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.

Does twice-weekly cabergoline improve anthropometrical and biochemical profiles in prediabetes? a randomized double-blind clinical trial pilot study

Dopaminergic signaling is one of the regulatory pathways being investigated for its implication in glucose metabolism. The aim of this study was to determine the effect of cabergoline on biochemical and anthropometric parameters in prediabetes stage [impaired fasting glucose and impaired glucose tolerance]. In this double blind, placebo-controlled, pilot study, 27 prediabetic adults were randomized to receive 0.25-mg cabergoline twice weekly for two weeks, followed by 0.5 mg twice weekly for next 14 weeks [n = 13] or placebo [n = 14]. All subjects were advised to follow a 500 kcal-deficit energy diet. Fasting plasma glucose [FPG], oral glucose tolerance, glycated hemoglobin [A1c], fasting, and 2-h insulin were measured at baseline and at 16-week follow-up. Homeostasis model assessment [HOMA] 2 was calculated to estimate steady-state beta-cell function, insulin sensitivity, and insulin resistance. Our results showed significant reductions in fasting [P = 0.004] and 2-h plasma glucose [P = 0.01] after treatment, and significant improvements in beta-cell function [P = 0.03] and insulin resistance [P = 0.04] in the cabergoline group. The trend of non-significant A1c changes was decreasing in the cabergoline group versus an increasing trend in the placebo group. All anthropometric parameters were similar between the two groups. Our results revealed that twice-weekly cabergoline could improve glucose metabolism in prediabetes stage. Larger studies of longer duration are warranted to investigate the effect of cabergoline in preventing progression of prediabetes to type 2 diabetes mellitus

Insulin receptor gene mutations in Iranian patients with type II diabetes mellitus

Patients with diabetes mellitus type II suffer from hyperglycemia because they are not able to use the insulin that they produce, often due to inadequate function of insulin receptors. There are some evidences that this deficiency is inherited in a dominant autosomal manner and leads to the malfunction of the pancreatic beta cells resulting in insulin excretion disorders. In this study, we sought to identify mutations in the insulin receptor [INSR] gene, which can cause insulin resistance in type II diabetic patients. DNA was extracted from peripheral blood cells of the patients [n = 128] diagnosed with type II diabetes. All 22 exons of the INSR gene of the patients were analyzed for mutations running PCR, conformation-sensitive gel electrophoresis and DNA sequencing, consecutively. Approximately 26% of the patients had genetic mutations; however, most of them were not reported. These mutations include exon 2 [His171Asn, Ile172Ser, Cys196Ser and Ser210Arg], exon 3 [Gly227Asp and Gly232Ser], exon 8 [Thr543Ser], exon 9 [a heterozygote was observed with no change in phenylalanine at position 669], exon 13 [two heterozygotes: Arg890Pro with Asn865 remaining unchanged], exon 14 [Ala906Gly and Pro918Trp with Arg902 unchanged], exon 17 [Val1086Glu] and exon 19 [His1157Gln with Thr1172 unchanged]. The lack of similar mutation records in literature and genetic data banks may suggest a geographic pattern for these INSR gene variants in our population

Impact of iodized oil injection during pregnancy on thyroid function tests of offsprings

Previous studies have shown that injection of iodized oil in pregnant women can be used as a prophylactic strategy for iodine deficiency disorders and may improve the growth indices of their offspring. Since administration of pharmacological doses of iodine may lead occasionally to large goiter and rarely to hypothyroidism, in the present study the thyroid function tests of neonates and infants born to women who had received 480 mg iodized oil intramuscularly during pregnancy were assessed and compared to those of a control group. Of 277 cord blood samples obtained from Mazandaran and Khohkiluyeh-Boyerahmad provinces, 125 made up the case [injected] and 152 the control [non-injected] group. Of 1026 blood samples of the neonates and infants from Mazandaran province, 544 made up the case and 482 the control group. Serum T[4] T[3] and TSH concentrations were measured with RIA kits. In the cord blood samples, mean serum T[4] in cases who had received iodized oil was lower than that of the control group: 140 +/- 32 vs. 149 +/- 33 nmol/L, respectively; p<0.03. T[3] and TSH were not however different. In the neonates and infants, T[4] and T[3] concentrations were significantly higher in the case than control group: 178 +/- 40 vs. 168 +/- 39 and 3.5 +/- 0.02 vs. 3.0 +/- 0.02 nmol/L, respectively, both p<0.001. In contrast, TSH concentrations were lower in the experimental group in comparison to control: 2.6 +/- 2.2 vs. 3.1 +/- 2.9 mU/L, respectively; p<0.001. Increased T[3] and decreased TSH were seen in infants of mothers who were injected in the second and third trimesters of pregnancy. Injection of iodized oil in pregnant women does not cause hypothyroidism in the offspings, however it does cause a transient increase in serum thyroid hormones and a decrease in TSH concentrations