Is early disease detection always beneficial? What are the differences between “Birds”, “Rabbits” and “Turtles”? These and other questions under discussion in the “De Gustibus” column.

According to the World Health Organization, papillary microcarcinoma of the thyroid is defined as a papillary thyroid carcinoma measuring ≤1 сm in the greatest dimension. Papillary microcarcinoma of the thyroid is a specific subgroup of papillary thyroid carcinoma and account for up to 30% of all papillary thyroid carcinoma. This review summarizes recent data on the surgical treatment, radioiodine treatment and postoperative surveillance papillary thyroid microcarcinoma.

About 5-15% of patients with differentiated thyroid cancer (DTC) primary or within follow-up have had distant metastases or inoperable tumor mass that are resistant to radioiodine therapy as well as dramatically deteriorate survival prognosis. Other treatment modalities (radiotherapy, chemotherapy etc.) also ineffective. Certain expectances are associated with target therapy with multikinase inhibitors with are selectively blocking onco-kinase molecular pathways. This review is devoted to analysis of those multikinase inhibitors which have been implemented in patients with radioiodine DTC. Comparative analysis of two most perspective multikinase inhibitors (sorafenib and lenvatinib) with evaluation of efficacy and adverse effects was conducted. Both of them successfully underwent 3 rd phase of clinical trial and were recommended as treatment of choice in progressive radioiodine-resistant DTC patients.

Subclinical hyperthyroidism occurs when the serum TSH is below the lower limit of the reference range and the free T4 and T3 concentrations are normal. Тhe clinical significance of subclinical hyperthyroidism is much debated. Subclinical hyperthyroidism has been associated with several biological effects on cardiovascular system, such as increased heart rate, left ventricular mass. Observational studies have reported an association between subclinical hyperthyroidism and coronary heart disease, incident atrial fibrillation, and cardiac dysfunction.

The article contains abstracts of actual modern international researches dedicated to management of various thyroid pathology and influence of accompanying states

Aim. To examine the association of polymorphisms Gly482Ser PPARGC 1A and Ala203Pro PPARGC 1B with the development of thyroid eye disease (TEO). Materials and methods. A total of 88 people: 52 patients with TEO, 36 - healthy individuals. Identified polymorphisms Gly482Ser PPARGC 1A and Ala203Pro PPARGC 1B by PCR. Results. When TEO detected differences in the frequency of allele and genotype SNPs investigated compared with the control. The prevalence of genotypes and alleles in patients with TEO (Gly/Gly - 38.5%, Gly/Ser - 34.6%, Ser/Ser - 26.9%, Gly-allele - 55.8%, Ser-allele - 44.2% gene PPARGC 1A; Ala/Ala - 19.2%, Ala/Pro - 55.8%, Pro/Pro - 25%, Ala-allele - 47.1%, Pro-allele - 52.9% gene PPARGC 1B). The prevalence of genotypes and alleles in the control group (Gly/Gly - 38.9%, Gly/Ser - 44.4%, Ser/Ser - 16.7%, Gly-allele - 61.1%, Ser-allele - 38.9% of the gene PPARGC 1A; Ala/Ala - 25%, Ala/Pro - 58.3%, Pro/Pro - 16.7%, Ala-allele - 54.2%, Pro-allele - 45.8% of the gene PPARGC 1B). Conclusion. At TEO more common genotypes Ser482Ser PPARGC 1A, Pro203Pro PPARGC 1B and Ser allele polymorphism Gly482Ser PPARGC 1A, Pro polymorphism Ala203Pro PPARGC 1B, as well as less common genotypes Gly482Ser PPARGC 1A, Ala203Ala PPARGC 1B and Gly allele polymorphism Gly482Ser PPARGC 1A, Ala polymorphism Ala203Pro PPARGC 1B. Polymorphisms and allele Gly482Ser PPARGC 1A gene and gene Ala203Pro PPARGC 1B do not modify the risk of TEO.

Aim. The aim of our study was to analyze thyroid status in adult patients with Hodgkin’s lymphoma in acute period after radiotherapy on neck region. Material and methods. Thyroid function (TSH, free T 4, anti-TPO) and thyroid ultrasound were evaluated in 22 adults (10 women, 12 men, mean age 30.2 yrs) with a history of Hodgkin’s lymphoma (HL) before radiotherapy on neck region, 7-14 days, 6 month, 1 year after treatment. Results. Incidence of subclinical hyperthyroidism was 13.6% in acute period (7-14 days) after radiotherapy on neck region. There was correlation between dose of radiation and incidence of acute thyroiditis ( r = 0.67, p = 0.03). TSH level fall directly after treatment (1.08 vs 1.88 mkMEd/l р = 0.03), but 6 month after this difference disappeared. T 4 free level decreased 1 yr after treatment (1.18 vs 0.99 ng/ml ) in compare with measurement before treatment ( p = 0,01). Thyroid volume decreased (9.8 ml vs 5.7 ml) 6 month after radiotherapy in compare with measurement before treatment ( p = 0.03), and keep on decreasing 1 yr after treatment (5.35 vs 9.7 ml p = 0.003). Conclusions. These data indicate that some patients with HL receiving high dose of radiotherapy on neck region can develop acute thyroiditis, but this abnormalities are transitory and do not reviewed treatment.

Aim. The study aimed to investigate the modifying influence of subclinical hypothyroidism (SH) on arterial hypertension (AH), the prevalence of masked uncontrolled hypertension, circadian blood pressure (BP) profile and cardiovascular disorders. Materials and methods. We investigated twenty-four hours BP monitoring data and cardiovascular parameters in 101 hypertensive patients with normal thyroid function ( n = 45) or SH ( n = 56). Then, we observed 44 patients with AH and SH within six months; 24 of them received levothyroxine. Results. Patients with AH and SH had higher risk of masked uncontrolled hypertension (for TSH ≥ 5 mU/L, OR 1.9 [1.11, 3.26], p = 0.016); increased pulse BP, daily BP variability, non-dippers rate as well as more marked myocardial hypertrophy, arterial dysfunction and microcirculation deterioration ( p < 0.05 for all parameters). Levothyroxine therapy reduced the incidence of masked uncontrolled hypertension, ambulatory BP value, non-dippers rate and intensified microcirculation ( p < 0.05 for all parameters). Conclusion. SH is a risk factor for masked failure of antihypertensive therapy. SH impairs the profile of ambulatory BP and target organs damages in patients with AH. These disorders can be partly corrected by the use of levothyroxine.

The review reflects the discussion questions on the issue of nodular goiter miniinvasive treatment, the reasons for endocrinologists and surgeons differences approaches, a vector search for consensus is provided.