DEZ decoding. Watch what is "des" in other dictionaries. Maintenance of common communications

All residents of apartment buildings in our country are serviced by management companies. Each of us pays for their services every month and periodically refers to housing and communal services. And how many were thinking about what kind of organization, where did they come from and why do we serve us? What conditions are the relations of utility services and residents of apartment buildings built? Let's try to disassemble these questions in detail.

What is HOA, housing and communal services, housing and communal services, housing and communal services?

Housing and operational management (HWU) is the local executive organization of housing and communal services (Housing and communal services), created in the Soviet Union and continuing its work in the Russian Federation. There were data from the departments at the receiving territories, within the boundaries of the microdistrict. Depending on the city, they had different names:

• housing and operating office (HSEK);
• repair and operating enterprise (rap);
• repair and operational management (REU).

All data of the institutions were created to maintain an apartment building. After the collapse of the Union of Soviet Socialist Republics, when the transfer of housing from public in private ownership began, the local bodies of housing and communal services were transferred to the municipality and were allocated to a separate department.

Since the beginning of the spring of 2005, the new Housing Code of the Russian Federation began working. It regulates the reform of housing and communal services, with the creation of instead of housing and operating departments, managers (CC) or housing owners (HOA). All house management companies are private. For the most part, they are created on the basis of the Jews and are headed by the same managers as before.

The entire infrastructure, which previously belonged to Housing, passed the ownership of the Criminal Code. This organization is essentially a housing and operating office that has changed the form of property and name. According to the old man, many tenants still call the GVKOM managers, even though it is not true.

What services will provide us with ZEK, talk further.

Services

The number of services that provide organizations included in the housing and utilities system (Jeques, etc.) varies from one to several dozen. Requirements for the timing and order of utility service are constantly being improved and change.

In our country there are no free services that provide the HSEK. After all, if even the tenants of unsuccessful apartments do not pay any service management company, then it makes the municipality.

In modern realities, the relationship between the Criminal Code and residents are built on a commercial basis. All citizens are obliged to pay for utilities in a timely manner, and the FAU is qualitatively and on time to fulfill the entire service list.

List of paid utilities:

• electricity;
• gas supply;
• (not only, but also roofs, visors of the entrance and block, etc.) and home service (incl., reasons for the appearance, etc.);
• other contractual work.

All utilities are paid according to signed between the management company and the owner of the housing, the contract.

All services and works provided by the JCCOM are divided into two categories: mandatory and optional. For mandatory services we pay monthly. They are included in the "Repair and Service of the House" or "for the maintenance and repair of housing." As an example -, washing the heating system or. Optional is the installation of new heating elements, non-standard plumbing or plastic window blocks. Order such services and pay them - the case is purely individual.

Mandatory services are carried out with different frequency:

• when carrying out technical trafficking and inspections;
• in the preparation of buildings to the autumn-winter period;
• as pollution, need and frequency of use;
• when preparing for operation in the spring-summer period.

And yes, you should not forget that if necessary, you can also get in the management organization.

And now we will tell about what the tariffs for utility services are dependent.

About ways to complain about the actions of public utilities told in the following video:

Tariffs depend on

What expenses provide for the payment for managing an apartment building, we were considered in the previous section. And if you take each structure separately, they all are different and require different content costs. Therefore, the payment of the Count "For the maintenance and repair of housing" will be varied for all residential buildings. It is determined based on defective statements and estimates.

The costs of maintenance and repair are calculated on the basis of the estimates required for the maintenance of general engineering systems, to remove indications from accounting devices, content, calculation and storage of data and many other articles. From what volume and frequency of the work carried out will be scheduled for owners of housing, the cost of service will depend on the owners.

The procedure for approving the amount of utility payments is determined at the general meeting of owners of housing with the obligatory participation of representatives of the house-controlling company. The minimum payment period is one year.

The termination and conclusion of the contract with the management companies or housing and communal services will be discussed below.

About how to complain about too high rates tells the following video:

Apartment building agreement with a management company

The main document that establishes relations between the "utilities" and the owners of the apartments is a contract for managing an apartment building. If the owners at the general meeting chose a home-controlled company, the contract is concluded with each of them individually.

When the Criminal Code is chosen by the partnership of the owners of housing, then the contract signs the HOA on the face of all owners of apartments. Finally, if the house belongs to the municipality, then the treaty on a competitive basis is signed between HFA and local authorities.

Is it necessary to form?

Immediately answer: it is necessary. After all, it regulates the number and cost of utility services and the frequency of their conduct. Points that are necessarily indicated in the contract:

• list of services and works on the maintenance and repair of general-known property;
• the composition of the common property;
• the procedure for the payment and amount of payment for utilities and the content of housing;
• the process of supervising the house management company and the implementation of its duties.

And now you will learn about what to do if the service agreement of the apartment building with the management company was not concluded.

What will happen if the contract is not concluded?

So, I did not conclude an agreement with the management company, what of this?

