IRANIAN JOURNAL OF ENDOCRINOLOGY AND METABOLISM (IJEM)
Year:2004 | Volume:6 | Issue:3(SN 23)|Papers Count:11

Introduction: Controversies still exist regarding the effect of mode of delivery and use of maternal Povidone-Iodine (PVP-I) disinfection at delivery on TSH levels. In this report, these issues were assessed. Materials and Methods: Cord blood spot samples of all live born neonates were collected since February 1998, in Tehran and Damavand, and TSH values 20 mU/L were considered as hyperthyrotropinemia (recalls). Data regarding vaginal (VGL) and caesarean section (CS) deliveries and PVP-I 10% and Chlorhexidine (CHL) 0. 5% (non-iodinated disinfectant) was recorded. PVP-I was used between 50-150mL in some VGL and 200-300 mL in all CS deliveries. Neonates <37 weeks’ gestation and <2500 g of birth-weight were excluded from the study. Results: Up to August 2002, 30492 cord spot samples were collected and 326 (1. 07%) were recalled. Median (95%CI) TSH values in VGL-PVP-I (n=16284) was 5. 2 (5. 9-6. 1) and in VGL-CHL (n=4166) was 5. 2 (5. 8-6. 1) mU/L (p=0. 81). Median (95%CI) TSH in CS-PVP-I (n=10042) was 4. 8 (5. 2-5. 5) mU/L that was significantly lower than those of VGL groups (p<0. 001). Frequency distribution of recalls in VGL-PVP-I (202 of 16284) and VGL-CHL (49 of 4166) was similar (p=0. 74) and was significantly lower in CS-PVP-I (75 of 10042) as compared to VGL-PVP-I (p<0. 001) and VGL-CHL (p=0. 012). The odds ratio (95%CIOR) of recall occurrence in VGL-PVP-I was 1. 7 (1. 28-2. 18) and in VGL-CHL was 1. 6 (1. 10-2. 27) as compared to CS-PVP-I. Conclusion: PVP-I had no effect on the elevation of cord spot TSH levels and recall rate in our program. Instead, the mode of delivery played a more effective role on the elevation of TSH values and recall rate.

Introduction: The sensitivity and specificity of waist circumference as an independent predictor of non-communicable diseases in young people have been demonstrated. This study aimed at comparing changes in waist circumference of Tehranian children and adolescents over a 3-year interval. Materials and Methods: Height, weight and waist circumference of children (3-10 years) and adolescents (11-19 years) of district 13 of Tehran were measured twice; in 1999 (n=3922) and in 2001 (n=1026,) within the framework of phases 1 and 2 of the Tehran Lipid and Glucose Study (TLGS). BMI was calculated dividing weight (in kg) by height square (in m2). Children and adolescents with BMIs of 25 and 30, at the age of 18 years, were considered overweight and obese, respectively, based on international curves. Results: Mean of waist circumference in male subjects at the ages of 5. 5, 6. 5, 11, 12, 16. 5(p<0. 05), 10, 13. 5 (p<0. 01), 15. 5 and 16 (p<0. 001) years old in the second phase of TLGS was significantly higher than that in first phase. In contrast, among female subjects, only in the 10-year olds, waist circumference was higher than that of the first phase (p<0. 05). Mean of BMI showed increase in 8. 5 and 18 year old males and 10, 13. 5, 15 and 16-year-old females (p<0. 05). Prevalence of overweight and obesity (based on BMI) was significantly higher only in females in the second phase as compared to that of the first phase (p<0. 05). Conclusion: In Tehranian male children and adolescents, waist circumference, as an indicator of central obesity, increased more than BMI over a 3-year interval. In females however, prevalence of overweight and obesity based on BMI increased more than central obesity. Urgent action is needed to reverse the trends and reduce the likely resulting medical and psychological costs that can be caused by the increase in obesity among young people.

Introduction: In recent years, increasing attention is being given to investigating the association between body levels of antioxidant vitamins and the prevention of disease. This study aims at evaluating the relationship between the status of serum calcium & vitamin D and vitamins A & E among Tehranian women. Materials & Methods: This was a cross sectional study in which 52 healthy pregnant women in their first trimester (less than 14 weeks) from 5 prenatal care centers, were assessed for their levels of serum calcium, vitamin D and vitamins A and E. Women using photo protection and calcium and vitamin D supplementation were excluded. Questionnaires were used to obtain demographic information and venous blood samples were taken after 12-14h of overnight fasting to measure serum calcium, vitamin D and serum levels of vitamins A & E. Pregnant women were divided to three groups; severely deficient (serum vitamin D levels<10nmol/l), moderately vitamin D deficient (serum vitamin D levels 10-25 nmol/l) and normal (serum vitamin D levels >25nmol/l). Serum levels of vitamin A, vitamin E and calcium were compared in these groups. A linear regression model and Post hoc test was used in the analysis of data. Results: Mean values of vitamin A and vitamin E in the severely vitamin D deficient, the moderate, and the normal vitamin D subjects were 1. 78±0. 4 and 1.0±0.5, 1.1±0.5 nmol/l and 14.2±5.0, and 17.9±4.7 and 14.7±6.0 µmol/l, respectively Serum calcium levels were 9.0±0.6,9.3±0.6 and 9.2±0.6 mg/dL respectively. Serum vitamin A level was significantly higher in the severely deficient group (p<0.001). There was significant linear regression between serum calcium level and vitamin A (r=0.37, p<0.01). Conclusion: Serum levels of vitamin A were significantly higher in the severely deficient group as compared to those moderately deficient and the normal group.

