Международный эндокринологический журнал Том 22, №5, 2026

Захворювання щитоподібної залози становлять клінічно гетерогенну групу ендокринних розладів, що потребують точної диференціації з функціональними порушеннями, доброякісними вузловими ураженнями, новоутвореннями невизначеного характеру та злоякісними пухлинами. Традиційні діагностичні підходи, включаючи біохімічну оцінку, ультразвукове дослідження високої роздільної здатності, стратифікацію ризику на основі системи Thyroid Imaging Reporting and Data System, тонкоголкову аспіраційну цитологію, класифікацію Bethesda й гістопатологічну верифікацію, залишаються основою клінічного прийняття рішень. Однак ці методи мають важливі обмеження, пов’язані із залежністю від оператора, цитологічною невизначеністю, перекриттям морфологічних ознак і труднощами прогнозування агресивності пухлини до початку лікування. У цьому огляді узагальнено діагностичні можливості та майбутні перспективи сучасних методів оцінки захворювань щитоподібної залози з особливим акцентом на імуноцитохімічні й імуногістохімічні маркери, молекулярно-генетичне та епігенетичне тестування, рідинну і цифрову цитологію, протеомне та метаболомне профілювання, поляризаційно-оптичні і лазерні методи, а також діагностичні платформи з підтримкою штучного інтелекту. Молекулярне тестування, включаючи аналіз змін BRAF, RAS, RET, NTRK, ALK, PAX8::PPARG, промотора TERT та TP53, має додаткову цінність при вузлах невизначеного характеру і підтримує персоналізовану стратифікацію ризику. Оптичні й лазерні методи забезпечують кількісну оцінку анізотропії тканини, організації колагену, ремоделювання строми та мікроархітектурної гетерогенності, хоча їх клінічне впровадження потребує подальшої валідації. Штучний інтелект, радіоміка, патоміка і мультимодальні моделі можуть зменшити варіабельність між спостерігачами й інтегрувати візуалізаційні, цитологічні, молекулярні та клінічні дані в індивідуалізовані діагностичні робочі процеси. Майбутнє діагностики захворювань щитоподібної залози полягає не в заміні усталених методів, а в розробці стандартизованих, зовнішньо валідованих, клінічно інтерпретованих мультипараметричних систем, які підвищують діагностичну точність, зменшують кількість непотрібних хірургічних втручань і підтримують ризик-адаптоване ведення захворювань щитоподібної залози.

Thyroid diseases constitute a clinically heterogeneous group of endocrine disorders that require precise differentiation between functional abnormalities, benign nodular lesions, neoplasms of uncertain etiology, and malignancy. Traditional diagnostic approaches, including biochemical evaluation, high-resolution ultrasound, risk stratification based on the Thyroid Imaging Reporting and Data System, fine-needle aspiration cytology, Bethesda classification, and histopathological verification, remain the basis for clinical decision-making. However, these methods have important limitations related to operator dependence, cytological uncertainty, overlapping morphological features, and difficulty in predicting tumor aggressiveness before treatment. This review summarizes the diagnostic capabilities and future prospects of modern methods for the assessment of thyroid diseases, with a particular emphasis on immunocytochemical and immunohistochemical markers, molecular genetic and epigenetic testing, liquid and digital cytology, proteomic and metabolomic profiling, polarization-optical and laser methods, and artificial intelligence-enabled diagnostic platforms. Molecular testing, including analysis of BRAF, RAS, RET, NTRK, ALK, PAX8::PPARG, TERT promoter, and TP53 alterations, has added value in indeterminate nodules and supports personalized risk stratification. Optical and laser methods provide quantitative assessment of tissue anisotropy, collagen organization, stromal remodeling, and microarchitectural heterogeneity, although their clinical implementation requires further validation. Artificial intelligence, radiomics, pathomics, and multimodal models can reduce interobserver variability and integrate imaging, cytological, molecular, and clinical data into personalized diagnostic workflows. The future of thyroid disease diagnostics lies not in replacing established methods, but in developing standardized, externally validated, clinically interpretable multiparametric systems that increase diagnostic accuracy, reduce unnecessary surgical interventions, and support risk-adapted management of thyroid diseases.

захворювання щитоподібної залози; вузли щитоподібної залози; рак щитоподібної залози; тонкоголкова аспіраційна цитологія; система Bethesda; ультразвукова діагностика; молекулярне тестування; імуногістохімія; оптична діагностика; штучний інтелект; радіоміка; персоналізована медицина; огляд

thyroid diseases; thyroid nodules; thyroid cancer; fine-needle aspiration cytology; Bethesda system; ultrasound diagnostics; molecular testing; immunohistochemistry; optical diagnostics; artificial intelligence; radiomics; personalized medicine; review

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