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1 case. Patient B, 19 years old, presented to the doctor with general and muscle weakness,
drowsiness, poor appetite, dry mouth, severe thirst (drinking up to 6 liters per day), increased
urination, weight loss of 7 kg in the last 2 months
1) Diabetes mellitus type 1(age, weight loss, IMT = 21.2)
2)Symptoms: polydipsia, polyuria, weight loss, dry skin, etc.
Insipidary syndrome: severe thirst, polyuria, polydipsia, dry mouth, weakness, pronounced general
and muscular weakness, decreased ability to work, drowsiness, weight loss
- Dehydration syndrome: dryness of the mucous membranes, skin, reduction of turgor of the skin,
hypotension, hypothermia
- Skin syndrome: skin and vaginal itching, "diabetic" blush (face, forehead, chin)
Ketoacidosis syndrome
Metabolic syndrome:Weight gain, arterial hypertension
3) Laboratory inspection plan:
OAK, OAM, BH
Determination of glycemia on an empty stomach with a glucometer (> 7) and ingestion after 2 hours (>
11.1)
Glycosylated hemoglobindetermination (HbAlc) N= to6.5% (48 mmol / l)
AndmmmunochemiluminescenceiC-peptide - a marker of residual insulin secretion in CD1 decreases
/ does not appear (at the rate of 0.28-1.32 pg / ml);
ELISA:
ICA - antibody to islet cells, GAD65 - antibodykdecarboxylase glutamic acid,
IA-2, IA-2 β - antibodies to tyrosine phosphatase,
IAA - antibodies to insulin;
Hormones:TTG, free T4
4)HbAlc-16.3 no ( up to 6.5). creatinine 109,8(45-115) ШФЖ 82 (85-150) urea 5.2 (2, 3-8.3) total
bilirubin 9.3 (up to 21.4)ALT 43no(to 41) AST 27 (to 31) IS 8.3 nocentury (3.5-5.5) No TTLP 6.1
(2.2-4.8) Thyroglobulin 4.29 (1.5 to 59) TJLP 0.74 (0.3-1.83) total protein 64.4 lowwidth(66-
87)Na142(135-145)Kali 4.1(3.5-5.5)
OAM: glucose 56(glucosuria) ketone bodies 4(ketonuria)

5) DC type 1, severe current, stage of decompensation

6)Treatment
Diet №9
Quit smoking
Appropriate physical activity
Lifelong insulin therapy - 0.5-0.75 units / kg intravenous injection
-Pampullary insulin therapy

-Hypoglycemic agent, short-acting insulin (insulin soluble (human genetic engineering))

-Hypoglycemic agent, insulin ultra-short action
-Hypoglycemic agent, insulin is a medium-acting drug (insulin isophane)
-Hypoglycemic agent, analogues of human insulin long-acting (insulin glargin, insulin detemir)
-Hypoglycemic agent, an insulin analogue of a human supernatural action (insulin degludek, insulin
glargin)

2 Case. Patient K, 60 years old, during a routine examination revealed an increase in plasma
glucose to 6.7 mmol / l on an empty stomach.

1. Metabolic syndrome. Prediabetes. Obesity 1 tbsp

3. Measurement of waist size. OAC, OAM, BH (glucose, protein, lipid profile, urea) coagulogram
C-peptide is a marker of residual insulin secretion (at a rate of 0.28-1.32 pg / ml).
Glycated hemoglobin (HbA1c) - ≥ 6.5%.
Ekg. Echocardiography, ultrasound of the abdomen, holter, radiology stop, efgds, MRI of the brain

4) HbAlc 6.1 (norm 4.3-5.6). Glucose 6.3 (up to 7) urea 3.4 (2.3-8.3) creatinine 65.8 (45-115) CFS 99
(80-120) total protein 70 (64-88). HS 4.56 (3.3-6.5) uric acid 469 (210-420) ALT 26 (up to 41) AST
25 (up to 35) sodium 138 (135-145) potassium 4.1 (3.5-5.5)
PGTT after 2 hours 7.5 mmol / l (up to 11.1)

