Vol 12, No 1 (2016)

De Gustibus
Trust but verify, or once again about evidence based medicine
Gerasimov G.A.

In everyday life doctors have to verify whether they can trust certain diagnistic procedures and treatment methods. There are different study types that vary in terms of their validity. This article reviews application of famous approach "trust but verify" to the selection of medical literature.

Clinical and experimental thyroidology. 2016;12(1):6-10
Editorial note
Discussion about European Thyroid Association guidelines on diagnosis and treatment of endogenous subclinical hyperthyroidism
Fadeyev V.V.

The article discusses European Thyroid Association guidelines on diagnosis and treatment of endogenous subclinical hyperthyroidism.

Clinical and experimental thyroidology. 2016;12(1):11-15
Review of literature
Role of thyroid hormones and iodine consumption in the ontopathogeny of various diseases: focus on interactions with glucocorticoids and some endocrine disruptors
Goudochnikov V.I.

Bibliographic mini-review is presented on participation of thyroid hormones in programming / imprinting phenomena during perinatal development, as well as on their interactions with glucocorticoids and some environment-polluting endocrine disruptors causing an increase in predisposition to several diseases in adult state and even in senile period. Besides, insufficient content of iodine was registered in pharmaceutical preparations with vitamins and microelements for consumption during gestation and lactation, contributing to higher risk of subclinical hypothyroidism. Finally, an attempt was made to attract more attention to possible existence of unidentified metabolic inhibitor that can interfere in the regulation of thyroid functions in aging.

Clinical and experimental thyroidology. 2016;12(1):16-21
Original Studies
Prophylactic thyroidectomy results among RET germline mutation bearers in families with hereditary forms of medullary thyroid cancer
Polyakov V.G., Shishkov R.V., Ilyin A.A., Viktorovna S.N., Ivanova N.V., Pimenov R.I., Kozlova V.M., Amosenko F.A., Lubchenko L.N., Kazubskaya T.P., Pavlovskaya A.I., Bleznukov O.P., Koshechkina N.A., Mikhaylova E.V., Panferova T.R., Matveeva I.I., Serebryakova I.N., Mikhaylova S.N., Medvedev V.S., Isaev P.A., Rumyantsev P.O., Abrosimov A.U., Kalinchenko N.U.

Genetically caused medullary thyroid cancer (MTC) is associated with unfavorable survival prognosis, so it makes necessary to develop new diagnostic techniques to reveal pre-clinical stage of disease as well as to introduce into clinical practice the effective method of tumor prevention. The article represents first in Russia summary clinical experience of prophylactic thyroidectomy have been executed in the period 1998 – 2015 yeas among ten bearers of RET gene germlinemutation in families with hereditary disease including syndrome MEN2A and familial MTC.

Aim: to evaluate the results of surgical treatment of asymptomatic carriers of germinal mutations in the RET gene.

Materials and methods. In the period from 1998 to 2015, in two centers: N.N. Blokhin Russian Cancer Research Center, Moscow and A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre, Obninsk was conducted prophylactic surgical treatment in 10 patients – asymptomatic carriers of germinal mutations in RET. Age of patients – from 2 to 23 years old. 9 patients – from families with the syndrome of multiple endocrineneoplasia type 2A (MEN2A), one – with the family of MTC. According to genealogy in 9 families of patients there have been cases of death from MTC or pheochromocytoma (PC). In all cases, surgical treatment was performed in a volume of TE, two patients additionally performed lymph node dissection VI level. The observation period after surgery ranged from 6 months to 16 years.

Results. DNA diagnostics in 8 patients identified a mutation in exon 11, in one case – in exon 10 and one patient had revealed two mutations in exons 13 and 14. The age of patients ranged from 2 to 23 years. Basal calcitonin level was elevated in 7 of 10 patients. Such prophylactic TE in 2 patients was supplemented by selective lymph node dissection. Histological examination of the removal of the thyroid gland (TG) revealed foci of medullary cancer in 6 of 10. At 2 patients revealed a C-cell hyperplasia and at 2 patients were found signs of the well expressed and weakly expressed sclerosis in thyroid tissue. The earliest age to identify MTC was a child 3 years old, mutations in codon 634, from a family where relatives observed for aggressive MTC. In the course of follow-recurrence was detected in one patient, a child of 15 years, a similar mutation carrier.

Conclusion. In view of the risk of MTC developing identifying a mutation in RET gene and preventive TE should be carried out as soon as possible. The high risk of MTC developing in RET-gene positive subjects was confirmed in this study (6 cases of cancer from 10 patients).

