Why health care system in Russia lags even public nutrition in its development? Current status of health care and ways for its improvments are discussed in this column.

One of the priorities of health care in most countries is the prevention of iodine deficiency disorders (IDD). About two billion people live in areas of natural iodine deficiency. It is known that insufficient intake of iodine in utero and in early childhood is the greatest danger. Changes caused by iodine deficiency in these periods of life manifest in irreversible defects of intellectual and physical development. However, the entire spectrum of IDD is wide and extends from reproductive disorders to specific thyroid diseases.

According to the World Health Organization (UNICEF), in 96 countries with iodine deficiency are already laws and regulations on mandatory salt iodization, only 13 countries do not have the law, including Russia. It is proved that the Russian population continues to live in conditions of uncompensated iodine deficiency.

In this connection it is extremely relevant conduct mass iodine prophylaxis and individual using preparations containing a physiological dose of iodine (such as Jodomarin) in high-risk groups on a statutory basis.

Primary hypothyroidism is one of the most common endocrine disorders. According to modern concepts, replacement monotherapy with levothyroxine (L-T₄) is the treatment of choice in primary hypothyroidism. In most cases, compensation of hypothyroidism leads to relief of symptoms and, as a consequence, improvement the quality of life. However, according to different authors, 5—10% of patients with hypothyroidism receiving adequate replacement therapy with L-T₄ have persistent symptoms of hypothyroidism, increased levels of anxiety and depression. The review discusses approaches to managing of such patients, and as one of the options — transfer to combination therapy with levothyroxine and triiodothyronine (L-T₄+T₃).

Background.

Previous surveys showed chronic iodine excess - median urinary iodine concentration (UIC) over 500 mcg/l — supposedly due to water contamination in population of Turinsk, a town in Sverdlovsk Region of Russia.

Aim.

Conduct an assessment of the effects of chronic iodine excess on thyroid function and spectrum of thyroid abnormalities in schoolchildren and adults.

Materials and methods.

Assessment was conducted in 100 schoolchildren and 100 adults residing in Turinsk and 97 schoolchildren and 100 adults in the control site (city of Pervouralsk) with optimal UIC. Assessment included thyroid ultrasonogrpahy, urinary iodine and dry spot TSH in schoolchildren and TSH and TPO-ab in adults. Iodine was also measured in random water samples from 10 households in Turinsk.

Results.

Median UIC in schoolchildren in Turinsk (719 mcg/l) was significantly higher (129 mcg/l) than in Pervouralsk resulting in higher prevalence of thyroid enlargement and TSH level. In adults TSH level as well as prevalence of sub-clinical hypothyroidism and autoimmune thyroiditis were higher in residents of Turinsk compared to control group from Pervouralsk.

Conclusions.

Iodine excess alters thyroid function in schoolchildren and adults increasing prevalence of thyroid enlargement in children and autoimmune thyroidis in adults.

The clue function of thyroid follicular cells is iodide (I) uptake and thyroid hormones production. NIS mediates the active transport of I into the thyroid follicular cells. It is impossible to perform effective ¹³¹I radioablation (¹³¹I RA) up to 10% of all differentiated thyroid cancer (DTC) owing to dedifferentiation and lost ability to cumulate I. To distinguish this group of patient preoperatively is difficult.

Aim.

To assess the utility of using membrane located NIS detection as marker of unfavorable prognosis for DTC after ¹³¹I RA.

Materials and methods.

We enrolled in our study retrospectively sixty patients with DTC operated from 2005 to 2008. Based on postop routine histology examination we performed TNM staging. Forty-five patients received ¹³¹I RA postoperatively. During 60 month of follow up recurrence were detected in 20 cases. In all 60 patients' level of membrane located NIS expression were detected immunohistochemicaly (IHC) in primary thyroid tumor. All statistical analysis performed using PC program Statistica 7.0.

Results.

We found that mean level of membrane located NIS expression in DTC is 4.5%, with maximum up to 10%, whereas mean level of NIS expression in normal tissue is 30—40%. Least mean level of NIS expression was in patients group with recurrence of DTC after ¹³¹I RA (p=0.00083). We proved that crutial for recurrence of DTC after ¹³¹I RA were decreased level of membrane located NIS expression less than 1%. As well as we found statistically significant correlation between Recurrence Free Survival (RFS) and level of NIS expression (p <0.005).

Conclusion.

Membrane location of NIS determines its functional activity, and membrane located NIS amount decreases in DTC. Detection of membrane located NIS in DTC has prognostic value.

Thyroid storm is a rare, life-threatening complication of thyrotoxicosis. It may be precipitated by an acute event such as discontinuation of antithyroid drug therapy, thyroid or nonthyroidal surgery, infection, parturition, or an acute iodine load. The variety of clinical presentations of this disorder can lead to delayed diagnostics and high mortality.

The typical and atypical clinical manifestations, diagnosis, and management of thyroid storm will be reviewed here. It also describes a case study of a young man with thyroid storm.