5) Metabolic syndrome. Prediabetes. Obesity 1 tbsp

Treatment: a) dietary recommendations, physical activity, behavioral therapy
b) diet + drug treatment (inhibition of lipase in the gastrointestinal tract 120 mg 3 p H per day Orlistat)
c) diet + surgical treatment (insertion of a balloon into the stomach, laparoscopic gastric lavage,
shunting,
Antidepressant. Serotonin and noradrenaline reversal inhibitors. 75/150 mg Venlafaxine
metformin 500,850,1000. glucophage, gluconyl

4 Case. Patient B, 46 years old, complained to the endocrinologist about general weakness,
swelling of the face and lower limbs, drowsiness, overweight ...
1. Endemic goiter, hypothyroidism
2.Edema syndrome, asthenovegetative syndrome, neurological syndrome, anemia, metabolic-
hypothermic
3. OAK, OAM, BH, thyroid hormones, iodine (120-220 mcg / l), thyroid ultrasound, ECG, X-ray, MRI
pituitary echocardiography of antibodies to TG and TPO
4) Anemia, thrombocytosis, no HS, no TTLP (2.2-3.5)
TSH 24 (0.3-4.2) free T4 6 pmol (10-22.2)
5. Diffuse endemic goiter, 2nd degree. Primary hypothyroidism. Overweight. Anemia
6. Treatment: Levothyroxine sodium 25, 50, 75, 100, 125, 150 mcg in tab.
The starting daily dose in manifest hypothyroidism: in patients 60 years - 1.6-1.8 mcg / kg; in patients
with accompanying diseases of the cardiovascular system and older 60 years - 12.5-25 mcg with
subsequent increase in 12.5-25 mcg each 6-8 weeks. After taking thyroid hormones for 4 hours to
avoid taking antacids, iron and calcium drugs.

5 cases. Patient A, 58 years old, complains to the doctor of swelling of the face, arms, legs,
general weakness, memory loss, often a feeling of tightness in the chest, pain is relieved by taking
nitroglycerin, and also complains of diarrhea.

1) Hypothyroidism
2) Metabolic-hypothermic syndrome:
- Water delay
- Наруш.обмен.липидов
Epidermal syndrome:
- Dryness
- Swelling of the face
Neurological syndrome:memory case. Decreased, indifferent, slow answers to questions
Dyspeptic syndrome:constipation
Cardiac syndrome
Asthenovegetative syndrome
Anemic syndrome
Circulatory-hypoxic syndrome
3) Inspection plan:
OAK, OAM, BH (protein, glucose, bilirubin, LS, urea, ALT, AST, SRB, SF)

- Ultrasound of the thyroid gland.

-Puncture biopsy of the thyroid gland.
-Determination of antibody titers to thyroglobulin and thyroperoxidase.
- CT or MRI of the brain (in central hypothyroidism).
- ECG
-Cardiologist consultation.

4) OAC: anemia, thrombocytosis

BH: no HS (3.5-5.5), no TTLP 5.1 (2.2-4.8), triglycerides 3.4 (0.6-2.3)
No TSH, low T4

5) Manifest hypothyroidism. heavy current. JIA. Anemia.

6) TREATMENT
Levothyroxine sodium25, 50, 75, 100, 125, 150 mcg in tab.
Starting daily dose in manifest hypothyroidism:
· In patients 60 years - 1.6-1.8 mcg / kg;
· In patients with accompanying diseases of the cardiovascular system and older 60 years - 12.5-25
mcg with subsequent increase in 12.5-25 mcg each 6-8 weeks.
Take in the morning on an empty stomach, not later than 30 min before the reception of food. After
taking thyroid hormones for 4 hours to avoid taking antacids, iron and calcium drugs.
Substitute doses of T4 for adults - 50-200 mcg / day, on average - 125 mcg / day.
After thyroidectomy for cancer of the thyroid gland, suppressive doses of 2.2 μg / kg per day are used.

