The article presents 28 World recommendations on elastography, published in 2016 by the expert group of the World Association of Specialists in Ultrasound Diagnostics in medicine. The levels of evidence for each provision and the level of recommendations are given with the percentage of experts voting. The methodology, the clinical interpretation of the indices of different types of elastographs: compression elastography, point shear wave elastography, dual shear wave elastography are discussed. It is emphasized that elastography is an additional technique for ultrasound, consisting of the grey scale and Doppler regimes. In some provisions, it is indicated that the imposition of clinical data, for example, on medullary thyroid cancer, occurs. Numerical values of elastography are given not only for focal pathology, but also for diffuse thyroid diseases. These provisions are discussed in comparison with nodular goiter recommendations 2016 of Russian Endocrinology Association with a search for ways to validate the provisions for introduction into practical health care. These recommendations are necessary for inclusion in the TI-RADS system valid for Russia with the inclusion of the ultrasonic criterion “elastography” of the thyroid gland in the protocol of mandatory examination of patients with diffuse and focal diseases of the thyroid gland.

Hypoparathyroidism is characterized by hypocalcaemia and normal or low levels of parathyroid hormone (PTH). The most common cause of hypoparathyroidism is damage to the parathyroid glands during anterior neck surgery. Conventional management of hypoparathyroidism is focused upon maintaining the serum calcium with oral calcium and active vitamin D, often requiring high doses and giving rise to concerns about long-term consequences including extracellular calcification and kidney stones. With current treatment, patients may suffer from large swings in serum calcium and are at a substantial risk of chronic renal failure, extracellular calcification. Replacement therapy of recombinant human PTH(1-84) can open up new opportunities for better control and improvement of quality of life.

Background. PHPT in developed countries is evaluated as the third endocrine epidemic following diabetes mellitus and thyroid gland diseases.

Materials and methods. 36 patients ill with hyperparathyroidism had been operated. The number of women prevailed and was equal to 81% (29 women) (c2 = 26.89, p = 0.0000). The age of the patients ranged from 33 up to 82. 17 patients had a mixed form of PHPT, 10 patients had a kidney form and 9 patients had an osseous form of the disease.

Results. Pre-operative ionized calcium median significance was 1.6 mmol/l. Mild degree of hypercalcemia was observed in 26 patients (72%), moderate degree was observed in 4 patients (11%) and 6 patients (17%) had a severe degree of hypercalcemia. Pre-operative PTH median was 169.95 pg/ml. The severity of the condition of the patients ill with PHPT was confirmed by the presence of hypercalcemia before the surgery which revealed in moderate statistically significant correlation of ionized calcium level with PTH level (r = 0,38, while p = 0,02) and adenoma size (r = 0.48, while p = 0.03). To provide adenoma topical diagnostics we used not less than 2 instramental investigation techniques. PTGs adenoma data were confirmed by ultrasonic examination and scintigraphy not more than in 79% and 72% of cases respectively, and MRI confirmed 88,2% of cases.

One or two PTG adenomas were removed in all patients. Al together 65 PTG adenomas were removed. Associating thyroid gland pathology was marked in 88% of cases (28 patients). Ionized calcium median was decreasing statictically significantly up to 1.14 mmol/l (0.46 mmol/l decrease – 29% while p = 0.00001) the day following the surgery. PTH value decreased significantly up to 70.45 pg/ml after the surgery (99.5 pg/ml – 58% decrease while p = 0.00001).

Conclusion. PHPT is more often met in women above 50 years old. Combined TG and PTG lesions were observed in 88% of cases and they demand simultaneous surgery and further investigation. More than one PTG adenoma was observed in 81% (29 patients) of cases and this is not considered to be typical for PHPT according to scientific data. More than one instrumental investigation methods are necessary for PTG adenomas topical diagnostics. We should be critical towards pre-operative data and keep in mind the possibility of multiple PTG lesion and apply the rule of symmetrical bilateral PTG location.

Aim. Amiodarone, a class III anti-arrhythmic can be a life-saving medication however it can also cause amiodarone-induced thyroiditis (AmIT). Though rare, it is a complex and life-threatening side effect. AmIT can cause significant cardiac dysfunction and lead to cardiac failure. Though generally treated medically, a small sub-group do not respond and their cardiovascular function continues to deteriorate. This select group is referred for a semi-elective total thyroidectomy. Without surgical removal of their thyroid gland these patients will continue to deteriorate, with a 30–50% mortality rate for those not operated on. The aim of this study was to assess for any indicators as to when these patients should be referred for total thyroidectomies and the efficacy of this method of treatment.

Method. A case series of patients with amiodarone-induced thyroiditis treated with a total thyroidectomy from 1998–2015 was used to retrospectively assess the efficacy and indicators for surgery.

Results. T4 values decreased quickly and significantly after surgery. Patients’ symptoms mostly resolved after surgery. No clear indicators were found to be common throughout the cohort as to how long medical therapy should be pursued.

Conclusion. Clinicians should view surgery as an effective and efficient treatment avenue for amiodarone-induced thyrotoxicosis. However, it is not clear when this treatment should be instigated. A case-by-case approach should be adopted when treating these complicated patients.