In accordance with the prisoners between owners of housing and the Criminal Code, the owners have the right to demand from the communal organization of reporting on the work and verified the quality and frequency of services provided. In case of detection of violations, it is necessary to require an immediate elimination from the Guide. If you refuse, you must refer to the contract to the controlling authorities. For example, to the State Housing Inspection and Rospotrebnadzor.

To appeal in his complaint, first of all, you must agree between you and the home-controlled company. And if you do not conclude it, then the "public utilities" will find a lot of loopholes to evade their direct duties that you pay monthly.

We really hope that our small essay helped you figure out why the management company is needed is that it represents and what is different from Hweak. Do not forget to pay utility bills in time and require quality work from utilities. And you will definitely see if you have or your HOA contract with the Criminal Code. If not, do it immediately. With unscrupulous execution of "public utilities" of their duties, do not hesitate to contact supervisory organizations or court. By the way, if you want, then it is worth discussing this issue from the Criminal Code.

The following video is devoted to the legal aspects of the most frequent issues in relation to housing and communal services:

The company "Zhilfond", who won a competition for managing several houses in the Southern Administrative District, faced large problems about which her leader Mikhail Konovalov.

There is money. It seems We were transferred to the management of several ordinary municipal homes. That is, Dzhe changed them to a private company, but the rules of the game were left for the same. And we understood our own skins, in what conditions the Directorate of the Unified Customer is located. The biggest problem is the system of budget financing. This is when money seems to eat, but strictly on a specific article. And there is no possibility to transfer them to another article. For example, in the house the roof flows. Its repair passes on the article "Overhaul." In order for this article to allocate funds, you need to apply. And wait. And on another article there is money. But on them the roof is impossible to repair - this is the misuse of funds. So we had with one of the houses on the street high. The roof flowed in March. So we failed with the repair all the rainy summer in anticipation when you allocate money for the roof repair. Although in April there were money, but on another article, from where they could not be transferred. Repaired the roof only in September. And on the twelfth floor from damp, the plaster sat down, there was also an entrance to repair. Aliens among others And also to perform repairs should have had only the commissioning organization. What is the competition here when people fuses? We would make repairs yourself and much cheaper. As a result, the money was spent much more. And how to measure moral costs? Residents are nervous, and there are no affairs to some expenses. Here, instead of the usual one for them, a kind of company came. Here they are to blame for all - Atu them! So the pilot project showed the advantages and disadvantages of various forms of municipal economy. The Directorate of the Unified Customer operates in the current system. This is a powerful structure that works according to certain rules, she is easier for it easier than small enterprises that only come to this industry. For the authorities they are their own. And we are in any other strangers. Thank God, gradually changes. People, ay! There is an opinion that it is better for the management company when residents live Slowly and do not interfere with anything. But I am convinced: this is rooted incorrectly. On the contrary, when a person has an idea of \u200b\u200bwhat he needs for comfort, and he declares it, it is wonderful. If the service is desired, it is also in demand. For example, if a young entity hears from parents that they have achieved repairs in the entrance, it is unlikely that he will hardly cover the freshly stained walls with its "frescoes". Therefore, it is difficult to overestimate the role of public self-government in the housing sphere. If it exists really, and not for a tick, then it is convenient for us to work with representatives of the house community, with HOA. The partnership of the owners of the housing is conducting a farm with private managers companies quite differently than with des. This, by the way, also showed a pilot project. Here we and the order of repair can determine and solve specific work on improvement. And with the same roof repair, they would have walked in time. I will give an example of a house participating in a pilot project on the street high. To lead on equal dialogues with the management company, the initiative group and residents of the house have chosen such an organization for themselves as a partnership of housing owners. In this, they were helped by employees of the Nagatino-Gardeners. Even prepared a special leaflet, which lists the positive aspects of the creation of a home owner partnership. Tszh was registered recently and only started work. But the first positive effect is already there - the concierge in the entrances received lists of phones, for which residents can contact the management company and cause masters if necessary. And with the same repair, the inhabitants themselves will decide when to do it, and not wait for the allocation of "target" money.

Recorded Alexey Myasnikov

With each DEZ, there is still a list of free utilities for tenants. It does not matter exactly what kind of property form for housing. As in a privatized apartment, so in the municipal, as well as in the service, the team of accidenters is obliged to eliminate malfunctions for free:

List of free DEZ services

who can count living in the house:

1. Changing the pads
2. Putting up waterpore reinforcement seals and eliminating water leakage
3. Required installation of inserts for the valve seat and polyethylene nozzles to the valve head
4. Elimination of any leaks, as well as a change in the flexible liner used in the accession of sanitary bloods, overflows and siphons, pipelines sections to plumbing devices, replacement of the rubber cuffs toilet bowl, due to cement mortar
5. Adjustment of the washed tank and eliminate its leaks
6. Strengthening the loose toilet, washbasin, sink or washing;
7. Elimination of the interface of the internal sewage pipelines and the SUPPRIBOROV, which occurred not by the fault of living
8. Clean and washing all internal sewage
9. Adjustment and regulation of hot water and heating systems, the elimination of air traffic jams, flushing pipelines and heating system, replace faulty standard heated towel rails, replacing the shut-off and regulating reinforcement. Such as valves, three-way cranes, dual adjustment cranes and air cranes
10. Check the technology of standard gas appliances. If necessary, free replacement of the details
11. Checking the standard electric stove. If necessary, the replacement of broken parts is done.
12. Combining work in the amounts necessary to maintain the operational qualities of building structures: small repair of floors, window and door fillings, eliminating the effects of leakage (not due to the fault of living) and other faults;
13. Blowing, repair or complete replacement of current or non-working batteries
14. Repair of electrical wiring, including on the staircase.