6 cases. A 34-year-old patient presented to an endocrinologist with complaints of overweight,

infertility, hair loss, drowsiness, general weakness, coldness.
Anamnesis plans pregnancy for 2 years….

1) Hypothyroidism
2) Metabolic-hypothermic syndrome:
- Water delay
- Наруш.обмен.липидов
Epidermal syndrome:
- Dryness
- Swelling of the face
Neurological syndrome:memory case. Decreased, indifferent, slow answers to questions
Cardiac syndrome
Asthenovegetative syndrome
Anemic syndrome

3)HSA, BMA (total cholesterol, HSLPNP, HSLPVP, triglycerides, potassium, sodium, iron) Hormone
analysis (TSH, T3, T4), Antibodies to TG and TPO, ECG, Echocardiography, ultrasound

4) Lab: anemiaHS is higher than 7.2(3.5-5, 5 mmol / l),Fe below 8 μmol / l(10-28), No TSH 19 (0.3–
4.2 μIU / ml), low T4 0.8 (10.5 - 21.8), ECG bradycardia.

5)The first manifestoлікhypothyroidismeoz, ZhDA easy degree

6) Em: Levotyroxine sodium
The starting daily dose for manifest hypothyroidism: - in patients up to 60 years - 1.6-1.8 mcg / kg, -
12.5-25 mcg with subsequent increase in 12.5-25 mcg each 6-8 weeks.
Take in the morning on an empty stomach, not later than 30 min before the reception of food. After
taking thyroid hormones for 4 hours to avoid taking antacids, iron and calcium drugs.
Substitute doses of T4 for adults - 50-200 mcg / day, on average - 125 mcg / day.
After thyroidectomy for cancer of the thyroid gland, suppressive doses of 2.2 μg / kg per day are used.

7 cases. A 53-year-old patient presented to an endocrinologist with a heart attack, weight loss (13
kg weight loss in 2 months)tty), trembling hands, crying, irritability, insomnia, impaired vision,
sand in the eyes, decreased ability to work.

1) Thyrotoxicosis (hyperthyroidism)
2) cardiovascular syndrome, psychoneurological syndrome, adrenergic, pain, asthenovegetative
Syndrome of ectodermal disorders: brittle nails, hair loss, hot, velvety on the skin, endocrine
ophthalmopathy Basic eye symptoms:
- symptom of Grefe - resignation of the upper eyelid from the edge of the cornea when moving the
eyeball down;
- Kocher's symptom - the departure of the eyeball movement from the movement of the upper eyelid
when looking up, in connection with which the area of the sclera between the upper eyelid and the
rainbow;
- Dalrympla symptom - wide opening of the eye sockets ("surprised look");
- Krause's symptom - increased glare;
- symptom of Shtelvaga - rare and incomplete migratory movements in combination withretractionthe
upper century;
- Rosenbach's symptom - small and rapid tremors of depressed or slightly closed eyelids.
- symptom of Moebius - violation of convergence (loss of ability to focus the eye when approaching
the subject)

3) Inspection plan:
OAK, OAM, BH, TTG, T3, T4
Ultrasound of the thyroid gland, ECG, echocardiography, CT, MRI

4) Stomach glucose unchanged, fasting glucose 4.69 (up to 7) protein 63 (64-83),creatinine74.7(45-

115) HS3.7(3.5-5.5) TTLP2.6(2.2-4.8) TJLP1.0(0.3-1.83) TG 1.5 (0.6-2.3),ALT 11.4 (up to 41), AST
14.6 (up to 31) SHF 97 (30-120)
OAMnorm
TSH 0.09 μIU / ml(0.3–4.2 μIU / ml), T4 free 34.7 (9 - 22.2)

5) Thyrotoxicosis, nodular toxic goiter (Graves' disease) manifest, moderate severity

