Percutaneous laser photocoagulation in the treatment of benign solitary thyroid nodules

Thyroid nodules are common and surgery is the usual treatment. One of the common complications after thyroid surgery is keloid formation in front of the neck which is an important cosmetic problem. Nodular goiter is a common disorder of thyroid and its common treatment is surgery. Considering the fact that with clinical evaluation and FNA, the risk of malignancy in these cases is low a non aggressive approach to this complication is necessary. This study aims to evaluate of the effectiveness of percutaneous laser photocoagulation [PLP] in reducing the volume of benign thyroid nodules. In this case-controlled clinical trial, 39 female euthyroid patients with solitary solid benign thyroid nodules were enrolled 18 patients were treated with ultrasound guided percutaneous laser photocoagulation, and 21 patients were included in the control group. PLP was performed by diode surgical laser with 1-3 watt output for 123-1019 seconds. All patients were followed up for 3 months. After PLP, mean nodule volume decreased from a baseline value of 26.3 +/- 23 mL to 15.1 +/- 13 at 3 months. Mean nodule volume reduction in comparison with baseline was 42.72%. Compressive symptoms showed relative decrease. No serious complication was seen, nor was any keloid or scar observed in the front of the neck. PLP can be a minimally invasive effective alternative treatment for symptomatic benign solitary solid thyroid nodules in patients not suitable for surgery

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

[Carney complex: a case report from Iran]

Carney Complex is an autosomal dominant syndrome that is defined with different tumors including myxoma in different organs, endocrine tumors and lentiginosis lesions. This is the first case report of this syndrome from Iran. Case: The patient is a 27 year old girl, referred with flank pain. Physical examination revealed hirsutism, truncal obesity, hyperpigmantasion and hypertension; Cushing's syndrome was suggested and confirmed with related classic biochemical tests. She had history of cardiac myxoma during her childhood and had been operated twice. Pituitary microadenoma and right adrenal adenoma were reported on MRI and CT-scan, respectively. Initially laparascopic right adrenalectomy was done; as expected, no remission in signs of Cushing's syndrome was observed after surgery. By laparoscopic adrenalectomy of the other site, Cushing's syndrome resolved. Pathologic report of 1st operation was adrenal adenoma with surrounding pigmented micronodular hyperplasia and of the 2nd one was just pigmented micronodular hyperplasia. Conclusion: We have reported a patient with Carney syndrome along with Cushing's syndrome due to bilateral adrenal hyperplasia and an adenoma in contralateral adrenal and microadenoma of the pituitary as an incidentaloma. This is a new presentation of Carney syndrome

[ Prevalence of clinical goiter and urinary iodine concentration in 8-12 years old students of Semirom in 2004 [15 years after execution of national program for elimination of iodine deficiency disorders]]

With respect to the high prevalence of goiter in Semirom before the initiation of National Program for Elimination of Iodine Deficiency Disorders [NPEIDD], the impact of the program on the prevalence of goiter in 8-12 years old students of Semirom was investigated in this study, after 15 years of sucessful execution of NPEIDD. After excluding students with any clinical evidence of hyper- or hypo-thyroidism, 1817 students aged 8-12 years were recruited based on a cluster sampling method. The participants were examined for the presence of goiter by experiencd endocrinologists. Urinary iodine was measured in 182 examined students, too. Chi- Square statistical method was used to analyze the data. Goiter was detected in 36.7% of the students [grade 1: 30.4%, grade 2: 6.3%]. The median urinary iodine was 18.5 and mean was 19.37 +/- 9.22 ?g/dl in collected specimens. The adequacy of urinary iodine in students of Semirom confirms the success of NPEIDD, however, the higher than expected prevalence of goiter in the region suggests the probable role of other goitrogenous or autoimmune factors. Further studies should be performed to investigate the possible causes

[ effect of folic acid and levothyroxine combination therapy on serum homocysteine levels of hypothyroid patients]

Elevated level of serum homocysteine, as an independent risk factor for cardiovascular diseases, has been reported in hypothyroid patients. Considering the effect of levothyroxine on lowering homocysteine levels in these patients, and the fundamental role of folate in the metabolic cycle of homocysteine, this study was performed to compare the level of homocysteine in patients with hypothyroidism following treatment either with levothyroxine alone or in combination with folic acid. In this double-blind clinical trial study, 60 hypothyroid patients were randomly divided into two groups [n=30 each], and both were treated with 50-100 microg of levothyroxine, with conjunction of an additional 1 mg folic acid [cases] or placebo [controls]. The level of fasting homocysteine, folic acid, and vitamin B12 was measured and compared in all participants at the beginning of the study and after TSH levels were normalized. The level of homocysteine in the case group was decreased from 15.77 +/- 6.33 micromol/L to 10.8 +/- 3.54 micromol/L [p<0.001], and was also decreased in the control group from 15.69 +/- 6.4 micromol/L to 13.9 +/- 6 micromol/L [p=0.03]. The difference in the mean serum homocysteine level between 2 groups was statistically significant at the end of the study [p=0.0165]. Although the level of homocysteine was decreased in both groups, it was lowered to a greater extent in the group who received levothyroxine and folic acid. It seems that using folic acid in conjunction with levothyroxine can lower the potential harmful effects of homocysteine, which may even be exerted over a short-time period more efficiently

Is there any difference in the plasma homocysteine levels of diabetes mellitus type II patients, impaired glucose tolerance subjects and normal people?

Hyperhomocysteinemia is associated with an increased risk of cardiovascular disease in diabetic patients. The aim of this study was to determine plasma homocysteine levels in diabetics and compare with control persons and also evaluation of correlation between plasma homocysteine concentration and diabetic related variables. This study was done on 39 type II diabetic patients, 27 subjects with impaired glucose tolerance and 23 normal persons referring to Endocrine and Metabolism Research Center of Medical university of Isfahan. Physical characteristics were recorded. After an overnight fast, a blood sample was drawn for determination of FPG, HbAlc - homocysteine, Cr. Cholesterol - Triglyceride and HDL- Cholesterol. Mean plasma homocysteine levels in the groups were compared by one way ANOVA. The Correlation of different parameters was tested by Pearson's correlation. There was no statistically significant difference in the plasma homocysteine levels of all the groups.[P=0.71]. Correlation between homocysteine levels and HbAlc was not significant [P=0.42] in diabetic patients. The findings suggest that diabetes does not influence plasma homocysteine levels. Also, there is no correlation between plasma homocysteine levels and HbAlc in diabetic patients