Search

Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases. To a large extent, the development of this disease is associated with metabolic syndrome. There is a pathogenetic association of NAFLD with obesity, type 2 diabetes mellitus (DM2), cardiovascular diseases and chronic kidney disease. Numerous studies demonstrate that an increase in the incidence of NAFLD occurs in parallel with an increase in the prevalence of obesity and DM 2. A number of scientific studies in the field of medicine have made it possible to identify the main pathogenetic mechanisms of the development of the disease, as well as the possibility of using various pharmacological drugs to correct these conditions. Currently, the possibility of using in the future a group of drugs that have a single mechanism for controlling the development of hepatic steatosis, and further progression with the formation of inflammation, cirrhosis and, in some cases, hepatocellular carcinoma, is being considered. Of particular interest is a class of drugs intended for the treatment of type 2 diabetes and obesity – glucagon-like peptide-1 receptor agonists (arGLP-1). A search was made of clinical studies, meta-analyses, literature reviews in databases and registries of medical publications over a period of 10 years. Changes in anthropometric indications, changes in non-invasive markers of liver steatosis, inflammation and fibrosis, as well as histological data on the background of the use of drugs of the arGLP-1 class were studied. It has been demonstrated that the study drug class may have a significant potential for impact on NAFLD. However, further studies with sufficient duration and histological evaluation are needed to fully evaluate the effectiveness of arGLP-1 in the treatment of NAFLD.

On September 30, 2022, a meeting of the interdisciplinary expert council “Prevention and treatment of obesity. How to Achieve a Healthy Metabolic Balance. To reduce the social and economic burden of obesity and its consequences in the Russian Federation, it is necessary to introduce socially significant initiatives to prevent obesity and increase its detection rate, as well as to update modern approaches to the treatment of this chronic disease, taking into account its multifactorial pathogenesis, comorbidity, risk of complications and patient disability. Based on the results of the scientific reports and discussions held during the expert council, the experts made decisions on a further plan within the framework of socially significant initiatives for the prevention of obesity

Coronavirus infection has become one of the biggest shocks of our time. Coronaviruses are viruses with a positive RNA chain, most often affecting the respiratory tract. The virus penetrates into human type II alveolar cells using receptors for angiotensin converting enzyme 2 (APF2). SARS-CoV uses specific host cell factors throughout its infection cycle. The virus replicates inside cells, distracting the body’s own cellular mechanisms, and binds the virion to the APF2 receptor. The number of COVID-19 patients is more than 100 million people. Many recovered people note the persistence of symptoms for several months after an acute illness. Most often, patients complain of shortness of breath, fatigue, general weakness, pain behind the sternum, palpitations. Many studies have clearly demonstrated the effect of COVID-19 on metabolic disorders, the development and progression of cardiovascular diseases and mortality. The studies have shown that inflammation is formed in the myocardium. Its pathogenesis is not fully elucidated. According to two main theories, APF2 plays an important role in myocardial damage, as well as a hyperimmune response, which can independently lead to myocarditis. The frequency and prognostic effect of COVID-19 myocarditis are unknown. This article analyzes the current literature data on the epidemiology, pathogenesis and clinical manifestations of postcovid syndrome, in particular subacute COVID-19 in the focus of cardiovascular disorders. The search for relevant literature was carried out on the basis of Web of Science, PubMed, by keywords: long COVID-19, cardiovascular diseases, postacute COVID-19 syndrome, SARS-CoV-2. The analysis included systematic reviews, meta-analyses, clinical studies, literature reviews published over the past 2 years.

