Maternal Thyroid Function and Birth Outcomes after Iodine Supplementation in Mild-to-moderately Iodine-deficient Pregnant Women in Thailand.

Objectives: To evaluate the effects of iodine supplementation in mild-to-moderately iodinedeficient pregnant Thai women on maternal thyroid function and birth outcomes. Methods: An RCT with 200 μg KI per day was conducted among 514 mild-to-moderately iodinedeficient pregnant Thai women. Blood samples were collected at baseline (<14 weeks of gestation), and follow up samples were collected in the 2nd, and 3rd trimester and at delivery in cord blood. Free T4 (fT4), thyroglobulin (TG) and thyroid-stimulating hormone (TSH) concentration were measured. Neonatal data was obtained from hospital records. Thyroid volume of the newborns was measured using ultrasonography. Data were analyzed per protocol by linear mixed models and linear regression models. Results: Cumulative loss to follow up was 20% in the 2nd trimester, 23% in the 3rd trimester, and 28% at delivery. Median maternal fT4, TG and TSH concentration did not differ significantly between treatment groups (p>0.05). Mean birth weight was 3150±410 g in the iodine group as compared to 3088±473 g in the placebo group (p>0.05); 4.8% of infants in the iodine group were low birth weight versus 7.9% in the placebo group. There were no significant differences in median fT4, TG and TSH concentration, and mean thyroid volume of the newborns between treatment groups (p>0.05). Conclusions: Maternal iodine supplementation normalized iodine status and resulted in lower maternal TSH concentrations during pregnancy. Further data analysis should reveal whether iodine supplementation has led to any improvement in child development in this population.

Cardiovascular examination with 3.0 Tesla magnetic resonance imaging: first 100 cases at Ramathibodi Hospital.

BACKGROUND: Cardiovascular magnetic resonance imaging (CMR) has been utilized for diagnosis in various cardiovascular diseases and most of those were performed on a 1.5 Tesla CMR system. Recently, a 3.0 Tesla magnetic resonance imaging system has been introduced into clinical practice, however the clinical experience on cardiovascular examination using this system is limited. Therefore, the authors' institution has integrated a team for developing a CMR program on this 3.0 Tesla system. OBJECTIVE: To describe the authors' experience on the 3.0 Tesla CMR system. MATERIAL AND METHOD: The data on patients referred to the authors' CMR unit between August 2004 and October 2005 were reviewed. RESULTS: One hundred patients were referred for CMR examination. The mean age was 56 years (2 month - 85 years) and 65 patients were male. The most common indication was to assess coronary artery disease (64 patients). The performed examination was divided into cardiac structure and function assessment (39%), stress testing (23%), coronary magnetic resonance angiography (13%), myocardial viability assessment (12%), magnetic resonance angiography (9%), and flow assessment (4%). CONCLUSION: The present study highlights that comprehensive assessment of various cardiovascular diseases can be performed on the 3.0 Tesla CMR system.

Inflammatory bowel disease in Thai children: presentations and outcomes of treatment.

Inflammatory bowel disease (IBD) is characterized by idiopathic chronic intestinal inflammation, due to abnormalities in gastrointestinal immunoregulation. Pediatric IBD has been rarely reported in Thailand. We describe eight children, five girls and three boys, who were diagnosed with IBD at Ramathibodi Hospital during 1999-2005 and had a follow-up of more than one year. Four cases had Crohn's disease (CD) and four cases had ulcerative colitis (UC). The ages at diagnosis ranged from 3.5 to 15.5 years. Diagnosis of IBD was delayed for more than 12 months in five patients. Five out of eight patients had early onset of disease, before 6 years of age. The manifestations included chronic diarrhea, abdominal pain, rectal bleeding and perianal lesions. The common extraintestinal manifestations were oral ulcer, anemia, weight loss and failure to thrive. Most patients had moderate to severe diseases and ileocolic fistula developed in one patient with CD. The disease was controlled with 5-aminosalicylic acid and corticosteroid in most patients. Four patients required additional therapy with azathioprine. Infliximab was used in two patients who were chronically steroid-dependent CD, one also had persistent ileocolic fistula and both patients responded well. During the follow-up period ranging from 1.1 to 5.8 years, three patients remained growth retardation; all had early onset of disease before 6 years of age, long duration of symptoms of more than 3 years before diagnosis and had multiple relapses. It is concluded that there is an increasing number of IBD in Thai children during the recent years. Most patients had moderate to severe diseases. Early onset of disease, delay in diagnosis and treatment are responsible for more complications, particularly persistent growth impairment. Early recognition of IBD and treatment are essential for a satisfactory long-term outcome.