Features of autonomic nervous system homeostasis in patients with chronic atrophic gastritis combined with thyroid pathology

Background. The indicators of heart rate variability reflect the vital processes of managing the physiological functions of the body — autonomic balance and functional reserves of its management mechanisms, the adaptive capacity of the body, and stress resistance. At the expressed disturbances of autonomic nervous system homeostasis, the risk of emergence and progression of diseases increases. This is especially true for the elderly, who are characterized by comorbidity. The purpose of the study was to assess the state of adaptive capacity and autonomic regulation of the body in patients with precancerous conditions of the stomach with the thyroid gland pathology. Materials and methods. Seventy-two patients with chronic atrophic gastritis were divided into groups: group I consisted of 34 patients with nodules in the thyroid gland; group II included 23 patients with pathological changes of the thyroid gland and 15 patients of group III had a normal thyroid gland. The heart rate variability was assessed based on the results of PRECISE-diagnostics. To diagnose the functional state of the small intestinal microbiota, a hydrogen breath test was performed. Results. In 81.9 % of patients with chronic atrophic gastritis and thyroid pathology, an imbalance of the sympathetic and parasympathetic parts of the autonomic nervous system with a prevalence of vagotonia including the patients with thyroid nodules (64.7 %) and pathological changes in the thyroid gland (56.5 %) (р < 0.05). A significant violation of the body’s adaptive capacity was found in 63.2 % of patients with chronic atrophic gastritis. The frequency of reduced adaptive capacity of the organism was twice higher in patients with comorbid pathology (p < 0.05). 56.1 % of patients with chronic atrophic gastritis associated with thyroid pathology experienced a decrease in functional reserves of the body. In the spectrum of detected disorders, 68.8 % of patients presented with depletion of functional reserves of the body with increased central control and 31.2 % of patients — hormonal imbalance with a predominance of the humoral link with the inclusion of autonomous control (p < 0.05). The analysis of the stress index showed in half of the examined patients insufficient stress resistance with a probable increase in mean figures to (136.8 ± 7.4) m/s (p < 0.05). Correlations were found between the frequency of detection of excessive bacterial growth syndrome and maladaptation (r = 0.64; p < 0.05), imbalance of the sympathetic and parasympathetic parts of the autonomic nervous system (r = 0.59; p < 0.05). Conclusions. The course of chronic atrophic gastritis associated with thyroid pathology is associated with an imbalance of sympathetic and parasympathetic parts of the autonomic nervous system, depletion of adaptive mechanisms, reduced functional reserves of the body, and stress resistance. At the same time, disorders of the body’s adaptive potential and changes in autonomic balance are associated with the disorders of the small intestinal microbiota, which requires a multidisciplinary approach to the management of patients with comorbid pathology of the stomach and thyroid gland.

Interdisciplinary Approach to Improving the Organization of Surgical Care for Patients with Thyroid Pathology

The interdisciplinary approach is recognized as the gold standard for organizing medical care for patients with oncological pathology. It is declared at the normative level in Ukraine, but the forms and methods of work, channels and methods of communication of specialists are not detailed. This requires further research, in particular, when providing surgical care to patients with thyroid pathology. The purpose of the study was to investigate the state of activity organization of multidisciplinary teams in the provision of surgical care to patients with thyroid pathology and to propose approaches for its improvement. Materials and methods: accounting forms No. 003 for 2019 (1208 units), constituent and administrative documents for the institution, department regulations, job descriptions, clinical pathway of patients (15 units in total). The base of research was communal non-profit enterprise "Kiev City Clinical Endocrinological Center". The methods, which were used, are systematic approach, medical and statistical, medical and geographical methods, content analysis, graphic. Results and discussion. Patients of the Department of Endocrine Surgery were from almost all regions of Ukraine. 3.5% of patients were referred by a general practitioner, 55.7% - by an endocrinologist, 40.1% - independently applied. Malignant neoplasm of the thyroid gland was detected in 33.9% of patients, non-toxic multinodular goiter – in 25.2%, benign neoplasm – in 16.3%. In 448 (37.1%) patients, 687 concomitant diseases and complications were identified. Their structure consisted of diseases of the heart and circulatory system – 40.0%, eye diseases – 3.1%, diseases of the nervous system – 2.0%. In order to meet the needs of patients, instrumental and laboratory studies, consultative examinations, consultations and surgical interventions were carried out. The low level of communication between inpatient doctors and outpatient doctors has been shown. This was the reason for the excessive length of stay in bed – 12.6 ± 2.7 days. There is a separate participation of specialist doctors in accompanying patients in the hospital. It was proposed to formalize the official status and develop a typical provision for a multidisciplinary team of specialists; joint discussion, debate, data exchange within the team and with outpatient doctors; afford access to corporate information for the team and coordinate the work of authorized employees. Conclusion. Improving the efficiency of multidisciplinary teams is possible by strengthening collaboration within the team and communication with outpatient doctors

The Prevalence of Signs of Thyroid Pathology among Students of the Karaganda Medical University According to the Survey

AIM: The objectives of the study were to study the signs of thyroid dysfunction in students at the Karaganda Medical University. MATERIALS AND METHODS: The survey was conducted among students of the Karaganda Medical University in the amount of two hundred people. Statistical methods were used for comparison among students of different courses. RESULTS: Among junior students, signs of thyroid dysfunction were more pronounced than among senior students. More than half of the examined students had a diagnosed thyroid pathology, which was more pronounced in students of one and two courses. CONCLUSION: Undergraduates are more likely to exhibit signs of stress-related thyroid dysfunction.

