In his regular column, the author discusses the experience of the countries of the Eastern and Southern Europe and Central Asia region in the aspect of adopting the draft federal law “On Amending Article 15 of the Federal Law “On Food Quality and Safety””, which is currently under consideration by Russian authorities. These changes set some mandatory requirements for the production, trade and use of iodized salt in the baking industry. If in the original form the draft law proposed a complex of rational measures to prevent iodine deficiency, the revised version restricts the mandatory use of iodized salt only by public catering organizations available to a relatively small segment of the population of Russia. At the same time, large groups of people living in rural areas, pregnant and lactating women, as well as low- and middle-income people remain without attention. Adopting the law in its current form will create a false impression that the measures are taken. But in fact, there is little that will change.

The new fourth edition of the WHO classification of tumors of endocrine organs published by the International agency for research of cancer (IARC) in 2017 as the previous third edition of 2004 pays substantial attention to the thyroid gland tumors. Experts revised criteria of malignancy in category of encapsulated non-invasive follicular thyroid neopasm with papillary-like nuclear features. The previous edition classified these tumors as malignant follicular variant of papillary thyroid carcinoma (PTC). The new edition considers their behavior status as borderline or tumors of uncertain malignant potential. An estimation of malignancy of follicular thyroid tumors is impossible in preoperative cytological smears due to unknown cytological markers of malignancy and in 10% tumors after surgery due to equivocal histological features of capsular/vascular invasion and/or doubtful PTC-like nuclear features. Criteria of non-invasive follicular thyroid neoplasm with papillary-like nuclear features as well as criteria of two classification categories of follicular and well differentiated tumors of uncertain malignant potential (UMP) are presented in this paper. A special attention is paid to diagnostic significance of invasive growth as a basic feature of malignancy. In connection with the revised criteria of international classification we discuss an importance of adequate histological examination and influence of new borderline categories on surgical treatment of encapsulated follicular thyroid tumors in the paper.

Universal salt iodization (USI) strategies gained strong momentum in countries of the Southern Europe and Central Asia (SECA) region during the 2000–2009 decade. By the end of the first decade, several countries in the region had already reached the goal of optimum iodine nutrition; other countries were quickly approaching this goal, and in only a few countries the progress toward USI had remained slow. This paper reports an overview of the two Sub-Regional workshops (for countries of Eastern Europe and Central Asia and South-Eastern Europe) conducted in 2015 and 2016. Both workshops demonstrate that the SECA region remains on track in the pursuit of USI for sustainable IDD elimination. Notwithstanding the noted imperfections, none of the data or information from countries of the region suggested that the conquest of iodine deficiency is seriously threatened. However, more efforts should be made to develop and streamline USI strategies in Russia and Ukraine, two major countries that are lagging behind.

Backgraund. Globally, it is estimated that 2 billion individuals have an insufficient iodine intake.

Aim. To assess iodine status and the effectiveness of iodine deficiency prophylaxis in adult population of St. Petersburg.

Methods. А retrospective analysis of the prevalence neonatal hyperthyrotropinemia in St. Petersburg for the period 2013–2014 was made. In a cross-sectional study were included 542 residents of St. Petersburg aged 18-77 years. All participants were divided into 3 groups according to age. Pregnant women were evaluated separately. All participants were questioned, the values of urinary iodine concentration (UIC) were analyzed.

Results. The frequency of neonatal thyroid-stimulating hormone concentrations above 5 mU/L was 6.9%. Iodized salt was used by 41.1% of all surveyed persons and 52.2% of pregnant women. Iodine supplements were taken by half of pregnant women. Median UIС of all participants was 91.2 mcg/L and corresponded to mild iodine deficiency. Median UIC in pregnant women was 112.4 mcg/L and corresponded to insufficient iodine intake.

Conclusions. The population of St. Petersburg lives in a region of mild iodine deficiency. Prophylaxis of iodine deficiency held in St. Petersburg in 2013–2015 was not effective enough. Persons of reproductive age and pregnant women had mild iodine deficiency.

Backgraund. The development of cardiovascular complications in patients with diffuse-toxic goiter (DTZ) is an actual problem of thyroidology. (SSS) in patients with DTZ.

Aims. To assess the contribution of zinc deficiency in the formation of cardiovascular complications in patients with Graves’ disease.

Methods. The study included 113 women aged 25–60 years with the diagnosis of DTZ: 54.0% (n = 61) with an average severity of thyrotoxicosis, 46.0% (n = 52) with severe. Duration of the disease is 1–5 years. The control group consisted of 37 women aged 25–60 years without pathology of the thyroid gland and CCC. All patients were evaluated: in the blood – the level of thyroid-stimulating hormone (TTG), free thyroxine (over T4), the concentration of antibodies to the thyroid-stimulating hormone receptor (AT to RTTG); in the hair – the concentration of zinc; ultrasound (ultrasound) of the thyroid gland, echocardiography (EchoCG), daily monitoring of electrocardiography (CM ECG).

Results. At DTZ deficiency of zinc in hair was observed in 66.4% (n = 75), in the control group – in 27.0% (n = 10) patients (p = 0.01). More often, zinc deficiency was found at a severe degree of DTZ in 82.7% (n = 43), atrial fibrillation (AF) in 77.4% (n = 24) cases, in CHF – 78.8% (n = 41) cases. The diagnostic model and the table of risk factors of CHF in points, including the definition of the level of zinc in the hair, are developed with the help of logistic regression. It is advisable to use the table for all patients with DTZ to determine the degree of CHF risk, with an average and high risk of developing CHF in the treatment of DTZ, it is shown to include zinc preparations.

Conclusion. The obtained data allow to consider that the zinc deficiency increases the probability of development of AF and CHF in patients with DTZ of severe severity, needs diagnostics and correction.

Most clinicians are well aware of the coexistence of medullary thyroid cancer and hyperparathyroidism in hereditary and sporadic multiple endocrine neoplasia syndromes. Тhe reported incidence of nonmedullary thyroid carcinoma in patients with primary hyperparathyroidism (pHPT) is only approximately 3%. Papillary thyroid carcinomas (PTC) is a malignant epithelial tumour. PTC represent up to 87% of all thyroid carcinomas. Atypical parathyroid adenoma (APA) are a subset of parathyroid neoplasms that exhibit some of the features of parathyroid carcinoma but lack unequivocal invasive growth. APA represents about 0.5–4% of cases of PHPT. As a group, they may be considered tumors of uncertain malignant potential. The clinical importance, and long-term outcomes as well as appropriate operative management and surveillance are not well defined for APA probably due to the overall low prevalence as well as the lack of a standard definition of APA.

We report two cases of a 63-year-old woman and 57-year-old man with a synchronous atypical parathyroid adenoma and papillary thyroid carcinoma. One of this patients had a classic symptoms of pHPT, including severe metabolic bone disease and renal disease, but another didn’t have. The mean preoperative calcium was 3,48 and 4,1 (range 2.12–2.6) mmol/l and a mean parathyroid hormone (PTH) of 1300 and 1533 (range 15–65) pg/ml, respectively. Thyroid ultrasound didn’t show a nodule with features of the thyroid carcinoma in both cases. The thyroid cancer was suspected after intraoperative revision. The patients underwent a total thyroidectomy and surgical excision of the parathyroid adenoma. Surgical pathology showed papillary microcarcinoma in both cases (in the first – unilateral, in the second – bilateral) and APA.

Awareness of this condition will enable clinicians to evaluate for possible thyroid pathology in patients with primary hyperparathyroidism. Both of these endocrine conditions could then be managed with a single surgery involving concomitant resection of the thyroid and parathyroid glands.