[The hypothalamo-hypophyseal system in patients with multinodular colloid euthyroid goiter]. / Sostoianie gipotalamo-gipofizarnoi sistemy u bol'nykh s mnogouzlovym kolloidnym éutireoidnym zobom.

Eighty patients with multinodular colloidal euthyroid goiter were examined. Thyrotropin-releasing hormone (TRH) test was carried out in 22 patients and 7 healthy women. The results of the test indicate a clear-cut tendency to reduction of hypophyseal TTH reserve in patients with multinodular euthyroid goiter with enlarged thyroid. In other words, clinical diagnosis of an euthyroid condition in the examinees appears to be groundless, particularly in patients with stage IV multinodular euthyroid goiter who may be referred to latent hyperthyrosis group on the basis of TRH test results. Three types of STH reaction were revealed by TRH test in these patients. The authors put forward a hypothesis on STH contribution as a growth factor to the pathogenesis of multinodular colloid euthyroid goiter.

[Association of multinodular euthyroid colloid goiter with various genetic markers]. / Ob assotsiatsii mnogouzlovogo kolloidnogo éutireoidnogo zoba s nekotorymi geneticheskimi markerami.

Distribution of blood groups ABO, Rh, P1, and MN was studied in 85 patients with multinodular euthyroid colloid goitre. An association has been revealed between the presence of this disease and MN blood group, as well as the absence of P1 antigen. These results permit us considering MN blood group and P1 antigen absence as factors of risk for multinodular euthyroid colloid goitre.

[Determination of autoantibodies to thyrotropin receptors in patients with diffuse toxic goiter]. / Opredelenie autoantitel k retseptoram tireotropnogo gormona u bol'nykh diffuznym toksicheskim zobom.

The blood level of antithyroid autoantibodies to TSH receptors was determined in patients with toxic goiter (TG) before and during antithyroid therapy using two biological methods (by the increment in the cAMP level in slices and primary monolayer culture of human thyroid cells) and a radioreceptor method (by inhibition of TSH binding with its receptors from the animal thyroid). Comparison of the results of these three methods has shown that all methods are almost equally valuable for diagnosis of new cases of TG. However the biological method was shown to be more sensitive and informative with regard to predicting the time of immunological remission during antithyroid therapy.

[An immunoenzyme method for determining autoantibodies to the microsomal antigens of human thyrocytes]. / Immunofermentnyi metod opredeleniia autoantitel k mikrosomal'nym antigenam tireotsitov cheloveka.

In order to investigate the role of autoantibodies in the pathogenesis of autoimmune thyroid diseases and for clinicoimmunological control of treatment, an enzyme-linked immunosorbent assay (ELISA) for the determination of autoantibodies against human thyroid microsomal antigens (TMA) was developed. ELISA was evaluated using sera from 156 patients with different thyroid pathology and diabetes mellitus and from 54 healthy donors. In parallel experiments the same sera were analyzed by an indirect immunofluorescence method for the presence of autoantibodies against TMA. Comparing all these data, both techniques appeared to have the same specificity, however ELISA was more sensitive than the indirect immunofluorescence method. Another advantage of ELISA is a possibility of long-term storage of microplates with immobilized antigen material without loss of antigenic activity. ELISA can be used for the determination of autoantibodies against TMA in human sera as a routine technique in clinical practice and experiments.

[The clinical "masks" of Hashimoto's goiter (the problems of diagnosis)]. / Klinicheskie "maski" zoba Khashimoto (voprosy diagnostiki).

Retrospective analysis of 240 case records of patients with histologically verified Hashimoto's disease has shown that in 62% it was masked by some other thyroid diseases, especially by multinodular and nodular euthyroid goiter. The most effective diagnosis before operation was made in patients using fine needle aspiration puncture biopsy whereas other methods were auxiliary.

[Antithyroid antibody dynamics in patients with Hashimoto's goiter receiving conservative treatment and after surgical interventions]. / Dinamika antitireoidnykh antitel u bol'nykh zobom Khashimoto na fone konservativnogo lecheniia i posle operativnykh vmeshatel'stv.

The content of antithyroid antibodies (AtAb) in the blood of patients with Hashimoto's goiter was studied over time, namely during the treatment with thyroid drugs and after surgical interventions of different scope. The patients' groups with diverse changes in the AtAb titers during the conservative treatment were revealed. The analogous types of the time-course of changes in antibodies to thyroglobulins (AbTg) were discovered after a surgical intervention irrespective of the operation scope whereas the persistence of antibodies to microsomal antigen (AbMa) after the operation depended on the mass of the remaining thyroid tissue. A correlation was found between the high titers of AbTg (rather than AbMa) and the elevated content of thyrotropic hormone in untreated patients with Hashimoto's goiter and after large-scope surgical interventions.

[Thyroid antibodies in autoimmune diseases of the thyroid and their dependence on the presence of autoantigens]. / Tireoidnye antitela pri autoimmunnykh zabolevaniiakh shchitovidnoi zhelezy i ikh zavisimost' ot prisutstviia autoantigenov.

