Leptin, insulin like growth factor-1 and thyroid profile in a studied sample of Egyptian children with down syndrome

Several mechanisms have been suggested for obesity in Down syndrome. Assessment of serum levels of leptin, insulin like growth factor-I [IGF-I], thyroid stimulating hormone [TSH] and free thyroxin [FT4] in a prepubertal Egyptian sample of children with DS compared to their age and sex matched healthy controls and sibs of some of them. A prospective case control study was conducted on 80 children, classified as follows: Groups I and II: enrolled 20 cases with DS for each, sibs were studied only for group I, group III: 20 healthy siblings of group I, and Group IV: 20 healthy controls. Anthropometric measurements, serum leptin, IGF-1, TSH, and FT4 assessment using enzyme linked immuno-sorbent assay [ELISA] were carried out for all studied children. DS children whether with studied sibs or without studied sibs had significantly higher mean values of leptin levels compared to sibs of group I and IV [P = 0.0001 for all]. Meanwhile, mean values of IGF-I showed statistically insignificant differences between all studied groups [p > 0.05 for all]. Studied DS children whether with studied sibs or without studied sibs had significantly higher mean values of TSH levels compared to sibs of group I and controls [P = 0.0001 for all]. Mean values of FT4 were significantly higher in enrolled DS without their studied sibs compared to sibs of group I [p = 0.01], while mean values of FT4 were significantly lower in sibs of group I compared to controls [p = 0.001] Serum leptin levels were significantly higher in studied DS children compared to both studied sibs and healthy controls and they were also positively correlated with BMI in studied DS children and their sibs highlighting a possible role of body fat% and leptin values in the path-ogenesis of obesity in DS children

Assessment of thyroid function in patients with hyperemesis gravidarum

Pregnancy is accompanied by changes in thyroid function. Human chorionic gonadotropin [hCG] is a glycoprotein hormone that has structural similarity to TSH. Women with hyperemisis gravidarum often have high hCG levels that cause transient hyperthyroidsm. This study was designed to investigate the role played by, Thyroid Stimulating Hormone [TSH], tri-iodothyronine [T[3]] and thyroxin [T[4]], in nausea and vomiting of hyperemesis gravidarum. We studied 90 pregnant patients in their first trimester of pregnancy. Patients were divided into two groups, 60 women in the hyperemesis gravidarum group who came presenting with severe ernesis gravidarum and 30 women as normal controls. There was a significant difference between the two groups as regards gestational age [p=0.003] with the hyperemesis group patients tending to have a higher gestational age [mean=8.3 weeks] than the control group [mean 7.5 weeks], gravidity [p=0.023] with the hyperemesis group having a higher rate than the control group, WBCs [p=0.0001] with the control group [mean 6840] tending to have a higher leucocytic count than the hyperemesis group [mean 6435]. There was a significant difference between the two groups as regards serum Free T level [p=0.001]; Free T[4] level [p=0.001] and TSH level [p=0.001] in 48 out of 60 patients [80%] of the hyperemesis group, ketonuria was present while it was absent in the control group. Positive correlations existed between serum Free T[3], Free T[4], TSH and ketonuria in the hyperemesis group of patients. In conclusion; Thyroid hormone levels [Free T[3], Free T[4] and TSH] are elevated in hyperemesis gravidarum and relate well with the severity of that condition

Assessment of thyroid functions and leptin hormone in pregnant women with hyperemesis gravidarum during the first trimester

