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Amiodarone is a drug used in the treatment of life-threatening arrhythmias, which can lead to the development of amiodarone-induced thyrotoxicosis. In most cases this pathology can be treated by conservative methods; surgical treatment is resorted to in cases of thyrotoxicosis refractory to medical treatment. This case report describes surgical treatment of a patient with amiodarone-induced thyrotoxicosis, progressive heart failure, neurological pathology, bilateral pneumonia, functioning tracheostomy, systemic infectious process, multiple organ dysfunction syndrome, who was treated in the intensive care unit. Due to the lack of response to therapy with antithyroid drugs (thiamazole, lithium preparations and pulse therapy with prednisolone) and a progressive deterioration of the condition in a short period of time, according to vital indicators, the patient underwent thyroidectomy. In the postoperative period, there was a decrease in the occurrence of chronic heart failure symptoms. Medical control of cardiac arrhythmias was achieved. Surgical stage proceeded without complications in the period of 30-days. The patient was discharged for outpatient rehabilitation treatment.

Introduction. In the cases of neurosurgery failure in acromegaly treatment, drug therapy with somatostatin analogues (SSA) octreotide or lanreotide is indicated. The effectiveness of SSA is limited by the presence of resistance, there is an opinion that in some cases it can be overcome by replacing one drug with another.Aim. Own experience analysis of transferring acromegaly patients from therapy with long-acting octreotide to lanreotide autogel 120 mg.Materials and methods. The case histories of acromegaly patients who were recommended to replace long-acting octreotide therapy with lanreotide therapy 120 mg were analyzed. GH and insulin-like growth factor-1 (IGF-1) dynamics was evaluated at least 6 months after the replacement of the drug. The target value for GH was considered to be less than 2.5 micrograms/l, for IGF-1 – an excess of no more than 30% of the upper normal limit.Results. 24 patients were transferred to lanreotide therapy 120 mg. Of the 19 patients with insufficient reduction of GH and IGF-1 on prolonged-acting octreotide therapy at a dose of 40 mg every 28 days (OCT40) the prescription of lanreotide 120 mg every 28 days (LAN120) led to the target values of both GH and IGF-1 in 4 (21%) cases. These patients had no more than a twofold excess of IGF-1, and the level of GH was less than 2.5 mcg/l on the background of OCT 40 therapy. In 6 (32%) patients, IGF-1 levels normalized or decreased, but GH remained outside the target values. In 9 (47%) cases, the replacement of the SSA did not lead to a significant positive dynamics in the levels of GH and IGF-1. The effects of lanreotide therapy 120 mg in another five patients initially treated with octreotide 20 mg are also described.Conclusions. Replacement of OCT4 with LAN120 may be effective in some patients with acromegaly. A slight increase in the level of IGF-1 together with the target values of GH before replacing the SSA may be the predictor of success.

Treatment of thyrotoxicosis caused by Graves’ disease or multinodular toxic goiter, is not difficult, in most cases, since the prescription of thionamides allows to normalize the level of thyroid hormones quickly and safety. But in a number of cases this therapy might be associated with serious side effects (agranulocytosis, toxic hepatitis, cholestasis), severe allergic reactions and also individual intolerance on thionamides. In such cases lithium carbonate is used, especially in severe thyrotoxic syndrome. It is known, that lithium can accumulate in the thyroid gland at a concentration 3–4 times higher than in the plasma. Perhaps, lithium uses Na+/I- ions. It can inhibit the synthesis and secretion thyroid hormones of thyroid gland. The article presents the cases reported the use of lithium carbonate in thyrotoxicosis treatment before thyroidectomy. Administering low doses of carbonate lithium (900 mg/ per day) renders significant decrease or normalization of thyroid hormones concentration within 7–14 days, thus it let perform thyroidectomy on the patients. No side effects have been identified with such a short course of lithium carbonate treatment.

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.

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.