BACKGROUND: Thyroid nodules are a prevalent issue, with an estimated incidence of 19% to 35% based on ultrasound examination and 8% to 65% based on autopsy findings [1]. In some cases, Plummer’s disease is observed, and nodular masses may be observed in 10% to 35% of Graves’ disease cases, with iodine accumulation of a different nature [2, 3]. One of the principal treatments for Graves’ and Plummer’s diseases is radioiodine therapy, which serves to exclude the possibility of malignancy in nodules. Furthermore, the pharmacokinetics of iodine is investigated, which represents the most time-consuming and labor-intensive stage of preparation for radioiodine therapy. In clinical practice, ultrasound is performed in accordance with the TI-RADS system, followed (if necessary) by fine-needle aspiration puncture biopsy, stratified according to the Bethesda system. However, the interpretation of ultrasound examinations is inherently subjective, whereas the use of decision support systems can reduce the number of fine-needle aspiration puncture biopsies by 27% and the number of missed malignant neoplasms by 1.9%. Furthermore, the quantitative characterization of nodal ultrasound may enhance the investigation of the pharmacokinetics of I-131 [4, 5]. AIM: The study aimed to develop a method for quantitatively characterizing ultrasound images of thyroid nodular masses for predicting malignancy and I-131 accumulation by nodular masses. MATERIALS AND METHODS: The study included 125 nodules with pathomorphologic findings (65 benign, 60 malignant) and 25 benign nodules (established by cytologic examination) of patients who underwent radioiodotherapy as part of the Russian Science Foundation grant project No. 22-15-00135. Longitudinal and transverse projections of thyroid nodules were obtained using GE Voluson E8 (36% of all benign nodules and 27% of malignant nodules) and GE Logiq E (64% of benign and 73% of malignant nodules). A pharmacokinetics study was conducted on 25 nodes obtained on a GE Logiq V2 device. The accumulation index of I-131 was determined after 24 hours. A spatial adjacency matrix, gray level line length matrix, gray level zone size matrix, and histogram were employed to investigate features based on ultrasound images. RESULTS: The malignancy prediction model, developed on the basis of the most significant features and after KNN correlation analysis, exhibited a diagnostic accuracy value of 72±3%, a sensitivity of 73±5%, and a specificity of 73±5%. An investigation of I-131 pharmacokinetics revealed that the maximum histogram intensity gradient (r=–0.48, p=0.08) and intensity entropy (r=–0.51, p=0.06) exhibited the highest Spearman correlation coefficient modulus with I-131 accumulation after 24 hours. CONCLUSIONS: The present study demonstrates the feasibility of using quantitative characterization of ultrasound images of nodal masses as a tool to monitor nodules before radioiodotherapy. This is with a view to subsequent adjunctive fine-needle aspiration puncture biopsy and prediction of I-131 accumulation after 24 hours.

According to modern concepts, Charcot’s neuro-osteoarthropathy (Charcot’s foot) is considered as an aseptic inflammatory process in individuals with distal polyneuropathy, which leads to damage to bones and joints. Most often, Charcot’s foot is formed in patients with diabetes mellitus (DM) and affects the foot and ankle joint. Diabetic neuroosteoarthropathy (DNOAP) is divided into active and inactive stages. The typical clinical picture of the active stage of diabetic neuroosteoarthropathy is edema and hyperemia of the affected foot, with a temperature gradient of more than 2 °C compared with an unaffected foot. The nonspecific clinical picture of the active stage of diabetic neuroosteoarthropathy makes it difficult to diagnose and often leads to the need for differential diagnosis of the active stage of diabetic neuroosteoarthropathy and osteomyelitis, which is one of the most difficult issues in clinical practice. Early detection of these conditions is crucial, since treatment of the active stage of diabetic neuroosteoarthropathy can prevent irreversible deformity of the foot, and detection of osteomyelitis will allow timely antibiotic therapy. Signs of changes in bone and foot structures in the active stage of diabetic neuroosteoarthropathy in images obtained by computer X-ray, magnetic resonance and emission tomography may be similar to signs of osteomyelitis, which determines the importance of choosing an imaging method when examining a patient and developing an effective algorithm for early diagnosis of DNOAP. In this review, the main attention will be paid to the distinctive features of the active stage of diabetic neuroosteoarthropathy and osteomyelitis when using imaging research methods.

