[Physiologic changes in serum T4, TSH during the neonatal period in suspected babies at hypothyroidism screening in Isfahan, Iran in 2009-2010]

Significant changes in thyroid hormones occur during the first weeks after birth. We assessed the degree of changes in thyroid-stimulating hormone [TSH] and total thyroxin [T4] concentrations in neonates screened seven days after the first high serum TSH levels, just before starting treatment. This prospective study was carried out on newborns referred for their high TSH concentrations on heel blood spot in hypothyroidism screening tests [5- 20 miu/ml], between December 2009 and December 2010. First, serum TSH and T4 were assessed by radioimmunoassay. One week later, in neonates with the first serum TSH >/= 10, serum TSH and T4 were rechecked before starting treatment. Any definite decision to continue treatment was based on the second test results. The results showed a significant decrease in serum TSH level after one week [p<0.01]. Serum T4 level increased significantly in neonates with the first serum TSH >/= 40 [p<0.05], while no significant difference was observed in other infants with the first serum TSH<40. Incidence rate of Congenital Hypothyroidism [CH] reduced from 1/329 to 1/851, during the study. It may be appropriate to repeat serum T4 and TSH concentrations after 2 and 4 weeks in neonates with normal serum T4 but elevated TSH. In the case of persistent TSH elevation, the infant should be treated as this can prevent unnecessary treatments, family stress and iatrogenic hyperthyroidism in these patients

Assessment of bone mineral density with dual energy X-ray absorptiometry in pre- and post-menopausal women

Osteoporosis is a chronic disease that contributes substantially to decrease physical activity and decline in the quality of life. Osteoporosis can be diagnosed easily with the use of dual-energy X-ray absorptiometry [DXA] equipment. The aim of this study was to investigate the magnitude of bone loss on proximal femur and lumbar spine LS in pre- and post-menopausal women from Isfahan Osteoporosis Diagnosis Center [IODC] since 2005. Bone mineral density [BMD] measurements using DXA have been performed at IODC. 185 pre-menopausal and 174 early post-menopausal women were selected randomly. A Norland XR46 system was used for the investigations. The student t-test was done to find the difference between the T-scores of the femoral neck [FN] and lumbar spine [LS] in pre- and post-menopausal women. Mean BMDs for the FN and LS in pre-menopausal women were 0.859 +/- 0.136 and 1.012 +/- 0.161 and in post-menopausal women were 0.816 +/- 0.119 and 0.919 +/- 0.140, respectively. Long-term BMD CVs of 1.0% and 1.2% for the LS and FN were found, respectively. The differences between the FN and LS for pre- and post-menopausal women were t = - 9.02, p < 0.05 and t = -3.50, p < 0.05, respectively. In spite of, the reported lower BMD T-scores for the LS compared with the FN for women, we found that the FN had significantly lower T-score than LS for both pre- and post-menopausal women

[Evaluation of the effect of dehydroepiandrostrone [DHEA] on insulin sensitivity in IGT patients]

Dehydroepiandrostrone [DHEA] is one of three adrenal hormones and the most abundant estroid hormone in the body. Compared to other adrenal hormones, it decreases with advancing age, being 10-20% in the seventies, hence it is called the fountain of youth. Recently DHEA has been noticed for many of its effects including its antidepressant, protective effect on neuron injuries, effect on the hypocampaus and vascular endotheliurn, and its effects on autoimmune disease such as Lupus and ulcerative colitis; there is however controversy regarding its effects on insulin sensitivity. Based on glucose tolerance tests, subjects were selected from among patients, attending the Isfahan endocrine research center; 30 IGT patients by cross-over were treated with DHEA or placebo for six months and insulin sensitivity at the beginning and the end of treatment were compared. In the first three months, the mean changes in the drug group were: DHEA-S 94micro g/dL [P-value0.008], HOMA-IR 0.62 [P-value 0.6], insulin 1 micro lU/mL [P-value 0.3], FBS 10.5 mg/dL [P-value 0.1] and changes in placebo group were: DHEA-S 2.5 [P-value 0.6], HOMA-IR 0.9 [P-value 0.03], FBS 15.5 [P-value 0.1], insulin 3.5 [P-value 0.05]. In the second three months, the mean changes in the drug group were: DHEA-S 166 micro g/dL, FBS 4.6 mg/dL, insulin 0.6 micro lU/mL, HOMA-IR 0.2, while changes in the placebo group were: DHEA-S 25, FBS 5.8, insulin 1.5, HOMA-IR 0.6. This study showed that the treatment with DHEA did not improve insulin sensitivity, but probably is effective in preventing increase in insulin resistance

