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Background@#This study compared the degree of sustained control of hyperthyroidism in patients with toxic multinodular goiter (TMNG) treated with long-term methimazole (LT-MMI) or radioactive iodine (RAI). @*Methods@#In this clinical trial, 130 untreated patients with TMNG were randomized to either LT-MMI or RAI treatment. Both groups were followed for 108 to 148 months, with median follow-up durations of 120 and 132 months in the LT-MMI and RAI groups, respectively. Both groups of patients were followed every 1 to 3 months in the first year and every 6 months thereafter. @*Results@#After excluding patients in whom the treatment modality was changed and those who were lost to follow-up, 53 patients in the LT-MMI group and 54 in the RAI group completed the study. At the end of the study period, 50 (96%) and 25 (46%) patients were euthyroid, and two (4%) and 25 (46%) were hypothyroid in LT-MMI and RAI groups, respectively. In the RAI group, four (8%) patients had subclinical hyperthyroidism. The mean time to euthyroidism was 4.3±1.3 months in LT-MMI patients and 16.3± 15.0 months in RAI recipients (P<0.001). Patients treated with LT-MMI spent 95.8%±5.9% of the 12-year study period in a euthyroid state, whereas this proportion was 72.4%±14.8% in the RAI-treated patients (P<0.001). No major treatment-related adverse events were observed in either group. @*Conclusion@#In patients with TMNG, LT-MMI therapy is superior to RAI treatment, as shown by the earlier achievement of euthyroidism and the longer duration of sustained normal serum thyrotropin.
ABSTRACT
Context: smoking is a global public health priority and accurate data of the local population is essential to improve the health policies against its use. Hence, this study aimed to summarize the important findings available on the prevalence of smoking and its association with non-communicable diseases, documented by one of the largest prospective community-based studies of Iran
Evidence Acquisition: all articles derived from the Tehran Lipid and Glucose Study [TLGS] in the last two decades, from the earliest publications until 30 January 2018 were reviewed for their findings on tobacco smoking
Results: the prevalence of smoking in non-diabetic adults >/= 20 years increased between baseline [phase I, 1999 - 2001] and followup [phase V, 2008 - 2011] from 25.5% to 35.4% among men and from 3.4% to 6.8% among women. In TLGS adolescents [10 - 18 years] water pipe use increased between 2003 and 2005 from 35.5% to 40.9% among boys and from 19.7% to 26.1% among girls. Regarding health hazards, smoking in men was associated with increased risk of combined impaired fasting glucose/impaired glucose tolerance [hazard ratio [HR] 1.69; confidence interval [CI] 95% 1.15 - 2.48] and hypertension [HR 1.26; CI 95% 0.98 - 1.63]. Moreover, men, even smoking less than 10 cigarettes per day, were at increased risk for cardiovascular diseases by HR 2.12 [CI 95% 1.14 - 3.95]. For women, the risk of chronic kidney disease dramatically increased 5.74-fold [CI 95% 2.71 - 12.15] among smokers. In the whole population, smoking contributed to 7.7% of all-cause mortality with HR 1.75 [CI 95% 1.38 - 2.22]. Other health aspects of tobacco smoke, including its impact on metabolic status, thyroid function, female reproductive system and life style have also been reviewed
Conclusion: considering hazards of smoking, there is the urgency for more effective preventive measures in Iran; emphasizing the need for further local studies on the hazards of smoking with special attention to women and adolescents and the independent hazards of water pipe use
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Context: hypertension [HTN] is a well-known modifiable risk factor for cardiovascular disease [CVD], chronic kidney disease and mortality. Positive effects of blood pressure [BP] lowering for prevention of CVD and death have been documented in several meta-analyses of randomized controlled trials
Evidence Acquisition: this review focuses on the key findings derived from the Tehran lipid and glucose study [TLGS] papers on different aspects of BP and HTN
