[Prevalence of autoimmune thyroiditis in school children 10 years after normalized iodine intake]

Iodine deficiency has been identified as a significant public health problem in Iran. The main strategy for control of iodine deficiency was country wide salt iodination. 10 years after starting this program, goiter is still endemic in some school children. The most important differential diagnosis is autoimmune thyroiditis. The aim of the present study was to evaluate prevalence of autoimmune thyroiditis in school children with normalized iodine intake. 1188 school children, aged 8-13 years, were selected by cluster random sampling to evaluate prevalence of goiter. From a total of 1188, 500 school children were chosen to assess urinary iodine excretion, free T4, free T3, TPO anti body [TPOAb] and TSH. Goiter was endemic in 39.6%[95% CI 36/3%-41/7%] but majority of them had grade I thyromegaly. Median urinary iodine excretion [18/8 microg/ dl] indicated normal iodine intake. Mean [95%CI] free T4, free T3 and TSH concentration were 13.1[12.8-13.3] pg/ml, 3.7[3.6-3.8]pg/ml and 2.5 [2.2-2.8] IU/ml respectively. TPOAb was positive in 3.7% of children with a higher prevalence in girls[P< 0.001]. The prevalence of hypothyroidism and hyperthyroidism was 9% and 0.2% respectively but only 0.8% of school children had TSH>10. There was a significant relationship between detection of positive TPOAb, prevalence of goiter and hypothyroidism; however no relation was seen between urinary iodine excretion status and detection of positive TPOAb, hypothyroidism and prevalence of goiter. Despite median urinary iodine excretion being normal, persistence of goiter suggested presence of goiterous factors; alhought the autoimmune mechanisms of thyroid may to some extent autoimmune of thyroid explain some part of the goiter prevalence it is however necessary to evaluate other factors

[Prevalence of goiter and iodine deficiency ten years after salt iodinezation in school children [8-13 years old] in Marvdasht]

Iodine deficiency was endemic in Pars province since several years. Mandatory production of iodinized salt for household use was started from 1994. The aim of this study was to evaluate the prevalence of goiter, urinary iodine excretion in school children ten years after starting the program. A cross sectional study in which 1188 school children, aged of 8 - 13 years, from Marvdasht city were chosen by random cluster sampling for evaluation of goiter prevalence according to WHO classification. Of these this 1188 school children, 500 persons were selected for evaluation of urinary iodine excretion [UIE] by digestion method, difference in UIE was assessed among different age groups, goitrous and non goitrous school children. Following the assessment, goiter was found to be still endemic in school children [39.6%] but majority of them had gradel goiter. Median urinary iodine [95% Cl] excretion levels in boys and girls and total number of school children were 17 micro g/dl [13.1-20.9], 22.4 micro g/dl [20.4-24.1] and 18.8 micro g/dl [16.1-21.5] respectively. Differences in UIE between two sexes were significant [P < 0.001] but differences among age groups were not significant. The UIE levels in goitrous and non goitrous school children were 18 micro g/dl [16.4-19.9] and 20 micro g/dl [17.1-22.9] respectively, with no statistically significant difference. Prevalences of school children with urinary excretion in normal, above normal and below normal ranges were 29.5%, 47.5%, 23% respectively, meanwhile less than 13% had urinary iodine excretion < 5 micro g/dl. We conclude that the iodine intake is sufficient but persistent, albeit, reduced prevalence of goiter in spite of adequate iodine supplementation suggests the existence of additional causes in goiterogenesis. It is necessary to consider the role of other factors in persistence of goiter

Prognostic factors in the relapse of Graves' disease following treatment with antithyroid drugs

Patients with Graves' disease exhibit a considerable rate of relapse after treatment with antithyroid drugs and require ablative therapy. The purpose of this study was to evaluate variables which can be used as prognostic factors in predicting the outcome of Graves' disease after treatment with antithyroid drugs. Age, sex, duration of antithyroid drug therapy, pretreatment T3 and T4 values, T3 to T4 ratio, size of thyroid gland before and after treatment, and the effect of salt iodination were determined in 439 patients at an endocrine clinic in southern Iran during a 15- year period. The patients included 338 [77%] females and 101[23%] males with a mean age of 34.1 11.2 years. Overall, the relapse rate was 62%. The relapse rates were 58% and 76% in females and males, respectively [P=0.001]. The mean age was 35.0 11.6 years in the relapse group [n=275] and 32.6 +/- 11.3 in the remission group [n=164] [P=0.03]. T4 was 20.4 6.3 and 18.1 5.4 g/dl in the relapse and remission groups, respectively [P=0.000]. In the relapse group, T3 was 443.0 189.5 ng/dl and in the remission group, it was 373.4 182 ng/dl [P=0.009]. T3 to T4 ratio was higher in the relapse group [21.8 8.3 vs 18.6 7.0 ng/ g, P<0.005]. Larger pre- and post-treatment thyroid size were associated with higher relapse rate [P<0.05 and P=0.001, respectively]. Logistic regression analysis showed that male sex, old age, higher pretreatment T4, T3, and T3 to T4 ratio, and larger pre- and post-treatment thyroid size were associated with higher relapse rates. Iodinated salt consumption and duration of treatment beyond 12 months had no effect on the relapse rate. Patients with male gender, older age, higher pretreatment T3, T4 higher T3/T4 ratio, and larger thyroid size before and after treatment have higher risk of relapse

