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BACKGROUND: Among different subtypes of pancreatogenic diabetes mellitus the biggest difficulties of glycemic control arise in patients after total duodenopancreatectomy (TDPE), first of all due to the presence of absolute insulin insufficiency.AIM: Estimating safety and cost-effectiveness Guardian Connect CGM system in early postoperative period in hospitalized patients after TDPE on continuous intravenous insulin therapy (CIVIT).MATERIALS AND METHODS: Glucose measurement results of 26 patients in early postoperative period after TDPE were analyzed. In 12 of them, we used Guardian Connect CGM system. In this group 43 cycles (1 cycle — 6 days, 258 days total) of CGM and 971 glucometer measurements used for CGM calibration were analyzed; in other 14 patients in whom only glucometer was used we analyzed 2496 glycemic values.Cost-effectiveness was calculated over 6 days for CGM and only glucometer use (including cost of CGM, glucometers, disposable materials, clinic wage-costs to medical staff for time required for glucose control).RESULTS: Glucose levels of group #1 were in the target range 5.6 to 10.0 mmol/L (66.7 vs 61.2%, p=0.003) and the range 4.3–11.6 mmol/L (85.2% vs 82.2%, p=0.038) more than in comparison with group #2.The frequency of hypoglycemic episodes (

TThe annual increase in the prevalence of type 2 diabetes mellitus emphasizes the relevance of the search for new treatment options, along with necessity for regular review of proven therapeutic solutions. Today, dipeptidyl peptidase-4 inhibitors (DPP-4i, gliptins) are effective and safe hypoglycemic therapy, which is included in modern standards of treatment of type 2 diabetes. In 2022, the availability of this group of drugs for Russian patients has significantly increased. This circumstance became a prerequisite for holding a National Council of Experts with the participation of members of the Russian Association of Endocrinologists. The task of the Council was to determine the place of DPP-4i in the treatment of patients with type 2 diabetes in 2023. During the meeting of the Council, experts summarized the evidence base of DPP-4i taking into account the latest scientific data and determined the optimal clinical portraits of patients for the use of DPP-4i in accordance with updated national recommendations.

The problem of eating disorders currently holds a special place in clinical practice. Bulimia nervosa is one of the main forms of eating disorders, characterized by the difficulty in its treatment and a long, recurrent course. Eating disorders are common in patients with type 1 diabetes mellitus (T1D), especially in adolescent girls.In this article, we present a clinical case of a patient with T1D and bulimia nervosa, which developed before the manifestation of T1D and progressed against its background. The patient is overly concerned with controlling body weight, specifically restricted the intake of carbohydrates, forcibly caused vomiting. During pregnancy fasting ketonuria («low-carb ketone») was repeatedly detected. The minimum weight was 37 kg (BMI 15.2 kg/m2). Particular interest of this case is the course of pregnancy, which ended in the antenatal death. The possible cause could be the restriction on carbohydrate food and prolonged stay in ketosis, that might lead to the development of pregnancy pathology. Additional examination also revealed multiple complications of diabetes and recurrent depressive disorder, which requires conjoint monitoring by an endocrinologist and a psychiatrist.Combination of T1D and eating disorder in a pregnant patient should be considered as an atypical course of the disease.

Introduction. In type 2 diabetes mellitus, an inevitable decrease in the secretion of β-cells of the pancreas occurs, which requires the initiation of insulin therapy. Currently, there have been no studies evaluating the features of insulin therapy in patients with diabetes type 2 and morbid obesity.Objective. To compare the effectiveness of different insulin therapy regimens in patients with type 2 diabetes mellitus and morbid obesity. Materials and methods. 140 patients with diabetes type 2 and morbid obesity were included in a 24-week prospective, non-blinded, randomized clinical study. The patients were divided into 4 groups: 1 – received basic-bolus insulin therapy in combination with metformin (n = 40); 2 – used prandial insulin in combination with metformin (n = 40); 3 – basal insulin in combination with empagliflozin and metformin (n = 30); 4 – received prandial insulin in combination with empagliflozin and metformin (n = 30). Initially, after 12 and 24 weeks, the level of HbA1c, fasting plasma glucose and during the day, body weight, daily insulin doses, frequency of hypoglycemia, and albumin in daily urine were assessed.Results. After 24 weeks of treatment, there was no statistically significant difference in the achieved HbA1c level between the groups (p = 0.65); in groups 3 and 4, there was a statistically significant decrease in body weight, daily doses of insulin and frequency of hypoglycemia compared to the first and second treatment groups (p = 0.029, p < 0.001 and p < 0,001, respectively); also registered a decrease in albumin in daily urine by 27% during the study period compared with the first and second treatment groups (p = 0.044).Conclusions. Administration of iSGLT-2 in combination with both basal and prandial insulin in patients with diabetes type 2 and morbid obesity has advantages over the basic-bolus regimen and the regimen of multiple prandial injections, despite the comparable efficacy.