Results: a prevalence of 23% for HTN has been reported in the TLGS population, aged >/= 20 years. Over a decade long follow-up, the crude incidence rate [95% CI] of new-onset HTN defined as systolic BP [SBP] >/= 140 mmHg and/or diastolic BP [DBP] >/= 90 mmHg, and not using antihypertensive medication was 33.63 [32.0 - 35.3] per 1000 person-years. Age, baseline SBP and body mass index were significant risk factors for development of isolated systolic HTN; regarding isolated diastolic HTN, baseline DBP and waist circumference were recognized as important risk factors whereas age, female gender and marriage were shown to be protective factors. SBP decreased significantly in both diabetic and non-diabetic participants; DBP showed a non-significant decrease in diabetic men and a statistically significant decrease in non-diabetic men. Among women, both those with and without diabetes [DM] generally experienced statistically significant decreases in DBP. Cox proportional hazard models showed that neither SBP nor DBP were associated with incident DM in the total population and in either gender, separately. All BP components were associated with CVD and all-cause mortality in the middle-aged population. Contribution of HTN to cerebrovascular events was also documented in the TLGS participants, aged >/= 50 years
Conclusions: several important findings regarding BP/HTN have been derived from the TLGS. According to data regarding the prevalence and incidence of preHTN and HTN and their contribution to cardiovascular morbidity and mortality in the TLGS population as a representative sample of Tehranian population, it is recommended that interventions be prioritized for lifestyle modifications for the prevention and appropriate management of preHTN/HTN
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Context: this review summarizes key findings of the Tehran thyroid study [TTS], a large scale community-based study with approximately a two decade follow-up, about the incidence, prevalence, and natural course of thyroid disorders as well as associations between thyroid diseases and metabolic syndrome [MetS], dysglycemia, and cardiovascular disease [CVD]
Evidence Acquisition: pubMed, Scopus, and Web of Science databases, and the library of Research Institute for Endocrine Sciences were used to search for TTS articles. Articles were subdivided based on the fields of prevalence, incidence and natural course, and associations of thyroid function with the incident hypertension [HTN], MetS and CVDs
Results: the 2.5th and 97.5th percentiles of serum thyrotropin [TSH] were 0.32 and 5.06 mU/L, respectively. Estimated reference intervals [2.5th and 97.5th percentiles] for thyroid peroxidase antibody [TPOAb] levels were 1.5 - 32.8 and 2.1 - 35 IU/mL in men and women, respectively. Euthyroid persistencywas93.24% during6years. There was a negative association between free thyroxine [FT4] levels and insulin resistance. Decreasing FT4 values over time would predict MetS in euthyroid and subclinical hypothyroid subjects [TSH < 10 mU/L]. The incidence of thyroid disorders in patients with diabetes, pre-diabetes and healthy controls was 14, 18, and 21 per 1000 person-years, respectively, indicating significantly lower incidence in individuals with diabetes compared to healthy controls. Serum FT4 within the reference range was positively associated with all blood pressure [BP] measures in the total population and in men; however, serum TSH was positively associated with only systolic BP [SBP], diastolic BP [DBP] and mean arterial pressure of men. No associations were found between various states of thyroid function and prevalence and incidence of CVD
Conclusions: a well designed cohort study aimed to investigate the gap in knowledge regarding thyroid disorders can generate many hypotheses to be examined in randomized controlled trials
ABSTRACT
Physical activity [PA] is associated with the metabolic syndrome [MetS] and its components. This study aimed to examine the association between PA and MetS and its components among normal weight and overweight/obese adolescent in Tehran Lipid and Glucose Study [TLGS]. This cross-sectional study includes 777 adolescents, aged 12-18 years, who were selected by multi-stage random cluster sampling from among TLGS participants. Subjects were classified as normal weight and overweight/obese based on the age- and sex-specific standardized percentile curves of BMI for Iranian population. Levels of PA were assessed using a standardized and modifiable activity questionnaire [MAQ], and categorized into tertiles. MetS was defined according to the Cook's criteria. Prevalence of the MetS was higher in overweight/obese than normal group [35% vs. 3%; P: 0.02]. Normal groups were more physically active [50% vs. 44%]; however, difference was not significant. There was a significant association between the light PA and risk of lower level of HDL-C before and after adjustment, in normal weight group [OR: 1.62, CI 95%: 1.11, 2.35; OR: 1.65, CI 95%: 1.12, 2.44, respectively]. The overweight/obese group with light and moderate PA had a higher risk of having abdominal obesity than those with vigorous PA, only after adjustment for determined covariates [OR: 1.11, CI 95%: 1.07, 1.21; OR: 1.06, CI 95%: 1.01, 1.08, respectively]; the association between MetS and PA was not significant. The results of this study confirm the association between PA and some individual components of MetS such as waist and HDL-C
