Endocrinological convalescent centre
Pyatigorsk

REPORT

Of investigation
Potential of treatment of nodular and multinodular goiter with ENDONORM®.
«Endocrinology» program

Supervisor of studies: Doctor of Medicine, professor Mishagin V.A.
Executive in charge of the section, Senior research associate, Ph.D. in medical sciences Akhkunbekova N.K.

 Relevance

Nodular goiter is a collective clinical term denoting space-occupying lesions of thyroid gland differing in morphology, detected by various modern diagnostic methods. The main one among them is ultrasound investigation. The term «multinodular goiter» applies to cases where two or more nodes are detected in the thyroid gland. The term «multinodular goiter» (1) comprises a number of the most common and frequent morphological forms of goiter. In cases of autoimmune thyroidites (Hashimoto's thyroidites) and subacute thyroiditis (de Quervain's thyroiditis), formation of the so-called pseudonodes is common (2). In addition, ganglial changes may occur based on the preexistent node. Multinodular goiter can occur in cases of morphologically different thyroid gland diseases such as adenoma, colloid goiter and others (3). Nodular goiter is one of the most frequently encountered abnormalities of thyroid gland (Table 1). The most common among them is nodular colloid proliferative goiter which is not a tumor. However, it is a popular belief among most endocrinologists up to now that such nodes are to be treated with thyroid hormone preparations, which is totally wrong. Prescribing thyroxine preparations for treatment of this abnormality has not been justified up until now, and clinical efficacy of thyroidal preparations hasn't been confirmed by any research work (4). It is noteworthy that, even from the psychological point of view, nodular goiter is constantly annoying a patient, this state can be classified as «constant stress». This results in complaints of malaise which shows itself in asthenia, occasional heart hurry, insomnia or sleepiness, apprehension, pressure in the neck area and so on.

 Research objective 

The aim of this research work was to investigate the effect of herbal medicine ENDONORM® for the treatment of nodular (multinodular) euthyroid goiter.

Table 1. Occurrence of thyroid gland nodes accidentally detected during ultrasound investigation (5).

Material and methods

 Thyroid glands of 92 patients have been examined (Fig. 1), having the following diagnoses: «nodular and multinodular euthyroid goiter», before and after ENDONORM® treatment. The medicine was prescribed in accordance with the classical scheme recommended for such abnormality by «Fitopanacea» experts, Moscow (1 cap 3 times a day 10 minutes before meals for 2 months with a 10-day break between the courses). The recommended number of courses is two.
As a control group, 36 patients with nodular (multinodular) colloid proliferative euthyroid goiter have been examined (22 women and 14 men). All patients were fit for case follow-up.

The diagnosis was made on the basis of ultrasound investigation made by «Medison SD-9900», and of cytological examination of node punctate after fine-needle aspiration biopsy using «MaxiCEEL» needle and controlled by an ultrasonic transducer (Fig.2).

Thyroid homeostasis condition monitoring was carried out by way of enzyme multiplied immunoassay of hormones (TSH, Triiodothyronine, free thyroxine, TG, anti-thyroglobulin autoantibodies, thyroperoxidase antibodies, thyroglobulin) with «ChemWell» automated biochemical analyzer.

 Findings

 Initial examination of the patients showed that thyroidal hormonal state did not differ from normal. 15% (14 patients) showed imperceptible increase of thyroglobulin concentration - 74,1 ± 0,64 IU/ml(P<0,l). After a course of ENDONORM® therapy thyroglobulin concentration came to normal, 64 ± 0,73 IU/ml (P<0,1).

According to the results of cytological examination, all the examined patients had nodular colloid proliferative goiter.

The basic physical screening examination was the thyroid gland ultrasonic scanning. According to its results, node diameter half decreased by its larger radius in 63% of cases (58 patients) (from 16-23mm to 8-12mm) (P<0,05), and in 19.6% of cases (18 patients) it decreased by 1.5 times (to 10.6-15.3mm) (P<0,05), and remained unchanged in 17.4% (16 patients) (Fig. 3). No growth of nodes was detected.

It is noted that ENDONORM® therapy is most effective in cases of multinodular goiter.
In the control group, for 89% of cases (32 patients), the node size remained unchanged, in 11% of cases (4 patients), growth tendency was detected (Fig. 4)

Discussion of the results

Despite the attitude of official medicine towards nodular euthyroid goiter as a nontumoral process, we would like to point out that colloid nodes in endemical regions always tend to grow. We do not suggest a consensus - is it necessary to share the opinion of our highly respected foreign colleagues (especially those in the US) that nodular colloid goiter is harmless? The territory of Russia is almost entirely an endemic zone in terms of iodine deficiency. What does it lead to?! All endocrinology manuals now declare the functional autonomy of the thyroid gland to be the consequence of iodine deficiency. Being reluctant to treat a disease resulting from iodine deficiency, namely a colloid node, we sentence ourselves to the necessity of treating future pathology. Based on the foregoing, we can speak of ENDONORM® efficiency in treatment of nodular and multinodular euthyroid goiter. Having noted the high efficiency of ENDONORM® in treating the pathology, we'd like to enlarge upon the mechanism of its action. Most probably the triterpene saponosides and glycosides of cinquefoil white which is the main component of the preparation, prevent the thyroid gland from production of labilizing thyroid mutations. Bearing them in mind (TSH receptor, a-subunits of adenylate cyclase cascade) and bearing in mind the results of the research, it is necessary to continue the study of the biologically active substance of cinquefoil white extracted in pure form.

At the present time, ENDONORM® is the only effective therapeutic agent for treatment of nodular and multinodular euthyroid goiter.

Conclusions

1. ENDONORM® is quite effective in treatment of nodular (multinodular) colloid proliferative goiter.
2. ENDONORM® can be recommended as a preventive measure against diseases resulting from iodine deficiency.

3. ENDONORM® must be recommended for introduction into clinical practice as a highly effective and harmless pharmaceutical preparation.

References

1. Dedov I.I., Troshina E.A., Aleksandrova G.F. Diagnostics, treatment and prevention of nodular forms of thyroid gland disorders: Guidebook for doctors. Moscow., 1999.
2. Dedov I.I., Melnichenko G.A., Gerasimov G.A. et al. Clinical recommendations of the Association of endocrinologists of Russia on diagnostics and treatment of autoimmune thyroiditis (Hashimoto's thyroiditis) in adults // Problems of Endocrinology. 2003. No.6, P.50-51.
3. Dedov I.I., Troshina Е.А., Yushkov P.Y. et al. Diagnostic of thyroid gland disorders. Moscow: Vidar, 2001. P. 128.
4. Dedov I.I., Troshina E.A., Yushkov P.Y., Aleksandrova G.F. Diagnostic and treatment of nodular goiter: Methods. Recommendations. Moscow., 2001.
5. Tan G.H., Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. // Ann Intern Med – 1997 – Vol. 126, N 3. – P. 226 – 231.

Chief endocrinologist of the Federal State Institution «Pyatigorsk State Resort Medicine scientific research institute of the Federal Medical and Biological Agency of Russia»,
  Doctor of Medicine, Professor Mishagin V.A.