Diabetes self-management education (DSME) is an essential part of effective and safe treatment of chronic conditions such as diabetes mellitus (DM). Though the data on DSME effectiveness in elderly are limited, all patients should be educated regardless of age. The form of learning and education program may vary depending on the clinical situation and the patient’s characteristics. Age-related problems, so-called geriatric syndromes, determinant heterogeneity of elderly diabetic population. Geriatric syndromes should be taken into account to choose proper treatment goals and optimal education programs. Functional dependency, cognitive decline, depression, sarcopenia, malnutrition and polypharmacy seems to be most important in the education context. The development of geriatric education program with a broad focus on solving both diabetic and age-related problems and its implementation on a wider range of institutions may be useful to improve diabetes self-management education of elderly in clinical practice. It is also necessary to initiate clinical studies to evaluate DSME effectiveness in elderly not only from the generally accepted diabetological criteria, but also considering its impact on age-related problems.

Thanks to modern treatment protocols, childhood cancer survivors (CCS) are a very fast-growing population nowadays. Cancer therapy inevitably leads to different late adverse effects, where endocrine disorders are highly prevalent, including growth hormone deficiency (GHD) which is the most common endocrine outcome after cancer treatment in childhood and contributes to impaired growth. Short stature is a big issue, which leads to problems in psychological and social adaptation of patients and reduces their quality of life. Impact of GH treatment on various physiological processes and global outcome of CCS is of great interest. Several studies have demonstrated an influence of GH and IGF-1 on the development/tumour growth, cell proliferation. In this regard, the issue of increasing the risk of cancer recurrence and/or the development of secondary neoplasms in CCS, causes a lot of controversy and is the subject of continuous evaluation. In this review, we went through the available data on the prevalence and pathogenesis of GHD following chemo- and radiotherapy, in particular after treatment of brain tumors and acute lymphoblastic leukaemia in childhood. In addition, here we discuss the existing problems in the diagnosis of GHD, the safety of GH replacement therapy, as well as the treatment algorithm of the GHD in adults.

Inhibitors of the sodium-glucose cotransporter type 2 (SGLT2i) are a modern class of antihyperglycemic drugs with an insulin-independent mechanism of action. Due to its ability to effectively lower blood glucose levels, improve a number of other cardiometabolic parameters (body weight, blood pressure, uric acid), as well as reduce cardiovascular and renal risks, SGLT2i have become drugs of choice for many of patients with type 2 diabetes mellitus (T2DM). Meanwhile, along with the generally recognized classes-effects of this group of drugs, there are intragroup features, including those associated with their different selectivity in sodium-glucose cotransporters of types 1 and 2 (SGLT1 and SGLT 2). For example, one of the most studied SGLT2i, canagliflozin, in addition to its inhibitory activity against SGLT2, can also moderately block SGLT1 in the intestine and kidneys that could give a maximum efficiency in the control glycemia and others cardiometabolic parameters. In addition, canagliflozin improves not only cardiovascular, but also renal prognosis in patients with T2DM, which is reflected in the corresponding indications in the summary of product characteristics of the drug. This document summarize the established and new data regarding the efficacy and safety of canagliflozin, as well as its place in the treatment of T2DM.