prospective, double-blind, randomized, placebo-controlled clinical trial of dexamethasone during the follicular phase in clomiphene resistant patients with polycystic ovary syndrome and normal DHEAS

In order to evaluate the effects of short course administration of dexamethasone [DEX] combined with clomiphene citrate [CC] in CC-resistant patients with polycystic ovary syndrome [PCOS] and normal DHEAS, a prospective, double blind, placebo controlled, randomized study was undertaken at referral university hospitals. Two-hundred and thirty women with PCOS and normal DHEAS who failed to ovulate with a routine protocol of CC received 200 mg of CC from day 5 to 9 and 2 mg of DEX from day 5 to 14 of the menstrual cycle. The control group received the same protocol of CC combined with placebo. Follicular development, hormonal status, ovulation rate, and pregnancy rate were evaluated. Mean follicular diameters were 18.4124 +/- 2.4314 mm and 13.8585 +/- 2.0722 mm [p<0.001] for treatment and placebo group respectively. Eighty-eight% of treatment and 20% of the control group had evidence of ovulation. The difference of cumulative pregnancy rate in treatment and control groups was statistically significant [p<0.0001]. Hormonal levels, follicular development and cumulative pregnancy rate improved with the addition of DEX to CC in CC-resistant patients with PCOS and normal DHEAS. This regimen is recommended before any gonadotropin therapy or surgical intervention

Effects of vanadyl sulphate on spermatogenesis in male rats

It is known that vanadyl compounds are capable of alleviating hyperglycemia in streptozotocin induced diabetic rats. To examine the effect of vanadyl sulphate [VS] on spermatogenesis of male rats. Male rats [n=10] were administered 32 mg/kg/day of VS orally and 50 mEq/l NaCl [as drinking water] for one month. Meanwhile, 11 male rats, the control group, received vehicle only; 50 mEq/l NaCl as drinking water. At the end of the study, blood testosterone level as well as spermatogram of rats in both groups were determined. The animals were sacrificed and their testes and epididimes were then studied under light microscope. In VS treated group, blood testosterone level, and sperm count were significantly decreased by 51% [normal = 2.83 0.7 ng/ml, p<0.001], and 80% [normal = 565 106/ml, p<0.05], respectively, as compared to the control group. However, sperm motility, shape, and histology of testes and epididymides were not different from those of the control group. Vanadyl sulphate has detrimental effects on spermatogenesis

Prevalence of postpartum thyroid dysfunction in Shiraz

Postpartum thyroiditis [PPT] is an autoimmune disease that usually occurs in the first year after parturition and presents with periods of transient thyrotoxicosis and/or hypothyroidism, and in some cases results in permanent hypothyridism. To determine the prevalence of PPT in healthy postpartum women in Shiraz, southern Iran. Of 460 postpartum women from Shiraz 385 cases who had no history of any medical problem or signs of other autoimmune disorders were selected during 1-8 months of postpartum period, to fill a questionnaire about signs and symptoms of their possible thyroid dysfunction. TSH and Anti-Tpo Ab were measured and FT4 assay was done on samples with abnormal TSH. 100 women at reproductive age were randomly selected as control group. Result: The clinical and biochemical prevalence of PPT were 33% and 11.4%, respectively [p<0.01]. Hyperthyroidism was more frequent in early months of postpartum period and hypothyroidism was more frequent in later months. Thyrotoxicosis and hypothyroidism occurred in 34 [8.8%] and 10 [2.6%] mothers, respectively. Positive Anti-Tpo Ab was found in 80% of patients and in 38% of the control group [p<0.0001]. Our results showed a high prevalence of PPT in women in Shiraz. This may be due to the transition from low to adequate iodine intake and participation of women in earlier postpartum period. The major difference compared to other studies is the high frequency of thyrotoxicosis

Hypothalamo-pituitary response before and after surgical stress [splenectomy] in Thalassemic patients