Pregnancy is accompanied by changes in thyroid function. Human chorionic gonadotropin [hCG] is a glycoprotein hormone that has structural similarity to TSH. Women with hyperemisis gravidarum often have high hCG levels that cause transient hyperthyroidsm. Leptin is a protein that is structurally similar to cytokine family. Studies have demonstrated that a rapid increase in leptin concentration during the first trimester is associated with hyperemesis gravidarum. This study was designed to investigate the role played by, Thyroid Stimulating Hormone [TSH], free triiodothyronine [FT[3]], free thyroxin [FT[4]] and leptin levels in relation to nausea and vomiting of hyperemesis gravidarum. We studied 90 pregnant patients in their first trimester of pregnancy. Patients were divided into two groups, 60 patients in the hyperemesis gravidarum group who came-presenting with severe emesis gravidarum and 30 patients as normal controls. There was a significant difference between the two groups as regards gestational age [p=0.003] with the hyperemesis group patients tending to have a higher gestational age [mean=8.3 weeks] than the control group [mean 7.5 weeks], gravidity [p=0.023] with the hyperemesis group having a higher rate than the control group, WBCs [p=0.0001] with the control group [mean 6840] tending to have a higher leucocytic count than the hyperemesis group [mean 6435]. There was a significant difference between the two groups as regards free T[3] level [p=0.001]; free T[4] level [p=0.001], TSR level [p=0.001], and leptin level [p=0.0001]. Ketonuria was present in 48 out of 60 patients [80%] in the hyperemesis group, while it was absent in the control group. Correlations existed between Free T[3], Free T[4], TSH and ketonuria in the hyperemesis group of patients. Leptin level correlated with metabolic products [creatinine, urea, and ketone bodies]. It does not correlate with any of the thyroid hormones [FT[3] or FT[4]] or TSR. This demonstrates that both thyroid hormones and leptin are independent factors associated with hyperemesis gravidarum. In conclusion; Thyroid hormone levels [Free T[3], Free T[4] and TSH] in addition to leptin are elevated in hyperemesis gravidarum and relate well with the severity of that condition

Functional status of the thyroid gland in complicated versus uncomplicated pregnancies

Many Adverse pregnancy outcome have been reported in pregnant women with thyroid dysfunction. The prevalence of thyroid dysfunction and its relation to pregnancy outcome had not been studied in our locality. To assess the magnitude of thyroid disorders during pregnancy and their relation to pregnancy outcome. A prospective clinical observational study. Subjects and One-hundred-fifty four, pregnant women attending the Ante-natal Care Unit, Mansoura University Hospital. Clinical examination was undertaken. Laboratory evaluation utilizing the highly sensitive chemiluminscent serum TSH assay was performed, together with estimation of serum total T3 and total T4. Cases with abnormal TSH levels were subjected to free T4 estimation to confirm the state of thyroid dysfunction. Urine examination, blood count, liver function tests, kidney function tests and plasma glucose were carried out. Thyroid and abdominal ultrasound were performed. The studied cases were classified into two groups; group 1; 12 women having different antenatal complications and group II; 42 women having no pregnancy complications. The studied cases were also grouped into rural and urban groups, according to their residence in villages or Mansoura town respectively No hyperthyroid cases were detected in either groups. The clinical manifestations of hypothyroidism were not fulfilled, but utilizing serum TSH and FT4 testing, forty five cases out of the 154 studied cases revealed subclincial hypothyroidism [29.2%] being significantly higher among the complicated pregnancy group [33.9%] than the non complicated group [16.7%] and significantly more frequent among the rural cases than the urban group [p<0.001]. Subclincial hypothyroidism has a tendency to increase with increasing gestational age. The most prevalent complications were severe preeclamptic toxemia in 73.7% and second trimester abortion in 15.8% of cases. Subclinical hypothyroidism is common, especially in rural localities. TSH screening of pregnant women in each trimester is suggested

Role of rosiglitazone in induction of ovulation in obese women with polycystic ovary syndrome and insulin resistance

To evaluate the role of rosiglitazone in treatment of obese polycystic ovarian women with insulin resistance and its effect on ovulation induction and pregnancy outcome together with looking for any synergistic effect of metformin when combined with rosiglitazone. Double blind, randomized, prospective, placebo-controlled trial. Kasr El-Aini Teaching Hospital Cairo University, Egypt. 75 obese women with PCOS and insulin resistance. Patients were divided into three groups with 25 women each. During the first month, the first group received rosiglitazone alone, the second group received a combination of resiglitazone-metformin and the third group received placebo. All participants had a base-line measurement of total testosterone level together with and oral glucose tolerance test for determination of insulin resistance in terms of fasting glucose and insulin and peak insulin levels. Ovulation was then induced for all patients using CC and HMG for one month while continuing the original medication. Re-assessment of total testosterone level and fasting glucose and insulin was then done at the end of the two months study period. Primary outcome measures are changes in serum total testosterone level and in measures of insulin resistance. The secondary outcome measures are the occurrence of ovulation and pregnancy rates. The two groups receiving insulin sensitizers showed marked improvement in insulin resistance. However, no improvement in hyperandrogenemia was elicited which may be due short duration of exposure. They also demonstrated high ovulation and pregnancy rates with a significant difference compared to the placebo group. These findings suggest that short-term rosiglitazone therapy is effective in improving insulin sensitivity and patient's response to induction of ovulation in obese PCOS cases with insulin resistance. Furthermore, combination of metformin-rosiglitazone did not prove superiority over the use of rosiglitazone alone