BACKGROUND: The issues of monitoring the effectiveness of iodine deficiency prevention programs are an important component in the process of iodine elimination. Neonatal thyrotropin (TSH) has been used as a criterion for the severity of iodine deficiency since 1994, however, the question of the “cut-off point” of the neonatal TSH level has been widely discussed in the recent literature.AIM: Evaluate the criterion for neonatal hyperthyroidism above 5 mIU/l from the perspective of monitoring iodine deficiency and establish a «cut-off point» on the model of healthy pregnant women with adequate iodine status.MATERIALS AND METHODS: A prospective study was conducted in a population of pregnant women in the city of Tyumen, with the formation of observation groups according to the level of iodine excretion in the urine — the main group (with adequate iodine status throughout the entire gestation period) and the comparison group (women with iodine levels less than 150 μg/l). The results of neonatal screening for congenital hypothyroidism in children of women participating in the study were evaluated. The frequency of neonatal TSH above 5mIU/l was assessed in the observation groups. ROC-analysis was performed and a «cut-off point» of the level of neonatal TSH was established as an indicator of iodine deficiency.RESULTS: The median urinary iodine concentration in the population of pregnant women in Tyumen was 159.05 μg/l, the incidence of goiter was 0.38%, the incidence of neonatal hyperthyroidism above 5 mIU/l was 2.88%, which characterizes adequate iodine intake in the pregnant population women. The frequency of neonatal TSH above 5 mIU/l in newborns from women from the main group was 1.47%, and in the comparison group — 9.3% (p = 0.076). ROC analysis revealed a threshold value of neonatal TSH of 2.77 mIU/l at the cut-off point, which corresponded to the highest value of the Youden index. Urinary iodine concentrations greater than 150 μg/l were predicted for nTSH values below this value.CONCLUSION: Analysis of databases of neonatal screening for congenital hypothyroidism makes it possible to effectively, quickly and at minimal cost annually assess the iodine status in the population. The established «cut-off point» of neonatal TSH in the model of healthy pregnant women with adequate iodine intake in our work is 2.77 mIU/l, the absence of statistically significant differences in the incidence of neonatal hyperthyroidism above 5 mIU/l from women with different iodine status during pregnancy indicate the need to revise the existing threshold of 5 mIU/l and may be an incentive to conduct large-scale studies in regions with different iodine supply.

This draft clinical practice guideline for the diagnosis, treatment and prevention of vitamin D deficiency is an update from a previous 2016 document. An analysis of the relevant literature data was carried out, with particular attention to meta-­analyzes, randomized clinical trials and systematic reviews published over the past 5 years. The updated recommendations were discussed and revised by the leading endocrinologists of the Russian Federation, who have expert status in this issue.The classification of 25(OH)D levels has been revised (in particular, the target range of 25(OH)D values has been specified), recommendations have been developed for screening of the disorders associated with vitamin D deficiency. The concept of vitamin D-associated toxicity and recommendations for its diagnosis and prevention have been introduced. Also, indications for the assessment of other vitamin D metabolites besides 25(OH)D, the main marker of vitamin D status, have been indicated.The section regarding treatment of vitamin D deficiency has been expanded and corrected. The major additions concerned the replenishment of the vitamin D deficiency and insufficiency in certain categories of patients (particularly, in the presence of the chronic kidney disease and autoimmune diseases, as well as in pregnant women) and monitoring of the effectiveness and safety of the therapy. The indications for prescribing active metabolites of vitamin D have been adjusted. Recommendations for the prevention of vitamin D deficiency in the general population have also been revised, taking into account large randomized clinical trials, meta-analyzes and systematic reviews of recent years.This publication is an expanded version of the federal guidelines.

Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive diseases characterized by a defect in one of the enzymes or transport proteins involved in the cortisol synthesis in the adrenal cortex. The most common form of CAH, which occurs in more than 90% of cases, is a 21-hydroxylase enzyme deficiency. The latter is subdivided into nonclassical and classic (salt-losing and virilizing) forms. The prevalence of classic forms of 21-hydroxylase deficiency ranges from 1: 14,000 to 1:18,000 live births worldwide. According to the data of neonatal screening in the Russian Federation, the prevalence of the disease in some regions ranges from 1: 5000 to 1: 12000, in the country as a whole - 1: 9638 live newborns. The non-classical form of CAH occurs more often - from 1: 500 to 1: 1000 among the general population. In second place is the hypertensive form of CAH - a deficiency of 11β-hydroxylase, which, according to the literature, occurs in about 1 per 100,000 newborns. These clinical guidelines were compiled by a professional community of narrow specialists, approved by the expert council of the Ministry of Health of the Russian Federation, and updated the previous version published in 2016. The clinical guidelines are based on systematic reviews, meta-analyses and original articles, and scientific work on this issue in the Russian Federation and other countries. The purpose of this document is to provide clinicians with the most up-to-date, evidence-based guidelines for the CAH diagnosis and treatment

