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Background: Nowadays, the Republic of Belarus belongs to the countries with sufficient iodine supply, which made it possible to reduce the incidence of non-toxic goiter and congenital hypothyroidism. However, even a slight change in iodine consumption influences the pattern of thyroid diseases. In addition to iodine deficiency, other environmental conditions, as well as genetic factors, play a significant role in the etiology of thyroid diseases., Aim: To analyze the dynamics of the main epidemiological indicators of benign thyroid diseases from 2009 to 2019 in the adult population of the Republic of Belarus, using the data of official state statistics., Materials and Methods: The indicators of the incidence and prevalence of benign thyroid diseases were studied on the basis of state statistics for 2009-2019. To analyze the dynamics of the studied indicators, regression analysis was used with the construction of linear and polynomial models., Results: A decrease in the incidence and prevalence of diffuse euthyroid goiter and an increase in the incidence and prevalence of nodular euthyroid goiter, thyroiditis, acquired hypothyroidism, Graves' disease, as well as the incidence of nodular toxic goiter were revealed., Conclusion: Obtained data indicate, that there is an increase in the prevalence of most of the studied thyroid diseases, despite the adequate iodine supply. The above justifies the need for further study of the causes of the identified trends, as well as the necessity of developing new methods of diagnosis and treatment of thyroid diseases.

Background: Toxic nodular goiter (TNG) is a rare disease in which the cause of hyperthyroidism is the presence of a node or nodes that autonomously secrete thyroid hormones. With children and adolescents this condition is extremely rare - in 5-7.5% of all cases of nodular goiter. Therapy of toxic nodular goiter is aimed at relieving the symptoms of hyperthyroidism taking into account the malignant potential of the nodular formation. In the available literature, there are no data on the clinical course, comparative results of cytological and histological data in patients with toxic nodular goiter, which debuted in their childhood., Aim: Analysis of the features of the clinical course, comparison of the results of cytological and histological studies of toxic nodular goiter in children and adolescents., Materials and Methods: A retrospective, single-center study of 21 patients with single-nodular toxic goiter, hospitalized at the Endocrinology Research Centre in the period from January 2016 to December 2019., Results: The mean age at the time of the survey was 13.9 years. Thirteen patients (65%) had manifest thyrotoxicosis, and seven (35%) had subclinical hyperthyroidism. More than half of children - 57.1% (n = 12) did not receive thyreostatic therapy. The cytological picture in 11 patients (61.1%) corresponded to benign changes (nodular colloid goiter or adenomatous goiter) - Bethesda II, in 4 patients - follicular tumor - Bethesda IV, in 4 children the study was not informative. 19 patients (90.5%) underwent surgical treatment (hemithyroidectomy). According to the results of histological examination, follicular adenoma was found in 44.4% of children with nodular toxic goiter with benign results of TAB (Bethesda II) and was found in 50% with revealing follicular neoplasia (Bethesda IV)., Conclusion: For the first time in the Russian Federation was carried out a comparative analysis of the characteristics of cytological and histological studies in children with toxic nodular goiter. It is significant that only in 10.5% (n=2) cytological and morphological results were consistent. The choice of radical treatment tactics should take into account the high frequency of mismatches between histological and morphological studies.

Background: At the time of seeking medical help, some patients have nodular/multinodular goiter of large and gigantic sizes, which leads to compression of the neck organs. In the structure of benign diseases, neck compression is diagnosed in 10% of cases, and tracheal narrowing is found in 84% of patients in this group. It was experimentally established that narrowing of the trachea leads to the development of hypertension in the pulmonary circulation. Patients with nodular/multinodular goiter with compression of the neck organs belong to the age group of 50 years and older, the peculiarity of which is comorbidity of varying severity. Cardiopulmonary syndromes may mask compression of the organs of the neck by the thyroid gland. As a rule, patients come and/or go to a cardiologist, pulmonologist, gastroenterologist and other specialists, as a result of which the timelines for timely surgical treatment are missed. Often, patients are delivered to the endocrine surgeon urgently due to the development of asphyxiation. The symptoms of impaired external respiration and the initial manifestations of pulmonary hypertension, as a result of compression syndrome, preceding this condition are evaluated only retrospectively., Aims: To study the frequency of tracheal compression and symptoms of chronic hypoxia in the structure of benign thyroid diseases requiring surgical treatment, as well as an assessment of the nature of comorbid pathology and the results of surgical treatment., Methods: A retrospective analysis of the results of surgical treatment of benign thyroid diseases for the period from March to August 2019 was carried out (100 observations)., Results: Toxic goiter prevailed in the structure of benign thyroid diseases (74%). Tracheal compression was observed in 69% of cases. When trachea was compressed, arterial hypertension statistically significantly prevailed (χ2, p≤0.01). The appearance of «wheezing» on inhalation/exhalation and an increase in its frequency were detected when the trachea narrowed to the thyroid gland to 10 mm or less in 10 cases (10%) with a statistically significant prevalence of pulmonary hypertension (χ2, p≤0.01). Thyroidectomy prevailed in the structure of operations (80%). There was no statistically significant increase in surgical complications depending on the severity of tracheal compression, age, and concomitant pathology. There were no fatal outcomes., Conclusions: Surgical treatment of patients with benign thyroid diseases complicated by compression of the neck organs is also shown safely regardless of age and associated pathology.