It should be known and remember!

Kitchen sinks, sinks in the bathroom, gas stoves and baths in unsuccessted apartments of the WEKK must be replaced after 15-30 years of years of use completely free !!!.

List of general free services:

1. Walls and facades:
- Sealing of seams and cracks, a batch of damaged sections of walls of bricks, repair of plaster, insulation of walls with frozen sites.
- Replacing the plums of window openings
- Strengthening of visors, various fences and railing porch

2. Roofs, drains:
- Replacement (complete or partial drainage pipes
- repair or replacement of roofing
- repair of waterproofing and insulation layer attic

3. Windows, doors:
- Replacing damaged windows of windows and doors in public places
- Strengthening and regulating the stroke of the springs at the entrance doors
- Installation of handles and decogets on the windows and doors
- Warming of windows and doors

4. Gender:
- replacement of floor sections and floor coverings in places that relate to property at home
- waterproofing of the floor in separate bathrooms of apartments with shift coverage after the expiration of the regulatory term

5. The improvement of the yard:
- Cleaning grass and leaves. Cleaning of large-sized waste

6. Sanifice housing:
- Wet sweeping of staircases and marches of the first 2 floors - daily
- Wet sweeping of staircases and marches above the second floor-go-weekly

Wet cleaning of the area in front of the valves of garbage chute - weekly
- Washing cabin of elevator - daily
- washing the staircases and landmark marches - monthly
- Washing windows, wet wiping walls, doors and plafoons on staircases, as well as window sills and heating devices, mailboxes and ladders attic, cabinets for electric meters and low-current devices, and window lattices - annually in spring

Maintenance of common communications

1. Central heating:
- Disconnect radiators with their slightest leaks
- Flushing of heating and hot water systems in a way to choose from: hydraulic or hydropneumatic
- Liquidation of air traffic jams in batteries and risers at home
- insulation of pipelines in the attic and in the basement

2. Water pipe, sewage and hot water supply:
- elimination of leaks, change of any gaskets and packing the glands in water taps and valve cranes in technical groups and places of elevator nodes
- Sealing Signs
- adjustment and repair of flushed tanks
- Cleaning pipelines of mountains. and cold Water supply

3. Power supply:
- Replacing the failed electrollamp
- Strengthening Plafons of lamps and fragile external sections

Emergency service at home:

1. Water pipe, sewage and hot water supply:
- change of intricate watershed cranes and mixers, shower and washers, shells and washbasins, toilet bowls and baths, as well as any shut-off reinforcement in apartments due to their expiration
- Replacing the unsuitable assemblies of columns of the award of water and nozzles of chimney, failed due to physical wear

- change of pipeline sections up to 2 meters
- elimination of sewage breaks inside the building
- Welding work on repair or full replacement of the pipeline

2. Central heating:
- Repair or complete replacement of damaged shut-off valves
- liquidation of leakage by sealing pipe compounds, reinforcements or heating devices
- Repair or complete shoghi replacement on pipeline
- change of plots of pipelines to 2 meters and sections of heating devices
- Welding works of PR repair or replace pipeline sections
- Installation of air cranes
- Work on troubleshooting in the furnaces and foci, whose users are more than 1st apartments, crossing them in special cases

3) Power supply:
- Replacing the faces of the building of the building of the building, excluding the network of residential premises (only common areas in communal apartments)
- Repair of electrical shields, the inclusion and replacement of spoiled automata of electrobatic and batch switches
- Replacement of fused inserts on electrical panels
- replacement of light sources
- Replacing the proceeded burners and switches, heaters of the roast cabinet and other elements of standard electric stoves in residential apartments

4. Other types of work when eliminating accidents:
- Fear tranche
- pumping water in the basement
- Opening of floors and punching a furrow over hidden pipelines
- Disabling the risers in the pipeline sections, the empty of the included sectors of the center system. Heating and hot water supply, as well as the opposite filling of them and start the system after elimination of the accident.

Educated in 1959.

Currently, Russia is replaced by Jeques (the Directorate of the Unified Customer), which are engaged in the organization of residential fund facilities.

Notes

Links

• housing and Operating Office (GEK) in the Moscow Encyclopedia

see also

• Directorate for the operation of buildings (DEZ)
• district operating management
• repair management

Wikimedia Foundation. 2010.