6- Diet: Diet (iodine restriction, caffeine X) Thyrostatics-Timazole, Radioactive iodine therapy, or

thyroidectomy (?)
The following drugs have a thyrostatic effect:
1. Derivatives of imidazole (thiamazole) and thiouracil (propylthiouracil) - the main means of
conservative therapy. Drugs inhibit the synthesis of thyroid hormones, as well as have effects that
reduce the immunological activity of DTZ.
2. Potassium perchlorate - is currently not used in the treatment of DTZ.
3. Lithium carbonate - has limited indications for the treatment of DTZ. The drug is prescribed only in
the mild form of the disease, as well as in the period of preoperative preparation when it is impossible
to use imidazole and thiouracil for complications (allergies and other). The first phase - the
achievement of euthyroidism:
- propylthiouracil intravenously with food intake of 100-150 mg 3-4 p. per day, 3-6 weeks or so
- thiamazole intravenously, independently of food intake, 30-40 mg 1 time per day or in 3 receptions,
3-6 weeks.
The second phase- maintenance of euthyroid status (after achieving clinical euthyroidism and
normalization of thyroid hormone levels in the blood). The dose of thiamazole is gradually reduced
over a period of 3-4 weeks, up to supportive (usually 5-10 mg / day), and propylthiouracil - up to 50-
100 mg / day.

9 cases. Patient K., 30 years old, complained to an endocrinologist about palpitations, tremors in
the hands, weight loss, emotional lability, increased tremors.
1. Hyperthyroidism
2. Pain syndrome, neurasthenic syndrome, syndrome of disorders of the cardiovascular system,
catabolic syndrome
3. OAK, OAM, BH, TTG, T3, T4
Instrumental research:
Ultrasound, scintigraphy, CT, MRI, TAB and cytological examination. ECG, Echocardiography

4. STD:
Hemoglobin-129 g / l norm (120-160)
Erythrocytes-4.9 norm (3.7-5.1)
Leukocytes-4.6 norm (4-9)
Platelets-285 norm (150-400)
ERG-45 mm / s above (2-15)
Lymphocytes-5 lymphopenia (18-40)
BHA:Glucose-5 mmol / l (3.3-5.7)
Total protein-70 g / l norm (64-83)
Urea-44 mmol / l above (2.3-8.3)
Creatinine-70 μmol / l norm (53-97)
Total cholesterol-4.8 norm (3.5-6.9)
TJLP-1.2 mmol / l below (1.6-4.9)
TTLP-3.6 mmol / l (0.7-2.2)
TG-1.08 mmol / l (0-2.25)
ALT-32 norm (up to 41)
AST-16 norm (up to 37)
ShF-78 norm (30-120)
Low TSH-0.2 (0.3-4.2)
T4-25,7 higher (9-22,2)
Ultrasound: PA is enlarged, not uniform
5.Thyrotoxicosis, nodular toxic goiter manifested, moderate severity
6- Diet: Diet (iodine restriction, caffeine X) Thyrostatics-Timazole, Radioactive iodine therapy, or
thyroidectomy (?)
The following drugs have a thyrostatic effect:
1. Derivatives of imidazole (thiamazole) and thiouracil (propylthiouracil) - the main means of
conservative therapy. Drugs inhibit the synthesis of thyroid hormones, as well as have effects that
reduce the immunological activity of DTZ.
2. Potassium perchlorate - is currently not used in the treatment of DTZ.
3. Lithium carbonate - has limited indications for the treatment of DTZ. The drug is prescribed only in
the mild form of the disease, as well as in the period of preoperative preparation when it is impossible
to use imidazole and thiouracil for complications (allergies and other). The first phase - the
achievement of euthyroidism:
- propylthiouracil intravenously with food intake of 100-150 mg 3-4 p. per day, 3-6 weeks or so
- thiamazole intravenously, independently of food intake, 30-40 mg 1 time per day or in 3 receptions,
3-6 weeks.
The second phase- maintenance of euthyroid status (after achieving clinical euthyroidism and
normalization of thyroid hormone levels in the blood). The dose of thiamazole is gradually reduced
over a period of 3-4 weeks, up to supportive (usually 5-10 mg / day), and propylthiouracil - up to 50-
100 mg / day.