Introduction: Postpartum thyroiditis ( PPT) is an autoimmune disorder that occurs in 5-10 percent of women after delivery. Although it usually has a transient course , long term follow up reveals permanent hypothyroidism in up to 30% of patients; this is related to its autoimmune pathogenesis. In this survey we have tried to determine the prevalence of permanent hypothyroidism and its relation to antibody titer, and sonographic and thyroid volume changes 3-5 years after PPT. Materials and Methods: Based on the data of our previous survey “ Prevalence of PPT in Tehran 1998-1999”, 54 women 3–5 years after PPT (case group ) and 50 healthy women (control group ), were enrolled. Initially a questionnaire containing demographic information, symptoms of thyroid diseases was completed and physical exams were carried out. Venous blood samples for T3,T4,T3RU, TSH, anti TPO and anti Tg antibodies were obtained, and eventually thyroid sonography was done. Results: Twenty-two percent of cases and four percent of the control group had hypothyroidism (p<0.01). Positive antibody titer in the case group was higher than in the control group (78%vs. 10% p<0/001). Comparison between hypothyroid vs. euthyroid women in the case group for mean antiTPO Ab. was significant (437± 283 vs. 127+221 p<0/001) and they also had more sonographic changes (78% vs. 18% p<0/001). Mean thyroid volume in hypothyroids was 35% greater than among euthyroid women of the case group. Conclusion :Based on the results, a high prevalence of hypothyroidism 3-5 years after PPT was observed in Tehran. High percentage of positive antibodies reveals a subclinical autoimmune course in the case group and elevated titers of anti TPO Ab reveals an acute process in hypothyroid women; this is in agreement with sonographic changes. We recommend long term follow up of women with PPT for inflammatory permanent hypothyroidism

Introduction: Iron deficiency is the most common single nutrient deficiency in the world and is a major concern for about 15% of the world’s population. Extensive data from animal and human studies indicate that iron deficiency impairs thyroid metabolism. Since, thyroid hormones play a vital role in growth, development and metabolism, the aim of this study, conducted in southern Iran, 2001-2002, was to ascertain the effects of administration of iron, iodine and iron+iodine on thyroid hormone profiles in iron deficient adolescent girls. Materials and Methods: This double blind clinical trial was conducted on 94 iron deficient adolescent girls; the selected subjects were randomly assigned in a double blind fashion to be placed in one of the four groups which, for 12 weeks, received a single oral dose of 190mg lipiodol plus 300mg ferrous sulfate 5 times a week, 300mg ferrous sulfate 5 times a week plus placebo, a single oral dose of 190mg lipiodol plus placebo, and the 4th group were given placebos, respectively. Fasting blood samples were collected at the beginning and at the end of the period, for analyses of indices Ferritin, TT4, FT4, TT3, FT3, TSH, RT3 and T3RU were measured via RIA, selenium using atomic absorption, and urinary iodine using the digestion method, TIBC, iron and albumin using the calorimetric method and hemoglobin using the cyanomethemoglobin method. For statistical analyses of data we used ANOVA,ANCOVA and the Paired t-test. Results: The analysis of food consumption revealed no significant change in nutrient intake during study, with the exception of energy, carbohydrate, vitamin A and vitamin C. There was a significant increase in Ferritin, hemoglobin and urinary iodine after administration of iron and iodine (p< 0.001). Indices of thyroid at the end of study revealed a significant increase in TT4, TT3, T3RU and a significant decrease in rT3 level, in comparison to the initial values (respectively in iron group: p<0.001, p<0.05, p<0.001, p<0.001 and in iron+iodine group: p<0.001, p<0.05, p<0.001, p<0.001). There were no significant differences in these indices between the iron and iron+iodine groups, but a significant difference was found when computed to the iodine and control groups. There was no significant difference in FT3 and TSH levels at the end of study in comparison to the initial levels or between groups, but FT4 value revealed a significant difference between beginning and end of study in iron and iron+iodine groups (p<0.001 and p<0.01 respectively). Conclusion: The results indicate that improvement of iron status of subjects is accompanied by an improvement in some indices of thyroid hormones. Comparison of these indices in iron and iron+iodine groups revealed that iodine supplementation had no effects on thyroid hormone changes due to iron supplementation.