The aim of this work was a clinical study of the patients with mutations in the SLC26A4 gene and clinical diagnosis of the Pendred syndrome. The Pendred syndrome is a hereditary autosomal recessive disorder characterized by combined pathology of the inner ear and the thyroid gland. CT of the temporal bones demonstrates the Mondini-type structural anomaly in the inner ear and enlarged vestibular aqueduct. Examination of the thyroid gland reveals hypothyroidism and euthyroid goiter. A total of 20 unrelated children at the age from 2 to 16 years presenting with the hearing loss of different severity were available for the examination. High-resolution CT of the temporal bones demonstrated abnormal development of the inner ear including the Mondini-type structural anomaly and enlarged vestibular aqueduct. Five children with congenital hypothyroidism suffered from bilateral sensorineural impairment of hearing. The routine methods of audiological and molecular genetic examination were used throughout the study., Results: As a result of molecular genetic studies, four out of the 20 patients were found to carry six recessive mutations of the SLC26A4 gene in the compound heterozygous and one such gene in the homozygous state which confirmed the hereditary nature of the disease. The children suffered the hearing loss of varying severity diagnosed at different age. The thyroid hypofunction in one child was identified when it was 2 years of age, and in two children at the age of 8 and 9 years., Conclusion: The first step in the diagnosis of the Pendred syndrome among children with congenital hearing loss was a CT scan of the temporal bones that showed incomplete separation of the curls of the cochlea and enlarged vestibular aqueduct. It is necessary to continue to study epidemiology, clinical and molecular genetics of the Pendred syndrome in the Russian population.

The purpose of the study--estimate of thyroid tissue quantitative alteration features in different types of goiter on the operative material with a data of morphometry (stereometry) data, histology and electron microscopy in the border (neighboring) regions of Georgia and the Azerbaijan. Cohort study group made up thyroid specimens from 187 patients with nodular euthyroid and diffuse toxic goiter operated in the clinics of Azerbaijan Medical University (Baku) and the National Institute of Endocrinology in Tbilisi for the period 2010 - 2012. Results of the follicules and capillaries morphometric study indicate common clinico-morphologic manifestations of thyroid disorders in the studied regions of Georgia and Azerbaijan, as well as to: 1) determinate capacity to the hyperplastic processes in the thyroid parenchyma under the nodular euthyroid goiter, 2) the disbalance between the clinical manifestation of the disease and its growth potential, which is important to define the "biological behavior" of thyroid nodules, including relapse.

The paper deals with etiopathogenetic and clinical peculiarities, and also therapeutic methods during the pathological processes in the thyroid system in the childhood. The most common of these processes is the diffuse nontoxic goiter, which results in abnormality of metabolic processes regulation in the child's growing organism and often signals to the beginning of many thyropathies.

There was effectuated an analyze of results of treatment of 1006 patients with different knot lumps of thyroid gland, operated in surgical departments of the 2nd CMCH by Mandryka P.V. for the period 1990-2007. Using of organ-saving operations is caused by necessity of maximum decreasing of after-operation complications and by necessity of saving of presecretion-producing function of thyroid gland. The substantiation of operation in volume of exsection with deleting of knot in the limit of healthy tissue is the results of analyze of anatomical structure not only of knot lump, but also of tissue of thyroid gland, beds to it: devascularization with appearance of fibroid changers was marked in 69,7%, dystrophic processes with thyroadentis--in 38,8% of examinations. Analyze of repeated operations brought to light, that in pathogenesis of development of backset the main role is played by etiology and anatomical structure of knot lump, but not the volume of effectuated operation. Using of organ-saving operations and accounting of endocrinological aspects permitted to heal 89,3% of patients.

The results of surgical treatment of 150 patients with polynodous euthyroid goiter were studied. There was shown the influence of various factors on the disease recurrence frequency.

