The authors analyze the diagnostic value of thyroid palpation method (two modifications) comparing its results with those of ultrasonographic volumetry. The study involved 118 children aged 5 and 14 of both sexes living in regions endemic for goiter. The thickness of thyroid isthmus was found virtually the same no matter how greatly the gland was enlarged. The results proved the necessity of age-specific corrections in the criteria of current interpretation of palpation data: the first degree in preschool children was most often indicative of thyroid hypertrophy whereas in the pubertal age it was just a variant of normal size. Interpretation with due account of these amendments improved the reliability of diagnostic value of palpation, its sensitivity being 636, specificity 676, and accuracy 654%. When the results of palpation are adequately interpreted, the examinees age and sex and the method of examination proper do not influence the data accuracy. The sensitivity of palpation in detection of nodules up to 10 mm in diameter proved to be null (in 6 of the 81 examined adolescents sonographic signs of incapsulated formation were seen in the thyroid). Bearing all this in mind, the authors discuss differentiated approaches to management of children and adolescents with the first degree of palpated enlargement of the thyroid.

Monitoring the normal growth of a child is one of the primary tasks of a pediatric endocrinologist. The most common abnormality of growth is a variety of options for its delay, detected in 3% of children. Much less often, the reason for a visit to the doctor is tallness. The most adverse cause of gigantism in children for health and life is conditions accompanied by hyperproduction of growth hormone (GH). In pediatric practice, the latter, admittedly, constitute an endocrine rarity. Thus, according to 11-year observations of more than 800 children at the Outpatient Center for Pediatric Endocrinology at North Shore University Hospital in the United States, in the structure of the growth pathology, the height rate was 2.5% - approximately 75 cases per 100,000 children. At the same time, for each case of seeking advice about excessive growth, there were about 40 appeals due to its delay. True gigantism is found only in every 5th child with unusually high growth, or less than 0.5% among children with deviations in body length. On the other hand, according to M. I. Balabolkin, only 9% of patients with acromegaly debut of the disease occurs at the age of 20. These statistics once again emphasize the extreme rarity of diseases occurring with abnormal excess growth in childhood.

Population frequency of neonatal hyperthyrotropinemia (NHT) in an iodine deficient region was studied with consideration for published reports about the relationship between prenatal iodine supply and fetal and neonatal thyroid function, and the efficiency of iodine prevention of this condition was evaluated by the results of overall screening of newborns for hypothyrosis. The concentrations of thyrotropic hormone (TTH) in whole blood specimens dried on paper were measured in 29588 newborns in the Belgorod region (Russia) in 1995-1998 using the Neonatal hTSH FEIA (Labsystems OY, Finland). Slight iodine deficiency in this region (median iodine excretion with urine 69 mcg/liter, n = 1313) was associated with an extremely high incidence of NHT: more than 5 iU/liter in 47% and more than 20 iU/liter in 7% newborns. Overall prevention with iodinated table salt during 1 year notably decreased the incidence of NHT (by 1.6 times, p < 0.001) and alleviated its severity from severe to mild degree. Preventive treatment of pregnant women by potassium iodide (200 mcg/day) during the same period more effectively decreased the incidence of the pathological parameter (five fold, p < 0.001). A lower incidence of NHT resultant from prenatal iodine treatment was associated with a lowering of the mean TTH level solely at the expense of the newborns with high levels of the hormone; if TTH levels were normal, they did not change. Therefore, thyroid dysfunction in newborns (NHT) indicates iodine deficiency in a region during intrauterine development; this abnormality can be prevented by iodine treatment in microdoses meeting the physiological requirement in iodine, which is increased during gestation. At the beginning of overall prevention of goiter by iodinated table salt, group prevention with potassium iodide is justified in risk groups, primarily in pregnant women; compensation of prenatal deficiency decreases the cost of screening for congenital hypothyrosis due to a lower requirement in TTH retesting.

Time course of changes in the incidence of diffuse toxic goiter (DTG) in children aged 0-14years was studied in 1986-1999 at territories with slight iodine deficiency and normal radiation levels in the Central Federal Region of Russia (Belgorod, Voronezh, and Orel regions, a total of 45 territories, n = 665,987). The mean incidence of DTG over 14years in this cohort was 0.59per 100,000 children annually, which corresponds to the prevalence of this condition at a territory with slight and moderate iodine deficit. A notable increase in the incidence of DTG was observed during recent 5 years (1995-1999) in comparison with the beginning of observation (1986-1990): annual number of new cases and the morbidity level doubled (from 2.6+ 0.7 to 5.6+0.5, p - 0.01, and from 0.39 to 0.84, p < 0.03, respectively). The relative risk, of DTG in childhood increased to 2.15 (1.13-4.15, p < 0.029) in recent years; this is true mainly for pubertal girls. These negative shifts in DTG epidemiology among children in Central Russia were not caused by principal changes in the level of iodine consumption and were observed in the presence of persisting slight iodine deficiency under conditions of neglected overall iodine prevention.

The purpose of the study was to search for causes that exert a negative effect on the mental development of patients with con­genital hypothyroidism (CH). A total of 85 children aged 5-17 years (65 patients with CH and 20 healthy individuals of the same age from their families) were examined. Their mental de­velopment was assessed by the D. Veksler test in the presence of clinical and hormonal compensation. The results have demon­strated that the start of therapy at month 1 of life provides high adaptive capacities and results in the normal level of mental development in children with CH (the mean IQ, 103±4 scores). The adequacy of the therapy performed also affects the mental development of patients with CH in future: children with normal intellect (IQ > 90 scores) received adequate hormonal replace­ment therapy within the first year of life in 90% of cases whereas hormonal compensation within the first year of life was noted only in 38% of the children with borderline intellectual deficiency (IQ = 70-89 scores). Perinatal pathology was more frequently de­tected in children with mental retardation: in children with oli­gophrenia and those with normal intellect, their maternal path­ological pregnancy was observed in 56 and 22%, respectively. Birth asphyxia was noted in 33% versus 15%. Familial and so­cialfactors played a role (but not decisive) in the formation of the intellectual level of a child with CH. It is concluded that the time of initiation and the adequacy of therapy play the leading role in the formation of intellect. The authors 'findings show it necessary to optimize a follow-up system for children with CH: a stricter clinical and hormonal monitoring of patients by an endocrinol­ogist and consulting of children with CH by a neurologist and a medical psychologist from their infancy.