Advances in the development and improvement of medical technologies and methods of processing medical images make it possible to highlight clinically significant characteristics that were not previously available to classical methods of medical imaging. Ultrasound diagnostics of thyroid gland nodules has a huge potential medical images processing. The article presents an overview of the existing ultrasound classification systems for thyroid nodules malignancy and the prospects for the development of intellectual tools TIRADS (Thyroid Imaging Reporting and Data System) classification system.

Purpose: To assess the association between socioeconomic factors and release criteria after iodine-131 radionuclide therapy in different countries. Material and methods: 15 countries and 104 socioeconomic characteristics were selected for the study. The association between characteristics and the residual activity level at which a patient may be released for different countries was established according to the value of Pearson product moment correlation coefficient (r>0.3). A linear regression model was constructed for the selected characteristics using Microsoft Excel analysis package. The model was used to calculate the acceptable activity level at which a patient may be released for Russia. Results: A fundamental difference between the model used for calculation of release criteria after radionuclide therapy with iodine-131 in Russia and the model recommended by the Nuclear Regulatory Commission was shown: the use of the effective half-life in the second one. Replacing the physical halflife by the effective half life allows increasing the discharge criteria of patients after therapy with Na131I by 30 %. A moderate correlation was found between the value of acceptable activity at patient discharge after radioactive iodine therapy and the following socioeconomic characteristics: scientific activity (r=0.32), quality of higher education (r=0.36), Global Health Security Index (r=0.34), length of roads (r=0.36), population growth rate (r=0.36), average housing area (r=0.38), and average salary per year (r=–0.33). A linear regression was constructed using the factors listed above. The following recommended value of activity and effective dose rate at patient discharge from hospital was obtained: 0.6 GBq and 30 µSv/hour. Conclusion: The study demonstrates that the release criteria for radioactive iodine therapy used in the Russian Federation (0.4 GBq and 20 µSv/h) do not correspond to the standard of living achieved in Russia, which is reflected by the socio-economic factors considered in the paper. The proposed arguments raise the task of revising the currently used model with a consequent increase in the discharge criteria. It was observed that the release criteria in the world are independent of some factors that are directly related to population exposure. The need to develop a unified objective algorithm for establishing release criteria, which takes into account different socio-economic status of states and can be applied for different radionuclides and radiopharmaceuticals, including innovative ones, has been identified.

Saul Hertz was a physician and scientist who invented and implemented the use of radioactive iodine (RAI) for medical purposes. The history of the development of this new non-invasive and effective method of treatment began in 1936, when Saul Hertz asked Karl Compton, president of the Massachusetts Institute of Technology: "Is it possible to artificially make iodine radioactive?" at the scientific session. The positive response was the beginning of Saul Hertz’s research in the field of nuclear medicine. Together with physicist Arthur Roberts, he studied the pharmacokinetics of radioactive isotopes of iodine and the possibility of using them for the diagnosis and treatment of thyroid disease (TD). In 1938, with the release of 131I, which emits gamma and beta rays and has a half-life of 8 days, RAI could be used not only in experiments, but also in clinical practice. On March 31, 1941, Dr. Saul Hertz performed the first RAI therapy for thyrotoxicosis. Nowadays, March 31 is called World Theranostics Day. Subsequently, Saul Hertz became the founder of the radionuclide treatment of TD, and based on the results of his work, the principles of RAI therapy for differentiated TD were developed. Currently, there are Dr. Saul Hertz Archives in Greenwich (Connecticut, USA) that store the works of this great physician and scientist.

The analysis of existing in different countries of the world approaches to the management of liquid radioactive waste (LRW) of patients generated during radionuclide therapy with 131I is carried out. The regulated values are given, on the basis of which criteria for the discharge of LRW containing 131I into a centralized urban sewage system are established for medical organizations in a number of countries. The most common strategies for the management of patients’ LRW after radiotherapy are considered. Compliance with the discharge criteria may be achieved by delaying radioactive effluents for decay in specially designed delay tanks or by its dilution with inactive effluents of a medical organization at the discharge point. The chosen strategy should be determined by the parameters characterizing the discharges of a particular organization, so as not to affect the capacity of the department and, as a result, the availability of the radiotherapy procedure to patients in the country. Defining a case-by-case treatment strategy or using the two strategies considered in combination with each other may be a more effective practice for treating patients with LRW. The latter may be relevant for medical organizations in Russia, where the discharge criteria is conservative, and at the legal level it is prohibited to use another strategy for handling LRW, except for storage for decay.