Autoimmune thyroid diseases (especially diffuse toxic goiter) are characterized by a higher frequency of the detection and concentration of serum thyroglobulin. The frequency of the detection of antibodies to thyroglobulin in Hashimoto's thyroiditis was higher and their concentration lower than in diffuse toxic goiter. The frequency of the detection of antibodies to microsomal thyroid antigen in autoimmune thyroid diseases was lower than that of antibodies to thyroglobulin and did not depend on a type of disease. In diffuse toxic goiter the level of antibodies to thyroglobulin showed positive correlation with the level of antibodies to microsomal antigen and negative correlation with serum thyroglobulin concentration. In Hashimoto's thyroiditis the level of antibodies to thyroglobulin correlated with the level of serum thyrotropin. One-six years after thyroid extirpation serum thyroglobulin was practically absent in patients with Hashimoto's thyroiditis, and the frequency of the detection of thyroid autoantibodies (especially antimicrosomal ones) was sharply decreased.

[Various aspects of the diagnosis and treatment of autoimmune thyroiditis]. / Nekotorye voprosy diagnostiki i lecheniia autoimmunnogo tireodita.

The authors conducted 4-year investigation of patients with autoimmune thyroiditis. All the patients were women aged 28 to 68 with the duration of disease from 5 mos to 10 yrs. Combined diagnostic methods included radioactive iodine absorption, scanning, puncture biopsy, indirect thyroidolymphography. Antibodies to thyroglobulin, T3, T4, and TTH were determined by RIA. Chronic thyroiditis was diagnosed in all the patients. The authors proposed a method of intraparenchymatous administration of steroid agents into the thyroid. This method was shown to be simple, effective, causing no complications. Conservative therapy of Hashimoto's thyroiditis should be performed not more than 2 years and not less than one year.

[Assessment of the effectiveness of conservative therapy of autoimmune thyroiditis using echographic study of the thyroid]. / Otsenka éffektivnosti konservativnoi terapii autoimmunnogo tireodita s pomosch'iu ékhograficheskogo issledovaniia shchitovidnoi zhelezy.

A thyroid enlargement was noted during ultrasound investigation of 41 patients with autoimmune thyroiditis. The structure of glandular tissue was inhomogeneous with zones of rarity and density. Repeated echography of the thyroid in 20 patients with autoimmune thyroiditis after prolonged thyrotherapy (thyroiodine at a daily dose of 0.1-0.2 g and 1.2 tablets of Thyreocomb daily) revealed diminished sizes of the thyroid in 9 patients, unchanged sizes of the thyroid in 11, unchanged echostructure of the thyroid in 17, in 3 patients thyroid tissue echogeneity was increased, its structure became more homogeneous, sizes became less. This method provides additional information on the topography, sizes and echostructure of the thyroid, assessing the effectiveness of conservative therapy.

[Association of antigens of the HLA system and Hashimoto's thyroiditis]. / Assotsiatsiia antigenov sistemy HLA i tireoidita Khashimoto.

A total of 18 patients with Hashimoto's thyroiditis aged 20 to 57 were examined (16 females and 2 males). The control group included 267 healthy donors. Antigens of A, B, C and D loci of the HLA system were determined in all the patients. HLA Dr3 was determined in 14 (77.8%) of 18 patients (p less than 0.01). The relative disease risk in carriers of this antigen was 12.6. At the same time a 6-fold decrease in the frequency of HLA Dr2 was found in the patients. The authors discussed the problem of the predisposing role of HLA Dr3 in the development of autoimmune diseases and of the "protective" properties of HLA Dr2.

[Value of echography in the differential diagnosis of benign and malignant corticosteromas]. / Znachenie ekhografii v differentsial'noi diagnostike dobrokachestvennykh kortikosterom.

Altogether 34 patients with corticosteroma were examined. In 29 (85%) of them accurate topical diagnosis was established as a result of ultrasonic investigation. All erroneous results were obtained only for corticosteromas of small sizes (4 cm and less in diameter). Tumors not exceeding 4 cm in diameter were benign in 88% of cases. If tumor sizes were over 4 cm, they were malignant in 89%. The earliest possible investigation for the presence or absence of a tumor was indicated to patients with hypercorticism.

[TRH test after subtotal thyroid resection for diffuse toxic goiter]. / TRG-test posle subtotal'noi rezektsii shchitovidnoi zhelezy po povodu diffuznogo toksicheskogo zoba.

Altogether 25 patients were examined one month after subtotal resection of the thyroid for diffuse toxic goiter. A wide spectrum of the TSH to TRH reaction was detected. The nature of this reaction made it possible to single out 4 groups of patients with a progressively decreasing and even paradoxical response of TSH to TRH. There were no correlations between the nature of the TSH to TRH reaction and the patients' thyroid status in the pre- and postoperative period, time-period of disease and the expression of autoimmune processes. Profound changes in function of the pituitary-hypothalamo-thyroid system were found in most of the patients at the above mentioned time after operation.

[Surgical treatment of autoimmune thyroiditis]. / Khirurgicheskoe lechenie autoimmunnogo tireoidita.

The authors used combined modality therapy including clinical, laboratory, x-ray, radiological, immunological and histological methods to diagnose autoimmune thyroiditis. Enlargement of the thyroid up to the 3-4 th degree, signs of compression or shift of the trachea and esophagus, the presence of nodes, progressive goiter growth and suspected malignant transformation served as indications for surgical intervention. Subfascial extirpation of the thyroid can be an operation of choice in surgical treatment of Hoshimoto's thyroiditis. A question of the time of surgical intervention cannot be considered completely solved.