. This anti-T4/C-AuNP bioconjugate was used for the analysis of the free thyroxine hormone in samples. The proposed method exhibited high performance immunosensors having a linear range of 0.52 to 65.1 pg/mL and the detection limit of 9.11 pg/mL.

Shear wave elastography in diffuse thyroid disease.

Our aim was to examine the contribution of shear wave elastography to ultrasonographic assessment in diffuse thyroid disease, specifically to evaluate the stiffness of the thyroid gland in diffuse thyroid disease and compare it with healthy controls. A total of 46 patients with diffuse thyroid disease were examined clinically, by conventional ultrasound, and shear wave elastography. The conventional ultrasound parameters followed were: volume, margin quality, presence of nodules, and vascularisation. We measured the mean, minimum, and maximum stiffnesses by shear wave elastography. Results were correlated with values in 128 healthy subjects. Patients with diffuse thyroid disease had significantly higher mean and maximal stiffnesses of the thyroid gland: 12.5 ± 5 kPa and 35.3 ± 12.8 kPa, respectively, and lower minimal stiffness: 0.5 ± 0.6 kPa than the healthy control group with mean, maximal, and minimal values of 9.5 ± 3.6 kPa, 22.5 ± 7.3 kPa, and 2.2 ± 2.1 kPa (P<0.001). Stiffness values were positively correlated with BMI and volume of the thyroid; they did not correlate with margin quality, presence of nodules nor vascularisation. Compared with healthy volunteers, thyroid glands of patients with diffuse thyroid disease had a blurred margin more frequently and the amount of nodules and vascularisation were higher. Patients with Graves-Basedow disease did not have significantly different mean, maximal, nor minimal stiffnesses than those with thyroiditis. Both mean and maximal stiffness of the thyroid gland are significantly higher in diffuse thyroid disease than in the healthy population, while minimal stiffness is lower.

Thyroid isthmus agenesis and its clinical significance in a large-scale multidetector CT-based study

ObjectiveThe purpose of this study was to estimate the incidence and clinical significance of thyroid isthmus agenesis based on multi-detector CT imaging in a large-scale study. MethodsData from 1601 patients who underwent neck multi-detector CT at our institution from January 2015 to March 2016 were included in this retrospective study. The morphology of each patient's thyroid gland was evaluated. We classified thyroid isthmus agenesis into two subgroups according to the thickness of the medial margin: clear-cut type (>4 mm) or tapering-edge type (≤4 mm). Associated thyroid pathologies were also evaluated. ResultsThyroid isthmus agenesis was present in 69 patients (41 males, 28 females), and its incidence was 4.77%. Eleven patients (0.76%) had the clear-cut type and 58 patients (4.01%) had the tapering-edge type. Papillary thyroid carcinoma was diagnosed in 4 patients (5.7% of isthmus agenesis patients). A total of 7 patients underwent thyroid function testing during the course of this study; 1 of these patients presented with borderline hyperthyroidism, and the remaining 6 were in a euthyroid state. The clear-cut type showed a statistically significant narrow gap and a high incidence of pyramidal lobes compared to the tapering-edge type. ConclusionThyroid isthmus agenesis is not a rare developmental anomaly of the thyroid gland on multi-detector CT. Based on the metastatic pathophysiology of differentiated thyroid cancer, more extended indications for lobectomy are expected in differentiated thyroid cancer patients with thyroid isthmus agenesis.

Massive Thymic Hyperplasia Secondary to Graves Disease

Graves disease (GD) has a well-known association with thymic hyperplasia, which is seen histo-logically in up to 38% of patients with GD. However, there have only been approximately 100 documented cases of Graves-associated massive thymic hyperplasia. Potential mechanisms of thymic pathology are reviewed. A 24-year-old female presented to the emergency department with dyspnea, palpitations, tachycardia, anxiety, and weight loss. She was evaluated for hyperthyroidism using labs (thyroid-stimulating hormone, free thyroxine, thyroid-stimulating immunoglobulins) and imaging (radioactive iodine uptake [RAIU] scan), leading to treatment with radioiodine. A computed tomography angiogram of the chest was also performed to evaluate for pulmonary embolism given the patient's presenting symptoms. Our patient was found to have undetectable thyroid-stimulating hormone, elevated free thyroxine (2.9 ng/dL), and elevated thyroid-stimulating immunoglobulins (399%). Diagnosis of GD was confirmed on RAIU scan. The computed tomography chest angiogram demonstrated a significant anterior mediastinal mass (7.9 × 6.9 × 6.3 cm). Treatment with radioiodine led to reduction of the mass by 76% in volume. While the patient's thyroid labs and RAIU scan were consistent with GD, the presence of massive thymic hyperplasia was atypical. However, the resolution of thymic hyperplasia after radioiodine therapy, without the use of thymectomy, was similar to other reported cases.