Longitudinal study of growth parameters in beta-thalassemia major on oral iron chelation

Children with thalassemia suffer from growth retardation. It had mainly been attributed to iron overload in the tissues and endocrine glands, chronic anemia, hypersplenism, folic acid deficiency, delayed or absent puberty. In addition a direct toxic effect on the bones has been observed in patients, before and during puberty, receiving continuous subcutaneous chelation therapy. The aim of this work is to monitor the growth of children with beta-thalassemia on oral iron chelation for early detection of growth and pubertal disorders. In this study, auxological, pubertal and laboratory data of 82 patients with beta-thalassemia major on hypertransfusion regimen and adjusted oral iron chelation following up at the hematology clinic at Cairo University Children's Hospital are studied. Height, weight, Body Mass Index, and US/LS ratio were followed up on a 3-monthly basis, over a period of 4 years. Height velocity and bone age were assessed yearly. Serum ferritin, thyroid including free T3, freeT4 and TSH and parathyroid functions including serum calcium, albumin, alkaline phosphatase and parathormone, folic acid, vitamin B12 levels, were measured in 38 of the cases at the end of the study and compared to 20 age and sex matched control. In this study 24/82 [29%] of the patients are short and remained so during the study. The US/LS ratio was abnormal in 17 cases [21%] and the ratio normalized in 7 by the end of the study. Bone age improved by the second year and returned slowed down thereafter. 52% of adolescents suffered pubertal delay and 35% needed HCG replacement to induce puberty. Serum ferritin, B12 and folic acid, Parathormone, calcium, phosphorus, alkaline phosphatase, free T3, T4, TSH were significantly different from controls. Patients in this series are hypocalcemic, hypoalbuminemic, with 65% B12 and 71% folic acid deficient, 8% had preclinical hypothyroidism while 34% had clinical hypothyroidism, one third are short and half of them have delayed puberty. The stature is not correlated to thyroid status. There was a significant correlation of height SDS and folic acid and albumin. Upper segment/Lower segment ratio was correlated to serum albumin, calcium and parathormone. Short stature is common among thalassemic patients. Puberty is delayed in half of them. Egyptian children with thalassemia are hypocalcemic, hypoalbuminemic, with an increased incidence of hypothyroidism, B12 and folic acid deficiency. Emphasis must be put on an adequate, balanced nutrition in these children with increased cell turn over

Histopathological and hormonal study of subacute toxicity of celecoxib on thyroid gland in rats

Celecoxib, a selective cyclo-oxygenase 2 inhibitor, was developed as a potential treatment for rheumatoid arthritis and osteoarthritis. It has good bioavailability and distribution and excellent safety profile in preclinical models. Although the effects of several NSAlDs on thyroid function tests have been investigated, a little was reported in literature about the toxic effect of celecoxib on thyroid functions. This study is one of fewer studies that investigated the subacute toxicity of celecoxib on thyroid function tests as well as on the morphology of thyroid gland in male rats. In this study, the doses of 10, 50 and 75 mg/kg/day of celecoxib were given to male rats orally for 28 days. At the end of the study, serum total triiodothyronine [T[3]], total thyroxine [T[4]] and thyroid stimulating hormone [TSH] levels of rats were analyzed by enzyme immunoassay [EIA] test kits. Thyroid glands of male rats were examined histopathologically. While there was no change in serum T[3] and T[4] of celecoxib-treated rats, there were a significant decrease in serum TSH levels of rats treated with 50, 75 mg/kg/day celecoxib for 28 days compared with those of control rats. In histopathological examinations, celecoxib-related changes were found in thyroid glands of celecoxib-treated rats [50 and 75 mg/kg for 28 days] showing lymphocytic infiltration, distorted acini, degenerated, exhausted colloid and interstitial hemorrhage. These changes in thyroid hormones and histopathology were dose-dependent

Value of urinary free cortisol/cortisone in assessing the activity of 11-beta-hydroxysteroid dehydrogenase in obese children: optimization of high performance liquid chromatography