Oral semaglutide is the first-in-class glucagon-like peptide-1 receptor agonist available in the form of pills administered per os. PIONEER — the clinical trial program assessing the efficacy and safety of oral semaglutide — demonstrated the dose-­dependent efficacy of the drug: the reduction of up to -1,4% in terms of glucose-lowering effects and the decrease of up to 5 kg in terms of weight loss. Moreover, oral semaglutide is superior in this regard compared to empagliflozin 25 mg, liraglutide 1,8 mg and sitagliptin 100 mg according to the dedicated trials of clinical program. From the cardiovascular perspective oral semaglutide has been proven to be safe. Therapeutic concentration of semaglutide in oral form is reached under ­several conditions: taking tablets on a daily basis in a fasting state with up to half a glass of water and waiting 30 minutes before drinking, eating, or taking other drugs. Most frequent adverse events were GLP-1 associated gastrointestinal reactions (­nausea, vomiting and diarrhea), most of the events were transient and occurred generally during dose escalation.

The presence of continuous glucose monitoring (CGM) systems has expanded diagnostic capabilities. The implementation of this technology into clinical practice allowed to determine the patterns and tendencies of excursions in glucose levels, to obtain reliable data concerning short-term glycemic control. Taking into consideration the large amount of obtained information using CGM systems, more than 30 different indicators characterizing glycemic variability were proposed. However, it is very difficult for a practitioner to interpret the data obtained due to the variety of indicators and the lack of their target values. The first step in the standardization of indices was the creation of the International Guidelines for CGM in 2017, where the Time in Range (TIR) (3,9–10,0 mmol/l, less often 3,9–7,8 mmol/l) was significant. To complement the agreed parameters and simplify the interpretation of obtained data using CGM, in 2019 the recommendations were prepared for the International Consensus on Time in Range, where TIR was validated as an additional component of the assessment of glycemic control along with HbA1c. In the literature review the issues of the association of TIR with the development of micro- and macrovascular complications in type 1 and 2 diabetes are considered. The relationship with other indicators of the glycemic control assessment was also analyzed and the dependence of insulin therapy on TIR was shown. TIR is a simple and convenient indicator, it has a proven link with micro- and macrovascular complications of diabetes and can be recommended as a new tool for assessing the glycemic control. The main disadvantage of TIR usage is the insufficient apply of CGM technology by the majority of patients with diabetes.

In the context of the increasing prevalence of diabetes, an important task is to educate the patient on the mandatory self-monitoring of blood glucose levels (SMBG), which is an integral component of the treatment and prevention of acute and chronic complications of the disease. On the basis of the SMBG data, it is possible to assess the parameters of glycemic variability, which is the fluctuations in blood glucose during the day and differences in blood glucose levels at the same time on different days. Due to the fact that GV is one of the main criteria for assessing the quality of glycemic control, its correction is considered as a new goal in the treatment of patients with diabetes.

Clinical guidelines have long been one of the working tools of the modern doctor, helping him quickly navigate the most effective proven methods of treatment and prevention of various diseases, and also to adapt these methods to the specific tasks of their patients and to achieve maximum personalization of treatment. Clinical practice guidelines are drawn up by professional non-profit associations and are approved by the Scientific Council of the Ministry of Health of the Russian Federation, while often one recommendation is prepared by two or even three associations. The peculiarity of the recommendations offered to your attention is that not only endocrinologists, but also therapists, cardiologists, gynecologists, gastroenterologists, and experts of many other specialties are involved in the prevention and treatment of obesity. The Multidisciplinary Working Group presents this a project in a multidisciplinary journal to bring together the efforts of several professional associations that associated with the need to pay attention not only to obesity itself but also to comorbid conditions. We are looking forward to constructive criticism and a comprehensive discussion of the problem on the pages of our journal.