Study of connection between intestinal microbiota and thyroid gland in patients with diffusive euthyroid goiter

Study of connection between intestinal microbiota and thyroid gland in patients with diffusive euthyroid goiter

Thyroid hormone levels and ultrasonographic changes in thyroid gland of patients on long-term lithium treatment for affective disorders: A controlled study

Background: Although lithium is known to cause thyroid dysfunction and increased thyroid gland volume, clinical examination and biochemical assessment are fundamental to thyroid workup of patients on lithium treatment. We aimed to determine the thyroid gland volume and the thyroid hormone levels of patients who have been receiving lithium treatment for affective disorders in comparison to voluntary healthy controls. Materials and Methods: This was a cross-sectional, hospital-based observational study, performed in 43 patients on long-term lithium treatment for bipolar disorder, major depressive disorder, and schizoaffective disorder. Patients with documented continuous and adequate serum lithium levels for more than or equal to 6 months recruited consecutively underwent ultrasonographic examination of the thyroid gland. Ultrasonographic examinations were also done in all gender- and age-matched healthy controls. All cases and controls underwent biochemical thyroid function tests. Results: There were no statistically significant differences in gender (P = 0.198; χ2 = 1.654) of cases and controls. Most of the cases were married; maximum number of them unemployed and belonged to the lower socioeconomic status. Total thyroid volume was significantly greater in the lithium-treated group than the control group (9.40 ± 1.41 vs. 4.79 ± 0.45). Clinical inspection and palpation only detected goiter in six (n = 6, 13.95%) of patients on lithium and none among controls. The mean triiodothyronine (T3), mean thyroxine (T4), and mean scores for thyroid-stimulating hormone were significantly increased in patients receiving lithium therapy as compared to controls. Conclusion: It would seem wise from a clinical point of view to include ultrasonographic examination of the thyroid gland as part of the standard thyroid workup before initiating lithium treatment.

Thyroid hormone levels and Thyroid Hormone Levels and Ultrasonographic Changes in the Thyroid Gland of Patients on Long-Term Lithium Treatment for Affective Disorders: A Controlled Study.

Background:Although lithium is known to cause thyroid dysfunction and increased thyroid gland volume, clinical examination and biochemical assessment are fundamental to thyroid workup of patients on lithium treatment. We aimed to determine thyroid gland volume and the Thyroid hormone levels of patients who have been receiving lithium treatment for affective disorders in comparison to voluntary healthy controls.Methods:This was a cross-sectional, hospital-based observational study which was performed in 43 patients on long-term lithium treatment for bipolar disorder, major depressive and schizoaffective disorders. Patients with documented continuous and adequate serum lithium levels for more than or equal to 6 months recruited consecutively underwent the ultrasonographic examination of the thyroid gland. Ultrasonographic examinations were also done in all gender- and age-matched healthy controls. All cases and controls underwent biochemical thyroid function tests.Results:There were no statistically significant differences in gender (P = 0.198; Chi-square = 1.654) of cases and controls. Most of the cases were married, maximum number of them unemployed and belonged to the lower socioeconomic status. Total thyroid volume was significantly greater in the lithium-treated group than the controls (9.40 ± 1.41 vs. 4.79 ± 0.45). Clinical inspection and palpation only detected goiter in six (n = 6, 13.95%) of patients on lithium and none among controls. The mean triiodothyronine, mean thyroxine, and mean scores for thyroid-stimulating hormone were significantly increased in patients receiving lithium therapy as compared to controls.Conclusion:It would seem wise from a clinical point of view to include ultrasonographic examination of the thyroid gland as part of the standard thyroid workup before initiating lithium treatment.

EXENATIDE TREATMENT REDUCES THYROID GLAND VOLUME, BUT HAS NO EFFECT ON THE SIZE OF THYROID NODULES.

Exenatide is a Glucagon-like Peptide-1 receptor agonist, which is widely used for type 2 diabetes mellitus (T2DM). Limited and conflicting results are present about the effect of exenatide on the thyroid gland. The aim of this study was to evaluate the effect of exenatide treatment on structural and functional features of the thyroid gland in patients with T2DM. The study was a prospective study, performed between 2015 and 2017. The laboratory values and thyroid ultrasonography features were compared before and after exenatide treatment. The study included 39 obese diabetic patients. After inclusion to the study exenatide was started and patients were followed up for 6 months. Total thyroid volume, thyroid function tests, serum carcinoembryonic antigen (CEA) and calcitonin levels, the size and appearance of thyroid nodules were compared between baseline and after 6 months of treatment. Exenatide at a dose of 5μg bid was started, increased to 10 μg bid after 4 weeks. We found a statistically significant decrease in thyroid volume (p=0.043) and serum thyroid stimulating hormone (TSH) levels (p=0.007), whereas serum ATPO. ATGl, fT4, fT3, CEA and calcitonin levels did no change with 6 months of exenatide treatment. There were no significant differences in the size and appearance of the thyroid nodules with treatment. The thyroid volume decrease was not correlated with TSH, body mass index and HbA1c reduction. Exenatide treatment for 6 months decreased serum TSH levels and thyroid volume, but had no effect on thyroid nodules and serum CEA and calcitonin levels.