BDNF blood serum linkage with BDNF gene polymorphism (rs6265) in thyroid pathology patients in the West-Ukrainian population

Objective. Brain-derived neurotrophic factor (BDNF) is identified as an important growth factor involved in learning and memory. Patients with Hashimoto’s thyroiditis can suffer from cognitive dysfunction, whereas BDNF is directly regulated by thyroid hormones. It seems reasonable to propose that changes in BDNF expression underlie some of the persistent neurological impairments associated with hypothyroidism. Methods. The study involved a total of 153 patients with various forms of thyroid pathology. BDNF levels in the sera of the patients and healthy individuals were quantified using enzyme-linked immunosorbent assay with highly sensitive Human BDNF ELISA Kit. Genotyping of the BDNF (rs6265) gene polymorphism using TaqMan probes and TaqMan Genotyping Master Mix (4371355) on CFX96™Real-Time PCR Detection System. Polymerase chain reaction (PCR) for TaqMan genotyping was carried out according to the kit instructions. Results. Distribution rs6265 variants in the patients depending on the different types of thyroid pathology showed no significant difference in the relative frequency of BDNF polymorphic variants. Presence of hypothyroidism, regardless of its cause (autoimmune or postoperative), there was a decrease in the serum BDNF levels in all genotypes carriers compared with the control group. The analysis of the correlation between BDNF levels and the levels of thyroid-stimulating hormone (TSH), thyroxine (T4), anti-thyroglobulin (anti-Tg), and anti-thyroid peroxidase (anti-TPO) antibodies showed a significant inverse relationship between BDNF and TSH levels (p<0.001), a direct correlation between BDNF and T4 levels in the blood (p<0.001), and a weak direct relationship between anti-Tg and BDNF levels (p=0.0157). Conclusion. The C allele presence is protective and associates with the lowest chances for reduced serum BDNF levels in thyroid pathology patients in the West-Ukrainian population. However, the T-allele increases the risk of low BDNF levels almost 10 times in observed subjects.

Environmental determinants of thyroid pathology

Ecological situation of many countries, including Ukraine, is characterized by progressive anthropogenic and technogenic pollution, which causes growth in thyroid pathology, the share of which is significant in the structure of endocrine diseases. The main causes of thyroid disorders include iodine deficiency in the environment, exposure to a number of widely used che­micals (thyrodisruptors), heavy metal ions. A variety of physical environmental factors are important. A significant increase in thyroid cancer is frequently associated with local or general exposure to ionizing radiation. Prolonged exposure to electromagnetic fields can lead to disorders in the gland's homeostasis. The functional capacity of the gland is also impaired by unsanitary living conditions, some bacteria and viruses, and improper nutrition. High sensitivity of the gland to external impacts and high social significance of thyroid pathology give grounds to consider the morphofunctional condition of the thyroid gland as a marker of ecological well-being of the environment.