10 cases. A 50-year-old female patient regularly complains of headaches to local general

practitionersand complained that it is usually associated with the use of antihypertensive
drugs ...

1.Acromegaly. Bassintracranial hypertension syndromes,Cerebrovascular Syndrome, Growth

Hormone Overdose Syndrome,Hirsutism, Damage to the cardiovascular system, Hepatomegaly
2. The diagnosis is made on the basis of complaints of almost constant excruciating headaches; data
review: highlighted large palms and feet with thick fingers, large head with large protruding ears and
rough drawings of the face, obvious prognathism, large tongue, enlargement of heart and liver;
PLANCHNOMEGALY laboratory examination: blood glucose level - 6.3 mmol / l.

3.biochemical analysis of blood: hypercholesterolemia, hypertriglyceridemia

STG (2-10 ng / ml)
Glucose tolerance test (after 75 g of glucose bag 30,60,90,120 min tex, normal LNG decreases)
level IFR-1 (somatomedina-C) in the blood (50-200 ng / ml)
study of levels of ACTH, cortisol, TSH, sv.T4, LH, FSH, testosterone, estradiol, osmolality of plasma
and / or relative density of urine, especially in the case of macroadenoma (UD - A)
CT, MRI of the area of the Turkish saddle with contrast enhancement;
PET when suspected ectopic tumor, secreting STG or somatoliberin;
Measurement of the thickness of the soft tissues of the foot in the area of the heel bone (norm in men
up to 21 mm, in women - up to 20 mm);

4. The main goal of treatment is the reduction of the level of STG in the blood and the elimination of
neurological symptoms: neurosurgical treatment; in case of impossibility of operative treatment or lack
of its effect, beam therapy is carried out in the area of the pituitary gland; Somatostatin and
bromocriptine are used in conservative treatment methods.
60 - 120 mg 1 time in 28
Analogues of somatostatin of long-term action
Lanreotide days, p / k
10-30 mg 1 time in 28 days w
Analogues of somatostatin of long-term action Octreotide
/m

bromocriptin
dopamine agonists Intravenously 10 to 20 mg / day in 2-4 receptions
e
Intravenous dose of 0.5 mg 3 times a week up to 0.5 mg
dopamine agonists cabergoline
daily

5. Secondary cardiomyopathy; arterial hypertension; diabetes mellitus; HSN; hypopituitarism;

emphysema of the lungs.
14 cases. Patient M.18 years old, my friends played the most football. 1 hour after the start of the
game, decreased activity, paleness, headache, body tremors..

1. Hypoglycemia
2. Adrenergic syndrome(caused by activation of the autonomic nervous system): Weakness,
sweating, tachycardia, tremor, elevated excitability, irritability
Neurological syndromes: Headache, paleness, Hypothermia, Convulsions, Coma
Neuroglycopenic symptoms: reduction of intellectual activity, dizziness, impaired coordination of
movements
3. STD, STD, BH, ECG
4. NSAID in the norm, ESR increased protein (up to 0.033 g / l), BPA low glucose (3.3-5.50
mmol / l), ECG tachycardia
5. Type 1 diabetes mellitus, hypoglycemic coma
6. mode: 1; diet: 9. When conserving consciousness - sweet drink
Doghospital medical aid is administered intravenously 40% solution of glucose in a dose of 20 to
100 ml; intramuscular injection of 1-2 ml of glucagon.In the hospital on the background of infusion
of 5% solution of glucose may be administered 0.1% solution of adrenaline (1-2 ml) and
glucocorticoids (prednisolone 40-60 mg, hydrocortisone 100-150 mg).