Increased secretion of glucocorticoids is associated with obesity and cortisol secretion is increased in subjects with idiopathic obesity, especially of central distribution. Intercon-version of active cortisol with inactive cortisone is catalysed by the isozymes of 11 beta -HSD activities in different tissues can be assessed by ratio of urinary free cort isol to cortisone. The present study was carried out to evaluate the free cortisol/cortisone ratio in urine of obese children and adolescents to clarify the role of 11 beta-HSD in the pathogenesis of exogenous obesity. Thirty obese children were included in the present study; they were recruited from those attending Diabetic Endocrine Metabolic Pediatric Unit [DEMPU], Children Hospital, Cairo University, for assessment of obesity. Ten apparently healthy, non obese children matched in age and sex, were also included as controls. Urinary free cortisol [UFF] was measured by radio immune assay [RIA] and High performance liquid chromatography [HPLC] while urinary free cortisone [UFE] was measured by HPLC. The obtained results showed higher ratio of UFF/UFE in obese children suggesting that cortisol metabolism may be enhanced in children with higher body fat. This finding is supported by the positive correlation encountered between UFF and both BMI and fat%, which can be attributed to a higher activity of 11 beta-HSD-1 expressed in both subcutaneous and visceral fat with increased reactivation of cortisone to cortisol. This highlights the value of the UFF/UFE in demonstrating 11 beta-HSD activity more than measuring UFF or UFE alone. Finally, HPLC method under adopted conditions was found to be rapid, reliable and specific for measurement of both UFF and UFE

Relationship between thyroid function and endothelium dysfunction in hemodialyzed patients

Chronic renal failure affects thyroid function in many ways. Disturbances in hemostasis and inflammation are common complications of kidney diseases. Endothelial dysfunction may link these two processes. The study was performed to assess thyroid hormones in relation to markers of endothelial damage and inflammation in hemodialyzed [HD] patients. Sixty patients on regular HD [40 patients treated with erythropoietin and 20 patients without erythropoietin therapy] and 30 healthy controls were studied. Thyroid hormones, markers of endotherlial damage [Von Willebrand factor [vWF], intracellular adhesion molecule [ICAM], marker of inflammation [high-sensitivity C-reactive protein [hsCRP] and tumor necrosis factor alpha [TNF alpha], hemostatic parameter [tissue plasminogen activator [tPA], kidney function tests, complete blood count, lipid profile, serum iron, serum albumin and total protein, serum calcium and phosphate were measured. The weekly erythropoietin dose and the patient demographics were recorded. Free T[3] were lower in HD patients compared with controls, markers of hemostasis, inflammation and endotherlial dysfunction were significantly higher in HD patients compared with controls. In all hemodialysis patients, free T[3] was independently related to time on dialysis, albumin, serum iron, total protein, triglycerides, total calcium, vWF, tPA and hsCRP. In the HD patients with CRP less than 6 mg/L, free T[3] was related to time on dialysis, total protein and triglycerides. While in HD patients with CRP greater than or equal to 6 mg/L, free T[3] was related to total calcium and hsCRP. Also in multiple regression analysis the predictors of free T[3] were hsCRP and dose of erythropoietin. We describe a novel relation between thyroid hormones and markers of endothelial dysfunction and inflammation in HD patients. Thyroid dysfunction is related to time on dialysis, endothelial damage, and inflammatory state, frequently encountered in uremia could be responsible for accelerated atherosclerosis and development of cardiovascular complications. Therefore, the relations between thyroid axis and endothelium in HD subjects merit additional studies

Toxic effect of paroxetine on electroencephalogram, thyroid function and ainino acids in rat

In the present study, the effects of acute and chronic [up to 30 days] treatment with paroxetine on electroencephalogram, amino acids, T[3], T[4], ALT, AST and Urea have been investigated. Furthermore, paroxetine concentrations in different organs of rats at the same time points have been measured. Chronic administration of paroxetine significantly increased ALT, AST activities, Urea, and T[3] levels while reduced T[4] levels. The drug also altered amino acids metabolism in liver and brain. Paroxetine showed EEG changes with pronounced stimulation and produced some dysphoria, sedation and hallucination effects similar to serotonin syndrome drugs

