“To study immunohormonal mechanisms and genetic factors regarding transformation of nontoxic diffuse goiter at the stages of sexual maturation under conditions of a light iodine deficiency”
(research supervisor – Doctor of Medical Sciences, professor O.I. Plekhova, 2010−2012 yrs)
Object of study: immunohormonal mechanisms and genetic factors of diffuse nontoxic goiter (DNG) transformation in the dynamics of pubertal maturation in children and adolescents, aged 7-19 years, with the diagnosed diffuse enlargement of the thyroid gland (TG) at pre-puberty or an early puberty.
Objective: to determine the timing and rates of sexual function formation, the incidence and structure of its disorders, and to single out the principal risk factors for these disorders development in adolescent girls, depending on the place of their residence.
Methods: clinical, ultrasound (TG-scanning), genetic (clinico-genealogical and immunogenetic analyses), radioimmunoassay (TSH, free thyroxin and triiodothyronine, sexsteroid-binding globulin, and tissue growth-stimulating factors), immunofermental (gonadotropic and sex hormones), immunological (antibodies to thyroperoxidase and thyroglobulin, indices of cellular and humoral immunity, and cytokine profile), biochemical, and statistical.
Theoretical and practical results: the role of genetic factors (hereditary burden, certain I class HLA antigens, and dermatoglyphic features) concerning the formation and character of DNG course in adolescents of both genders has been defined, and a number of informative endogenous and exogenous risk factors for an unfavorable course of DNG have been established in our study. Transformation of the pathology , first diagnosed at the pre-or an early puberty, has been revealed in the course of sexual maturation. A favorable course of DNG was observed in half of boys and one third of girls under examination, in the rest of the patients (20,0% of girls and 34,6% of boys) the disease was accompanied with some signs of the thyroid dysfunction, or there were diagnosed other forms of thyroid diseases. DNG manifestation in children at the pre-puberty or at an early puberty takes place against the background of an increased incidence of immune disorders and an imbalance of cytokines, the nature of which depends on gender and on the rates of sexual development. A dynamic observation (remote catamnesis) has shown that the incidence of immunologic disturbances decreases mostly due to normalization of humoral and phagocytic links of the immune system, but the imbalance of immunocytes is observed nevertheless. It is shown that a long-term presence of the goiter leads to some disturbances in the physical development of the majority of boys, often owing to a short stature or a deficient body weight. A disharmonious physical development in girls is formed significantly less frequent than in boys, mainly due to their overweight. It has been established that disorders of the physical development are associated with the signs of thyroid dysfunction and lower levels of the insulin-like growth factor -1 in boys. A negative impact of DNG availability on sexual development has been revealed mainly in males, its delay has been diagnosed in a third of the boys. There were found some sex-related differences in the mechanisms of the delayed puberty development. The results obtained make it possible to predict the DNG course for the patients of both genders.
Novelty: the nature of the DNG course has been first analyzed during puberty, and some risk factors and immunohormonal mechanisms for an unfavorable course of the disease have been established. There were worked out factor models, confirming participation of cytokines in the development of immunohormonal disorders in DNG, depending on gender.
Effectiveness: an algorithm for predicting the course of the disease in boys and girls with DNG will reliably improve (probability 75%) prognosis of the disease at its early stages, making possible carrying-out preventive and rehabilitation measures in adolescents.
Fields of application: endocrinology and pediatrics.
