Diagnosis of the causes of thyrotoxicosis (destruction or increased functional activity of the thyroid tissue in nodular and diffuse thyroid pathology) is a key point in determining the management of patients with this pathology. Scintigraphy is the method of choice in differential diagnosis of the causes of thyrotoxicosis assessing the functional state of the thyroid gland. According to variable medical interest, thyroid scintigraphy can be performed using ⁹⁹mTc-pertechnetate or radioactive iodine isotopes (¹²³I, ¹²⁴I, ¹³¹I). For thyroid uptake evaluation used scintigraphy with ⁹⁹mTc-pertechnetate radiopharmaceutical, which is not organificates and quickly excretes from thyroid tissue. In case of thyroid iodine pharmacokinetics investigation radiopharmaceuticals labeled by iodine isotopes (¹²³I, ¹³¹I, ¹²⁴I) are used. The review includes original scintigrams, tables and diagrams. Article shows thyroid scintigraphy informativity analysis, evaluates the place and role of the thyroid scintigraphy examinations in modern diagnostic algorithms taking into account the history of the disease, laboratory tests, ultrasound (TIRADS) and result of FNA (Bethesda). Additionally authors focused on existing clinical guidelines analysis. An optimized algorithm for the diagnosis and treatment of diffuse and/or nodular thyroid pathology associated with thyrotoxicosis is proposed.

Clinical decision support (CDS) systems are the medical technologies that go through their life cycle. Evaluation of effectiveness and safety should be carried out at its various stages – at the development, in clinical trials, licensing, clinical and economic analysis, health technologies assessment. To date, the effectiveness and safety of CDS systems vary and are ambiguous – there are both successes and failures. Hundreds of clinical trials are carried out, and more than a hundred of systematic reviews are published. When evaluating the efficacy and safety of CDS systems, two types of outcomes are usually estimated: indicators of medical care (volume, time, costs, etc.), and patient outcomes (clinical and surrogate). A slight increase in physicians’ adherence to clinical guidelines has been observed, but it had very small influence on surrogate outcomes, and there is no effect on clinical patient outcomes. A slight increase in risk with respect to patient outcomes was found in only a few studies. However, the methodological quality of the evidence is very low. In this regard, a few products based on artificial intelligence have so far approached the licensing phase. The field of CDS systems is developing, but not yet sufficiently studied, and there is a long way to real successes ahead. Meanwhile, there is a wide gap between the postulated and empirically demonstrated benefits of CDS systems.

Medication effects on the immune system often lead to the development of adverse events such as autoimmune diseases. The thyroid gland is organ whose embryonic development features are predisposed spontaneous and induced lesions with various autoimmune effects.

Cytokinin-induced thyroiditis (in 50–70% of cases proceeds as a destructive thyroiditis), thyroid dysfunction following immune checkpoint inhibitors (using the combined treatment CTLA-4 + PD-1/PD-L1 leads to an increase hypothyroidism rates up to 20%). Some researchers presume that can develop thyroid dysfunction following treatment lithium.

Authors emphasize that predisposition to autoimmune mechanisms thyroid diseases also has bipolar affective disorder and treatment with interferon-alfa in hepatitis C.

For many of these clinical situations, national and international associations adopted clinical recommendations and physicians have been introduced to optimal screening algorithm of correcting treatment in risk groups.

Immune rehabilitation therapy (IRT) is actively used in the treatment of many diseases. The effect of these drugs on the thyroid gland is most fully described for multiple sclerosis, HIV infection and bone marrow transplantation. The peculiarity of the non-specific effect of IRT preparations on the thyroid gland can lead to transient disorders or manifest in the late long-term period after completion of the IRT. This complicates the targeted diagnosis of a whole range of diseases, which means it increases the risk of development and progression of complications, worsens the patient’s quality of life and prognosis.

In this article we reviewed for our readers European clinical guidelines for thyroid dysfunction, following IRT, published in 2019. The recommendations are relevant not only for Endocrinologists, but also for Rheumatologists, Infectious disease specialists, Transplantologists, GP and many other specialties. Earlier, in the Journal of Clinical and Experimental Thyroidology a description was already made for immuno-mediated endocrinopathies, developing in the treatment of cancer patients with inhibitors of immune response control points. These endocrinopathies have their own distinctive features and are of interest in the study of adverse events from the thyroid gland. They are reflected in clinical recommendations and open up new aspects for the Endocrinologists about the effect of modern drugs on the thyroid gland.

This time, the traditional column “De Gustibus” was prepared by three authors who began writing fragments of this article in late January – early February this year, once again discussing position of various departments and individuals about the development and adoption of the federal law “Prevention of iodine deficiency disorders in Russian Federation”. The fate of this unfortunate and necessary law reveals the shortcomings of education, culture, the level of scientific research, the state of prevention of non-communicable diseases, the social responsibility of business and many other problems that exist in our society. Self-interest and absurdity can become a downfall in which once again this necessary law will disappear.