Hypothalamic pituitary thyroid axis in critically ill patients

Patient with critical illness has disturbed thyroid function tests sick euthyroid syndrome' in the form of low total and free T 3, T 4 [FT 3, PT 4] and low level of the serum TSH. We investigated the hypothalamic-pituitary-thyroid axis and its relation to the mortality and/or morbidity before and after TRH stimulation. Bas-line serum TSR, free T 3, T 4 and after 200 microgram TRH, stimulated serum TSR, free T 3,and free T 4, were measured in 17 patients presented with acute critical illness, in 24 patients with chronic illness and in 20 healthy control. The results showed significant reduction in baseline and impaired secretion of thyroid hormones [FT 4 and PT 3] as well as TSH level in patients groups compared to control group. In acutely ill patients this reduction is mainly in PT 3, while in chronic patients reduction of both FT 3 and FT 4 were evident. A bolus I.V. injection of TRH in critically ill patients leads to marked increases in the serum TSR without changes in serum FT 3 or FT 4 and outcome of patients. It was found that serum TSH, FT 4 and serum albumin were correlated significantly with the mortality and morbidity of critically ill patients than APACHE II score inspite of its long term used in the prediction of morbidity and mortality in such patients. However follow up measurements of FT 4 and TSH can take it as a marker of recovery of critical illness. The results demonstrated an impairment of the hypothalamic-pituitary-thyroid axis in patients with critical illness and serum levels of FT 4 and TSH can be used in the prediction of morbidity and mortality in such patients

Initial [99m]Tc thyroidal kinetics in thyrotoxicosis: patterns and usefulness in differential diagnosis of toxic nodular goiter

This prospective study included 74 untreated hyperthyroid patients as well as 25 age- matched healthy controls aiming at assessment of initial Tc 99m thyroidal kinetics' patterns in different types of thyrotoxicosis, its usefulness in differential diagnosis of toxic nodular goiter, mainly discrimination between its immune and non-immune variants, compared to CDFS and to find-out which of the parameters evaluated was the best in such issue. Patients were selected and divided into four groups according to their definitive diagnosis based on clinical laboratory data, sonography and Tc 99m static thyroid scan. Group I: included 23 patients with Graves ' disease, group 2 : included 26 patients with toxic nodular goiter, group 3: included 10 patients with single toxic adenoma, group 4-.included 15 patients with thyroiditis. All patients,except group 4 patients, had statistically significant higher FI values compared to control subjects [p<0.05]. Moreover, group 1 and 4 patients [cases with immune thyrotoxicosis] showed statistically significant higher PI values compared to other groups [non-immune thyrotoxic patients] as well as control group [p<0.05].Group 1 and group 4 patients showed almost similar PI values [p>0.05]. Also, group 2 and 3 showed almost similar PI and FI values [p >0.05]. Retrospective analysis of PI and FI values of group 2 patients [toxic nodular goiter] revealed different behaviour of their PI values. Cases with immune variants of toxic nodular goiter had higher PI values than non-immune variants [p< 0.0001] despite their almost similar FI values and hormonal levels. Regarding the sensitivity and specificity, PI showed statistically significant higher values than those of CDFS in differentiating immune from non-immune variants of toxic nodular goiters [p<0.002 and <0.0003 respectively]. our results suggest that initial Tc 99m thyroidal kinetics done as a part of the routinely done static thyroid scan is an objective, non-invasive simple methods that can be useful in discrimination between immune and non-immune variants of toxic nodular goiter with better sensitivity and specificity than CDFS