BACKGROUND: Lacrimal glands and lacrimal pathways are one of the main undesirable targets during radionuclide therapy using I-131, namely, in 24% of cases, secondary lacrimal pathways obliteration occurs [1]. In the legislation of the Russian Federation in the field of atomic energy use, there are a number of administrative documents obliging to keep records and control of individual radiation doses with the provision of data to the unified system for monitoring individual radiation doses of citizens. At the same time, statistical analysis does not include systematic accounting and control of individual doses of internal radiation to patients, in particular, to the lacrimal apparatus, when using nuclear medicine methods for therapeutic purposes. AIM: To develop a software and hardware preventive complex — a system for accounting and monitoring dose loads on lacrimal pathways during radioiodotherapy. MATERIALS AND METHODS: GE Discovery NM/CT 670 imaging systems, GE Discovery NM 630, the Xeleris 4 DR Workstation nuclear Medicine Workstation and the I-131-based radioisotope were used. To exclude the ingress of radioisotope into lacrimal pathways, the use of vasoconstrictive drugs and the use of tear point obturators were considered. The client part of the web service was implemented based on the React JavaScript library. The development of the Backend component was carried out in the Python programming language. RESULTS: To assess the risk of complications, a method was developed that takes into account the following parameters: age, gender, total administered activity to the patient, the presence of current lacrimation at the time of hospitalization, the presence of menopause (for women) and the accumulation index I-131 in lacrimal pathways. The primary data (anamnesis and prescribed treatment) are entered by the patient's attending physician in the questionnaire during the initial examination. At 72 hours after the introduction of radioisotope, using a molecular imaging system, a medical physicist determines the index of accumulation of radioisotope in lacrimal pathways. Based on the data obtained, the overall risk level of secondary obliteration of the lacrimal tract is determined and, depending on the result obtained, appropriate recommendations are made to the patient. Since the described process is quite time-consuming in a clinical setting, an intelligent medical decision support system has been developed that allows automating the process and minimizing the likelihood of errors. CONCLUSION: The development of a software and hardware preventive complex will make it possible to prescribe preventive methods with greater efficiency at all stages of the course of treatment in order to minimize the occurrence of adverse events (such as secondary obliteration of the tear ducts), which in turn will improve the quality of life of patients.

SUBSTANTIATION. It is known that about 69% of all thyroid nodules undergoing surgical treatment are benign formations, and up to 75% of patients with an intermediate cytological conclusion undergo unnecessary surgical intervention. This suggests that improving the quality of differential diagnosis of nodular formations will avoid excessive economic costs for the healthcare system. In this regard, AI technologies in diagnostic algorithms for the classification of thyroid nodules were involved.AIM. Improving the efficiency of automatic classification of thyroid nodules on ultrasound images by using a set of neural network models.MATERIALS AND METHODS. We used ultrasound images of thyroid nodules available in open sources and obtained with the help of 3 ultrasound devices of Endocrinology Research Centre as part of Project № 22-15-00135 of the grant of the Russian Science Foundation. This article check the hypothesis that the size of the training set cannot be increased by repeating similar images from the ultrasound cine loop of one patient, but only by expanding the dataset with new unique specimens of other patients and/or data from the augmentation process.RESULTS. As a result, a neural network model EfficientNet-B6 was proposed to solve the problem of EU-TIRADS classification of thyroid nodules based on ultrasound images of the thyroid gland.CONCLUSION. The results obtained allow us to advance in the use of artificial intelligence methods for personalized medicine in thyroid diseases.

Graves’ disease (GD) is the leading cause of hyperthyroidism in pediatric patients. Radioactive iodine therapy (RAIT) is widely used to treat GD. However, it is still unclear exactly what determines the efficacy of RAIT in childhood and adolescence. The objective of our study was to reveal the most significant predictors of the efficacy of RAIT in pediatric GD patients. A single-center prospective observational exploratory study enrolled 144 pediatric patients (124 females and 20 males) between 8 and 18 years of age who underwent dosimetry-guided RAIT for GD for the first time. The estimated parameters included sex, age, thyroid volume, thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone receptor antibodies (TRABs) at baseline and 12 months after RAIT, 10- to 20-min 99mTc thyroid uptake (