Hypoparathyroidism is a rare endocrine disease. In most cases in adult patients, the cause of hypoparathyroidism is damage or removal of parathyroid glands during surgical interventions on the neck; other causes are rarely observed.Case report. A 52-year-old man with episodes of seizures, intense muscle pain, progressing for 7 years and resistance to treatment with myorelaxant, anxiolytics and nonsteroidal anti-inflammatory drugs was examined and hypocalcemia associated with low parathyroid hormone and excessive urinary calcium excretion was found. Ultrasound examination didn't reveal any changes in parathyroid glands. The patient was diagnosed with idiopathic hypoparathyroidism. Treatment with calcium supplements and active metabolites of vitamin D led to an improvement in clinical symptoms and laboratory parameters.Discussion. Hypoparathyroidism as part of several genetic syndromes was excluded due to the late- onset of the disease and the absence of concomitant diseases. Ultrasound of the parathyroid glands made it possible to rule out metastasis and storage diseases. It is recommended to perform genetic testing of the chromosomes 22 and 10 to exclude rare variants of syndromic hypoparathyroidism with the late-onset in the form of isolated hypocalcemia.

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

In the world, the number of patients with carbohydrate metabolism disorders is steadily growing. Over the past 10 years, the number of patients with diabetes mellitus in the world has more than doubled. Moreover, there is not only an increase in the number of patients with diabetes mellitus, predominantly type 2 diabetes, but also with prediabetes. The term «prediabetes» means impaired glucose tolerance and impaired fasting glycemia. To date, it is obvious that the development of prediabetes lead not only to the higher risk of diabetes mellitus in the future, but also of cardiovascular diseases. Factors that increase the risk of cardiovascular events in patients with prediabetes includeare the following: insulin resistance, accompanied by arterial hypertension and dyslipidemia, and postprandial hyperglycemia. Therefore, it is very important to timely identify patients from the risk group, diagnose and treat carbohydrate metabolism disorders already at the stage of prediabetes. Also it is very important to identify the patients from the risk group, diagnose and treat carbohydrate metabolism disorders at the stage of prediabetes. Treatment of patients with prediabetes implies, first of all, lifestyle modification (moderate hypocaloric nutrition with predominant restriction of fats and simple carbohydrates and regular physical activity of moderate intensity) in order to reduce weight. If lifestyle changes are ineffective, drug therapy may be prescribed. The article discusses the studies conducted to assess the effectiveness of lifestyle modification, as well as various options for antihyperglycemic therapy (metformin, glucagon-like peptide receptor agonists, alpha-glucosidase inhibitors, orlistat) for the treatment of patients with prediabetes. It also provides data on long-term follow-up of patients with prediabetes who received different treatment options.

Melatonin is a special hormone that act as an internal synchronizer of circadian rhythms, the organism physiology and behavior to the environmental day and night and seasons of the year. The present urban society and the industrial production processes as organized should be considered, as both depend on the presence of indoor lights during the night and include the profuse use of electronic devices whose screens are rich in blue wavelength light. Light during the night delays the beginning of the secretory episode of melatonin and blunts its peak, causing chronic hypomelatoninemia. Hypomelatonemia, that causes deprivation of sleep and eating behavior disorders, along with low physical activity, can be the reason of the obesity, «non-infectious epidemic of the 21st century». According to this, the use of melatonin drugs for obesity treatment can be effective. Further prospective, controlled, randomized trials in this area are required to confirm this hypothesis.

Elderly patients with diabetes type 2 represent complex and heterogeneous group with different diabetes complications and comorbidity, polypharmacy, functional and cognitive state. Each of those factors should be taken into account to choose the best glycemic targets as well as the most tailored treatment so that it is necessary for endocrinologist to perform geriatric assessment. The most favorable antidiabetic drugs for elderly are safe in terms of hypoglycemia and cardiovascular risks, can be used irrespective of kidney function, do not affect weight or bone mineral density, and are available in fixed combinations with other drugs. Dipeptidyl pepti-dase-4 (DPP-4) inhibitors meet all these requirements with low adverse events rate. Interdisciplinary approach, close interaction with patient and his relatives and considerations for both intensification and deprescribing are keys to successful treatment in this patient subgroup. Cardiovascular events are the most common cause of death and hypoglycemia is highly unfavorable in elderly because it can lead to falls, life-threatening arrhythmias, and cognitive impairment. So deprescribing in elderly with diabetes should be primarily aimed at minimizing of cardiovascular events and severe hypoglycemia risks. For this purpose, it is considered to the reject use of sulfonylureas, glinides, insulins in favor of safer ones (metformin, GLP-1 receptor agonists, SGLT-2 inhibitors, DPP-4 inhibitors).