[Evaluation of family training effect on salivary cortisol and behavioral symptoms in children and adolescents with disruptive behavior disorder]

Association between biological factors and disruptive behaviors in children and adolescents is important to investigate. Antisocial, aggressive and delinquent behaviors in adults often begin early in life. Basal cortisol is a valuable biological characteristic of children with disruptive behavior disorder [DBD]. In this study the effect of family training on basal salivary cortisol in children with DBD was investigated. This is a clinical trial study. Basal salivary cortisol levels were studied in 19 children between 8-13 years old with DBD, before and 2 months after treatment [family training]. The disruptive behavior of the child was assessed with child behavior checklist [CBCL]. Before and after treatment cortisol levels and score of behavior were compared. Data was analyzed using descriptive statistics, paired T test and pearson correlation. Salivary cortisol before family training was 7.9 +/- 4.6 nmol/L and after that was 10.46 +/- 3.84 nmol/L which was significantly different [p<0.001]. Behavior score before treatment was 72.05 +/- 10.10 and after that was 49.361 +/- 1.89 that was also significantly different [p<0.0001]. Children with lower basal salivary cortisol had a better response to intervention. Parent training is an effective method for behavioral modification in DBD. Salivary cortisol can be considered as a predictive factor for severity of disruptive behavior, also the response to parent training in children with DBD

Is iron deficiency responsible for endemic goiter in semirom?

In spite of iodine fortification programs, goiter is still hyperendemic in Semirom, a mountainous region in the central part of Iran. This study was conducted to assess whether iron deficiency could be responsible for the high prevalence of goiter in this region. A total of 1828 schoolchildren, aged 7-13 years, were evaluated for presence of goiter, and 220 cases were randomly selected. Urine and serum samples were collected from these children and assayed for urinary iodine concentraton [UIC] and serum ferritin, iron, thyroxine [T4] and thyroid stimulating hormone [TSH] concentrations. In the 1828 children evaluated, 670 cases [36.7%] were goitrous, with goiters of grade 1 or 2. The mean UIC in children was 19.3 +/- 9.1 micro g/dl. Mild [UIC <10 micro g/dl] and moderate [UIC <5 micro g/dl] iodine deficiency was detected in 6.4% and 3.2% of cases, respectively. Only 1.8% of children were severly iodine deficient [UIC <2 micro g/dl]. The median serum ferritin concentration was 26.6 ng/ml [95% CI: 24.2-28.9], and 11 cases [5%] had serum ferritin concentrations less than 20 ng/ml. Goiter rate was 48.3% and 50.3% in children with low and normal serum ferritin levels, respectively [P = NS]. It seems that factors other than iodine and iron deficiency may, at least partly, be responsible for the high prevalence of goiter in the area studied. Further investigations for evaluating other micronutrient deficiencies and autoimmunity in goitrous children would contribute to the planning more effective goiter control programs

[Evaluation of the relation between dehydroepiandrostrone [DHEA] level and insulin sensitivity]

DHEA and its sulfate form is an adrenal hormone and is the most common steroidal hormone in body and despite of other adrenal hormones increases with age, so it is called youth fountain. Recently, DHEA is noticed increasingly because of its multiple effects. Its effect on insulin sensitivity is controversial. In this study the relation between Dehydroepiandrostrone [DHEA] level and Insulin sensitivity is investigated. In this cross-sectional analytical study, samples were selected among female relatives of diabetic patients referring to Isfahan Endocrine Research Center. They were divided into three groups including; diabetic, impaired glucose tolerance and normal glucose tolerance, each 30 persons. In these groups blood sugar, lipid, CBC, Insulin and DHEA-S levels were evaluated and the rate of Insulin sensitivity was determined using HOMA-IR and the relation between insulin sensitivity rate and DHEA in the three groups was compared. Data was analyzed using one way ANOVA and T tests. The mean of variables in the three groups of diabetic, impaired glucose tolerance and normal glucose tolerance for DHEA-S was 127, 113, 129 mcg/dl; Insulin 7.7, 1.10, 8.3 mcg/ml; HOMA-IR 1.6, 3.5, 1.8 and fasting blood sugar 86, 135, 89 mg/dl; respectively. Comparison of mean of variables showed that the difference between DHEA-S in groups was not significant. Also there was no meaningful relationship between DHEA-S and blood sugar. In the group with normal glucose tolerance, DHEA-S with HOMA-IR and insulin had a partial meaningful relation [p<0.06]. Overally DHEA has no meaningful relation with insulin sensitivity and HOMA-IR, but this relation is meaningful in the three groups and the relation between DHEA-S with HOMA-IR in the group with normal glucose tolerance is partially meaningful