Introduction: Chronic renal failure is associated with certain abnormalities in thyroid function. There is a paucity of information on thyroid function after renal transplantation. The aim of this study was to evaluate and compare results of thyroid function tests in patients with chronic renal failure, before and after renal transplantation. Materials and Methods: We designed a case-control study; the case group consisted of 30 patients, with no thyroid dysfunction, under dialysis, selected for renal transplantation. The control group had 40 healthy individuals, without any thyroid abnormality. Serum levels of thyroid related hormones including FT4, TT4, FT3 ,TT3 and TSH were measured using commercially available radioimmunoassay (RIA) kits. After renal transplantation, patients that had been treated with Cyclosporine, Prednisolone and Azathioprine, were divided into two subgroups based on their serum levels of blood urea nitrogen, creatinine and kidney function: patients with primary graft function (group I) and patients with delayed graft function (group II). Thyroid function tests were evaluated 10 and 30 days after transplantation. Results: In hemodialyzed patients, the mean levels of measured thyroid function tests were within normal range but when compared with controls, mean levels of thyroid hormones were low and no changes were observed in TSH levels. Ten days after graft, reduction in the serum levels of thyroid hormones and TSH were seen in both the groups. There were more alterations in group II than in group I. On the 30th day following the transplant, the changes in group I returned to normal levels and compared to those seen before the operation showed a marked improvement; when compared, however, to those of the controls, the levels of FT3, TT3, TT4 were still low. In group II, the TT3 levels were below normal and in comparison to those prior to the operation, reduction in the levels of TT4, TT3 and FT4 were observed. Conclusion: It is concluded that there is a possible relationship between the levels of thyroid hormones and renal function following transplantation.

Introduction: The result of studies using suppression dose of L-T4 on solid benign cold thyroid nodule have been conflicting; percutaneous ethanol injection(PEI) into cold nodules has been proposed as an alternative treatment. The aim of this study was to evaluate the effect of this therapy and the result of ethanol injection on different cytologic benign thyroid nodules. Materials and Methods: The study population consisted of 50 patients with benign cold thyroid nodules, that had been unresponsive to suppressive levothyroxin therapy for 6 months. These nodules were injected with PEI, intra-nodularly, three times. Thyroid nodule volumes were assessed by high resolution ultrasongraphy before and after ethanol injection, and the relation between nodular size reduction, clinical parameter,and cytopathologic features was determined. Results: Mean pretreatment nodule volume was 20. 83 mL±8.37 (range 4-46cc) and 3 months after ethanol injection, it was 12. 88±8. 7 mL, P(0/001). Appropriate response (50% or more) was observed in 36% of patients and neither clinical parameter nor pretreatment cytopathologic features or size of nodule were related to nodular volume reduction. Conclusion: Our data suggest that PEI is an appropriate treatment for thyroid nodules, unresponsive to suppressive levothyroxin therapy. Nodule reduction is independent of cytopathologic features or pretreatment nodular size.

Introduction: Gestational diabetes mellitus (GDM) is a disorder of carbohydrate metabolism which should be detected for the first time during pregnancy. Without the appropriate screening methods, it is usually missed & causes complication for both mother & fetus. The aim of this study was the estimation of prevalence of GDM in pregnant women of Bandar Abbas. Materials and Methods: During a 2-year study (from March 2002 to March 2004) 800 pregnant women were evaluated in obstetric clinics of Hormozgan University. Initially, medical history and risk factors for GDM were recorded and physical examinations were carried out. Then, standard, oral glucose tolerance tests (OGTT), with 50 gr. Glucose, with a cutoff point of 130 mg/dL, were performed. All cases with positive screening tests underwent three hour OGTT with 100 gr glucose. Results: Prevalence rate of GDM in our study was 6. 3% (CL 95%= 4. 7%-8. 4%) according to National Diabetes Data Group criteria and 8. 9% (CL 95%, 6. 9%-11. 3%) according to Carpenter Coustan criteria. The mean age of GDM patients (28. 2±5. 6 years) was significantly higher than the healthy group (24. 6±5. 2 years) (p<0. 001). The means for the number of pregnancies, systolic blood pressure & body mass index (BMI) were significantly higher in the GDM group, in comparison to the healthy group (p<0. 05). The three risk factors of age ≥ 25 years, history of macrosomia & BMI ≥ 27 kg/m2 were correlated with GDM (p<0. 05). We would have missed 12. 9% of patients, had we followed ADA recommendations (American Diabetes Association. Conclusion: This study showed that GDM has a high prevalence in Bandar Abbas compared to reports from other areas of Iran, and screening all pregnant women in Bandar Abbas for GDM, regardless of the risk factors for GDM or clinical manifestation of diabetes, is necessary.