Abstract The fate of melanin in the epidermis is of great interest due to its involvement in numerous physiological and pathological processes in the skin. Melanin localization can be assessed ex vivo and in vivo using its distinctive optical properties. Melanin exhibits a characteristic Raman spectrum band shape and discernible near-infrared excited (NIR) fluorescence. However, a detailed analysis of the capabilities of depth-resolved confocal Raman and fluorescence microspectroscopy in the evaluation of melanin distribution in the human skin is lacking. Here we demonstrate how the fraction of melanin at different depths in the human skin in vivo can be estimated from its Raman spectra (bands at 1,380 and 1,570 cm−1) using several procedures including a simple ratiometric approach, spectral decomposition and non-negative matrix factorization. The depth profiles of matrix factorization components specific to melanin, collagen and natural moisturizing factor provide information about their localization in the skin. The depth profile of the collagen-related matrix factorization component allows for precise determination of the dermal–epidermal junction, i.e. the epidermal thickness. Spectral features of fluorescence background originating from melanin were found to correlate with relative intensities of the melanin Raman bands. We also hypothesized that NIR fluorescence in the skin is not originated solely from melanin, and the possible impact of oxidized species should be taken into account. The ratio of melanin-related Raman bands at 1,380 and 1,570 cm−1 could be related to melanin molecular organization. The proposed combined analysis of the Raman scattering signal and NIR fluorescence could be a useful tool for rapid non-invasive in vivo diagnostics of melanin-related processes in the human skin.

The aim. Based on a pharmacoeconomic analysis (PHe) of the use of sodium-glucose cotransporter-2 inhibitors (iSGLT2) and dipeptidyl peptidase-4 (iDPP-4) inhibitors to determine the optimal treatment strategy in patients with type 2 diabetes mellitus (T2DM) with inadequate glycemic control in metformin. Methodology. PE based on the clinical data obtained in the Russian multicenter observational epidemiological study FORSIGHT-T2DM and data obtained by analyzing and synthesizing previously published results of randomized controlled trials. Based on the obtained by Markov modeling outcomes we conduct a cost-eff ectiveness analysis with a calculation of cost-eff ectiveness ratio (CER). The time horizon was 7 years. Results. The highest survival rate observed in patients taking alogliptin and empaglifl ozin. The lowest total direct medical costs was on linagliptin (511,830 rubles) and canaglifl ozin (663,571 rubles). The highest utility index according to the EQ-5D questionnaire in iDPP-4 group was on vildagliptin (0.496), in iSGLT2 group on dapaglifl ozin (0.489) and canaglifl ozin (0.489). The highest life years gained (LYG) in iDPP-4 group was on alogliptin (0.65 years); in iSGLT2 group on empaglifl ozin (0.51 year). The highest quality adjusted life years (QALY) was on alogliptin (0.32) and empaglifl ozin (0.25). The results of PHe showed that the lowest discounted CЕRLYG was on alogliptin (937 921 rubles) and empaglifl ozin (1 645 559 rubles). The lowest discounted CЕRQALY was on alogliptin (1 918 522 rubles) and empaglifl ozin (3 369 349 rubles). The sensitivity analysis confi rmed that increasing the price of empaglifl ozin and alogliptin by 25 % and / or reducing the proportion of patients who reached the target of HbA1c level by 25 % when taking empaglifl ozin or alogliptin did not change the most cost-eff ectiveness strategy. Conclusion. The results of this PE showed that alogliptin and empaglifl ozin have the lowest CЕRLYG and CЕRQALY. In patients with inadequate glycemic control on metformin add-on empaglifl ozin or alogliptin is the most cost-eff ective treatment strategies.

Amiodarone-induced type 2 thyrotoxicosis remains a significant problem of modern endocrinology and cardiology. The unique pharmacological character and multifaceted properties of amiodarone explain its high prescription frequency and the leading position among antiarrhythmic drugs. In its turn, cytotoxicity and supra-physiological iodine content in the drug increase the risk of drug-induced destructive thyroiditis. The development of thyrotoxicosis leads to recurrence of cardiac arrhythmias, increased left ventricular dysfunction and manifestations of chronic heart failure. Correct identification of the type of thyrotoxicosis determines the subsequent patient management strategy. Glucocorticoids have been recognized as the first-line treatment among the possible therapy options. Rapid correction of thyrotoxicosis is crucial, especially in elderly patients with severe heart disease. Of interest for practical medicine is the search for specific predictors (deep understanding of the pathogenetic mechanisms) and new possibilities of therapy for amiodarone-induced thyrotoxicosis type 2.