• DDT (poison)
• Jazz: hire work

Watch what is "des" in other dictionaries:

Des ... - Dz ... [Fr. des ... from, times) prefix, denoting destruction, removal or absence of something l. Dictionary of foreign words. Komlev N.G., 2006. Des ... (Fr. des ... from ..., once ...) Prefix, denoting destruction, removal or no matter ... Dictionary of foreign words of the Russian language

des- - Dés. De .., des. .. (before vowels), prefix. When the formation of noun and verbs makes a value. The opposites of the action called the base producing, or the cancellation of this action (disorganizing, disorient, ... ... Historical Dictionary of Gallicalism Russian Language

Des ... - Dz ... see de ..., desavuivation (from Franz. Desavouer to refuse to express disapproval), in international law a refutation of the head of state or the government of actions or statements of a diplomatic or other official representative ... ... ... Big Encyclopedic Dictionary

des. - (new). Reduction, UPOTR. In new difficult words in the meaning. disinfection, eg. fumigatory. Explanatory dictionary of Ushakov. D.N. Ushakov. 1935 1940 ... Explanatory Dictionary Ushakov

des ... - (neol.). Reduction, UPOTR. In new difficult words in the meaning. disinfection, eg. fumigatory. Explanatory dictionary of Ushakov. D.N. Ushakov. 1935 1940 ... Explanatory Dictionary Ushakov

des ... "Dead ... des ..., Pri." The same as de ...; UPOTR. Instead of "de" before vowels, for example Disorganization, disinformation. Explanatory dictionary of Ozhegov. S.I. Ozhegov, N.Yu. Swedov. 1949 1992 ... Explanatory dictionary of Ozhegov

des ... - Des ... [De]. [from Franz. Dés from, times] Prefix. Denotes removal, termination, destruction or no matter what Disinformation, disorient. * * * DEZ ... See de ... ... encyclopedic Dictionary

Des ... - Dz ..., watch de ... Modern encyclopedia

Des- - Prefix 1. See de (1 *) Explanatory Dictionary of Ephraim. T. F. Efremova. 2000 ...

Des- - Prefix 1. See de (2 *) Explanatory dictionary of Ephraim. T. F. Efremova. 2000 ... Modern explanatory dictionary of the Russian language

des ... - Dz ... \u003d de ... Explanatory dictionary of Efremova. T. F. Efremova. 2000 ... Modern explanatory dictionary of the Russian language

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The term "diffuse euticide goiter" (DEZ) is indicated visible and / or palpable increase in the thyroid gland.

DEZ is a general diffuse increase in the thyroid gland without disturbing its function. The main cause of DEZ is the insufficient iodine content in the environment and, as a result, reduced by its consumption by the population with the familiar food. Depending on the prevalence of DEZ, the population distinguishes sporadic and endemic goiter.

The goiter is considered to be endemic if the frequency of the occurrence of goiter in children of junior and middle school age is more than 5%. DEZ - pathology of young people. In more than 50% of cases, it develops to 20 years of age, and in women goiter develops 2-3 times more often than in men, while, as a rule, in those periods, when the need for iodine is elevated (sexual ripening, pregnancy , lactation).

In accordance with the criteria adopted by WHO, UNICEF (UN assistance Foundation) and ICCIDD (International Council for Quality Medicine), the region can be considered free from iodine deficit if the median of Yoduria is in the range of 100-300 μg / l, and the prevalence The goiter does not exceed 5%. In Russia, there is practically no territory that is prosperous in terms of the risk of developing iodhythic goiter. According to epidemiological surveys 1991-2006, the frequency of various forms of goiter in the Russian Federation ranges from 10 to 40%.

The most common cause of DEZ development is the deficiency of iodine. At the same time, hypertrophy and hyperplasia of the thyroid gland are compensatory and are aimed at providing the body by thyroid hormones. What are the mechanisms of such adaptation to insufficient iodine?

First, the absorption of iodine by the thyroid gland increases by increasing its active capture.

Secondly, the preferential synthesis of triiodothyronine (T3) occurs, which is the most active thyroid hormone, while it is not necessary for its synthesis 4, but only 3 iodine atoms.

Thirdly, the secretion of iodine by the kidneys is reduced, the recycling of endogenous iodine increases, which increases the efficiency of the biosynthesis of thyroid hormones.

Fourthly, the content of iodine in the colloid is reduced (due to the preemptive synthesis of monoiodithosine, and not diodthyrosine) and thyreoglobulin in the colloid (by increasing proteolysis).

In the early stages of the development of goiter (i.e., children, adolescents and young people) there are compensatory hypertrophy of thyroidocytes. The thyroid gland is represented by a mass of small follicles, practically not containing colloid. Such goiter is called parenchymal, it is the result of successful adaptation.

Another morphological version of DEZ is a colloid goiter. It consists of large follicles containing a huge amount of colloid. In the formation of this type of goiter, a number of mechanisms prevents the optimal work of the thyroid gland. There is an imbalance between the synthesis and hydrolysis of thyreoglobulin, the degree of iodization of thyroglobulin is reduced. Iodine leakage from the thyroid gland and reduce the synthesis of uodththththnic. Changes in a similar type prevail in the tissue of the thyroid gland of the operated patients.

