Russian guidelines for diagnostic of thyroid nodules gained some actual questions: necessity of ultrasound (US)-screening of the thyroid cancer, indications for fine needle aspiration and exam of calcitonin, necessity of unification of US and cytopathology classification for signs of thyroid nodules. This article is offer to discussion.

The objectives of this study was to identify the incidence of hypocalcemia, depending on the surgery and to examine the main predictors of postoperative hypocalcemia in patients with adenocarcinoma of the thyroid for medical treatment.Materials and Methods. Data were collected prospectively from 2011 to 2014. We analyzed 98 patients after surgical treatment for thyroid cancer. All patients underwent thyroidectomy, some patients without prophylactic сentral neck dissection ( n = 41, group A), and the proportion of patients with suspected metastatic lymph nodes more сentral neck dissection was performed ( n = 57, group B). Depending on the calcium concentration postoperative patients in groups A and B were further divided into two subgroups. In one subgroup of postoperative calcium level in the serum was 2.0 mmol/l or less, and in subgroup 2 exceeded2.0 mmol/l. Also, patients were determined in pre- and postoperative levels of 25 (OH) D, parathyroid hormone in the serum.Reults. Using logistic regression analysis showed that factors predictive postoperative hypocalcemia are: preoperative 25 (OH) D - less than 15 ng/ml ( p <0.001), postoperative PTH level in the blood serum - below 10 pg/ml ( p = 0.01).Conclusions. In most cases, age, low preoperative level of 25 (OH) D serum levels and low postoperative PTH level in blood serum is largely associated with the development of postoperative hypocalcemia. Among the factors influencing the development of postoperative hypocalcemia major role in the evaluation group played the volume of surgical intervention - a worst case was a combination of thyroidectomy with сentral neck dissection.

This article analyzed the tactical error in the diagnosis of nodal thyroid diseases. At the moment, thereis a wide arsenal of instrumental studies, with high accuracy the correct diagnosis before surgery. For the diagnosis of thyroid cancer is common to use a triad of research: ultrasound thyroid hormone study (TSH, fT4), fine-needle aspiration biopsy. If you suspect a metastasis of differentiated thyroid cancer in addition to biopsy it is advisable to explore the washout of the needle for thyroglobulin. In case of suspicion of occult sclerosing microcarcinoma form for the differential diagnosis with aberrant thyroid tissue expedient to thy-roid scintigraphy with pertechnetate. In carrying out scintigraphy with 99mTc pertechnetate sodium extra thyroid tissue accumulates radiopharmaceutical, and lymph node metastaseschanged not

Background. Aortopulmonary window is a rare localization of ectopic parathyroid glands. This localization is the difficulty in diagnosis and surgical treatment, especially in conditions of the heavy somatic pathology that develops with prolonged of kidney replacement therapy. Persistence of tertiary hyperparathyroidism after cervical revision does not give in medical treatment, accompanied by the progression of bone and systemic symptoms of the disease, including death.Materials and Methods. Illustrates a case successful diagnosis and surgical treatment this rare disease. We discuss the treatment and diagnostic tactics. Female patient (age 66) had the experience of peritoneal dialysis for 6 years. She underwent cervical parathyroidectomy. Ectopic mediastinal paratiroma detected by gamma scintigraphy (from 99mTc-MIBI). Determination of the exact tumor location proved to be impossible before the surgery due to bad mental condition of the patient. Localization of adenomas was defined on the surgery after a sternotomy. Results. Operation efficiency proved decrease parathyroid hormone from 2095 pg / ml (before operation) to 10 pg / ml (1.5 months after surgery). After surgery, there was a mediastinal hematoma. The patient was discharged 21 days after surgery healed by.Conclusions. The use a sternotomy leads to the removal of the tumor. This access may be used when an unknown location. This access is a forced for tertiary hyperparathyroidism.

The article presents a rare clinical observation of combination of bilateral gigantomastia with myasthenia. The debut of myasthenia dangerous to sudden respiratory failure. Timely diagnosis myasthenia is important for adequate anesthetic management of patients benefit in the early postoperative period. Due to the high risk of toxic-anaemic syndrome is considered one of the stages of mastectomy.