Thyroid dysfunction in type 2 diabetes

The association between diabetes mellitus and thyroid disorders was always a matter of medical interest. The explanation of that association is still debatable whether through metabolic, immune, vascular or multifactorial. The aim of the present study was to identify subjects at risk of clinical or subclinical thyroid dysfunction by other investigation modalities in diabetics. Forty seven type 2 diabetic patients 21 men and 26 women with age xx ranging from 40-70 years and 20, age, sex and weight matched healthy control subjects were subjected to: estimation of fasting, postprandial plasma glucose. Estimation of serum free T3 and T4 and TSH by radioimmunoassay. Thyroid scan dynamic and static using technetium[99m]. Thyroid colour coded duplex Doppler study of the inferior thyroid arteries. Exclusion criteria included drugs that interfere with thyroid functions. As regards Technetium thyroid scan: the perfusion index [PERI] was significantly higher in patients compared to control subjects [p-value < 0.009]. A negative correlation was found between the duration of DM and the functional index which was statistically significant in diabetic women [r = -0.4264, p=0.03]. Thirty percent of patients were detected to have dynamic thyroid scan characteristics of thyroiditis with marked increase of the perfusion index, marked decrease of the functional index till zero and replacement of slope II and III with a plateau. As regard duplex Doppler Results: the mean pulsatility [PI] and resistivity [RI] indices were found to be higher in patients with thyroiditis [as evident by thyroid scan]. The peak systolic, diastolic, end diastolic and mean velocities where statistically lower in those patients compared to control. The mean value of pulsatility and resistivity indices were significantly higher in patients with subclinical hypothyroid state than control subjects, whereas, thyroid gland volume, blood flow and blood velocities showed no statistically significant difference. Tc[99m] dynamic thyroid scan and duplex Doppler sonography detected hypofunction and abnormal perfusion while the thyroid hormones were still on the low normal side. So, it is recommended to use these investigation tools in following up patients with long standing diabetes specially in those who show clinical or laboratory evidence of thyroiditis, [such as neck pain, thyroid swelling or elevated ESR]. A condition which is not uncommon in patients with Type 2 diabetes

Histological and biochemical study on the toxic effects of 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin [TCDD] on the follicular cells of thyroid gland of rats

2,3,7,8, TCDD and related substances are ubiquitous environmental pollutants causing a wide variety of pathological alterations. They are capable of altering endocrine homeostasis. This work was carried out to study the histological and biochemical changes of acute and chronic administration of TCDD on the follicular cells of thyroid gland of rats. Thirty six male Sprague-Dawley rats were used in this study. They were divided into three groups. Group I was given corn oil and served as a control group. Group II was given 10 micro g/Kg TCDD as an acute single oral dose. Group III was further subdivided into subgroup IIIa and subgroup IIIb that were given 0.125 micro g /Kg/ day TCDD for 4 weeks and 16 weeks respectively. At the end of the experiment, animals were sacrificed and thyroid glands were removed and examined by light and electron microscope [EM]. Biochemical estimation of serum thyroxin [T[4]], triiodothyronine [T[3]] and thyroid stimulating hormone [TSH] were also done to all animals. Histologically, Thyroid gland of group II showed beginning of follicular hypertrophy and hyperplasia in some follicles. These follicles were lined by high cuboidal epithelium with appearance of follicles lined by more than one layer of cells. Dilated rough endoplasmic reticulum [rER], well developed Golgi apparatus and numerous lysosomes were evident. Microvilli of some follicular cells were short and blunted. Subgroup IIIa and IIIb showed signs of hyperactivity affecting most of the follicles. These changes were more pronounced in animals of subgroup IIIb that received TCDD for 16 weeks. Most of the follicles were small and irregular. Many of them were lined by tall columnar epithelium with appearance of papillary projections in their lumens that appeared empty or with sparse scalloped colloid. EM examination revealed marked dilatation of rough endoplasmic reticulum and prominent well developed Golgi complexes with accumulation of numerous lysosomes and membrane bound colloid droplets. Some follicles of this group revealed degenerative changes due to direct toxic effect of TCDD. These histological changes were accompanied by a significant decrease in serum level of T[4] and a significant increase in TSH level. These biochemical changes were more pronounced in animals that received TCDD for 16 weeks. TCDD had deleterious effect on thyroid gland which is time and dose dependent