Glycemia variability (GV) is an important factor in assessing the quality of glycemic control, as it contributes to the development of micro- and macrovascular complications of diabetes. Currently, there are mathematical methods for assessing GV, obtained using data from professional continuous glucose monitoring (PCGM). PCGM is one of the most modern, innovative technologies that allow assessing the quality of glycemic control and GV in patients with diabetes. The widespread clinical use of PCGM and the interpretation of the data obtained are limited by the lack of generally accepted reference values, as well as by the cost of technology. Reference ranges are needed to interpret the PCGM data in order to improve the quality of glycemic control in patients with carbohydrate metabolic disorders. Aim. Determine the reference ranges for glycemic variability indicators based on the data of professional continuous glucose monitoring to assess the quality of glycemic control. Materials and methods. We studied a population of people without carbohydrate metabolism disorders. A portable Medtronic iPro2 system (USA) was used for PCGM. A sensor was introduced into the subcutaneous fat of the subject, with the help of which 288 glucose measurements were made per day. Calibration was carried out by the subject himself 4 times a day using an individual glucometer. GV parameters were calculated using the Care Link iPro2 Medtronic and EasyGV version 9.0 programs in order to work out the reference ranges. The duration of the study inclusion period was 2 months. The observation period of the participants was 6 days. Results. As a result of the study, the following reference ranges were obtained: the median sensor glucose was 5.0 [4.8; 5.4] mmol/l, TIR – 98.0% [95.0; 99.0], TAR – 0.0% [0.0; 0.0], TBR – 1.5% [1.0; 5.0], GMI – 5.4% [5.3; 5.6], CV – 13.6% [11.6; 15.1], SD – 0.7 mmol/l [0.6; 0.9], MAGE – 1.5 mmol/l [1.2; 1.7], MAG – 0.7 mmol/l/hour [0.6; 0.9], M-Value – 3.7 mmol/l [1.8; 4.4], J-index – 10.4 [9.4; 13.1], CONGA – 4.6 mmol/l [4.5; 5.0], HBGI – 0.7 [0.6; 0.9], LBGI – 2.9 [1.5; 3.2], ADRR – 1.1 [1.0; 2.3]. When conducting a comparative analysis of indicators of glycemic variability, it was found that there were no statistically significant differences depending on age, gender and BMI. Only TBR had statistically significant gender differences (p = 0.007). When carrying out the correlation analysis, only GMI, sensor glucose, M-value, J-index, CONGA, LBGI indicators were statistically significantly correlated with all indicators of the time spent in the ranges. Conclusion. In the course of the study, reference ranges for GV indicators were determined – TIR, TAR, TBR, GMI, CV, sensor glucose, SD, MAGE, MAG, M-Value, J-index, CONGA, HBGI, LBGI, ADRR in the russian population. The obtained values will help physicians in the interpretation of the PNMG data, the wider use of the method in clinical practice, and the expansion of diagnostic capabilities for disorders of carbohydrate metabolism.

Public organization “Russian Association of Endocrinologists”. Clinical guidelines.&nbsp

BACKGROUND. In Russian Federation, there are no large-scale cross-sectional multicenter epidemiological studies assessing the prevalence of vitamin D deficiency and insufficiency in different geographical latitudes. Insufficient solar insolation and inadequate vitamin D content in food dictate the need to study the epidemiological structure of low vitamin D status in Russia.AIM. To assess the incidence of vitamin D deficiency and insufficiency among the population living in the regions of the Russian Federation located at latitudes from 45 ° to 70 °.MATERIALS AND METHODS. The first stage of the Russian multicenter non-interventional registry study using the «crosssectional» method was carried out from March 2020 to May 2020.RESULTS. In regions that represent a geographically representative sample of regions of the Russian Federation with a high risk of developing low levels of vitamin D, it’s deficiency was noted in 55.96%, and the level of deficiency and insufficiency was recorded in 84.01%.CONCLUSION. Close attention to the wide scale of the problem of vitamin D deficiency and insufficiency in the Russian Federation will contribute to the progressive formation of various educational and preventive programs necessary to strengthen health and improve the quality of life of the population.

The study was undertaken to evaluate the efficiency of the 2003-2004 neonatal screening for congenital adrenal hyperplasia (САН) in Tyumen and to estimate the prevalence of classical forms of 21-OH deficiency in the newborns by the results of the screening. Neonatal 17-OHP levels were determined in 20,011 neonatal infants by bilateral enzyme-linked immunosorbent assay (ELISA) at a sensitivity of 0.13 n/mol/l, by using "Delfia Neonatal 17-OHP" kits. In 124 (0.61%), the level of 17-OHP was greater than 60 nmol/l; retests identified 2 babies with salt-loosing САН. Thus, the Incidence of classical forms of САН was 1:10,005 in the Tyumen population. In low-weight premature infants, 17-OHP levels were significantly higher than those in full-term or normal-weight babies.Цель исследования - оценка эффективности неонатального скрининга на ВДКН за 2003-2004 гг. в Тюмени и определение распространенности классических форм недостаточности 21-ОН у новорожденных по результатам скрининга. Уровень неонатального 17-ОНР определен у 20 011 новорожденных методом двустороннего флюорометрического иммунофермент-ного анализа (ELISA) чувствительностью 0,13 нмоль/л с использованием наборов "Deffia Neonatal 17-ОНР". У 124 (0,61%) новорожденных уровень 17-ОНР был выше 60 нмоль/л, по результатам ретестов выявлено 2 ребенка с солыперяющей формой ВДКН. Таким образом, частота классических форм ВДКН в тюменской популяции составила 1:10 005 новорожденных. У недоношенных детей с низкой массой тела уровень 17- ОНР достоверно выше, чем у рожденных в срок и с нормальной массой тела.