A comparative analysis of thyrotoxicosis in 180 males and 121 females has shown that during the recent 15 years the number of males operated upon for diffuse toxic goiter (DTG) has become 2.6 times greater. Thyrotoxicosis in men is characterized by an aggressive course, is followed by cardiac complications, ophthalmopathy, impaired sexual function, appearance of foci of malignant growth, spread of diffuse hyperplasia of the thyroid gland behind the breast bone and trachea. Cessation of thyreostatic therapy resulted in quick recurrence of the disease. Repeated courses of treatment with thyreostatics increased the risk of irreversibility of changes in the heart muscle, impairment of regenerative abilities and massive lymphoid infiltration of the thyroid tissue followed by hypothyrosis. Early surgical treatment of men with DTG facilitated a rapid and reliable restoration of vitally important functions and recovery of most operated men and women.

The results of surgical treatment of various forms of diseases of the thyroid gland in 254 children are analysed in follow-up periods of 12 months to 20 years. Functional compensation of the thyroid occurred in all patients with nodular forms of goiter who were subjected to operation which did not exceed hemithyroidectomy in volume. The analysis showed that operative treatment of children with the diffuse toxic form of goiter attended by the autoimmune component lead to hypothyroidism in 76.6% of patients, whatever the activity of the thyroid tissue, and a recurrence developed in 11.7% of those who were operated on. In children without the autoimmune component postoperative hypothyroidism was found in 48.6% of those examined, a recurrence was found in 3.2% of cases. The indications for operative treatment are specified, measures for the prevention of postoperative complications are listed.

The article characterizes the mortality rates of nodular and mixed euthyroid goiter in the Ukraine Republic and discusses the results of surgical treatment of 681 patients with various forms of goiter. In view of the double increase of the number of cases of thyroid carcinoma in the last 4 years, the authors suggest resecting the thyroid gland more extensively than in the previously conducted economical resections. Radioimmunological study of the thyroid hormones and thyrotropin in dynamics showed activation of hypophyseal +thyrotropic function after the operation. The authors, therefore, recommend using thyroidin without fail. Postoperative recurrences-1.5%, stable hypothyroidism-1.8%.

The data on incidence of goiter in inhabitants of Kiev province for 5 years after Chernobyl accident, increase in number of operations performed for nodular forms of autoimmune thyroiditis and thyroid cancer are presented.

The authors discuss their experience in treating 815 patients who underwent an operation for nodular euthyroid and toxic goiter. Thermography was used in the examination of 367 patients and the results were compared with those of radioisotope scanning of the thyroid, intraoperative findings, and the results of histological study. It was established that in complex with clinical methods of examination, thermography is very important in making the differential diagnosis of thyroid diseases. The specific features of surgical tactics in patients with nodular goiter are shown. Economical resection of the gland together with the node is recommended in nodular euthyroid goiter and subtotal subfascial resection of the involved lobe or the thyroid gland in nodular toxic goiter.

A comparative analysis of 2419 case histories of patients operated on for different thyroid diseases, has shown that the frequency of adenocarcinomas in lymphadenoid goiter is almost like in nodular and multinodular goiter however they are detected usually in the form of microfoci. Thyroid cancer in patients with lymphadenoid goiter combined with nodular goiter and/or adenoma is detected twice as more frequently than in patients with (multi)nodular goiter. Routine methods of investigation do not permit preoperative detection of malignancy against a background of lymphadenoid goiter.

Altogether 252 case records of patients operated on for thyroid cancer were analyzed to determine the frequency of combination of a neoplastic process with autoimmune thyroiditis. Analysis of morphological findings of the operative material has shown that thyroid cancer in autoimmune thyroiditis occurs 2.5-times less than in adenomatous goiter and 1.5-times less in diffuse toxic goiter. The resultant conclusion is that the combination of thyroid cancer with autoimmune thyroiditis occurs more seldom than cancer with diffuse toxic goiter and adenomatous goiter, and the combination of autoimmune thyroiditis with diffuse toxic goiter and adenomatous goiter occurs more frequently than that with thyroid cancer.

A detailed examination of 281 patients who had undergone primary surgery for nodular formations in the thyroid was carried out. In most cases, up-to-date methods of preoperative diagnosis (thyroid scanning, diagnostic puncture followed by cytological examination and X-ray examination of soft tissues of the neck to detect calcinates in the gland) were employed. Thyroid cancer was detected in 18.1% of these cases, while background tumor process was not established in 2.1% of patients only. Cancer incidence rates were similar in the cases of single nodes (17.3%) and multiple nodes (19.3%) in the thyroid. Considering the high risk of cancer in the pathologically-altered thyroid tissue, extrafascial surgery for nodular formations rather than intrafascial (for ablastic reasons) should be indicated in patients living in areas where goiter is endemic.