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Data regarding the influence of minor changes in thyroid function on body mass index [BMI] are scarce and conflicting. This study aims to evaluate the association between normal levels of serum TSH and BMI, taking into consideration the effect of smoking tobacco. In this cross-sectional community-based survey, 1581 randomly selected subjects who had no histories of thyroid disorders were studied within the framework of the Tehran Lipid and Glucose Study. Serum TSH and TPOAb were measured from the fasting serum samples. Weight and height were measured and BMI was calculated. TSH concentrations within the reference range were positively associated with BMI [P < 0.002]. Each unit increase of 1 microU/ml in TSH was associated with an increase in mean BMI of 0.31 kg/m2 [95% CI: 0.1 - 0.5, P < 0.002], an association which remained significant after adjustments for sex, physical activity, and smoking and in the subgroup with negative thyroid autoimmunity. The association between BMI and TSH remained significant only in nonsmokers [P < 0.004]. The results suggest that a significant positive association exists between TSH and BMI in euthyroid nonsmokers
Subject(s)
Humans , Male , Female , Body Mass Index , Smoking , Cross-Sectional Studies , Thyroid Function TestsABSTRACT
Poorly treated or untreated maternal overt hyperthyroidism may affect pregnancy outcome. Thyroid dysfunction and hyperthyroidism is present in about 0.3% and 2-3% of pregnancies respectively. Thyroid hyperfunction and hypofunction are more prevalent and usually go unrecognized. If thyroid dysfunction remained undiagnosed and has not been treated appropriately, would result in serious adverse pregnancy outcomes and treat both mother and her fetus. The aim of this review is to mention many aspects of hyperthyroidism in pregnancy and lactation in depth. Literature review was performed using MEDLINE between years 1960 and 2010, with the terms [Hyperthyroidism and pregnancy], [Anti-thyroid drug and pregnancy], [Radioiodine and pregnancy], [Hyperthyroidism and lactation], [Anti-thyroid drug and lactation], both separately and in conjunction with the terms [fetus], [neonate] and [maternal]. We selected proper study design of survey, case control and cohort studies, and clinical trials and review papers if the authors had at least four articles of their own in the list of references of review paper. The strategy used to search for articles was developed with the assistance of a research librarian. Antithyroid drugs are the main therapy of maternal hyperthyroidism during the lactation. All forms of antithyroid drugs can be used in pregnancy. As there are some reports regarding teratogenicity of methimazole [MMI], Propylthiouracil [PTU] is preferred in the first trimester and should be replaced by MMI after this trimester. Radioiodine is absolutely contraindicated for treatment of hyperthyroidism in pregnancy. Subtotal thyroidectomy in second trimester is indicated if hyperthyroidism is uncontrolled. MMI is the mainstay of the treatment of postpartum hyperthyroidism, in particular during lactation. Management of hyperthyroidism during pregnancy requires special considerations because maternal thyroid disease could have adverse effects on the mother, fetus and neonate
Subject(s)
Humans , Female , Thyrotoxicosis/drug therapy , Pregnancy , Lactation , Pregnancy Outcome , Hyperthyroidism/diagnosis , Hyperthyroidism/drug therapy , Antithyroid AgentsABSTRACT
Parathyroid hormone-related protein producing pancreatic neuroendocrine tumors have been infrequently reported. Here-in, we report a case of an Iranian woman who had such a tumor during pregnancy, and gave birth to a female neonate with esophago-tracheal fistula and imperforated anus. Hypercalcemia was diagnosed at postpartum because of elevated serum calcium levels in the neonate and neurologic deterioration of the mother. Extensive literature review revealed 42 cases with pancreatic neuroendocrine tumors and hypercalcaemia. The clinical and laboratory findings of such patients are reviewed in this manuscript