Efficacy and Safety of Long-Term Methimazole versus Radioactive Iodine in the Treatment of Toxic Multinodular Goiter

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.

Blood pressure and hypertension: findings from 20 years of the Tehran lipid and glucose study [TLGS]

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

Tehran thyroid study [TTS]

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

Iranian type 2 diabetics may not have serum testosterone level lower than healthy subjects; a case-control study

Diabetes mellitus is a common metabolic disease. Its association with low level of testosterone is controversial. This study aimed to investigate the association between serum total testosterone, free testosterone index [FTI], and sex hormone-binding globulin [SHBG] in Iranian men with type 2 diabetic.A case-control study was conducted on 38 non-diabetic and 36 diabetic men aged 40-60 years old with Body Mass Index [BMI] 18-40 [kg/m2]. Fasting serum total testosterone, SHBG, FBS [Fasting Blood Sugar], HbA1C, and other hormone tests were measured. Logistic regression adjusted models was used to asses the association of total testosterone, free testosterone and SHBG level with type 2 diabetes.The mean age of participants was 47.7+/-5.7 years. Serum total testosterone, FTI, and SHBG had no difference between case and control groups. There was no significant difference in total testosterone, FTI and SHBG between the patient with and without glycemic control.Logistic regression analysis showed an inverse relationship for total testosterone in the lower tertile concentration and type 2 diabetes, but adjustment of HbA1c eliminated the correlation between total testosterone and diabetes. According to logistic regression analysis, SHBG and FTI were not significantly associated with type 2 diabetes.Our findings suggest that serum testosterone level of the type 2 diabetics may not be lower than healthy subjects in Iranian men

Relationship between patients' perception of the importance of diabetes and metabolic control and pursuing chronic complications of disease

Type II diabetes is a metabolic disorder. Environmental factors and patient awareness have major roles on chronic complications. The purpose of this study was to determine the association of patients' perception of t the importance of diabetes and metabolic- control and pursuing of chronic complications. 194 patients with diabetes enrolled from diabetes clinic of Institute Endocrinology and Metabolism in a cross-sectional study, from February to March 2010. Data were collected using a questionnaire to assess the personal demographics, individual approach in pursuit of complications, and glycemic control, as well as patient perception and attitude toward the importance of disease process and follow-up. Level of perceptions was determined as well, moderate and weak. Out of 194 patients, 77 [39.7%] were male and 117 [60.3%] female. Mean age was 52.18 +/- 10.17 years. 69.2% did not know what the glycosylated hemoglobin was. In 71.4%, willing to participate in decisions making on medical treatment was good and they knew that with initiation of insulin therapy, they would have better metabolic control. 68.9% of patients had regular follow-up for eye complications, and 51% for cardiac complications. Follow-up for diabetic foot complication was poor. Patients with good perception had regular follow-up regarding cardiac, eye and renal complications. These results indicate that better perception of diabetic patients might improve their compliance for regular follow- up regarding the pursuit of chronic complications, especially cardiac, eye and renal problems. Although, the metabolic- control of patients had not the association with patient perception about the importance of diabetes