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The OBJECTIVE of the study was to analyze the experience of performing thyroidectomy (TE) in patients with amiodarone-induced thyrotoxicosis (AmIT) at our centre.METHODS AND MATERIALS. The study included 12 patients with AmIT who underwent TE. Medical records were analyzed to assess the features of the AmIT and indications for TE. We also studied the operation protocols and postoperative follow-up data. Intraoperative, early and long-term postoperative complications were recorded. The long-term TE results were evaluated by the dynamics of the left ventricular ejection fraction (LVEF) based on the echocardiography data.RESULTS. The main indications for TE included the resistance of thyrotoxicosis to medication and worsening of the cardiac pathology. No cases of thyrotoxicosis progression or thyrotoxic crisis were registered during the operation. The vocal cord paresis developed in one case, completely restored in a year. Blood loss was minimal in all cases. Other intraoperative complications were absent. Not a single death was registered in the early postoperative period. At this period, a short paroxysm of atrial fibrillation resolved on its own was registered in patient with arrhythmogenic right ventricular dysplasia. A patient with biventricular chronic heart failure of a high functional class died 39 days after the operation due to a massive pulmonary thromboembolism. The long-term results of TE were evaluated in eight patients. In four out of five patients with initially reduced LVEF, it increased. In three patients with initially normal LVEF, it did not change.CONCLUSION. Thyroidectomy is an effective and safe treatment in patients with AmIT, including those with the persistent thyrotoxicosis and severe cardiac pathology. The success is possible when the preparation of patients for the intervention is carried out by a team of specialists experienced in treating of such patients.

Aim. To explore genesis of the left ventricle hypertrophy in acromegaly patient, with the method of next generation sequencing. Material and methods. Standard clinical and laboratory minimum was done, with electrocardiography, 24 hour ECG monitoring, echocardiography, magnete resonance tomography of the heart, new generation sequencing on the IlluminaHiSeq 2000 equipment with simultaneous analysis of 108 genes associated with idiopathic hypertrophic cardiomyopathy (HCMP) and phenocopies of HCMP. Results. At the age 59 y. o. the female patient had beed first time diagnosed with asymmetric HCMP, non-obstructive type (interventricular septum 19 mm, posterior wall 11 mm, pressure gradient in outflow tract of the left ventricle (OTLV) — 25 mmHg). At the age 62 y. o. she developed HCMP with dynamic obstruction of OTLV (pressure gradient in OTLV up to 80 mmHg) with progressing dyspnea on exertion, and required non-surgical reduction of interventricular septum. By the computed tomography data, at the age 63 y. o. the patient was diagnosed with endocellar hypophysis microadenoma (a tumor 6,7*7,3 mm), somatotropic hormone — 53,39 mU/L (normal: 0,1-20 mU/L), insulin-like growth factor 1 — 359 ng/mL (normal: 118-314 ng/mL). However, with retrospective analysis of her photos, even from the age 40 y. o. there were enlarged hands, feet, nasal cartilages, ears, lips and eyebrow arcs that witness for long lasting disease course. With the new generation sequencing, there were no pathological mutations revealed. Conclusion. The case represents hypertrophic cardiomyopathy as a leading clinical sign in acromegalic cardiomyopathy that imitated idiopathic HCMP. Patient management in such case should include on-time etiopathogenetic therapy that works against disease progression, and in some cases even for regression of the left ventricle hypertrophy.

Introduction. Common is considered that surgical procedures in patients with diabetes mellitus (DM) must be performed at a stable level of blood glucose and at a stable hemodynamic. Aim. Determine effective anesthesia technique for diabetic foot (DF).surgery. Materials and methods. 30 patients (59.5 (53; 67) yr old, 16 female and 14 male) with DM and DF surgery were included in a retrospective study. Spinal anesthesia was used in 10 patients (SA group). In the presence of contraindications to spinal anesthesia we used the blockade of the sciatic nerve (SNB group, 10 patients), or general anesthesia with tracheal intubation (GA group, 10 patients). Data are presented as median (25th, 75th percentile). Results. In the SA group mean arterial pressure (MAP) decreased from baseline by more than 20% in 80% of patients, in the SNB group - in 30% (p = 0,03) and in the GA group - in 60% of patients (ns). The median of maximum decrease in MAP during anesthesia was 25 (20; 27)% for the SA group, 16 (13; 22)% for the SNB group (p = 0,03) and 21 (15; 24)% for the GA group (ns). Infusion volume was lower In SNB group than in the SA group (500 (500; 750) vs 1500 (1500; 2000) ml, p

Graves' ophthalmopathy is one of most frequent extrathyroid manifestation of autoimmune thyroid diseases. In 3–5% cases it has severe progress and requires specific therapy. There are many methods of treatment and it's getting more and more, but that demonstrate no sufficient effectiveness. In this review was made an essay to systematize current data. Also guidelines of consensus EUGOGO for treatment of ophtalmopathy is represented here.