Multiparity as a risk factor inducing pituitary function failure in the elderly

Hypopituitarism is difficult to diagnose in eldery people. The presentation usually are non specific with symptoms such as lethargy, pallor, falls, urinary incontinence, confusion, fever and even coma. Hormone replacement therapy resulted in improving quality of life [1,2]. Physicians dealing with elderly patients should bear this easily treated condition in mind. Prompted by striking features in four females, all over 60 years admitted to ourhospital with unexplained lethargy, altered state of consciousness and loss or diminished pubic hair with normal obstetric history but gravida more than 7. Pituitary assessment was done which proved hypopituitarism in all the 4 cases. This attracts our attention to study the relation between multiparity and pituitary dysfunction. Patients and methods: This study was a semiprospective study, over 7 years between June1992 till April 2000. The study included 22 female patients, age between 60-79 years with parity ranged from 4-13 with the majority of cases [91%] have parity more than 5. The control group included 20 females of same age group but nullipara or have one parity only. All were admitted to the hospital due to unexplained lethargy, generalized weakness and altered sensorium. Endocrine disturbance was clinically suspected. Thorough physical examination and history was taking emphasizing on the obstetric history. Hormonal assay [RIA], LH, FSH, estradiol, cortisol, TSH, T3, FT4, ACTH and prolactin were measured, 800am along with Na and k.CT brain and /or MRI were done for pituitary glands. Hormonal assay showed statistically low mean level of LH, FSH in the multiparous group compared to the control group [P<0.01]. TSH was normal in both groups, while T3, FT4, estradiol and cortisol were slightly lower than the control but the difference was not statistically significant except for estradiol and cortisol. Similar results were found as regards ACTH and prolactin. MRI showed empty sella in the majority of multiparous group 15 cases [68%], while only in 5 cases [25%] of the control group. The difference was significant. Final clinical diagnosis, showed definite pituitary dysfunction in majority of multiparous group, 12 cases had hypogonadotrophine associated with secondary hypothyroid in 4 cases, or with secondary hypoadrenalism in 4 cases, three cases have hypopituitarism, one case with hyperprolactinemia and two cases with SIADH syndrome and three cases have normal hormonal assay in spite of some clinical signs suggesting hormonal deficiency. Control group had much less hormonal disturbance, only one case has hypogonadotrophine, one case has hyperprolactinemia and one case with primary hypothyroid. We found definite relation between number of parity and pituitary dysfunction, the risk ratio was 4.1, [95% CI 1.7-9.5]. We recommend that physician dealing with elderly patients should consider the possibility of hypopituitarism in ill elderly grand multipara female patients, when no obvious diagnosis can explain their conditions, especially if signs of hormonal disturbance were detected as absent or diminisihed pubic hair, pallor and buffy face. Hormonal study must done for these patients

Subtotal thyroidectomy and cervical block dissection: its effect on graves ophthalmopathy and thyroid function

The thyroid gland and or cervical lymph nodes have been implicated as the major source of synthesis and secretion of TSAb responsible for the hyperthyroidism of Graves disease [GD]. Although an immunogenic pathogenesis of Graves ophthalmopathy [GO] has been proposed, the actual mechanisms of retrobulbar involvement are not well defined. To determine whether cervical lymph nodes might have a role in the development of GO and whether these nodes participate in the activation of thyroid tissue remnant following sub total thyroidectomy and hence recurrence of hyperthyroidism, we examined the effect of cervical lymphadenectomy on GO and thyroid function after subtotal thyroidectomy. A series of 30 patients who had GD with varying degrees of GO were included in this study. Subtotal thyroidectomy and excision of cervical lymph nodes as well as lymphatic trunks was carried out in 15 patients [group A]. While subtotal thyroidectomy alone was done in the other 15 patients [group B]. Exophthalmometry, TSAb level and magnetic resonance imaging [MRI] of the orbit were done before surgery and also 1 months, 6 months and yearly for 3 years thereafter. There was a statistically significant reduction in exophthalmometric measures, 6 months postoperatively in group A compared to group B. There was a further reduction at 1 year and was the same at subsequent periods. One month after surgery, TSAb levels decreased significantly in group A compared to group B. A further decrease of TSAb levels was observed at 6 months and almost normalized at 1 year in group A. Six months after surgery, TSAb levels in group B were higher than those in group A, but still lower than the values before surgery. MRI of the orbit in the presurgical period showed extraocular muscle enlargement of all patients with GD even those with no clinical opthalmopathy. Six months postoperatively, there was a significant reduction in extraocular muscle thickness as well as the individual muscle/optic nerve ratio in group A compared to group B. There was a further reduction at 1 year and remained unchanged thereafter. Recurrence of hyperthyroidism was observed in one patient of group B, 3 years after surgery but in none of group A. A larger size of lymphatic trunks and greater number of lymph nodes was excised from the side of the neck corresponding to higher grade of exophthalmopathy. [1] The observed improvement of exophthalmos following cervical lymph node dissection, implies the potential role of these nodes in the initiation of retrobulbar immunological process responsible for GO. Support for this observation comes from the fact that the side with greater pxophalmos had a larger number of lymph nodes and lymphatic trunks in the neck than on the contralateral side. [2] The significant reduction of TSAb level following hymphnode dissection points to these nodes as a major source of TSAb which when reaches a pathological level in the circulation it could lead to recurrence of hyperthyroidism. [3] Subtotal thyroidectomy and cervical hymphadenetomy seems to be a logic alternative to the standard thyroidectomy in concern of its ameliorating effect on GO, moreover, it can be used to prevent progression of the process in patients without clinical evidence of GO [4] This operation could be used to prevent the recurrence of hyperthyroidism especially in patients with high preoperative TSAb titer