Introduction: There have been some reports documenting the antidiabetic effect of tarragon in traditional medicine. In this investigation we studied the hypoglycemic and hypolipidemic effects of tarragon in an experimental model of insulin-dependent diabetes mellitus. Materials and Methods: Male Wistar rats (n=32) were divided into four groups, i.e. the control, tarragon-treated, diabetic, and diabetic tarragon-treated groups. For induction of diabetes, streptozotocin (STZ; 60 mg/Kg; i. p. ) was used at a single dose. A serum glucose level higher than 250 mg/dL was considered a diabetic state. The treatment groups received oral administration of tarragon-mixed pelleted food (6. 25%) for a period of one month. Results: Statistical analysis and comparison of data obtained one week prior to and two weeks after administration of tarragon showed increase in serum glucose levels among the diabetic group (p<0.001); tarragon treatment produced no significant reduction in this respect. In addition, the triglyceride level was higher in the diabetic group and there was a significant reduction in this parameter in the tarragon-treated diabetic group as compared to the untreated diabetic group in the fourth week after the experiment (p<0. 01). Cholesterol levels, however, showed no significant reduction in the tarragon-treated diabetic group in comparison to the untreated diabetic group. Conclusion: The results of this study clearly indicate that oral administration of tarragon for one month could significantly reduce only serum triglyceride levels in insulin-dependent diabetic rats.

Introduction: Ischemic heart disease is one of the most important causes of mortality in diabetic patients. In this study it is to determine the prevalence of electrocardiogram change and risk factors of Ischemic heart disease among known type 2 diabetic patients in Isfahan Endocrinology research center. Materials and Methods: In this case control study 2350 type 2 diabetic patients randomly selected. For analyse of ECG, The detailed minnesota codes assigned to each tracing were grouped according to the whitehall criteria in to 1- probable CAD (mainly Q wave items) 2- possible CAD (mainly ST, T wave items) 3- CDA not likely (normal recorols and other minnesota cades) Results: 24/4 percent of diabetic patients have abnormal electrocardiogram. Aged adjasted sex specific. Prevalence abnormal ECG in probable CAD group 3% for women and 9/8% for men (p< 0. 0004). And in possible CAD group 20/4% and 17/4% (p<0. 03) for men and women respectively. Age, Duration of diabetes, Hypertention, Proteinuria, Triglycerid, LDL colestrol and smoking in men are most important risk factor in 1 and 2 group of diabetic patients with abnormal electrocardiogram. Conclusion: Coronary artery disease is prevalent in type 2 diabetic patients, and attentions prevent and control risk factors should be taken.

Introduction: Various investigations of total (bilateral) adrenalectomy for Cushings disease have yielded different results. Previous studies showed a different incidence and prognosis of Nelsons syndrome. The aim of this study is to investigate and present the long term results of total adrenalectomy for bilateral adrenocortical hyperplasia (Cushings disease). Materials and Methods: During a ten-year period between 1991-2001, a total of 54 patients with Cushings syndrome were diagnosed and operated upon at teaching hospitals of Tabriz University of Medical Sciences and followed at endocrine clinics. Thirty-nine patients (27 females and 12 males) with Cushings disease and a mean age of 32. 6 years, underwent total adrenalectomy and were followed for one to ten years (mean duration of follow up 6. 4 years). Results: The remission rate following bilateral adrenalectomy was 100%. In 2 patients after a period of steroid replacement therapy, there were signs of steroid overdosage. Replacement therapy was discontinued in both. Classic Nelsons syndrome characterized by severe and progressive mucocutaneous hyperpigmentation, very high levels of plasma ACTH and invasive macroadenoma as diagnosed by pituitary CT or MRI scan developed in 2 patients (5%) 4 and 6 years after adrenalectomy. In another 2 patients (5%), despite severe hyperpigmentation and very high levels of serum ACTH, there was no pituitary mass at imaging (non-classical Nelsons syndrome). Thus a total of 4 patients (10.2%) with a mean age of 23 years developed Nelsons syndrome during the follow up period. All patients were females. Three patients (two females and one male) died of colonic carcinoma, pancreatic malignancy, and metastatic adenocarcinoma of unknown origin with intraperitoneal seeding and liver metastasis. Conclusion: We conclude that total adrenalectomy is an effective method of correction of hypercortisolism in Cushings disease. The incidence rate of Nelsons syndrome following total adrenalectomy in the present study is lower than that reported in previous studies. It seems that younger females are at a higher risk of developing Nelsons syndrome.