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The issues pertaining to etiology, pathogenesis, clinical manifestations, and treatment of endocrine ophthalmopathy (EOP) are discussed. EOP is a heterogeneous autoimmune eye disease most frequently associated with Graves’ disease even though it is just as well encountered both in the patients presenting with chronic autoimmune thyroiditis and in the absence of thyroid dysfunction. Although pathogenesis of EOP remains to be elucidated its autoimmune nature with the involvement of sensitized T-lymphocytes and autoantibodies against orbital tissues leaves no doubt. The understanding of mechanisms underlying the development of EOP gave impetus to the creation of new groups of medicines selectively acting on various pathogenic processes associated with this disease. The management of EOP remains a challenging problem requiring a multi-disciplinary approach for its solution.

Objective: to assess hormonal and metabolic parameters and psychological status of young men with obesity. Methods: The study included 60 men with obesity (BMI>30 kg/m2) divided in two groups. Patients in the first group (n=30) received orlistat for 12 weeks (120 mg 3 times daily with meal). Patients in second group (n=30) followed hypocaloric diet and aerobic exercise. All patients were examined before treatment and after 12 weeks. Evaluation included hormonal and biochemical analyses, 48 patients were examined by psychological questionnaires (Beck Depression Inventory, Beck Anxiety Inventory, Liebowitz Social Anxiety Scale, Dutch Eating Behavior Questionnaire). Results: Patients that received orlistat treatment showed significant decrease of body mass: 50% of patients had decrease more than 5%, 30% of patients - more than 10% (p

Aim. To analyze the association between the polymorphic markers in CTLA4, TNF, IL10 and IL16 genes and the risk of manifestation of endocrine ophthalmopathy (EO) in patients with Graves’ disease (GD). Materials and methods. Case-control study included 248 patients with GD. Using polymerase chain reaction we studied the distribution of alleles and genotypes of polymorphic markers such as A60G (rs3087243) in CTLA4 gene, G(-308)A (rs1800629) in TNF gene, G(-1082)A (rs1800896) in IL10 gene, T3249C (rs4778641) in IL16 gene among 141 patients with Graves’ disease and EO and 107 patients with GD without EO. Results and discussion. The frequencies of A alleles and the AA genotypes were significantly increased and the frequencies of G alleles and the GG genotype polymorphic markers rs3087243 of CTLA4 gene and rs1800896 of IL10 gene, as well as the GG genotype polymorphic marker rs1800629 of TNF gene were reduced in patients with GD and EO. The polymorphism in CTLA4 gene was also associated with the activity and the severity of EO. The comparative analysis of the allele and genotype frequency distribution of polymorphic markers of IL16 gene did not show the significant difference. Conclusion. The risk of manifestation and the development of EO in patients with Graves’ disease can be caused by not only environmental, but also genetic risk factors.

Most of the most respected researchers in the field of thyroidology agree that the ideal treatment for diffuse toxic goiter (DTZ) should ensure the rapid elimination of the clinical symptoms of thyrotoxicosis and be accompanied by a minimal risk of complications for the patient [1, 2, 7]. Unfortunately, at present, clinical practice does not have a treatment method that fully meets these requirements. The choice of treatment method for DTZ is largely determined by the commitment of specialists and their experience in the application of a particular treatment method, the characteristics of national endocrinological and surgical schools, the capabilities of a particular medical institution, as well as the sex, age of the patient, options for the clinical course of the disease, the patient’s wishes and some others factors. It can be noted that the recommendations given by experts in Europe, the USA and Japan are different. Conservative therapy with antithyroid drugs is quite widespread in European countries, but the low frequency of achieving stable remission of the disease does not satisfy endocrinologists [1,5, 32, 40, 42]. Radioactive iodine therapy, which is widely used in the USA and Western Europe, which is a rather effective method of treating DTZ, over time leads to the development of hypothyroidism in almost all patients [16, 20], it is also necessary to take into account the risk of developing thyroid cancer, breast, infertility and severe osteoporosis in women in the premenopausal period [10, 13, 18, 19]. Surgical treatment occupies a significant place in the treatment of DTZ, providing the patient with the most rapid achievement of the euthyroid state, however, like any surgical intervention, it is accompanied by a number of characteristic complications [2, 46]. Nevertheless, in Japan, thyroidectomy is considered the main treatment for DTZ.