Vol 11, No 1 (2017)

National clinical recomendations
2017 Russian clinical practice guidelines for differentiated thyroid cancer diagnosis and treatment
Beltsevich D.G., Vanushko V.E., Rumiantsev P.O., Melnichenko G.A., Kuznetsov N.S., Abrosimov A.Y., Polyakov V.G., Mudunov A.M., Podvyaznikov S.O., Romanov I.S., Polyakov A.P., Sleptsov I.V., Chernikov R.A., Vorobyov S.L., Fadeyev V.V.

Abstract

The Russian clinical practice guidelines for diagnosis and treatment of differentiated thyroid cancer is dedicated to the management of patients with differentiated thyroid cancer. The guideline modifications 2016 include the following matters: indication for fine-needle aspiration biopsy, calcitonin screening, standards for biopsy results, new positions of postoperative risk stratification, indication for suppressive therapy and thyroid replacement therapy, targeted therapy in patients with radioiodine-refractory differentiated thyroid cancer.

Endocrine Surgery. 2017;11(1):6-27
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Clinical practice
The role of intrа- and postoperative ACTH and cortisol levels measurement in patients with Cushing’s disease as an early predictors of remission
Nadezhdina E.Y., Belaya Z.E., Rozhinskaya L.Y., Azyzjan V.N., Ivashenko O.V., Ilyin A.V., Kolesnikova G.S., Stanoevich I.V., Lapshina A.M., Grigoriev A.Y.

Abstract

Objectives. The aim of this research was to study the dynamic changes of intra- and early postoperative hormonal parameters (ACTH and cortisol) as predictors of hypercorticism remission.

Material and methods. 50 patients with confirmed Cushing`s disease (CD) were sampled for this research. The patients were divided into 3 groups depending on the outcome of the operation. The first group – patients with secondary adrenal insufficiency confirmed by clinical picture and the level of cortisol less than 50 nmol/l; the second group – with normalization of levels of ACTH and cortisol; the third – with the persistence of the CD. The results of intraoperative studies during the transnasal adenomectomy were then studied. The group sample consisted of 38 women and 12 men, aged 15–66 years. To assess the levels of ACTH and cortisol blood sampling was performed from a peripheral vein. The first sample was taken during the incision of the Dura mater, the second – immediately after removal of the tumor and the last – 20 minutes after the removal of the adenoma. Then, 1 day after the surgery the hormones mentioned above were studied in all patients. The levels of ACTH and cortisol were measured by immunochemiluminescent analysis on the automated system Cobas 6000 (Roche, France). Reference intervals ACTH 0–30 ng/ml, cortisol123–626 nmol/l.

Results. The analysis of the obtained data did not suggest a relationship between the changes of intraoperative indicators of hormonal status and the likelihood of disease remission (p > 0.125). In the postoperative period, of the 50 patients, 41 (82%) developed adrenal insufficiency, 5 (10%) showed normalization and in 4 patients (8%) adrenal insufficiency was not observed. The results of the hormonal research after 1 day had a correlation with the frequency of postoperative remission (p < 0.125).

Conclusion. Intraoperative measurement of levels of ACTH and cortisol is not appropriate and cannot serve as guidance for further tactics of the surgeon to define the totality of tumor removal.

Endocrine Surgery. 2017;11(1):28-37
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Clinical Case
Surgical treatment of giant adenomas of parathyroid glands in primary hyperparathyroidism
Makarov I.V., Prokofjeva N.A., Romanov R.M., Akhmataliev T.K.

Abstract

Primary hyperparathyroidism is a serious disabling disease. The lack of screening for hypercalcemia in the Russian Federation is a serious obstacle to the timely provision of specialized surgical care for patients with hyperparathyroidism. Early diagnosis of primary hyperparathyroidism and surgical removal of parathyroid glands adenomas can prevent complications development from the kidneys and other organs and systems.

This article presents two clinical case reports of surgical treatment for patients with primary hyperparathyroidism and giant parathyroid glands adenomas (5.8×3.5×1.5 cm, weighing 16.5 g, and 6.0×3.5×2.5 cm, weighing 40 g). In both cases, the concentration of parathyroid hormone and total calcium in blood was significantly increased (586.7 pg/ml and 3.12 mmol/l, and 876 pg/ml and 3.55 mmol/l, respectively). In both cases, the parathyroid gland adenomas were found too late, and the patients were sent out for surgeon treatment untimely.

Both patients underwent surgery. Postoperative period without complications. Removal of adenomas was performed under visual control of recurrent laryngeal nerves. In the early postoperative period there was a sharp decrease of parathyroid hormone and ionized calcium concentrations in blood, which confirmed the adequacy of the treatment. The patients were discharged in a good condition for further supervision of a surgeon and endocrinologist in an out-clinic.

Endocrine Surgery. 2017;11(1):38-44
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Postoperative diagnostics case of the patient with kidney canсer metastasis in the thyroid gland in combination with left internal jugular vein thrombosis
Panevin T.S., Selivanova L.S., Latkina N.V., Panevin N.S.

Abstract

We present a clinical case of the 68-years-old woman with complaints of enlarged neck, more pronounced at the left side and sore throat. In the course of ultrasound examination, conglomerate mass in left of thyroid gland was revealed. More than that, in the lumen of the internal jugular vein the formation of an average echogenicity was found. Following fine-needle aspiration biopsy revealed signs of colloid struma (Bethesda II). The patient underwent left-sided hemithyroidectomy. Atrevision while the operation the left thyroid gland is enlarged in the size due to the nodal formation spreading to the left angle of the lower jaw and locating retrosternal and behind trachea. Postoperative histological examination revealed metastasis of kindey cancer in the left thyroid gland with the signs of invasive growth to surrounding vessels and muscles.

Endocrine Surgery. 2017;11(1):45-50
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