Aim : The aim of this study was to evaluate the efficacy and safety of the new ultra-long-acting insulin degludec (Tresiba®) in the treatment of type 2 diabetes in routine clinical practice. Methods : This primary health care clinical observational study included 20 insulin-naive type 2 diabetic patients (mean age: 57.2 years, range: 54.4–61.5 years), who were inadequately controlled on maximum tolerated doses of oral antidiabetic drugs (OADs) and in whom baseline insulin therapy with ultra-long-acting insulin degludec was initiated. The duration of treatment was 6 months. The list of procedures met the ‘Standard of primary medical care in non-insulin-dependent diabetes mellitus’, as approved by the Ministry of Health of the Russian Federation (12.28.2012 №1581-n). Quality of life was assessed using the SF-36 questionnaire. All patients provided written consent before participating in the study. Results : In the outpatient setting, insulin degludec was well tolerated by all the patients. During the observational period, there were no events of symptomatic hypoglycaemia confirmed by self-measured plasma glucose (blood glucose level

Iodine supply remains the global problem due to the wide prevalence and a wide range of clinical manifestations in all age groups of population. However, iodine deficiency is a nutritional deficiency and the solution of this problem lies in the organization of rational nutrition of the population. The purpose of this study was to examine the food features of the population of the mild iodine-deficient region from the standpoint of adequacy of iodine sufficiency. The analysis of nutrition of the population of Tyumen Region in 2005 and 2016 was carried out according to official statistics of Tyumenstat; results of sanitary-hygienic and biomedical monitoring for the period from 1994 to 2016. A sociological study was conducted on a representative nested sample using the questionnaire method. The study involved schoolchildren (n=744) and their parents (n=677), students and full-time students (n=623). Probabilistic was sampling and nesting. Statistical sampling error does not exceed 4%. Analysis of the level of food consumption by residents of the Tyumen region over the period from 2005 to 2016 showed an increase in consumption per capita of fish and fish products (from 23.8 kg in 2005 to 33.1 kg in 2016 at recommended level of 22 kg). At the same time, a sociological study showed that only 1-4% of the population consumed iodine-rich products daily and only 53% of respondents regularly used iodized salt. The analysis of the results of biomedical monitoring over the 20-year period of the existence of preventive programs in the Tyumen region showed significant improvements in the situation in the region: median of ioduria increased significantly from 77 to 125 μg/l and the incidence of goiter in pre-pubertal children decreased from 85% in 1994 to 6.8% in 2016 (р=0,001); the incidence of neonatal hyperthyrotropinemia significantly decreased from 44.3% in 1994 to 3.9% in 2017 (р=0,001). However, most indicators did not reach the target values recommended for iodine-rich region, which indicated the insufficient effectiveness of the existing voluntary prevention system. The solution of this problem is using of iodine-enriched foods of mass consumption, such as bread and bakery products.

To test FTO, KCNJ11, SLC30A8, and CDKN2B for association with type 2 diabetes mellitus (DM), the allele and genotype frequency distributions were established for several polymorphisms of the genes. A comparison of allele and genotype frequencies between DM patients and healthy subjects implicated CKNJ11, SLC30A8, and CDKN2B, but not FTO, in the disease. The genes that affect insulin production and secretion in pancreatic β cells proved to play a main role in type 2 DM in the Russian population.

To study the association with diabetes mellitus type 2 we performed analysis of the distribution of frequencies of alleles and genotypes two polymorphic markers of TCF7L2 gene. The study included groups of T2DM patients and unrelated controls of Russian origin. Analysis of the distribution of frequencies of alleles and genotypes of the polymorphic marker rs7903146 of TCF7L2 gene showed the presence of association with T2DM in Russian population, while for the marker rs12255372 was not found statistically significant associations with type 2 diabetes. We can conclude that in Russian population TCF7L2 gene is associated with development of T2DM.

