This review of literature discusses modern concepts of the diagnostics and treatment of nodular and multinodular non-toxic goiter.

The effects of hyperthyroidism and hypothyroidism on cardiovascular system and cardiovascular events mortality risk is reviewed in this article. Also the problems of levothyroxine replacement in hypothyroid patient with cardiovascular diseases are discussed.

In this article the question on expansion of indications to endoscopic en-donasal surgeries is surveyed. Experience of surgical treatment of 9 pa-tients with endocrine ophthalmopathy in a stage of medicamental indemni-fication of thyroid gland function and with the expressed clinic of exoph-thalmos is submitted. Operations were carried out by transethmoidal ap-proach, with a resection of medial and inferior orbital walls. The estima-tion of surgical technics, features of postoperative patients managing and results of treatment was carried out). Positive dynamics on retrogress of exophthalmos is marked at 90% of patients, development of a transitional postoperative diplopia in 55% which was kept at 11% of patients. In the postoperative period it is not marked complications. In comparison with external surgical access advantage of endonasal decompressions was shown

The aim of this study was to offer the optimal levels of daily iodine intake during pregnancy and lactation. One-stage epidemiological survey was carried on in two cities: Nizhny Novgorod (n = 220) and Smolensk (n = 119). The pregnant women were divided into two groups: Group 1 (n = 161) – KI (200 micrograms/day) and Group 2 (n = 178) – KI (300 micrograms/day). Reearch methods included: ultrasound examination of a thyroid, urinary iodine concentration (UIC) measuring, analysis of thyroid stimulating hormone (TSH), free thyroxin (fT4), thyroperoxidase autoantibody (AT-TPO). After 3 months of iodine prophylaxis during pregnancy the median UIC increased to 259,6 (pNN = 0.00) and 120,8 µg/l (pSm = 0.00) in the 2nd group, and in the 1st group the iodine excretion in urine has compounded 96.9 (pNN = 0.00) and 83.5 µg/l (pSm = 0.00). In Nizhny Novgorod during lactation there was an insufficient concentration of iodide in urine in group 1 and in group 2 there were normal indexes of a median urinary iodine – 88.6 and 123.2 µg/l accordingly (p = 0.00). In Smolensk the median UIC was dropped, however in 1st group it was statistically significant (p = 0.03), median urinary iodine was 41.1 and 70.3 µg/l in groups 1st and 2nd accordingly (p = 0.04). The median UIC >100 µg/l has been noted at 10.5% of women in the 2nd group, and in the 1st group of patients by sufficient UIC has not been detected. Consequently, the median level of urinary iodine indicate optimal iodine nutrition during pregnancy and lactation and the requirement of iodine is at least 300 µg/day.

To ivestigate circadian and individual variability of TSH, fТ4, fТ3 in subjects without evident thyroid dysfunction. 27 persons at the age of 18–60 years have been included. Measurements of serum TSH, fT4, fT3 were performed at 8.00–9.00 and 14.00–16.00 during the day and at 8.00–9.00 in 4–6 weeks. The median of TSH concentrations in the morning was 2.28 mU/l, at the daytime – 1.6 mU/l (р < 0.05). The amplitude of TSH circadian variability reached 58% (Me = 21.45%). According to the current TSH reference ranges (0.4–4.0 mU/l) all participants had an euthyroidism in the morning and at the daytime. According to the proposed TSH reference ranges (0.4–2.5 mU/l) 12 participants (44.4%) in the morning and 4 participants (14.8%) at the daytime have been classified as having a hypothyroidism. TSH levels in 4–6 weeks differed from initial on -42.8–7.71%. Statistically and clinically significant variability of fT4 has not been found. Variability of fТ3 has appeared statistically significant and correlation with TSH changes.

The results of comparative preoperative cytological and postoperative histological investigation of 3714 patients with thyroid nodules are presented. The causes of discrepancies are discussed and measures of their diminution are proposed. Great value of fine needle biopsy to differ thyroid nodules but follicular neoplasia into benign and malignant are determined. Its sensitivity in our clinics is 98.7% and specificity – 100%. Necessity of the of the second FNA if the first one is non informative is established.

To evaluate the quality of compensation of hypothyroidism, clinical and labora-tory parameters and quality of life of patients with varying degrees of compensa-tion. Two hundred ambulatory patients with primary hypothyroidism receiving levothyroxine (L-T4) for more than one year participated in the study. Patients were examined at baseline and in 6 months. The scores for the Short-Form 36 (SF-36), symptoms of hypothyroidism and lipid profiles were analyzed. Only 58% (84/200) of patients were euthyroid. After 6 months of correction of replacement therapy, hypothyroidism was compensated in 75.5% of patients, decompensated – in 24.5%. We revealed lower level of scale of physical functioning (p = 0.019) among patients with increased level of TSH (>4 mU/l) in comparison with euthyroid patients. As soon as compensation was achieved patients showed better physical functioning (p = 0.01). There were no difference in the quality of life between the patients with decreased TSH and those with compensated hypothyroidism, however, the achievement of compensation was accompanied by improvement in role-emotional functioning (p < 0.016). In the group of patients with TSH > 4 mU/l hypercholesterolemia occurs more frequently than among patients with compensated hypothyroidism (p = 0.041), but the achievement of compensation led to significant reduction of total cholesterol (p = 0.09) and LDL (p = 0.012). Conclusion: In spite of relative simplicity of L-thyroxin replacement therapy many patients with hypothyroidism remain decompensate. Active followup of the patients with decompensated hypothyroidism improves the precision of thyroxine replacement and contribute to better quality of life and lipid profile.