[Thyroid gland alterations in Perm region residents as observed by means of ultrasonography].

Thyroid gland (TG) ultrosonography, performed in 2000 residents of Perm region (370 men and 1630 women aged 18 to 84 years), showed that only 1/3 of the subjects had no TG abnormalities. Despite mass iodine prophylaxis, resumed in Perm more than 6 years ago, and group iodide prophylaxis that is being actively introduced at present, the prevalence of goitre has not decreased. On the contrary, it has risen from 26.3% to 42.3% in Perm region since 90-s. Nodules were found in one out of five subjects. TG diseases were significantly more frequent in women than in men. The majority of the subjects had no complaints, and any abnormality, including TG cancer (6 cases), was found by chance. The reduction of TG size with age is not typical of Perm population, and the increase of TG volume in the elderly (both men and women) is due to TG nodules formation. Thus, preventive ultrasonography should be introduced widely in order to reveal TG abnormalities at early stages, not only among the population of iodized regions, but also in ecologically unfavourable ones. This diagnostic test must become a necessary procedure in preventive examinations of people exposed to occupational hazards.

[Influence of anthropogenic pollution on thyroid structure in Perm population].

The comparison of the thyroid structure in 73 Perm sitizens who died in the 1960s with that of 59 citizens who died in the 2000s revealed in the latter group symptoms of "tissue maladaptation" (retention of follicular colloid with cystic transformation of the follicles, lymphoplasma cell infiltration with oxyfilic thyrocytes transformation into B-cells, appearance of areas with a rough connective tissue in colloidrhagia and edema with capillary collapse, calcium deposits into the vessels and stroma). It is proven that these morphological changes are due to the effects of xenobiotics. Pronounced increase of heavy metals deposits in the thyroid by the 2000s was reported. Such thyroid pathomorphosis inevitably results in hypothyroidism.

[Trace elements and endemic goiter]. / Mikroélementy i éndemicheskii zob.

The effects of xenobiotics on morphological structure and function of the thyroid gland (TG) were analysed. Salts of heavy metals (zink, lead, copper, cadmium, surma etc.) were measured in TG of 152 citizens of Kama region who had died of trauma in the 1960s (n = 73), 1990s (n = 20) and 2000s (n = 52). TG is shown to accumulate xenobiotics. As the examinees had no occupational contact with heavy metal salts (HMS), their deposits in TG is explained by anthropogenic pollution of the environment. HMS in the thyroid tissue was much lower than in later decades indicating aggravation of environmental pollution in the Urals. Being protoplasmic poisons, HMS bind proteins and provoke immune reaction. All the examinees who died after 2000 had histologically proved deposits of immunocompetent cells in TG tissue--lymphoid and plasmic TG infiltration. In the 1960s these TG alterations were absent. Goiter endemia can be stopped by improvement of environmental protection in each ecopolluted region and mass iodine prophylaxis.

[Trends of mental and somatic diseases during therapy of endemic goiter]. / Dinamika psikhicheskikh i vegetativnykh narushenii na fone lecheniia endemicheskogo zoba.

The trend of mental and somatic diseases was studied in 70 patients with epidemic goiter (EG) treated with L-thyroxine or iodides during 1-5-year follow-up. Borderline mental disorders (diminished memory and attention, emotional and intellectual disorders) were found to be stable in these patients. The most delicate functions of the brain, such as the capacity for analysis and synthesis, are particularly vulnerable. Irrespective of the age of a patient, his/her educational level, occupation, the size of goiter, concrete rather than abstract logic thinking are prevalent in patients with EG. Drug treatment of EG only improves the patients' health status, but fails to eliminate evolving mental disorders even if the sizes of the thyroid can be brought to the normal values, the use of L-thyroxine is more effective that that of iodides.

[Autonomic system disorders in endemic goiter]. / Vegetativye narusheniia pri éndemicheskom zobe.

Vegetative tonicity, reactivity and provision were studied in 88 patients with endemic goiter (EG) aged 18 to 40 years. Vegetative dystonia syndrome (VDS) in EG develops as parasympathicotonia. Subjective symptoms of vegetative dysregulation are more pronounced in high reactive and personality anxiety, in neurotism, they do not depend on extra- or introversion. VDS in EG deteriorates mental and physical performance, attention. Vegetative reactivity in EG becomes hypersympathicotonic. Vegetative dystonia affects reaction to the disease. Prolapse of heart valves often seen in EG patients results rather from hypothyroid edema of the myocardium than from VDS. Therefore, treatment of such patients with beta-adrenoblockers is not grounded. Vegetative dysregulation gradually attenuates in response to replacement hormone therapy with thyroxine.

[Mental status of patients with iodine-deficiency goiter]. / Osobennosti psikhicheskogo statusa u bol'nykh iododefitsitnym zobom.

Personality and intellectual characteristics were examined in 76 patients with iodine-deficiency goiter (IDG). Subclinical hypothyroidism forming as early as IDG of the 1st degree impairs abstractive and integral thinking, psychological maladaptation to the disease, high anxiety, neurotism, diminished intellectual performance, deterioration of memory, attention, predominance of thinking of concrete-action type. To prevent intellectual disturbances, IDG patients should receive replacement therapy with adequate doses of thyroid hormones preparations.

[Echocardiographic evidence of heart state in patients with hypothyreosis]. / Sostoianie serdtsa u bol'nykh gipotireozom po rezul'tatam ékhokardiografii.

Echocardiographic examination of 41 patients has demonstrated that mitral prolapse (MP) of the 1st and 2nd degree is frequently associated with latent or apparent hypothyroidism and occasionally with prolapse of the tricuspid and/or aortic valve. As a rule, MP has a silent course without regurgitation and is diagnosed at ultrasonography. Its correction is made by replacement with thyroid hormones. Beta-adrenoblockers for MP treatment are contraindicated in hypothyroidism. MP complications (sudden death, thromboembolism, infectious endocarditis) are rare in patients with hypothyroidism. Thyroid insufficiency sometimes is accompanied with hydropericardium which is symptomless and is detected only at echocardiography.