MULTIGLANDULAR PARATHYROID GLAND DISEASE: AN INCIDENTAL DISCOVERY IN NORMOCALCEMIC PATIENTS DURING THYROID SURGERY.

CONTEXT: Several enlarged parathyroid glands could be found during thyroid surgery in normocalcemic patients without evidence of primary or secondary hyperparathyroidism, indicating multiglandular parathyroid gland disease (MGD). OBJECTIVE: Clinical role of various levels of serum ionized calcium (Ca2+) in patients diagnosed with incidental MGD during thyroid surgery remains controversial. The aim of the study was to evaluate the features of PHPT and the clinical role of serum Ca2+ in normocalcemic patients diagnosed with incidental MGD. STUDY DESIGN: A prospective study of patients with normal preoperative Ca2+ to be operated on for thyroid diseases in 2010-2013 and diagnosed with MGD during thyroid surgery. METHODS: An analysis of clinical data from 3,561 patients to be surgically treated for thyroid diseases revealed 219 (6%) patients with MGD and normal serum Ca2+. Further data analyses showed patients with MGD and high normal (≥1.25 - 1.3 mmol/L) serum Ca2+ (n = 89) and with moderate-low (1.0 - 1.24 mmol/L) serum Ca2+ (n = 130). RESULTS: Primary hyperparathyroidism was diagnosed intra- and post-operatively in 48 (54%) patients with high-normal serum Ca2+ and in 2 (2%) patients with moderate-low serum Ca2+ (p<0.0001). Parathyroid hormone, serum Ca2+ as well as urine calcium excretion were elevated in 2 (2%) patients with moderate-low serum Ca2+ and in 18 (20%) patients with high-normal Ca2+ at follow-up (p<0.0001). CONCLUSION: Serum Ca2+ level within the normal range, but higher than 1.25 mmol/L (high-normal) is associated with primary hyperparathyroidism, which should be considered in patients with visually diagnosed MGD, but without clinical symptoms of hyperparathyroidism.

[Efficacy of surgical treatment of medullary thyroid carcinoma in patients with regional and distant metastases].

Results of surgical treatment of 93 primary patients with medullary thyroid carcinoma within 1995-2009 years, including 26 (28%) - with hereditary disease (MEN2 syndrome) were analyzed. The best long-term results were observed in group of noninvasive tumor without metastases at the time of operation (39% - clinical and biochemical recovery, 32% - clinical remission). No one patient with extrathyroid tumor invasion and regional/distant metastases has completely recovered. Hereditary forms of disease are more aggressiveness in comparison with sporadic carcinomas with higher rate of distant metastases (31 and 21%) and worse survival. In sporadic group 3 (6%) patients and in hereditary group - 4 (12%) died from progression of distant metastases within 8-15 years after primary operation. Complete recovery was seen only after radical primary operations. Repeated surgery was palliative. Implementation of calcitonine screening and genetic testing for Ret-protooncogene mutation is an important task for Ukraine medicine to improve results of medullary carcinoma treatment.

["Incidental" thyroid carcinoma among patients in surgical treatment for nontumors thyroid desease].

Incidence of unexpected diagnosis of thyroid carcinoma among operations on benign thyroid surgical diseases (nodular goiter and Graves' disease) was studied in 608 patients within 2008-2009 years in specialized clinic of endocrine surgery. In 56 (9.2%) patients the "incidental" thyroid carcinoma including 43 (77%) - papillary microcarcinoma were diagnosed in histological investigations. In 10 (18%) patients which were performed within the first postoperative week. Repeated surgery demonstrates increased risk of complication (damage of parathyroid glands, recurrent laryngeal nerves and other anatomic structures of neck) considering less favoring conditions for secondary operations, it is worth to implement wider indications to frozen section, radical primary operation (total thyroidectomy at multi-nodular bilateral goiter and Graves' disease), and also maximal complete examination prior to surgery.

Influence of single nucleotide polymorphisms of vitamin D receptor-gene on the level of osteoassociated hormones linkage with postmenopausal osteoporosis.

The levels of osteoassociated hormones, macroelements, interleukines, cyclic nucleotides and activity of alkaline phosphatase were being detected in the blood plasma of 74 postmenopausal women with and without osteoporosis (OP). Bone mineral density (BMD) and the metacarpal index were being assessed according to the results of densitometry. The allele polymorphisms vitamin D receptor gene (VDR) Cdx2 (rs11568820) and TaqI (rs731236) were being identified with the help of the polymerase chain reaction. The major genotype CC TaqI was found in the group without OP 3.4 times more often than with OP, while the minor genotype TT was found 3.4 times more often with the presence of OP. The presence of the genotype CC TaqI decreased the risk of OP progress by 5.5 times, and the genotype TT TaqI increased by 5.4 times. The presence of the minor allele T was associated with the higher levels of interleukin 1ß, BMD and lower testosterone blood level. The major homozygote AA Cdx2 was found in women without OP 2.9 times more often, while the minor genotype GG - 5.4 times more often with the presence of OP. The presence of the major homozygote decreased the risk of OP progress by more than 5.3 times, while the minor homozygote increased the risk by 8 times. The presence of the minor allele G in the genotype was associated with the increase of parathyroid hormone, phosphorus, magnesium, alkaline phosphatase activity in blood, BMD and with the decrease of testosterone, progesterone and calcium blood levels.

[Surgical treatment of multinodular goiter in iodine deficiency states]. / Khirurgichne likuvannia bagatovuzlovykh form zoba pry iodoefitsytnomu stani.

Data are submitted from the analysis of factors of the pathogenesis of multinodular non-toxic goiter in 380 persons. Of these, 256 underwent surgery. An apparent iodine deficiency in the body (in two thirds of patients) has been found out to be an important cause of development, progression and recurrence of goiter. Only 5 to 14 percent of patients, predominantly those presenting with recurrent goiter, demonstrated an elevated level of thyrotrophin. More commonly seen in these patients is inherited predisposition to goiter. The authors attach much value to urine iodine levels, and consider it mandatory that a correction of iodine deficiency be carried off with available drugs both during the conservative treatment and in recurrences.