There is no doubt that all adaptation reactions are stimulated and controlled by a thyrotropic hormone (TSH). However, as shown in many works, the level of TSH in DEZ does not increase. In the course of a number of studies in vivo and in vitro, new data on the autoregument of the thyroid gland with iodine and autocrine growth factor (ARF) were obtained. According to modern ideas, the increase in TSH products or an increase in the sensitivity of thyroidocytes is only secondary importance in the pathogenesis of the iodhythic goiter. The main role is given to the ARF, such as the insulin-like growth factor of 1 type (IRF-1), the epidermal growth factor (ERF) and the growth factor of fibroblasts (FRF), which, in conditions of reduction of iodine in the thyroid gland, have a powerful stimulating effect on thyroidocytes. It was experimentally shown that when adding thyarocytes, the CI was observed a decrease in TSH-induced, CAMF (cyclic adenosine monophosphate)-aired expression of IRF-1 M-RNA, with its full cessation with a significant increase in the dose of iodide.

It is well known that iodine itself is not only a substrate for the synthesis of thyroid hormones, but also regulates the growth and function of the thyroid gland. The proliferation of thyroidocytes is in the inverse dependence on the intratiffid content of iodine. High doses of iodine inhibit the absorption of iodine, its organizational, synthesis and secretion of thyroid hormones, absorption of glucose and amino acids. Yod, entering the thyarocyte, enters into cooperation not only with Tyirosile residues in thyreoglobuline, but also with lipids. Formed as a result of this compound (iodolactons and iodaldehydes) are the main physiological blockers of the ARF products. In the thyroid gland of a person, many different iodolactons are identified, which are formed by the interaction of membrane polyunsaturated fatty acids (arachidon, doxagexenoy, etc.) with iodine in the presence of lactoper oxidase and hydrogen peroxide.

In conditions of chronic iodine deficiency, a decrease in the formation of yodlipids - substances constraining the proliferative effects of the ARF (IRF-1, FRF, ERF). In addition, in case of insufficient iodine content, there is an increase in the sensitivity of these ARF to the growth effects of TSG, the production of the transforming growth factor-B (TFR-B) is reduced, which is normal in the proliferation inhibitor, angiogenesis is activated.

All this leads to an increase in the thyroid gland, the formation of the iodhythic goiter.

In general, the development of DEZ depends on many factors that are not fully studied. In addition to the iodine deficit, other factors related to the development of goiter include smoking, receiving some medicines, emotional stress, chronic infection. Also also have the floor, age, hereditary predisposition.

In case of endemic zob, genetic predisposition can be realized only in the presence of an appropriate external factor - iodine deficiency in the environment. In the absence of genetic predisposition, a light or even moderate iodine deficiency may not lead to the formation of goiter, since this deficit will be compensated for by more efficient operation of systems that provide synthesis of thyroid hormones. With severe iodine deficiency, even the maximum activation of compensatory processes may not always prevent the formation of goiter in persons who do not have genetic predisposition.

To estimate the degree of thyroid increment to the WHO palpation (2001), the following classification is recommended.

The zero degree is the goiter (the volume of each share does not exceed the volume of the distal phalange of the thumb of the surveyed hand).

1st degree - goiter is palpable, but not visible at the normal position of the neck. This also includes nodal formations that do not lead to an increase in the gland itself.

The 2nd degree - goiter is clearly visible at the normal position of the neck.

The sensitivity and specificity of the palpation method to assess the degree of goiter is rather low. Therefore, to accurately determine the size and volume of the thyroid gland, within the framework of epidemiological research, it is recommended to conduct an ultrasound research (ultrasound).

The volume of the thyroid gland is calculated taking into account the width (W), length (e) and thickness (T) of each share and the correction coefficient of ellipsoid according to the following formula

V pin \u003d [(Ø pr x d x m) + (sh l x d x t l)] x 0,479.

In adult goiter is diagnosed if the volume of the gland, according to the ultrasound, exceeds 18 ml in women and 25 ml in men. The child has the volume of the thyroid gland depends on the degree of physical development, so before the study, the growth and weight of the child is measured and on a special scale or according to the formula, the body surface area is calculated. In children, the thyroid gland is compared with the normative indicators (depending on the surface area of \u200b\u200bthe body).

The clinical picture of DEZ depends on the degree of increasing the thyroid gland, since its function remains normal. By itself, the fact of a small increase in the thyroid gland during its normal function is practically not reflected in the work of other organs and systems. In the overwhelming majority in conditions of light and moderate iodine deficiency, a small increase in the thyroid gland is found only with a targeted examination.

In the conditions of severe iodine deficit, goiter can reach giant sizes. Also, on the background of DEZ, in the future, a nodal goiter can develop, including with autonomously functioning nodes.

DEZ treatment

Events to eliminate iodine deficit in the USSR were adopted thanks to epidemiological studies initiated before the Second World War, an outstanding surgeon-endocrinologist and a specialist in the prevention of O. V. Nikolaev. They included mass production of iodized food salt, the use of iodine tableted drugs among risk groups, creating opposite dispensaries. Against this program, the iodine deficit in Russia has been largely overcome from 1955 to 1970. After it happened, in the "Victory Over DEZ" sign, it was decided to gradually turn the measures for its liquidation, and the diagnosis of endemic goiter Replace on the "thyroid gland hyperplasia".