Sindrom iritabilnog kolona kao prva manifestacija Hašimotovog tireoiditisa

Introduction. Hashimoto's thyreoiditis has a complex effect on the gastrointestinal tract, which includes hormone receptor alteration, neuromuscular disorders, myopathies caused by intestinal wall infiltration. Case report. A 44-year-old patient appears in the family medicine clinic due to moderate pain in the lower part of the abdomen present for the past three months, which intensifies before defecation and stops immediately after defecation. He has two to four liquid stools daily in which he has not noticed the presence of mucus or blood for the past two months. He negates earlier illnesses as well as diseases relevant to heredity. Physical examination provides a neat finding. Ultrasound examination of the abdomen is within the age range. Thyroid ultrasound identifies the right flap of a 48x24x10 mm diametre with hypoechogenic calcified nodus 14x12 mm in diameter (meets the criteria of the American Thyroid Association for aspiration biopsy), left flap of 44x20x14 mm diameter. The following are the laboratory findings: TSH 7.66 mIU/l, FT4 6.42 pmol/l, TG 5080 ng/ml, calcitonin 8.94 pg/ml, TG-At 24.99 IU/ ml, TPO-At 500 IU/ml. The patient is instructed on a hygienic dietary regimen and includes spasmolytic and antidiarrheal, and referred to a nuclear medicine specialist who performs an aspiration biopsy (TBSRTC IV follicular tumor). The Oncology Consilium indicates surgery (right-sided lobectomy) with extempore verification and further follow-up. Pathohistological examination of the removed right lobe excludes the presence of malignant disease (struma coloides multinodosa glandulae thyroideae). Antidiarrheal therapy is discontinued and replacement therapy is administered (levothyroxine sodium tablets 50 mcg, qd). Subsequent proctosigmoidoscopy shows a neat finding. One year after surgery the patient is in remission of the disease. Conclusion. Diagnostic evaluation of the thyroid gland in patients with irritable colon syndrome significantly improves quality of life, reduces occupational absenteeism and health care costs.

Molecular-genetic mechanisms in development of degree of function and hyperplasia of thyroid gland of patients with nodular goiter with autoimmune thyroiditis and thyroid adenoma

Molecular-genetic mechanisms in development of degree of function and hyperplasia of thyroid gland of patients with nodular goiter with autoimmune thyroiditis and thyroid adenoma

A study to determine the incidence of carcinoma of the thyroid gland in patients treated for multinodular goiter

Background: In the population today, the presence of multi nodular goiter (MNG) is found in quite a few people and this may be due to various reasons. The patients should be thoroughly evaluated and a detailed history must be collected. Surgical treatment is offered to patients for various reasons. The objective of this research article is, to determine the incidence and the type of carcinoma of the thyroid gland in patients treated for multinodular goiter.Methods: A total of 105 patients who had multinodular goiter were studied. The study was carried out at SRM Medical College Hospital and Research Center, Kattankulathur, Tamil Nadu, India, from March 2016 to February 2019, for a period of three years. A detailed history was obtained and a thorough clinical evaluation was done. Investigations such as, complete blood count, thyroid function tests, ultrasound of the neck, and fine needle aspiration cytology were done. The patients then underwent total thyroidectomy and the operated specimens were subjected to histopathological examination (HPE). Out of the total of 105 patients that were studied, 21 patients were found to have carcinoma of the thyroid gland. The statistics were analysed using SPSS package 16.0.Results: From the results it was seen that papillary carcinoma of the thyroid gland was most commonly found in the operated specimens. The findings were compared with other studies.Conclusions: In patients with multinodulargoiter, a thorough evaluation and a detailed histopathological examination of the operated specimens must be done.