Purpose: Secondary acquired lacrimal duct obstruction (SALDO) is one of the complications of radioiodine therapy. SALDO is formed a few months after therapy if there is a sufficient uptake of radioactive iodine by the nasolacrimal duct. To date, risk factors leading to SALDO are unclear. The objective was to determine the correlation between the tear production level and radioactive iodine-131 uptake in the lacrimal ducts. Methods: Basal and reflex tear production was studied in 64 eyes prior to the therapy with radioactive iodine-131 after drug-induced hypothyroidism. The condition of the ocular surface was assessed using the Ocular Surface Disease Index (OSDI) questionnaire. Seventy-two hours after the radioactive iodine therapy, scintigraphy was performed, which determined the presence or absence of iodine-131 in the lacrimal ducts. T-statistics and the Mann–Whitney criterion were used to identify the differences between the groups. The differences were considered significant at P ≤ 0.05. The current tear production level in patients receiving radioiodine therapy was determined using a mathematical model. Results: A statistically significant difference between the basal (p = 0.044) and reflex (p = 0.015) tear production levels was found in cases with and without iodine-131 uptake by the lacrimal ducts. The probable current tear production level corresponds to the sum of basal and 10–20% of reflex tear production. The uptake of iodine-131 was found regardless of the OSDI results. Conclusion: The probability of iodine-131 uptake by the lacrimal ducts rises as the tear production level increases.

Thyroid functional autonomy (TFA) is the most frequent reasons of subclinical or manifest thyrotoxicosis. Diagnosis of the causes of thyrotoxicosis (destruction or increased functional activity of the thyroid tissue in nodular and diffuse thyroid pathology) is a key point in determining the management of patients with this pathology. Scintigraphy is the method of choice in differential diagnosis of the causes of thyrotoxicosis assessing the functional state of the thyroid gland. Thyroid scintigraphy can be performed using 99mTc-pertechnetate. After normalization of the level of thyroid hormones is confirmed, radical treatment is recommended. It could be surgery or radioactive iodine therapy (RAI). In some cases, especially in the elderly women, TFA is combined with thyroid nodules (TN), which can cause pressure symptoms, cosmetic complaints, and thyroid dysfunction. Minimally invasive treatments, such as percutaneous ethanol injection (PEI) sclerotherapy, has been proposed, especially for pressure symptoms and cosmetic complaints, as an alternative to surgery. The presented clinical case will demonstrate the possibility of use sclerotherapy and RAI for the successful treatment of TFA with TN.

Thyroid cancer is the most common tumor of the endocrine system, 1-3% of all malignant neoplasms as of 2021. Differentiated forms, papillary and follicular, with a relatively favorable prognosis, are detected in 90% of cases. In recent years, therapy for well-differentiated thyroid cancer (WDTC) has not significantly changed and includes surgical treatment, hormone therapy, radioiodine therapy when indicated, and dynamic monitoring with possible expansion to advanced therapeutic options in cases of disease recurrence. However, there are a range of unresolved issues that are continuing to be actively investigated by new laboratory and instrumental methods. Particularly, one of these issues is the preparation in patients with differentiated thyroid cancer for radioiodine therapy. Radioiodine therapy (RIT) is considered as one of the first targeted therapies for thyroid cancer with a history of over 80 years of use, the main purpose of which is ablation of residual thyroid tissue as well as therapy of distant and/or regional metastases of thyroid cancer. The combination of surgical treatment and subsequent radioiodine therapy provides a favorable prognosis in patients with WDTC, but there is a remaining possibility of insufficient response to radioiodine therapy, which may be associated with multiple factors, including the phase of preparation for RIT. The publication provides a review of the scientific literature on the aspects of preparation of patients with WDTC for radioiodine therapy. The principles of preparation are based on the recommendations of the leading expert societies and studies published in the world practice, as well as known side effects during preparation for radioiodine therapy and thereafter, their impact on patients' quality of life, effectiveness and long-term results of treatment. Materials and Methods Scientific articles and reviews from Medline, Cochrane, and Google Scholar databases were searched by keywords, and recommendations regarding WDTC of the scientific societies were used. Articles in Russian and English with full-text availability were selected; those published after January 2023 were excluded. A systematic evaluation of 130 sources was performed, general trends in the modern approach to patient preparation for radioiodine therapy and current problems were highlighted, and results and conclusions were formulated

ПРИМЕНИМОСТЬ ТЕКСТУРНЫХ СТАТИСТИЧЕСКИХ ПРИЗНАКОВ УЛЬТРАЗВУКОВЫХ ИЗОБРАЖЕНИЙ В ДИФФЕРЕНЦИАЛЬНОЙ ДИАГНОСТИКЕ УЗЛОВЫХ ОБРАЗОВАНИЙ ЩИТОВИДНОЙ ЖЕЛЕЗЫ А.А.Трухин, А.В.Манаев, С.М.Захарова, Е

The paper presents the results of investigation of the possibility of using textural statistical features to classify the images of ultrasound diagnostics of thyroid nodules. Ultrasound diagnostics has a significant potential for quantitative diagnostics. New information technologies allow us to identify characteristics that complement the classical methods of image analysis in medicine.