Multiple endocrinopathy is a common manifestation in thalassemia. Although the response of the stress hormones to induced hypoglycemia has been studied in these patients, the impact of surgical stress is not yet determined. The hypothalamo-pituitary-adrenal axis of 27 thalassemic patients [TP], [4-15 years old [y.]] admitted for splenectomy, was evaluated before and after surgical stress during 1996-8. Blood samples for measurement of ACTH, cortisol, growth hormone [GH], thyroid stimulating hormone [TSH] and prolactin [PRL] were taken a day before and also approximately two hours after surgical insult. For comparison, 22 non-thalassemic patients [NTP] [3.5-14 y.] admitted for elective laparotomy, were selected as the control group. The cortisol response after surgical stress was significantly higher than baseline in both the TP [17.4 +/- 6.3 vs 30.81 +/- 11.49 micro g/dl; P<0.001] and the NTP [20.65 +/- 9.1 vs 36.87 +/- 11.08 micro g/dl; P<0.001]. NTP showed a significant elevation of ACTH upon surgical stress [P<0.001], while the difference between pre- and post-stress ACTH was not statistically significant in TP [P=0.123]. However, the ACTH concentration before operation in TP. was significantly higher than that of NTP [P<0.042] with no remarkable difference after surgical stress between the two groups [P=0.261]. GH increased significantly after operation in TP and NTP [P< 0.016 and <0.05, respectively]. A significant change in TSH [P< 0.03] and PRL [P< 0.004] was also observed in TP after operation. The hypothalamo-pituitary as well as the pituitary-adrenal axes are usually intact and responsive in TP. It is concluded that, the remarkable increase in ACTH concentration before operation may be due to a decreased adrenal reserve. Thus, the possibility of primary partial adrenal insufficiency, particularly under stress situations, should be considered in every thalassemic patient

study on etiologies of hirsutism and screening for late - onset congenital adrenal hyperplasia due to 21 - hydroxylase deficiency

Eighty hirsute women [Ferryman and Gallwey score >/= 8] who were referred to the endocrinology clinics of Shiraz university and ten control normal nonhirsute women were assessed in this study. Baseline 17-hydroxyprogesterone [17 OH PG], cortisol, stimulated 17-hydroxyprogesterone and cortisol after 30 minutes of cosyntropin [short acting ACTH] injection were measured for screening of late-onset congenital adrenal hyperplasia [LOCAH] during follicular phase. Baseline testosterone, Luteinizing hormone [LH], follicular stimulating hormone [FSH], thyroid stimulating hormone[TSH], prolactin [PRL] and dihydroepian drosterone sulfate [DHEA-So[4]] were also measured. The ovaries were visualized in 42 patients by sonography. Of the 80 hirsute women, 3 had late-onset CAH due to 21-Hydroxylase [21 OH] deficiency [3.8%], 43 women diagnosed as having Polycystic ovary syndrome [53.7%] and 34 women diagnosed as having idiopathic hirsutism [42.5%]

Treatment of thyroid hot nodules by percutaneous ethanol injection

Twenty-eight patients with autonomously functioning thyroid nodules of 2-6 cm diameter were selected. Fifteen patients were clinically and biochemically hyperthyroid. Depending on the nodule size, 2-4 ml of 95% ethanol was injected into the nodules. There were no major complications. Thyroid scans were done at two-month intervals and repeated injections were done only if the hot nodules were still present. 71.4% needed only one, 25% needed two, and 3.6% needed three injections for complete ablation of the hot nodules. On follow-up examination all nodules had shrunken in size and those patients with hyperthyroidism showed improvement of their symptoms. The hormone levels also returned to normal range.Repeated thyroid scans showed disappearance of the hot nodule and gradual resumption of function of the previously suppressed thyroid tissue. This study shows that percutaneous ethanol injection is a safe and cheap alternative to surgical and radioiodine ablation of AFTN's and this can be achieved in most cases in one or two sessions. Importantly, with this method, the chance of future hypothyroidism will be nil

Effects of intracisternal TRH on basal acid output and serum gastrin in hyperthyroid rats

Rats were made hyperthyroid by oral levothyroxine therapy to evaluate the role of thyrotropin-releasing hormone [TRH] as a central neurotransmitter for the changes of basal acid output [BAO] in the state of thyroid dysfunction. It was shown that [BAO] decreases with the concomitant elevation of serum gastrin level. Elevated serum gastrin in hyperthyroid rats returned to base line by intragastric infusion of 0.1 N hydrochloric acid [HCL]. In the next step, intracisternal injection of TRH to another group of hyperthyroid rats increased BAO and decreased serum gastrin level. It is concluded that decreased central TRH as a consequence of hyperthyroidism [negative feedback], decreases [BAO] which secondarily leads to hypergastrinemia

Mitral valve prolapse in Graves' disease

The prevalence of mitral valve prolapse was investigated by echocardiography in 191 Graves' disease patients from southern Iran. One hundred and fifty-eight asymptomatic healthy subjects were selected as a control group. Fifty-three patients [27.7%] with Graves' disease had mitral valve prolapse compared with 18 [11.39%] in the control group. The difference was statistically significant [p<0.05]