Background: According to the Iodine Global Network, the Russian Federation is a region of mild iodine deficiency. At present, in Russia there is no systematic monitoring of the state of iodine deficiency in the regions. Existing legislation establishes the voluntary nature of iodine prophylaxis. In this regard, the issue of studying the iodine supply of the population of the Siberian region on the example of the city of Novosibirsk is relevant.

Aim: of research is to evaluate the availability of iodine and the effectiveness of the prevention of iodine deficiency among teenagers 13-18 years old and young people 19-25 years old in Novosibirsk.

Materials and methods: The research includes representative samples of pupils from 13 to 18 years old (612 people of both sexes, 62 of them have completed a questionnaire about the use of iodized salt, urine samples do determine UIC were taken from 60 of them ) and young people from 19 to 25 years old (101 people of both sexes. They all filled out the proposed questionnaire, 27 people were identified UIC). We used such methods as questionnaires, determination of UIC, comparison of the obtained data with the results of clinical and population studies conducted in Novosibirsk in 1994-1995, 2004-2005, 2009-2010.

Results: In 2005 32.7% of adult population consumed iodized salt. In 2010, 47% of adolescence surveyed consumed iodized salt. According to a survey conducted in 2019 it was found that among adults 19-25 years old 19.8% know that they consume iodized salt. Among schoolchildren from 13 to 18 years old, 8.1% know for sure that use iodized salt. In 1994-1995 mUIC in persons of reproductive age in Novosibirsk was 47 μg / L. In 2005 mUIC in the adult population (45-69 years old) was 107 μg / L. In 2010 mUIC was 93 μg / L, UIC less than 50 μg / L was determined in 7% of samples, among school children. In 2019 MUIC amounted to 111 μg / l in adult population, the proportion of urine samples with UIC less than 50 μg / l - 10.7%. MUIC was 123 μg / l in 2019 among adolescence, the proportion of urine samples with UIC less than 50 μg / l - 14.5%.

Conclusions: Over the 24-year period of observation, there is a significant improving the iodine supply of the population in Novosibirsk. The low awareness of the young generation of the inhabitants of Novosibirsk about iodine deficiency and measures for its prevention was recorded.

Amiodarone is an antiarrhythmic drug that is commonly used for treatment of various supraventricular and ventricular arrhythmias. Amiodarone and its main active metabolite desethylamiodarone have a direct dose-dependent cytotoxic effect on thyroid follicular cells. Consequently, some patients receiving amiodarone may develop thyroid dysfunction: amiodarone-induced hypothyroidism (AIH) or amiodarone-induced thyrotoxicosis (AIT). The diagnosis, classification, and treatment of amiodarone-induced thyroid dysfunction remain to be a challenge to all clinicians deal with this problem. This draft of clinical recommendations was developed by a group of specialists experienced in the diagnosis and treatment of amiodarone-induced thyroid dysfunction. AIH does not require amiodarone withdrawal. Thyroxine treatment is recommended for all patients with manifest AIH, subclinical forms of AIH do not always need its prescription. There are two main types of amiodarone-induced thyrotoxicosis: AIT type 1 (is a hyperthyroidism that develops due to excessive iodine intake in autonomous thyroid nodules or latent Graves ‘ disease) and AIT type 2 (develops due to destructive thyroiditis because of the cytotoxic effect of amiodarone). In addition, there is a mixed form, which has features of both types of AIT. Autonomous AIT 1 is characterized by the presence of one or more «hot» nodules in the thyroid. Elevated TSH receptor antibodies or typical clinical manifestations confirm the diagnosis of diffuse toxic goiter and, consequently, AIT1. Colour-flow Doppler sonography (CFDS) is proposed as the basic method of differential diagnosis of AIT 1 and AIT 2. CFDS «pattern 0», usually indicates AIT 2, the presence of «patterns I-III» mostly typical for AIT 1. The thyreostatics are recommended for AIT 1, oral glucocorticoids for AIT 2 and their combination for a mixed AIT. Emergency thyroidectomy should be applied to patients with deteriorating cardiovascular pathology and ineffective drug therapy. In the absence of clinical suspicion on thyroid dysfunction, thyroid hormones assessment should be done 3 months after the start of amiodarone treatment, thereafter every 6 months.

Armenia was one of the first post-Soviet countries, that after a relatively short break has restored the production of iodized salt at the beginning of the 2000s, and in 2004 adopted a decree that made the production and import of iodized salt mandatory, as well as its use in the food industry. A 2016 national survey showed high sustainability of the iodine prophylaxis program in Armenia – median urinary iodine concentration (UIC) in schoolchildren and pregnant women (PW) was in the optimal range (242 and 226 μg/l, respectively), and coverage of households with quality iodized salt was 95%. In addition to iodized salt used in households, more than 50% of iodine was consumed with processed foods, primarily bakery products. An essential advantage of the iodine prophylaxis program in Armenia is that it provides adequate iodine status not only for the general population, but also for PW. At the same time about 37% of PW used iodine supplements, which were not necessary. The experience of Armenia shows that the analysis of screening datasets for neonatal hypothyroidism screening makes it possible to efficiently and at minimal cost annually evaluate the iodine status of the population. And if the frequency of TSH levels > 5 mIU/L exceeds 3%, the health authorities should consider this as an alarm and conduct a more detailed assessment to find out the cause of the iodine status insufficiency and take appropriate measures

Thyrotropinoma is a rare pituitary tumor that causes the development of thyrotoxicosis syndrome as a result of hyperproduction of thyroid stimulating hormone (TSH). In the Russian literature over the past 10 years, one case of thyrotropinoma in a child, four cases of TSH-producing pituitary adenoma in women and only one in a man have been described. The article presents a unique clinical case of a 20-years history of observation of a patient with TSH-oma. The rarity of this disease led to the fact that it took more than 10 years to make a correct diagnosis. The first operation of thyroid gland was performed before the diagnosis of pituitary adenoma and inappropriate TSH secretion syndrome. That right hemithyroidectomy was supposed to cure a toxic adenoma of thyroid gland. The diagnosis of thyrotropin-secreting piruitary tumor was established only after 6 years even after finding a combination of pituitary adenoma and thyrotoxicosis. After that, the patient steadfastly refuses neurosurgical treatment, despite the presence of macroadenoma with intrasellar growth. The therapy with somatostatin analogs led to patient’s intolerance with gastrointestinal side effects and hospitalization for acute pancreatitis. The absence of the therapy due to low compliance led to long-term persistence of thyrotoxicosis. The absence of signs and symptoms of expanding tumor mass (visual field defects, loss of vision, headache, partial or total hypopituitarism) demonstrates the slow growth of this kind of pituitary tumor. The long-term effect of elevated TSH levels led to diffuse goiter with compression of the neck organs, and the need of the surgical treatment of the thyroid. Stable euthyroidism after the operation led to stable normoglycemia in the patient with previously diagnosed diabetes mellitus type 2. This fact should keep an attention of physicians and endocrinologists to screen for the secondary reasons of hyperglycemia in a patient with diabetes mellitus manifestation. Long-term history of thyrotoxicosis led to the deleterious effects of thyroid hormone excess on the heart (atrial fibrillation, cardiomyopathy, cardiac failure). Those effects are still observed even after thyroidectomy and medical euthyroidism achievement. This fact demonstrates the importance of early diagnosis and treatment of TSH-omas.