Genes TCF7L2 and SLC30A8, encoding transcription factor-4 and transmembrane zinc transporter-8, respectively, play an important role in the regulation of development, proliferation, and pancreatic β cell function. In the present study we examined polymorphic markers of genes rs12255372 [NT_03359.12:g33557428G->T] of TCF7L2 gene and rs13266634 [NP_776250.2:p.R325W] of SLC30A8 in groups of Russians with type 2 diabetes (T2D) (n = 588) and healthy normoglycemic controles (n = 597). Significant association of allele T (rs12255372) and allele R (rs13266634) with a higher risk of T2D development has been found (OR = 1.37 and 1.22, respectively). Adjustment for the effect of potential nongenetic risk factors resulted in a further increase in the OR values, from 1.54 (P = 0.24) to 1.89 (P = 0.046) for homozygous carriers of the T allele and from 1.29 (P = 0.035) to 1.35 (P = 0.019) in the individuals homozygous for the R allele. The patients homozygous for predisposing allele T (rs12255372) or R (rs13266634) had significantly lower insulin concentrations in the blood 2 h after glucose tolerance test (GTT) as well as lower values of HOMA-β, β cell homeostasis indicator compared to the carriers of other genotypes. Thus, we have shown that the rs12255372 and rs13266634 markers are independent genetic T2D risk factors in a Russian population.

West Siberia is the region, where annual sunlight days amount is very small because of geographical location in high latitudes. So, all inhabitants have high risk of vitamin D deficiency, what is proved OP fractures frequency studies. To estimate bone mineral density (BMD) loss in endocrinological patients, we performed 528 persons with such diseases as diabetes mellitus type 1, hypothyroidism, toxic goiter and glucocorticoid-dependent bronchial asthma. BMD was measured by DEXA method in forearm distal parts. Atraumatic fractures were registered in 15,3 %.We demonstrated high frequency of osteopenic syndrome (62,6-80%) in endocrine patients, more expressive in postmenopausal women. The received data allowed to determinate OP risk factors for our territory.

The article is devoted to the monitoring of the iodine deficiency program in West Siberia

Aim. To assess efficacy of different methods of iodine prophylaxis in pregnant women living in conditions of goiter endemia. Material and methods. Standard clinical, laboratory and device tests for iodine deficiency according to WHO criteria were made in 156 pregnant women living in the territory affected by goiter endemia. Of them, 121 examinees had no thyroid pathology, 35 ones had diffuse euthyroid goiter. All of them received different kinds of iodine prophylaxis. Results. The occurrence of neonatal TTH values over 5 iU/l in neonates born by mothers free of thyroid pathology on potassium iodide prophylaxis when pregnant was 9.1%. This is much lower than in conventional iodine prophylaxis - 17.24% (p < 0.01). A comparative analysis of the efficacy of potassium iodide-200 in pregnant women with diffuse euthyroid goiter and its combination with L-thy roxin has shown that by the effect on lessening frequency of neonatal ТТЯ over 5 Ш/l the above schemes do not differ significantly, thyroid reduction is more prominent in pregnant women on thyroxine with potassium iodide. Conclusion. The index of neonatal TTH is an objective criterium to control efficacy of different methods of iodine prophylaxis in pregnancy.

The aim of the study was to evaluate the condition of bone system in 335 subjects with thyroid gland dysfunction (TGD), residing in iodine deficit areas. Among the subjects there were 116 individuals with thyrotoxicosis (TT), and 219--with hypothyroidism (HT). The control group included 200 practically healthy people of comparable age and sex. The examination included: evaluation of pain syndrome intensity using a 4-point scale; revealing of atraumatic fracture background; measurement of serum levels of thyroid stimulating hormone (TSH) andfree thyroxin by immune-enzyme assay; measurement of bone mineral density (BMD) by dual-energy x-ray absorptiometry using a Dexa-Scan DX-10 device (Direx, Israel) with evaluation of the results according to 1994 WHO recommendations. 79.3% of TT patients and 68% of HT patients suffered from pain syndrome. The difference in atraumatic fracture rate between the groups was insignificant. The mean BMD values in subjects with TGD dysfunction corresponded to osteopenia, while in the control group they were within normal limits. The difference in osteopenic syndrome rate between TT and HTpatients was insignificant, although osteopenia was revealed in 25% of TT patients. The frequency of BMD decrease grew with age; however, this parameter was higher in all groups of patients with TGD vs. control. The most prone to osteopenia are postmenopausal women regardless of thyroid dysfunction character; difference in BMD decrease frequency between men and women with preserved menstrual function, was insignificant. Osteopenic syndrome was more frequent in men with TGD then in healthy men. Thus, in residents of iodine deficit areas TGD is a factor of BTMD decrease.