GLP-1 receptor agonists are a class of drugs with high efficacy, a good safety profile recommended as second-line drugs after metformin for the treatment of type 2 diabetes mellitus. Dulaglutide is a GLP-1 analogue designed for once weekly subcutaneous injection using recombinant technology and approved for use as monotherapy or in combination with other hypoglycemic agents in many countries. The randomized multicenter clinical trials have shown the advantage of dulaglutide monotherapy it had with respect to glycemic control over metformin in patients previously on diet therapy and no less efficacy compared with liraglutide monotherapy in daily injections. When used in combination with other hypoglycemic agents (including metformin, sulfonylurea preparations, metformin and pioglitazone, metformin and prandial insulin, insulin glargine), dulaglutide was no less effective than liraglutide at a dose of 1.8 mg per day and lowered the glycated hemoglobin level more significantly than sitagliptin, exenatide for injections twice a day and insulin glargine in the studies lasting 26–104 weeks. In this case, dulaglutide at a dose of 1.5 mg/week resulted in a weight loss lasting for two years of therapy. Dulaglutide was generally well tolerated, and a convenient disposable once-weekly self-injecting syringe-pen of the drug significantly improved the patient’s quality of life and encouraged adherence to therapy.

Introduction. The multidisciplinary approach, including pharmacological therapy, educational therapy, cognitive-behavioral therapy (CBT) has the leading role in management of patients with diabetic polyneuropathy (DPN). There is no domestic experience in the multidisciplinary treatment of DPN patients. Study purpose – study of efficiency of DPN patients management using a multidisciplinary approach. Patients and methods. The study included 50 patients (29 women and 21 men) aged 20 to 78 years (mean age = 57.6 ± 10.2 years) with diabetes mellitus (DM) of type 1 and 2 and DPN. All patients received multidisciplinary treatment consisting of pharmacotherapy, educational programs, KPT. All patients by Cocarnit (for 9 days). The observation period for the patients was 12 weeks. All the patients underwent assessment of neuropathic and asthenic symptoms. Results. Many patients were newly diagnosed with concomitant neurological (lumboischalgia, cervicalgia, tunnel syndromes, headaches, insomnia) and emotional (anxiety, depression) disorders. Authentically significant reduction in the average positive neuropathic and asthenic symptoms, improvement in average pain sensitivity was observed from Day 10 and persisted until 12 weeks of observation. Best value of effectiveness of interdisciplinary treatment was observed in patients with Stage 2 DPN. Conclusion. There is a low level of diagnostics of combined neurological and emotional disorders in patients with diabetes and DPN. The multidisciplinary treatment allows relatively quickly and firmly to reduce the severity of neuropathic and asthenic symptoms in DPN patients, most effectively – at the Stage 2A of DPN. The use of Cocarnit is effective and safe in complex therapy of DPN patients.

In today’s clinical practice, the treatment of type 2 diabetes mellitus should be targeted not only at achieving glycemic control, but should also affect other modified risk factors for cardiovascular disease including hypertension, overweight, frequent hypoglycemia, etc. [4] Empagliflozin is the first antidiabetic drug with the new approved indication allowing it to be used for the reduction of cardiovascular mortality risks in patients with type 2 diabetes and comorbid cardiovascular diseases.

Secondary hypothyroidism is a very rare cause of hypothyroidism in adults. Clinical manifestations of secondary as well as primary hypothyroidism are nonspecific; in addition, thyroid hormone deficiency often clinically simulates other tropic hormone deficiencies, thus complicating timely diagnosis of the disease. Certain difficulties are also caused by replacement therapy in secondary hypothyroidism, since the level of free thyroxine in the blood is used as the criterion for evaluating levothyroxine dosage, and questions about the use of peripheral markers of thyroid function to assess the adequacy of therapy remain understudied.

