The thesis is dedicated to increasing the efficiency of diagnostics and treatment of patients with nodular goiter based on the study of clinical, hormonal indices, macro- and microelement supply of population in conditions of iodine deficiency.
To achieve this goal and perform our tasks, we used the up-to-date general clinical, biochemical, immunoenzymometric, spectrophotometric, instrumental and statistical methods of research. In the course of this research, 128 people who permanently reside in the Precarpathian region were examined, including 49 patients with diffuse endemic goiter, 60 patients with nodular endemic goiter aged from 21 to 65 years old and 19 practically healthy people making up the control group of the appropriate age.
For the first time the thesis outlines the theoretical generalization and innovative solution of topical scientific and practical endocrinology problem, consisting in increasing the efficiency of diagnostics and treatment of patients with nodular goiter, in iodine deficiency conditions at the territory of Prykarpattia. The research of assessment of the iodine deficiency level proceeded in Precarpathian regions in patients with nodular endemic goiter. The given research is the first to have revealed the significant differences in estimating the intensity of iodine deficiency in patients with diffuse and nodular goiter according to the data of main epidemiological criterion for iodine supply estimate – iodine median in urine: in patients with nodular goiter, the iodine deficiency is moderate (56.00 ± 4.12 mcg/l), while the iodine intake is insufficient; the patients with diffuse goiter have low iodine deficiency (24.00±3.65 mcg/l) and insufficient iodine intake. The probable increase in thyroglobulin was revealed in blood of patients with nodular goiter – 72.45±5.78 ng/ml (in the control group – 33.45±3.45 ng/ml) as the intensity index of iodine deficiency in the region, which confirms the iodine deficiency in the patients examined. The special feature of our research work is that for the first time in Ukraine the macro- and microelement supply of population was established in the regions of Prykarpattia with various degrees of iodine deficiency, their importance in occurrence of nodular goiter. Our research project also determined the scientifically-substantiated need to make research into the indices of selenium, zinc content in blood serum and hair in patients with nodular endemic goiter for the purpose of early diagnostics of microelement supply disorders. For the first time, the data were obtained concerning the macro- and microelement supply (zinc, selenium, copper, iron) of patients with nodular endemic goiter in comparison with patients with diffuse goiter. The determination of selenium level in blood of examined patients showed its significant decrease in all groups of patients with diffuse goiter (0.02±0.01) and those with nodular goiter (0.01±0.00) as compared with the control group (0.10±0.01 ml/l) (p˂0.001). The zinc level was even lower in patients’ hair – almost 4.0 times (42.35±4.34) in patients with diffuse goiter and over 7.0 times (21.40±3.22) in patients with nodular goiter in comparison with the group of practically healthy persons (p˂0,001). Apart from that, the direct and strong correlative interconnection was detected between the iodine and zinc levels in the organism of persons examined, in the group of patients with both diffuse endemic and nodular goiter with the probability of error-free prognosis p˂0.001. The direct and strong correlative link can be also observed between the concentration of iodine and selenium in blood of the persons examined (p˂0.001). As proven, the combined iodine and Se deficiency intensifies the problem of iodine deficiency. The scientific data were supplemented with regard to the role of shear-wave elastography. Referring to the research fulfilled in our country, the average indices of shear wave rate were as follows, as a wave passed through a tissue: in the unchanged parenchyma of thyroid gland – 1.5±0.24 m/s, in benign nodules 1.8±0.56 m/s, in case of suspected malignant tumors - 2.9±0.42 m/s. We defined the significant impact and reasonability of L-selenomethionine used in the dosage of 200 mcg per day and zinc glycinate used in the dosage of 50 mg per day to cure patients with nodular goiter, when combining the therapy with potassium iodide drugs 200 mcg per day depending on the found metabolic disorders, macro- and microelement supply of population in conditions of iodine deficiency. Key words: thyroid gland, iodine deficiency, nodular goiter, essential microelements, diagnostics, treatment. Branch – medicine.