New patterns of menstrual disorders’ treatment – unification of the method

Effective treatment of menstrual cycle disorders, elimination of polypragmasia, and unification of the method in various types of menstrual disorders is an important task of modern science and practice.The aim of the study was to optimize the treatment of menstrual disorders with drugs of plant origin, by comparing the clinical efficacy of TazalokTM and Vitex agnus-castus.Design: a comparative study.Materials and methods. Under the supervision there were 60 patients aged 23–37 years with various forms of menstrual disorders, divided into two groups of 30 people, in accordance with therapy. Patients of the main group I received TazalokTM for treatment of menstrual disorders, 45 drops 2 times a day, patients II (comparison group) received 40 drops of Vitex agnus-castus 1 time per day. The course of therapy was 3 months. The main group and the comparison group were divided into two subgroups of 15 patients, in accordance with the peculiarities of the menstrual disorders. Subgroup IA of main group – patients with heavy bleeding during the menstrual period, IВ – patients with scanty menstruation. In the comparison group: IІА – heavy menstrual bleeding, IIB – meager menstrual bleeding. All patients underwent a hormonal study before and after 3 months of treatment, sonographic monitoring, evaluation of subjective complaints.Results. There was normalization of the level of steroid hormones, the thyroid gland hormones. A significant decrease in cortisol levels was in patients taking TazalokTM. Sonographic characteristics of the pelvic organs, mammary glands, and the thyroid gland in patients treated with TazalokTM showed a positive trend, the disappearance of the pathological vascularization of target organs. Decrease in complaints by 2–3 weeks of taking.Conclusion. TazalokTM is an effective medicine for the treatment of various clinical forms of menstrual cycle disorders, has a wider range of effects compared with Vitex agnus-castus.

Exosomes Expressing Thyrotropin Receptor Attenuate Autoantibody-Mediated Stimulation of Cyclic Adenosine Monophosphate Production.

Background: Exosomes or small extracellular vesicles secreted from cells are nanovesicles with a diameter of 40-150 nm, which play a number of roles in both physiologic and pathologic processes. In Graves' disease (GD), autoantibodies bind to the thyrotropin receptor (TSHR) on the surface of thyroid follicular epithelial cells and stimulate thyroid growth and thyroid hormone synthesis and secretion via cyclic adenosine monophosphate (cAMP) production. The present study aimed to confirm the existence of TSHR in exosomes secreted from thyroid cells and to define the role of TSHR exosomes in GD. Methods: Exosomes were isolated by differential centrifugation from the culture medium of the human thyroid follicular epithelial cell line (NTHY-ori 3-1) and thyroid carcinoma cell lines (8305C, 8505C, and FTC-133). TSHR expression in cell lysates and exosomes was evaluated by Western blot analysis. In order to study the function of TSHR exosomes, human embryonic kidney (HEK) 293 cells stably expressing TSHR (HEK/TSHR) were established. Using exosomes isolated from both HEK and HEK/TSHR cells, the binding capacity of the M22 human monoclonal autoantibody to TSHR exosomes and their effect on M22-mediated stimulation of cAMP production in HEK/TSHR cells were evaluated. As a positive control for the functional assay, human recombinant TSHR chimera protein capable of binding to TSH was used. Results: TSHR was detected in exosomes from cancer cells as well as normal epithelial cells. An in vitro binding assay showed that alkaline phosphatase-labeled M22 bound to TSHR exosomes in a dose-dependent manner. M22 dose-dependently stimulated intracellular cAMP production in HEK/TSHR cells. The addition of exosomes from HEK/TSHR cells but not those from parental HEK cells significantly ameliorated cAMP production stimulated by treatment with M22 in HEK/TSHR cells. A decoy effect similar to TSHR exosomes was observed for human recombinant TSHR chimera. Conclusions: The results suggest that exosomes expressing TSHR may be secreted from normal and cancerous thyroid cells. In the thyroid gland of patients with GD, TSHR exosomes may exert a decoy effect by sequestering autoantibody, thereby ameliorating autoantibody-mediated activation of thyroid function.

Hydatid cyst of the thyroid gland with tracheal fistula: A case report and review of the literature

Hydatid disease, also known as echinococcal disease, is a zoonotic disease caused by Echinococcus infection. Hydatid cysts of the thyroid are rare. The present case study reports on a patient with hydatid cyst in the thyroid with tracheal fistula. A 54-year-old male patient without any history of exposure to farm animals was hospitalized due to fever and productive cough with occasional hydatid daughter cyst. The patient was diagnosed with a hydatid cyst of the thyroid gland with tracheal fistula by relevant examination. An operation was performed to remove the hydatid cyst and to repair the fistula. The patient took oral albendazole after surgery to prevent hydatid recurrence. Operative recovery was uneventful and the patient resumed his normal activities. Prompt diagnosis and an appropriate surgical treatment prevented a potentially fatal outcome. Furthermore, the characteristics of thyroid cystic echinococcosis, and its diagnosis and treatment in the present case and other cases reported in the literature were summarized and reviewed. Although the thyroid gland is rarely affected, hydatid cyst disease should be considered as a differential diagnosis of cystic lesions of the thyroid gland in patients living in regions where hydatid cyst disease is endemic.