ЦЕЛЬ: описать клинический случай терапии радиоактивным йодом по поводу болезни Грейвса (БГ) у пациентки с синдромом Шерешевского-Тернера (СШТ). МАТЕРИАЛЫ И МЕТОДЫ: пациентка Б., 21 год, наблюдается у гинеколога-эндокринолога с диагнозом: «СШТ, врожденный гипотиреоз», кариотип с потерей Х-хромосомы (45, Х0). Терапия левотироксином инициирована в 3 года в дозе 25 мкг (уровень ТТГ неизвестен), с титрацией до 56 мкг в сутки. Препарат отменен в возрасте 21 года в связи со снижением уровня ТТГ, клиническими проявлениями тиреотоксикоза. По результатам лабораторной диагностики установлен манифестный тиреотоксикоз: ТТГ – 0,004 мЕд/л (0,4–4,6), св. Т4 – 36,9 пмоль/л (11–22), св.Т3 – 9,78, пмоль/л (3,8–7,3). Без предварительного уточнения генеза заболевания назначен тиамазол в дозе 30 мг со снижением до 15 мг в сутки. На фоне приема препарата в течение 1 мес у пациентки появилась иктеричность склер, в биохимическом анализе крови – повышение печеночных трансаминаз: АЛТ – 67 Ед/л (5–40), АСТ – 55,9 Ед/л (5–40). Проведена дифференциальная диагностика заболеваний печени: первичной патологии печени и желчевыводящей системы не выявлено. Пациентка переведена на терапию пропилтиоурацилом 50 мг в сутки. Учитывая сохранение субклинического тиреотоксикоза и повышение печеночных трансаминаз, препарат был отменен. По данным ультразвукового исследования ЩЖ в ноябре 2021 г. выявлены признаки диффузного токсического зоба, обнаружены антитела к рецепторам тиреотропного гормона – 8,96 МЕ/л (0–1,75), установлен диагноз БГ. Проконсультирована радиологом НМИЦ эндокринологии, в связи с непереносимостью тиреостатиков (ТС) в виде токсического гепатита, рисками хирургического лечения и наличием сопутствующей генетической патологии методом выбора стала терапия радиоактивным йодом (РЙТ). Для расчета эффективной и безопасной терапевтической активности 131I выполнено дозиметрическое планирование. По итогу расчетная терапевтическая активность составила 566 МБк. После РЙТ отмечена нормализация тиреоидного статуса, уменьшение клинических проявлений тиреотоксикоза и положительная динамика лабораторных показателей функции печени: АЛТ – 30 Ед/л (5–40), АСТ – 21 Ед/л (5–40). С развитием пострадиационного гипотиреоза начата терапия левотироксином. Мы считаем, что проведение РЙТ у пациентов с СШТ или другой хромосомопатией должно рассматриваться индивидуально. Стоит отметить, что не только терапия ТС, но и РЙТ могут привести к нарушению функции печени. Известно, что печень активно участвует в метаболизме тиреоглобулина и тиреоидных гормонов, в составе которых есть 131I. У трети пациентов, проходящих дозиметрическое планирование в НМИЦ эндокринологии, наблюдалась фиксация 131I в области печени от 1,1 до 10,3%, при этом в большинстве случаев она не превышала 4%. Мы предполагаем, что главные предикторы фиксации 131I в тканях печени – индекс захвата 99mTc, захват 131I на 24 ч и характер удержания 131I в ЩЖ с 24 по 48 ч. ВЫВОДЫ: функция ЩЖ при СШТ с возрастом может изменяться, поэтому тиреоидный статус необходимо тщательно контролировать. На сегодняшний день патофизиологические аспекты более частого развития аутоиммунной патологии ЩЖ у пациентов с СШТ изучены недостаточно. Предполагается, что она может развиваться в результате гаплоинсуффективности генов Х-хромосомы, избыточной продукции провоспалительных цитокинов, снижения уровня противовоспалительных цитокинов и первичной яичниковой недостаточности. Дальнейшее изучение аутоиммунных нарушений при СШТ может способствовать лучшему пониманию патогенеза аутоиммунных заболеваний в целом.