In Western Europe, up to the 60s of the last century, drugs of the thyroid gland were used, the effectiveness of which was determined not only by the content of thyroid hormones, but also a large number of iodine.

To date, there are three options for conservative DEZ therapy:

• levothyroxin monotherapy,
• monotherapy with iodine preparations
• combined therapy with Joda and Levothyroxin drugs.

Monotherapy with Levothyroxin was scientifically substantiated in the treatment of DEZ in describing the control of the thyroid gland by the hypothalamic-pituitary system. In the experiment on the rats it was shown that artificially modeled severe iodine deficiency leads to an increase in the level of TSH, which, in turn (as well as exogenously administered TSH), can lead to the formation of goiter. It was assumed that in conditions of iodine deficiency, the synthesis and secretion of thyroxine T 4 and T 3 are reduced, for which iodine is the main structural component, which, according to the principle of negative feedback, leads to strengthening the secretion of TSH. Therefore, the main purpose of the therapy with levothyroxin was the suppression of TSH, which contributes to an increase in the thyroid volume (supgrass therapy). However, it was repeatedly shown that the decrease in the volume of the gland does not depend on the degree of CTG suppression. There are also studies that argue that the average level of TSH in iodhythic areas is reliably lower than in those areas where iodine is normal. Moreover, there are experimental data that demonstrates that to stimulate the growth of follicles containing a sufficient amount of iodine is not possible by the introduction of TSH.

As mentioned above, the appointment of Levothyroxin was widely used to treat DEZ in the past. At the same time, at the initial stage, excellent results were achieved. Many clinical studies have shown that already 3-4 months from the beginning of therapy, there was a significant (at least 20%) decrease in the volume of the gland. The literature provides data on the efficiency of using various doses and combinations of thyroid hormones. So T 3 at a dose of 50 μg per day is the most effective to reduce the volume of the thyroid gland. Next, as the efficiency decreases, options are followed:

• (T 4 50 μg + t 3 12.5 μg) twice a day;
• T 4 150 μg per day + iodine 150 μg per day;
• T 4 75 μg per day + t 3 18.75 μg per day;
• T 4 200 μg per day;
• T 3 37.5 μg per day.

Most often, doses were used in clinical practice - 150 μg in adults and 100 μg in adolescents. However, numerous work unambiguously demonstrated the "cancellation phenomenon" - an increase in the size of the thyroid gland almost to the initial level after a short time after the cessation of treatment. This phenomenon is due primarily to the fact that when the TTG is suppressed, the activity of Na + / i-Simporter decreases, and therefore, the active seizure of iodine with thyroid gland decreases. Against the background of a sharp drop in the intrathyroid content of iodine, when the drug is canceled, a new increase in the gland occurs. Also, the side effects of therapy hormones of the thyroid gland include the possible occurrence of drug thyrotoxicosis, tachyrhythmia, osteoporosis, which limits the use of this group of drugs with long-term treatment of DEZ. However, sometimes in order to quickly achieve the therapeutic effect, they resort to the appointment of a short-term course of treatment with levothyroxin with a further transition to supporting therapy with Iodine preparations.

Monotherapy with Iodine preparations is etiotropic therapy. The work of the last 10-15 years have shown that the increase in TSH products or the increase in the sensitivity of thyroidocytes is only secondary importance in the pathogenesis of the iodhythic goiter. In case of insufficient intake of iodine, the amount of iodine lipids decreases in the gland (basic inhibitors of growth factors), which has a powerful stimulating effect on the growth of thyarocytes.

The main role at the same time is assigned to local ARF, such as IRF-1, ERF and FRF.

The stage of "Renaissance" therapy of DEZ Iodine came in the 1980s of the last century. Many studies were limited by the fact that at that time an ultrasound measurement of the thyroid sizes could not be performed. So, G. Hintze and D. Emrich in 1983 in its work on the treatment of iodhyate goiter, as the main marker change in the volume of the thyroid gland, was used by the neck circumference. The authors showed that the appointment of 400 μg of iodine also effectively reduces the volume of the thyroid gland, as is 150 μg of Levothyroxin (estimate after 12 months from the beginning of treatment), and at the same time, in contrast to Levothyroxin, the result of therapy with iodine is preserved for a long time after its cancellation .

With the extensive introduction to practical medicine, ultrasound, randomized controlled studies on the effect on the course of iodineic goiter are being influenced by various therapy modes. At the same time, the dose of iodine ranged from 100 μg and higher, including pharmacological, in the case of using iodized oil. The appointment of 100-150 μg iodine has proven itself in the treatment of goiter in children.