To characterize action of thyroid hormones overproduction on bone mineral density.Pain intensity was graded according to 4-score scale, atraumatic fractures in the past were recorded, mineral bone density (MBD) was studied, TTH and T4 levels and biochemical indices of calcium-phosphorus and bone metabolism were studied, thyroid volume was calculated by J. Brunn (1981) and USI data in 116 patients with diffuse toxic goiter aged 20-65 years compared to 200 healthy controls matched by gender and age.Pain in bones was registered in 79% examinees (1.8 +/- 0.2 scores, on the average). Atraumatic bone fractures were in 9.5% (8% in the controls). MBD reduction was revealed at densitometry in 71% patients with thyrotoxicosis. It was most frequent and severe (in UD--1.78 +/- 0.1 SD, in MD--2.1 +/- 0.1 SD) in patients with severe disease associated with intensive bone remodeling. Loss of MBD does not depend on DTG duration. Mild thyrotoxicosis had no negative effect on bone tissue. Significant differences between patients with thyrotoxicosis and drug euthyrosis by rate and severity of osteopenia were not observed.Patients with DTG, especially in severe DTG, demand prophylactic measures concerning osteopenia immediately after diagnosis of thyrotoxicosis.

To assess efficacy of different methods of iodine prophylaxis in pregnant women living in conditions of goiter endemia.Standard clinical, laboratory and device tests for iodine deficiency according to WHO criteria were made in 156 pregnant women living in the territory affected by goiter endemia. Of them, 121 examinees had no thyroid pathology, 35 ones had diffuse euthyroid goiter. All of them received different kinds of iodine prophylaxis.The occurrence of neonatal TTH values over 5 iU/l in neonates born by mothers free of thyroid pathology on potassium iodide prophylaxis when pregnant was 9.1%. This is much lower than in conventional iodine prophylaxis--17.24% (p0.01). A comparative analysis of the efficacy of potassium iodide-200 in pregnant women with diffuse euthyroid goiter and its combination with L-thyroxine has shown that by the effect on lessening frequency of neonatal TTH over 5 iU/l the above schemes do not differ significantly, thyroid reduction is more prominent in pregnant women on thyroxine with potassium iodide.The index of neonatal TTH is an objective criterium to control efficacy of different methods of iodine prophylaxis in pregnancy.

New standards of the thyroid volume proposed by F. Delange (1977) are now being introduced. In view of this, we compared incidence of goiter by F. Delange and by R. Gutekunst (1988) criteria. The examination covered 3920 schoolchildren in 12 settlements of the Tyumen region in 1996. Iodine deficiency was mild to moderate. The greatest deficiency was observed in the North. Ultrasonic investigation of the thyroid by standards of R. Gutekunst (1988) was also indicative of the greatest iodine deficiency in the North. In the Far North, Polar Urals there was severe goiter endemia, in the rest areas the endemy was moderate. By F. Delange (1977) criteria, mild and moderate endemy was in the Far North and Polar Urals, the endemy was absent in the rest areas. As shown by comparison of the palpation data to thyroid ultrasonography, iodinuria, R. Gutekunst criteria are more reliable whereas criteria of F. Delange provide overestimated data.

Epidemiological rvaluation of goiter endemia and iodine deficiency in population of the Middle Ob region.Thyroid palpation and ultrasonic investigations, iodine measurements in the urine were made in 6256 children and adolescents aged 8-17 years.Euthyroid condition was clinically stated in all the examinees. Palpation discovered thyroid enlargement in 36.78% of the examinees. Age prevalence was: 27.3, 33.28, 42.8, 46.18% in children and adolescents aged 8-10, 11-12, 13-14 and 15-17 years, respectively. Ultrasound detected goiter in 30.6% of the examinees. The occurrence was 34.78, 31.68, 28.2, 19.8% in the above age groups, respectively. No significant differences by thyroid size existed in girls versus boys. Urinary iodine was low in all the age groups.The Middle Ob regions belong to zone of goiter endemia with mild to moderate iodine deficiency. This dictates the necessity of introduction of special programs of iodine deficiency control and prevention.