Vol 26, No 14 (2019)

Hypothyroidism is one of the most common thyroid disorders. Its clinical presentation is variable and non-specific. In many cases hypothyroidism may long remain undiagnosed masquerading as diseases of other organs and systems. This article reviews multimorbid presentations of hypothyroidism, describers some of its “masks" that any clinician may encounter in his/her daily practice. The authors emphasize the need for measuring thyroid stimulating hormone in individuals with several comorbidities to be able to make timely diagnosis of hypothyroidism and initiate hormone replacement therapy.

The prevalence of obesity around the world keep growing and reaches the size of a pandemic. Currently, it is known that adipose tissue is not just an inert energy depot, but an active endocrine organ, producing a number of biologically active substances. This review article discusses the functions of certain hormones of adipose tissue (adipokines) and the possibilities of their therapeutic use. The search for ways of therapeutic correction of adipokine secretion disorders and their effect on the metabolism and functioning of systems is considered an urgent task of modern medicine. It seems promising to create synthetic adiponectin preparations, leptin receptor activators, and drugs affecting leptin resistance.

Background. The high prevalence of diabetes mellitus (DM) and the rapid increase in the number of patients have a significant impact on the healthcare systems of all countries of the world. A high risk of developing complications of diabetes, leading to disability and death of patients, is a source of additional costs for the treatment of this disease. The achievement and maintenance of target values of glycemic control, determined by the glycated hemoglobin (HbA1c) level, is considered as the most important measure to prevent the development of complications of diabetes. Despite all the modern possibilities for the treatment of diabetes, there are patients with an HbA1c level that significantly exceeds the target values in any dispensary group. Any approaches that can lead to a decrease in the HbA1c level in these patients should be actively used in real practice. The Federal Diabetes Register (FDR) is a database of personified records of diabetic patients. Using this database, it is possible to carry out activities that are specifically aimed at active management of patients who have the worst glycemic control indicators. Objective. An attempt to achieve reduction in the number of diabetic patients with a HbA1c level of >11.0% in the practice of treating diabetes at the outpatient level of the endocrinological service using a complex of organizational approaches and clinical tools. Methods. A sample was formed from the Moscow segment of the FDR, and included 417 patients with type 1 diabetes mellitus (DM1) and 3 584 patients with type 2 diabetes (DM2) with an HbA1c level of >11.0%. The Moscow Healthcare Department sent an order to outpatient sites (where these patients were followed-up) to carry out activities aimed at improving glycemic control indicators (intensification of ongoing therapy, referral to training at the Diabetes School, hospitalization in the endocrinology unit of a hospital, etc.) with subsequent determination of the HbA1c level at 3 and 6 months. Results. After 6 months of follow-up, 285 DM1 patients (95.3% of the number of patients who had data on the HbA1c level [n=299]) had HbA1c level <11.0%. Only in 4.7% (14 people) of DM1 patients, the HbA1c level was >11.0% after 6 months of observation. Also, 97.5% of DM2 patients (among the patients who had data on the HbA1c level during follow-up [n=2 948]) reached a HbA1c level <11.0% after 6 months of observation, and only 2.5% had a HbA1c level >11.0%. The baseline mean HbA1c level was 12.6% in DM1 patients (n=417) and 12.3% in DM2 patients (n=3 584). After 6 months of follow-up, this indicator decreased to 8.5% in DM1 patients (n=299), and to 8.2% in DM2 patients (n=2 948). Conclusion. Comprehensive measures, including organizational approaches and clinical tools used on the basis of personalized records of diabetic patients, allow to achieve a significant improvement in carbohydrate metabolism in most patients.

Background. Diffuse toxic goiter (DTG) is a systemic autoimmune disease that results from the production of antibodies to the receptor for thyroid-stimulating hormone (AB-rTSH) of the thyroid gland and presents clinically with thyrotoxicosis syndrome. Thyrotoxicosis of pregnancy negatively affects pregnancy course and outcomes and increases the risk of perinatal complications, which is a serious problem commonly encountered by endocrinologists and obstetrician-gynecologists in their clinical practice. Conservative management of hyperthyroidism in pregnancy is aimed at reducing the risk of threatened preterm birth, preeclampsia, chronic placental insufficiency, prelabor rupture of membranes, and fetal hypoxia and hypotrophy. Objective. The study aimed to investigate the risk of recurrent thyrotoxicosis and the incidence of obstetric complications in pregnant women with DTG. Methods. The study analyzed the results of monitoring thyroid function in 71 pregnant women with a confirmed diagnosis of DTG, and the structure of obstetric complications in the study cohort. Clinical evaluation included thyroid ultrasound and testing for thyroid-stimulating hormone (TSH), free thyroxine (fT4), and serum AB-rTSH. Results. There was a relationship between the serum level of AB-rTSH and the clinical features of DTG in pregnancy. The study evaluated the possibility of using quantitative parameters of AB-rTSH for predicting the risk of recurrent thyrotoxicosis, proposed diagnostic cut-off value for AB-rTSH, which helps identify the appropriate strategy for thyrostatic therapy. Conclusion. The most favorable course of DTG and the best perinatal outcomes were observed in a subgroup of patients with serum AB-rTSH levels below 7.25 IU/l.

This review presents actual ideas about the role of insulin resistance in pathogenesis of type 2 diabetes as well as the correctability of this mechanism. At the present stage 11 pathogenetic mechanisms of type 2 diabetes were determined. Recently the focus has shifted from hyperglycemia to the restoration of beta-cell function, which is impossible without solving the problem of insulin resistance. Thus, early pathogenetic combination therapy of type 2 diabetes is an actual way to manage this disease. Insulin sensitivity improvement is specifically attributed to metformin and thiazolidinediones, other classes of antidiabetic drugs have just indirect effect. In Russian Federation an original complex drug preparation, containing technologically processed highly diluted antibodies to the beta subunit of the insulin receptor and to endothelial nitric oxide synthase, was registered. This drug has hypoglycemic effect, as well as additional benefits such as insulin resistance reduction, increase in adiponectin production and improvement of the vascular wall.