In adult iodine at a dose of 100-150 μg per day, it turned out not so effective as in children, but the tendency to reduce the volume of the thyroid gland is also traced. In the science literature of the 80s of the XX century. You can find work, where iodine in doses and 500 μg, and 400 μg, and 300 μg per day, were used to treat the goiter. And all of them demonstrate the comparable efficacy of monotherapy with iodine with monotherapy with levothyroxin and combined therapy with iodine preparations and levothyroxine, as well as the most resistant effect after the abolition of drugs. However, there is data according to which the use of high doses of iodine sometimes causes the thyroid dysfunction (hypo-or hyperthyroidism). And although more significant evidence is needed to recognize this fact, the following situation is generally accepted: Therapeutic doses of iodine at DEZ almost do not differ from preventive and amount to 150-200 μg per day. Thus, when conducting a double-blind placebo, a controlled study in Germany was confirmed by the effectiveness of 200 μg iodine for the treatment of iodineic goiter. The volume of the thyroid gland decreased by 38% in 6 months and stored as at least at least the same time. In another study, an influence on the size of the gland 200 μg of iodine and 100 μg of Levothyroxine was estimated. The effectiveness of these two dosages was shown, and the attention was once again focused on the fact that the degree of decrease in the volume of the thyroid gland does not depend on the level of TSH.

In numerous modern work, success is demonstrated in reducing the prevalence of goiter thanks to the introduction of universal self-iodization programs. As for the holding of group prophylaxis, it is now quite enough 150 μg of iodine per day for adolescents, 200 μg - for pregnant and nursing women.

In the recent years of recent years, the issue of the development of autoimmune processes in the thyroid gland is widely discussed against the background of the reception of iodine-containing drugs. At the same time, there are works as confirming this influence and denying. G. Kahaly In his work studied the efficiency and safety of low doses of iodine at DEZ. He noted that when using 200 μg iodine, an increase in the level of antibodies to thyroid peroxidase, antibodies to thyroglobulin, a significant increase in lymphocytic infiltration in gland tissue occurs only in 97% of cases. In contrast to these facts, a group of researchers from Austria did not fully discovered the above-described changes in the appointment of 200 mg of iodine to patients with iodhythic goiter. In general, the development of autoimmune processes in the thyroid gland is most likely depends on the population characteristics of the region, which requires more detailed, carefully planned research.

Combined therapy with Iodine and Levothyroxin drugs can be carried out both by simultaneous reception of levothyroxine preparations and potassium iodide and the use of their fixed combinations. Among them are the most commonly used drugs containing 100 μg of Levothyroxin and 100 μg of iodide (iodhyrox). Therapy with yodthyrox, as it was repeatedly shown, has several advantages.

First, affecting several pathogenetic mechanisms for the formation of goiter, hypertrophy, and thyarocyte hyperplasia are suppressed. This makes it possible to achieve results, by the effectiveness of high-level-comparable monotherapy (with a much smaller content), which, in turn, reduces the number of side effects associated with the reception of thyroid drugs.

Secondly, the tendency to the development of the "phenomenon of cancellation" is also reduced with a short-term break in treatment.

Thirdly, the suppression of the TSH level is less pronounced, for example, compared to the levothyroxine effect at a dose of 150 μg.

• Reducing the volume of the goiter is more pronounced in the case of combined therapy (40%) than with levothyroxin monotherapy (24%) (Schumm et al.).
• Less frequency of the side effects of levothyroxine and potassium iodide (as smaller dosages are used than with monotherapy).
• The effect (reduction of goiter) is developing faster than with the potassium monotherapy iodide.
• The dose titration is not required, since the ratio of the active ingredients is selected optimally.

There are many works confirming these advantages. In one of them, the treatment of DEZ in 74 randomly selected patients was compared. Patients were obtained either 150 μg of Levothyroxine, or 100 μg of Levothyroxin + 100 μg of iodine for 6 months. Against the background of combination therapy, the decrease in the volume of the gland was somewhat more pronounced (by 30% compared with 25%, the difference is unreliable). The decrease in the size of the gland did not depend on the degree of CTG suppression. In addition, in the group of patients who received combined treatment, in the future it was possible to maintain the reduced volume of the gland at replacement therapy of 100 μg iodine daily. In the group of patients treated only with Levothyroxin, such preventive treatment was less effective. In the second study, 82 patients were included, in randomly therapeutic purposes, either 100 μg of Levothyroxine were prescribed, or 100 μg of Levothyroxine + 100 μg of iodine as long as 6 months. Reducing the volume of the gland against the background of Levyotroxin was 24% compared with 40% against the background of a combination of drugs, the differences had statistical significance. Thus, in adult patients, the levothyroxine plus iodine combination is a more preferred treatment compared with iodine monotherapy (at least in the same doses) and comparable to the similar dose of Levothyroxin. Many researchers note that 150 μg of iodine in combination with an individually selected dose of Levothyroxin at the rate of 1 μg / kg of weight is more preferable for the treatment of endemic goiter in adults.

Summing up the foregoing, it can be concluded that the main goal in the treatment of iodhythic goiter is not only a decrease in the thyroid gland, but also maintaining the result achieved. For this, the drugs of iodine are as in the form of monotherapy and as part of combination therapy with Levothyroxin.