Clinical and experimental thyroidology. 2016;12(1):22-33
Assessment of the provision of iodine supply to pregnant and lactating women in Kyrgyzstan
Sultanalieva R.B., Beishekeyeva G.I., Gerasimov G.A.

Aim. To determine the effectiveness of the implementation of the National Program for the Prevention of Iodine Deficiency Disorders in the Kyrgyz Republic for 2010–2014, the iodine sufficiency of the country’s population and the main risk groups – pregnant and lactating women – was assessed.

Methods. 1815 samples of dietary salt have been examined for iodine content through an iodometric titration method at the level of production and sale and in public catering. Urinary iodine was assessed among 139 pregnant women and 151 lactating women through a cerium arsenit method at the laboratory of the Kazakh Academy of Nutrition, which is involved with a Global network on quality control EQUIP.

Results. It was determined that 76.6% of salt was supplied by local enterprises and 23.4% of salt was of foreign origin. The iodine content was below 25 mg/kg in 55% of salt samples; in 2% of salt samples the iodine content was more than 55 mg/kg, and only in 43% of salt samples the iodine content corresponded to GOST (40 ± 15 mg/kg). The average iodine content in salt samples collected from the households of pregnant and lactating women was 19.8 mg/kg, which is twice lower than the standard prescribed by GOST (40 mg/kg), and in 2/3 of salt samples iodine content was below the threshold level of 25 mg/kg. The median of urinary iodine among pregnant women was 103 mg/l, and among lactating women – 91.6 mg/l, which is indicative of inadequate iodine provision.

Conclusion. Current measures to improve the quality of iodized salt in Kyrgyzstan are insufficient.

Clinical and experimental thyroidology. 2016;12(1):34-37
Possibilities traditional and liquid-based cytology combined with immunocytochemical detection of some molecular markers in the preoperative diagnosis of well-differentiated thyroid cancer
Berjozkina I.S., Saprina T.V., Zima A.P., Isaeva A.V., Latipova V.N., Mukhamedov M.R., Bazilevich L.R., Popov O.S., Kasojan K.T., Brynova O.V., Brazovskaya N.G.

Aim. To establish the diagnostic value of liquid and traditional cytological diagnosis with immunocytochemical (ICC) detection proteins (galectin-3, nucleophosmin, Ki-67) in the preoperative diagnosis of well-differentiated thyroid cancer and analysis of the effect of the autoimmune process in the thyroid gland in the diagnostic accuracy.

Materials and methods. The traditional liquid-based cytology was performed on 107 samples and immunocytochemistry performed on 56 samples with histological findings: colloid goiter in 24 cases, 4 cases of Hashimoto’s thyroiditis, 4 cases of follicular adenoma, 22 cases of papillary cancer.

Results. The results of a comparison of cytological and histological findings. The results of studies of diagnostic accuracy expression of galectin-3, nucleophosmin, Ki-67 for the diagnosis of thyroid cancer. A formula was developed to help determine the presence of malignancy in thyroid with high accuracy.

Conclusion. The diagnostic accuracy of the method of liquid-based cytology is higher than the traditional method of cytology. ICC expression of Ki-67 method has 81.8% of sensitivity and 100% of specificity for the preoperative diagnosis of thyroid cancer. Conjoint definition HS Ki-67 and liquid-based cytology increases the sensitivity and specificity of the diagnosis of well-differentiated thyroid cancer preoperative to 100%. There no detected relations between the expression of galectin-3, NFM, Ki-67 and the presence an autoimmune process in the thyroid.

Clinical and experimental thyroidology. 2016;12(1):38-45
Case Report
A rare germline mutation c.2752 A>G (p.M918V) in the RET protooncogene in a patient with medullary and papillary thyroid carcinomas in cervical lymph node metastases: a case report and review of the literature
Amosenko F.A., Khvostovoy V.V., Shchagina O.A., Polyakov A.V.

We report a rare germline RET mutation c.2752 A>G (p.M918V) found in a 62-year-old man with synchronous medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) (follicular variant) in cervical lymph node metastases with significant predominance of MTC. DNA sequencing of six exons (10, 11, 13–16) of the RET protooncogene from peripheral blood leucocytes was performed to exclude hereditary MTC in our patient. Postoperative CT was 20 pg/ml (N = 2–6 pg/ml). Pheochromocytoma and hyperparathyroidism were excluded. Genetic analysis of first-degree relatives showed that one of them, the healthy eldest son (37 y.o.), was a carrier of rare ATG>GTG heterozygous mutation at position c.2752 of the protooncogene RET. A 96-year-old mother of the patient and his younger son have not this mutation. The proband`s father was not available. The mutation was not revealed in 100 unrelated normal individuals. The clinical history is presented.

Clinical and experimental thyroidology. 2016;12(1):46-52

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