DOSE-DEPENDENT EFFECTS OF LEVOTHYROXINE IN HEART FAILURE IN PATIENTS WITH CONCOMITANT THYROID PATHOLOGY

Currently, the use of thyroid hormones in the setting of heart failure (HF) is still an "open book". There are several unanswered questions: the regimen, doses and schedule of drug use, as well as the consequences of such therapy. Large clinical studies can provide information on the effect of these hormones on the long-term prognosis in patients with heart failure. At the same time, the presence of comorbid thyroid pathology, which requires the prescription of levothyroxine (LT), makes it possible to partially answer these questions. The aim is to study of the dose-dependent effect of LT on the course of HF in patients with autoimmune thyroiditis (AIT). Material and methods. The study included 218 patients with HF on the background of post-infarction cardiosclerosis. 109 (50.0 %) patients with AIT received LT due to hypothyreosis in the past. These patients intake LT during 2 years before included in the study and have euthyreosis. Whether the levels of thyroid stimulating hormone (TSH), free triiodthyronine (FT3) and free thyroxine (FT4) were determined. Results. Patients who used LT, comparing with patients without this drug, had smaller end-diastolic diametr (EDD) and end-systolic diametr (ESD) and end-diastolic volum (EDV) and end-systolic volum (ESV) of left ventricle (LV) and 22.9 % greater LV ejection fraction (EF) (+ 22.9 %, p = 0.0001), as well as higher low serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP) level (- 26.3 %, p = 0.009). In the subgroup of patients taking LT at a dose of 0.1 to 0.69 μg/kg, ejection fraction of left ventricle (LVEF) did not differ from patients without this tritment. At a dose of 0.7-1.19 μg/kg, LVEF is higher compared with that of patients who did not take LT (+ 37.9 %, p = 0.0001) and patients who took LT at a dose 0.1 - 0.33 μg/kg (+ 36.9 %, p = 0.0001). LVEF was the highest in patients taking LT at a dose of > 1.20 μg/kg. The use of LT for 2 years reduces the risk of re-hospitalization (RH) due to decompensation of heart failure (Odds ratio = 0.490 (0.281-0.857), p = 0.018) and a tendentious decrease in the risk of combined endpiont achieving (- 27.9 %, p = 0.074). The ROC analysis showed that the risk of RH in patients with heart failure due to decompensation of the disease decreases with the use of LT at a dose of > 0.53 μg/kg (sensitivity – 56.62 %, specificity – 60.98 %, p = 0.016). Conclusions. The use of LT in patients has a dose-dependent positive effect on LVEF. The largest LVEF is observed in patients taking the drug at a dose of > 1.2 μg/kg. The use of an LT dose of > 0.53 μg/kg leads to a significant decrease in the frequency of re-hospitalization due to decompensation of heart failure during 2 years. Keywords: heart failure, autoimmune thyroiditis, levothyroxine, left ventricular, ejection fraction.

A case-control study on thyroid surgery in geriatric patients

<p class="abstract"><strong>Background:</strong> With the progressive aging of the population, thyroid pathology with surgical indication occurs at increasingly advanced ages. The authors aim was to analyze the forms of presentation of thyroid disease and rate of complications of thyroid surgery performed in geriatric patients and to compare it to the same parameters in younger patients.</p><p class="abstract"><strong>Methods:</strong> This was a 7 year retrospective case-control study, with patients who underwent thyroid surgery. The study group included patients above 65 years old and a control group under 65 years old, who underwent thyroidectomy.</p><p class="abstract"><strong>Results:</strong> A total of 81 patients were included. The mean volume of thyroid nodules at presentation was significantly higher in the study group compared to the control group, regarding the disease presentation, it was an accidental imaging finding in 59% of patients of the study group, while in the control group there were more compressive symptoms at presentation. The rate of postoperative complications in geriatric patients was 29% versus 20% in the control group, a difference that was not statistically significant.</p><p class="abstract"><strong>Conclusions:</strong> Given the high number of comorbidities presented by geriatric patients, the symptoms of thyroid disease can be undervalued, explaining the greater number of accidental imaging findings and the greater volume of nodules at the time of surgery. Our results show that geriatric thyroid surgery is safe and has acceptable postoperative morbidity. The detection of thyroid pathology in these patients is a greater challenge, which can obscure symptoms, delay diagnosis and worsen prognosis.</p>

25-OH Vitamin D blood serum linkage with VDR gene polymorphism (rs2228570) in thyroid pathology patients in the West-Ukrainian population

Vitamin D is known to alter immune regulation. It binds to the vitamin D receptors (VDR) expressed on T lymphocytes and macrophages. In individuals with Hashimoto’s thyroiditis, serum vitamin D levels were found to be lower compared to healthy controls. The study’s objective was to investigate the association between VDR gene polymorphism (rs2228570) with blood serum levels of 25-OH vitamin D in patients with thyroid pathology from western Ukraine. The study involved a total of 153 patients with various forms of thyroid pathology. 25-OH vitamin D levels in the serum of the patients and healthy individuals were quantified with ELISA using the 25-OH vitamin D Total (Vit D-Direct) Test System ELISA Kit (Monobind Inc.®, United States, Product Code: 9425-300) on the EIA Reader Sirio S (Seac, Italy). Genotyping of the VDR (rs2228570) gene polymorphism was performed using TaqMan probes and TaqMan Genotyping Master Mix (4371355) on CFX96™Real-Time PCR Detection System (Bio-Rad Laboratories, Inc., USA). Polymerase chain reaction (PCR) for TaqMan genotyping was carried out according to the kit instructions (Applied Biosystems, USA). Our research identified that that genotype variants of VDR rs2228570 are not risk factors for reduced serum 25-OH vitamin D or vitamin D deficiency in patients with various forms of thyroid pathology patients in the West-Ukrainian population. Vitamin D levels were significantly lower in the carriers of AA and AG genotypes with hypothyroidism caused by autoimmune thyroiditis. In AA genotype carriers with postoperative hypothyroidism, 25-OH vitamin D levels were significantly lower compared to AA genotype carriers with autoimmune thyroiditis.