The role of somatic mutations in sporadic thyroid cancer is unclear today. Probably they coming out as aetiological factors in carcinogenesis as well as, respectfully to many authors, can to participate in TC pathogenesis and to determine the clinical course and prognosis of the disease. For today as main oncogenes taking part in initiation of thyroid malignant tumors are considered: RET/PTC, TRK, PTEN, P53, RAS, MET, PPARγ. By means of genetic investigations scientists are trying to solve problems with thyroid cancer differentiated diagnostics (cytokeratin-19, cytokeratin-20, mesothelial cells antigen (Hector Battifora MEsotelial (cell) or HBME-1), loss of heterozigitoty (LOH) in short arm of 3 chromosome (gene VHL -von Hippel Lindau, 3р26). Recently in foreign literature appeared reports of activated mutations in gene BRAF which most frequently are occurred in melanoma and papillary TC. Prognosis of thyroid cancer may reflected by the LOH as a biological breakage as well as changes of tumor suppressive gene P53 which fraught with decrease of disease prognosis. Thus, both researchers and clinicians have many questions concerning the role of genome, particularly in order to precise of genetic abnormality influence on tumor growth and therefore for assessment of clinical prognosis and with aim to chose adequate treatment tactic in each case.

This review of literature is dedicated to goitrogenic environmental factors, their goitrogenic mechanisms and their potential role in pathogenesis of endemic goiter.

There was investigation carried out in group of 54 children (42 females and 12 males) aged between 10.3 and 17.2 years (median - 13. years) for the purpose of the estimation of the clinical significance determination of the general autoantibodies to the TSH recepetor (TBII) in differential diagnostics hyperthyroidism. In 45 from 54 cases (83.3 %) there was Graves’ disease (GD) diagnosis set, while high level of TBII was detected amongst 44 from those children (97.8%). Amongst patients with subacute thyroiditis and uninodal toxic goiter together with 7 children, initially estimated by us as “AIT, hyperthyroidism” the values TBII were in limit of reference interval. But for all of that unexpectedly there was detected normal level of Ab-TPO amongst all patients in this group, and - normal echogenic in 6 from 7 cases. From the one hand, high level of Ab-TG and heterogeneous structure may be estimated as particular qualities of hyperthyroidism clinical course during AIT by amongst children. However, absence of the row of diagnostic signs with long-lasting euthyroid condition do not allow us to estimate that cases as hyperthyroidism phase of AIT. From the other hand, we can suppose that we observe the diagnostic of natural clinical course of GD cases in phase of immunological remission. The detection of normal level of TBII in absence of typical clinical signs of GD amongst children with manifestation of hyperthyroidism let us retreat from active therapeutic intervention and choose the method of dynamic observation.

Goal. To work up clinical and morphological criteria of thyroid authonomy and progressive growth in nodal colloid goiter (NCG). Methods. A group of patients with nodal euthyroid goiter (NEG) (40 patients) and a group of patients with nodular toxic goiter (NTG) (40 patients) were formed to compare clinical and morphological criteria of NCG growth to/with development of functional autonomy (FA). All patients were conducted research including physical examination, thyroid palpation, ultrasound, blood level of TSH and T4, scintigraphy, aspiration (needle) biopsy, immunocytological and immunohistological reactions and statistics. In the study the method of indirect immunoperoxidase reaction with monoclonal rat/mouse antigens to Ki-67, TSH, galectin-3, Apo-test (“Dako Corporation”, “Novocastra Laboratories Ltd.”) was used. Results. 1. In NEG expression of cell proliferation marker Ki-67 for certain rises pro rata to increase of proliferation degree, and in NTG grows according to FA development. 2. Apoptosis expression in NEG decreases according to degree of thyrocytes in a nodule, but in NTG falls pro rata to accumulation of thyroid FA. 3. Positive reaction for TSH in NEG tissue was found in 100%, whereas negative reaction for this receptor in NTG tissue was observed in 81% of all cases. 4. Galectin-3 was expressed in focuses of severe dysplasia of thyroid nodes tissue comparable to galectin-3 expression in the tissue of high-grade differentiated adenocarcinomas. Summary/conclusion. 1. Severe and moderate expression of Ki-67 and mild or negative immunomorphological reaction for Apo-test allows to refer such kinds of nodules to fast-growing/rapid-growing ones. 2. Reliable negative expression TSH receptor in the tissue of NCG is evidence of FA development and is an indication for a treatment of radioactive iodine or for an operation. 3. Galectin-3 probably is an early marker of malignant transformation in thyroid tissue. 4. Having conducted complex research of NCG patients using clinical, laboratory, morphological and immunomorphological methods allows to optimize the diagnostics of thyroid nodular diseases, to work out clinical and morphological criteria of progressive growth and FA, to determine ways of their treatment and prognostic tendencies taking into account pathological and morphofunctional features of NCG.

Aim of the study. To estimate the meaning of thyroid suppression test as the method for diagnosis of functional thyroid autonomy (FA). Materials and methods. The main group consisted of 50 patients (46 females, 4 males) older 40 yrs with multinodular euthyroid whose basal scintigraphy demonstrated one or more areas of increased Tc 99m thyroid uptake. Twenty two individuals of control group (27.5 [23; 38.75] yrs) with no thyroid abnormalities underwent only basal thyroid scintigraphy. Thyroid suppression test protocol for the main group included 10 - 14 days of 2 μg/kg L-thyroxin (L-T4) intake prior to repeated scintigraphy under suppression. Results. Basal TcTU in control group was significantly lower (1.51% [1.16; 1.76]) than in the main group (1.67% [1.4; 2.2]). TcTU of the main group did not correlate with thyroid volume (r = 0.012; p = 0.9), “hot” nodule volume (r = 0.08; p = 0.5), TSH (r = 0.026; p = 0.9), and thyroid hormones levels. Thyroid suppression test reviled FA in 62% (31/50) patients. TcTU under suppression (TcTUs) in the main group of 50 patients was 0.87% [0.76; 0.87]; it was significantly lower than TcTU (W = 1275; p < 0.001). TcTUs did not depend upon thyroid volume (r = -0.097; p = 0.501), in contrast to TcTU it was a weak negative correlation with basal TSH level (r = -0.328; p = 0.020), a weak positive correlation with basal fT4 (r = 0.38; p = 0.007) and fT3 levels (r = 0.54; p < 0.001), moderate positive correlation with “hot” nodules volume. Comparing the patients who developed thyrotoxicosis with those who stayed euthyroid showed that the usage of Tc 99m uptake decrease degree (%) while suppression from the basal, but not TcTUs, is more effective for individual prognosis of thyrotoxicosis development. Patients who demonstrate the decrease of Tc 99m uptake less than 30-35% while thyroid suppression test have the biggest risk of FA decompensation and thyrotoxicosis development independently of absolute TcTUs values.