The question remains what to appoint first. It is obvious that the intratiffid concentration of iodine is significantly higher in the initial reception of iodine preparations than combined with levothyroxin drugs. This fact once again confirms the etiotropic nature of the treatment with iodine, as well as the feasibility of the start of treatment precisely from the appointment of iodine drugs.

In our opinion, the DEZ therapy algorithm can be represented as follows.

• For the treatment of children with DEZ, potassium iodide is recommended in a dose of 100-150 μg per day, adolescents - at a dose of 150-200 μg per day.
• Treatment of adults should be carried out at a young age (up to 45-50 years), since it is often possible to achieve the desired result, and there is also a small risk of the availability of the functional autonomy of the thyroid gland, in which the reception of iodine can provoke thyrotoxicosis. In the first 6 months, 200 μg of potassium iodide per day is acquitted.

Persons with DEZ over 45-50 years have shown active dynamic observation with the annual determination of the level of TSH and conducting the ultrasound of the thyroid gland.

• In the absence of a pronounced effect, the transition to the combined therapy can be recommended for the combined therapy. In this case, the preference should be given either a fixed combination of 100 μg of iodine and 100 μg of Levothyroxine (yodthyrox), or an individually selected dose of levothyroxine at the rate of 1 μg / kg of weight in combination with 150 μg of iodine per day.

But, on the basis of modern ideas, whatever initial treatment of the goiter was conducted, its sharp cessation cannot be recommended without further conducting preventive measures - the use of iodized salt.

Literature

1. Gerasimov G. A., Fadeev V. V., Sviridenko N. Yu. Melnichenko G. A., Dedov I. I. Yodmethy-free diseases in Russia. M., 2002.
2. Gartner R., DUGRILLON A., Beechtner G. Evidence That Iodolactones Are The Mediators of Growth Inhibition by Iodine On The Thyroid // Acta Med Austriaca. 1996; 23 (1-2): 47-51.
3. Knudsen N., Bulow I., Laurberg P., Ovesen L., Perrild H. Low Socio-Economic Status and Familial Occurrence of Goitre Are Associated with a High Prevalence of Goitre // EUR J Epidemiol. 2003; 18 (2): 175-81.
4. Kohn L. D., Shimura H., Shimura Y., Hidaka A., Giuliani C., Napolitano G., Ohmori M., Laglia G., Saji M. The Thyrotropin Receptor // Vitam Horm. 1995; 50: 287-384.
5. Edmonds C. Treatment of Sporadic Goitre with Thyroxine // Clin. Endocrinol. 1992; 36 (1): 21-23.
6. Einenkel D., Bauch K. H., Benker G. Treatment of Juvenile Goitre With Levothyroxine, iodide or a Combinationation of Both: The Value of Ultrasound Grey-Scale Analysis // Acta Endocrinol. 1992; 127 (4): 301-306.
7. Hintze G., Emrich D., Koebberling J. Treatment of Endemic Goitre Due to iodine Deficiency With Iodine, Levothyroxine or Both: Results of a Multicentre Trial. // EUR. J. Clin. Invest. 1989; 19 (6): 527 - 534.
8. Leisner B., Henrich B., Knorr D., Kantlehner R. Effect of iodide Treatment on Iodine Concentration and Volume of Endemic Non-Toxic Goitre in Childhood // Acta Endocrinol. 1985; 108 (1): 44-50.
9. Feldkamp J., Seppel T., Becker A., \u200b\u200bKlisch A., Schlaghecke R., Goretzki P. E., Roher H. D. iodide or L-Thyroxine to Prevent Recurrent Goiter In An iodine-Deficient Area: Prospective Sonographic Study // World J Surg. 1997; 21 (1): 10-14.
10. Wilders-Truschnig M. M., Warnkross H., Leb G. The Effect of Treatment with Levothyroxine or iodine on Thyroid Size and Thyroid Growth Stimulating Immunoglobulins in Endemic Goiter Patients // Clin Endocrinol (OXF). 1993; 39 (3): 281-286.
11. Papanastasiou L., Alevizaki M., Piperingos G., Mantzos E., Tseleni-Balafouta S., Koutras D. A. The Effect of iodine Administration On the Development of Thyroid Autoimmunity in Patients with Nontoxic Goiter // Thyroid. 2000; 10 (6): 493-7.
12. Kahaly G. J., Dienes H. P., Beyer J., Hommel G. iodide Induces Thyroid Autoimmunity in Patients with Endemic Goitre: A Randomized, Double-Blind, Placebo-Controlled Trial // EUR J Endocrinol. 1998; 139 (3): 290-297.
13. Pfannenstiel P. Therapie der Endemischen Struma Mit Levothyroxin und Jodid. Ergebnisse Einer Multizentrischen Studie // Deutsche Med. Wochenschr. 1988; 113 (9): 326-331.
14. Saller B., Hoermann R., Ritter M., Morell R., Kreisig T., Mann K. Course of Thryroid Iodine Concentration During Thryroid of Endemic Goiter With iodine or Combination of Iodine or Levothyroxine // Acta Endocrinological. 1991; 125: 662-667.

E. A. Trohin, doctor of Medical Sciences
N. V. Galkina
ENTS RAMN, Moscow