ABSTRACT
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: 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
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