Background: Maintenance of stable glycemic control is an important prerequisite of effective treatment of patients with type 1 diabetes mellitus (DM). The ultra-long-acting basal insulin degludec allows for reduction of glycemic variability and for a substantial reduction in the rates of hypoglycemia with equivalent glycemic control. Evaluation of the impact of this novel insulin on diabetes-dependent quality of life and patient satisfactions with the treatment is necessary for comprehensive assessment of treatment efficacy.Aim: To study changes of glycated hemoglobin (HbA1c), rates of hypoglycemia, diabetes-dependent quality of life and treatment satisfaction in patients with type 1 DM, who have been switched to insulin degludec.Materials and methods: This open 12-week observational comparative study included 25 patients with type 1 DM (median age, 36 [20; 63] years), who were switched to insulin degludec in combination with a ultra-short insulin analogue. The control group included 21 patients with type 1 DM (median age, 40 [23; 63] years), who continued their treatment with a long-acting insulin analogue glargine. At baseline and at week 12 after switching to insulin degludec, we assessed HbA1c level, mean insulin dose, depression score, diabetes-dependent quality of life and patient satisfaction with the treatment with the use of the Russian versions of the diabetes-specific questionnaires “Audit of Diabetes-Dependent Quality of life” (RuADDQoL), and “Diabetes Treatment Satisfaction Questionnaire” (DTSQ), respectively.Results: At 3 months, there was a significant reduction of the HbA1c levels in the main and the control groups to 7.57% (Ме 7.5 [7.1; 8.4]; р=0.03) and 8.18% (Ме 7.8% [7.4; 8.7]; р=0.04), respectively. The mean reduction of this parameter under treatment with degludec was slightly higher than under treatment with glargine (0.73 vs 0.57%, respectively), at 3 months the difference being statistically significant (p=0.034). To achieve an equivalent glycemic control, the mean daily dose of insulin degludec was reduced by 26%. Switching to insulin degludec was associated with a significant reduction in non-severe hypoglycemia rates by 45% (р

Type 2 diabetes mellitus (T2DM) is a high risk factor for the development of macrovascular complications. Several large studies have demonstrated the fundamental role of early extensive blood glucose control in the prevention of these complications. An aggressive approach in achieving normoglycemia in patients with T2DM and existing macrovascular complications could lead to an increase in cardiovascular outcomes, which has a clear association with hypoglycemic conditions. Insulin therapy (IT) remains one of the most effective pharmacological treatments for diabetes provided adequate and timely prescription. The advent of long-acting insulin analogues helped not only to reduce the incidence of hypoglycemia as one of the most clinically relevant adverse events of IT, but also marked certain prospects in the prevention of type 2 diabetes in people with prediabetes.

Combination of lifestyle changes and drug therapy is necessary to achieve and maintain optimal glycemic control in type 2 diabetes. Currently, various hypoglycemic drugs of both tableted and injectable forms with different mechanisms of action are used. The article presents data on modern approaches to the selection of glucose reducing drugs for type 2 diabetes mellitus.

The interdisciplinary interim experts’ council on March 3, 2016 in Moscow have considered the EMPA-REG OUTCOME trial results and suggested a number of propositions and recommendations on further empagliflozin’s cardiovascular effects investigation and its clinical application in patients with type 2 diabetes at high cardiovascular risk.

The global number of patients with diabetes mellitus (DM) has been growing steadily. Over the past decade, the number has more than doubled and reached 371 million people by 2013. [1] In most cases it is type 2 diabetes. The dangerous consequences of DM include micro- and macrovascular complications: nephropathy, retinopathy, lesions of the major blood vessels in the heart, brain and lower limbs. Late complications of DM are a major cause of disability and mortality of the patients.

Hypothyroidism is one of the most common endocrine diseases. The article tells about prevalence, etiology and clinical pattern of hypothyroidism. The principles of diagnosis of thyroid hormone deficiency and levothyroxine replacement therapy are discussed. Factors that affect the quality of hypothyroidism compensation, and major causes of the disease decompensation are also considered.

Thyroid hormone administration after thyroid tumors surgery is a part of complex treatment strategy. In case of papillary, follicular and poor-differentiated carcinomas suppressive treatment regime is indicated with target TSH level ≤ 0.1 IU/l. Intensity and duration of TSH suppressive treatment regime depends on tumor recurrence risk group and presence of severe cardio-vascular disease. In case of medullary and anaplastic thyroid cancer require substitutive treatment regime as well as after benign tumor surgery. If patient has been undergone partial thyroid resection by reason of benign tumor the suppressive treatment necessity would be settled in terms of postsurgical TSH level. Thereafter on substitutive or suppressive L-thyroxine treatment patient has achieved target TSH level the further control of it is conducting half in year and annually later.