Some biochemical alterations in serum and tissues of rats after administration of diazepam drug

Diazepam is a member of benzodiazepine derivatives used in veterinary medicine as a sedative, tranquilizer, behavioral modifier and anaesthesia induction agent and in human practices as muscle relaxant, anticonvulsant and hypnotic. This work was carried out to study the effect of diazepam on thyroid gland and some biochemical parameters in serum and tissues of albino rats. The study included 60 adult male albino rats which were classified into three equal groups. Each group subdivided into two equal subgroups of ten rats, each one represent the control and injected with saline and the other represent the test group and injected with diazepam [10 mg/kg] for one, two and three weeks for group I, II and III respectively. The obtained results showed significant increase in serum T[3] [group II and III], Glucose [second and third groups], urea [in third group only], creatinine [group II and III], ALT [alanine amino transferase] in all groups and in both total and direct bilirubin [group II and III]. While significant decreases were recorded in serum total proteins [in II and III groups], albumin and A/G ratio in all groups, in addition to vitamin C and glycogen in liver tissue [group II and III]

Correlative study between the thyroid gland and dysfunctional uterine bleeding

Thyroid gland hormones are highly implemented in the pathogenesis of dysfunctional uterine bleeding [1] The clinical profile may cast light on that link but other times the patient seems euthyroid with normal T[3]; however T[4], TsH and LH may show minor errors. Other laboratory profiles pertinent to hypothyroidism confirm the scepticism. Endometrium biopsies 46.7% showed proliferative endometrium, 43.3% had a cystic glandular hyperplasia while 10% had secretory type of endometrium. There was no correlation between the type of endometrium and thyroid function tests. We conclude that careful examination and laboratory investigations [thyroid function tests] for patients with menorrhagia helps to diagnose early cases of hypothyroidism and so their early treatment with thyroid replacement therapy

Scintigraphic study of patients with hyperthyroidism before and after radioactive iodine therapy

This study was carried out on 20 patients with hyperthyroidism. The diagnosis was based on clinical, laboratory, isotopic study and thyroid scan. Thyroid scanning was done at two stages; one before radioactive iodine therapy and one 6 months after treatment. Thyroid scintigraphy before treatment revealed that 16 patients had Gravs' disease [80%] and four patients had toxic nodular goiter [20%]; two patients had hot nodules and two had toxic multinodular goiter. It was useful for calculating the dose of radioactive iodine as it helps in estimation of gland size. After treatment 19 patients showed normal trace uptake accumulation, while one patient still had an increase trace uptake indicating persistent hyperthyroid scintigraphic picture and this was confirmed by clinical manifestations and laboratory tests. Two patients with normal trace uptake had hypothyroid manifestations as confirmed by clinical and laboratory findings. Accordingly, our conclusion is that thyroid scintigraphy is a helpful tool for diagnosis, verification of the type of hyperthyroidism and for estimation of the therapeutic dose of radioactive iodine but not for follow up after treatment

Effect of calcium channel blockers on the hemodynamic changes of hyperthyroidism

To study the effect of Ca[+2] channel blockers on hemodynamic changes in hyperthyroid patients, 14 patients were classified in to group I [seven patients received verapamil for one month] and group 2 [seven patients received both verapamil and carbimazole for one month]. Verapamil controlled the hemodynamic changes such as pulse rate, hyperkinetic apex and ejection systolic murmur in the majority of patients. The EGG showed positive changes under verapamil therapy alone, but relative to the combined effect with carbimazole, these changes were incomplete. The peripheral blood flow was corrected enermously by verapamil but its combination with carbimazole made the blood flow nearer to the control value than its action alone. Verapamil as a calcium channel blocker, controlled significantly blood pressure, pulse pressure, mean arterial blood pressure and improved many cardiac complications. verapamil also improved the hemodynamic state in one patient who had had a bronchial asthma where propranolol is contraindicated. Verapamil can be regarded as a good therapeutic tool in prevention of cardiac injury secondary to persistent ischaemia reported to be common in thyrotoxicosis