Buldygina Y. Graves' disease: pathogenetic aspects, clinico-morphological and immune factors, optimization of personalized treatment algorithms.

The work is devoted to studying the features of the clinical course, the morphofunctional state of the thyroid gland, immune and metabolic parameters in Graves' disease (GD) to improve the algorithms for its diagnosis and treatment. The frequency and nature of nodular formations in GD were studied and it was found that thyroid cancer occurs in 10.52% of patients, in the structure of which papillary carcinoma makes up 92.82%, follicular carcinoma – 4.61%, medullary carcinoma – 2.56%. It has been established that the presence of GD complicates the preoperative diagnosis of thyroid carcinomas. Based on the received data, an algorithm for preoperative diagnosis of thyroid nodular formations in GD was created. The study of incidental papillary thyroid carcinomas in Graves' disease proved that they are microtumors in 34% of cases and in 66% of cases – true occult tumors, which should be classified as minimally invasive, because when thyroidectomy is performed, they do not lead to any complications in the postoperative period. New scientific data were obtained regarding the pathogenetic role of antibodies to TSH receptor in the development and progression of GD. It has been established that the level of antibodies to TSH receptor is a reliable prognostic marker that can be used to predict relapse and remission of GD, both during long-term drug therapy and after surgical treatment. The cytokine links of immunoregulation of GD and thyroid-associated orbitopathy (TAO) were studied, which made it possible to establish the specificity of IL-1β as a marker of the activity of the inflammatory autoimmune process in the orbits in GD. The need to determine the level of Se in patients with GD was studied and scientifically substantiated, since selenium deficiency of various degrees was recorded in 72.58% of cases among them, and it was proved that with the existing selenium deficiency, the use of selenium-containing drugs should be long-term – at least 6 months. The role of vitamin D in the pathogenesis of GD was determined, and a probable negative correlation between antibodies to TSH receptor and the level of 25(OH)D in the group of patients with TAO was revealed, which allows us to consider vitamin D deficiency as an additional significant factor in the development of TAO against the background of GD. A comparison of the effective methods for diagnosis and treatment of TAO in GD was performed. It was found that MRI of the orbits is a priority method for determining the state of the orbital muscles, especially during the active stage of TAO.