Gastric bypass surgery in morbid obesity: Influence on thyroid function tests and insulin resistance status.

Background: There are inconsistent results about the effect of gastric bypass surgery on thyroid function tests in morbidly obese subjects. The aim of this study was to investigate the changes in thyroid function tests and insulin resistance status in euthyroid morbidly obese subjects before and three months after gastric bypass surgery (GBS). Methods: Twenty-nine subjects with morbid obesity (BMI≥40) were enrolled in this before-after study. Patients with known thyroid disorders or a history of thyroid ablative therapy, users of drugs that affect thyroid function, or fasting blood sugar and insulin were excluded. TSH, Free T4, total T3, fasting blood sugar and insulin level, and BMI were measured before and 3 months after GBS. Statistical analysis was performed with appropriate tests and p<0.05 was considered significant. Results: Body mass index (BMI), insulin sensitivity index (HOMA-IR), and total T3 significantly decreased after bypass surgery (all with p<0.001) but no significant changes were seen in TSH (P=0.203) and FreeT4 (P=0.33). There was a significant negative correlation between changes in HOMA-IR and changes in FreeT4 (P=0.038, r= -0.38). There was no statistically significant correlation between the percentage of excess BMI loss (%EBMIL) and changes in T3 (P=0.66), Free T4 (P=0.92), TSH (P= 0.27), and HOMA-IR (P=0.17). Conclusion: Although significant changes can occur in BMI, insulin sensitivity index, fasting blood sugar, and T3 in short-time follow-up after bariatric surgery, significant TSH and FreeT4 changes may need longer follow-ups.

Preoperative Vitamin.D Status and Post-Total Thyroidectomy Hypocalcemia.

Introduction: Hypocalcemia is a common complication of total thyroidectomy (TT). This study was designed to investigate the effect of preoperative vitamin.D (Vit.D) status on the occurrence of post-total thyroidectomy hypocalcemia. Materials and Methods: Patients who underwent TT without parathyroidectomy were divided into three groups based on their preoperative Serum Vit.D levels (<20 ng/ml, 20-30 ng/ml, and ≥30 ng/ml were considered deficient, insufficient, and normal Vit.D levels, respectively). Serum levels of calcium and phosphorus were measured before and 24 hours after surgery in all patients. The patients were examined for clinical symptoms and signs of hypocalcemia postoperatively. In cases with positive clinical symptoms and signs of hypocalcemia and/or calcium levels <8 mg/dl, PTH level was measured before starting calcium infusion, while serum calcium and phosphorus levels were also measured 24 hours later. Results: Among 100 patients enrolled in this study, 81% were females. The mean age was 36.60±8.32 years. Before surgery, the mean Vit.D level was 26.9±16.89 ng/ml, while 47% of cases had normal Vit.D level, 32% had insufficient vitamin levels, and 21% had Vit.D deficiency. Twenty-four hours after surgery, the calcium (P=0.356) and phosphorus (P=0.743) levels were not significantly different between the three Vit.D groups. A comparison of postoperative PTH levels between the three Vit.D groups showed no significant difference (P=0.596). Conclusions: Based on our findings, preoperative serum Vit.D levels did not affect postoperative serum calcium levels.

The Prognostic Role of Metabolic and Endocrine Parameters for the Clinical Severity of COVID-19.

OBJECTIVE: An outbreak of coronavirus disease-19 (COVID-19) began in December 2019 and spread globally, overwhelming the entire world. COVID-19 is a public health emergency of international concern. Due to its high morbidity and mortality rate, recognition of its risk and prognostic factors is important. We aimed to understand the relationship between metabolic and endocrine parameters and the prognosis of COVID-19. METHODS AND MATERIALS: This was a cross-sectional clinical study. A total of 70 patients with severe COVID-19 were enrolled. Laboratory results at the first admission time (including complete blood count, C-reactive protein, lactate dehydrogenase, blood glucose, calcium, phosphate, albumin, creatinine, magnesium, lipid profiles, liver enzymes, thyroid hormones, cortisol, and vitamin D) and outcome data were recorded. We divided patients into (1) intensive care unit- (ICU-) admitted and non-ICU-admitted and (2) survivors and nonsurvivors for estimation of severity and prognosis. We determined the risk factors associated with critical illness and poor prognosis. RESULTS: Patients with higher white blood cell (WBC) count and phosphate levels had significantly higher ICU admission rates. According to univariate analysis, serum levels of T3, phosphate, and WBC as well as the duration of hospitalization were associated with mortality. Multivariate analysis revealed that only WBC and duration of hospitalization were independent predictors for mortality rate in COVID-19 patients. CONCLUSION: Our findings suggest that longer duration of hospitalization and higher WBC count are associated with poor outcomes in patients with COVID-19.

Designing internet-enabled patient education for self-management of T2D diabetes-The case of the Razavi-Khorasan province in Iran.

BACKGROUND: The number of people with diabetes is estimated to increase to 642 million by 2040, with most having type 2 diabetes. Patients with diabetes require continuous monitoring and possible treatment changes. Patient education is the process of enabling individuals to make informed decisions about their personal health-related behaviours and internet-enabled interventions have the potential to provide support and information to patients with diabetes. OBJECTIVE: The aim of the study was to design a portal prototype based onto two models of care and a contextualised education programme to support the self-management of diabetes patients by involving stakeholders in the Iranian province of Razavi-Khorasan. METHODS: A Design-Based Research framework was adopted. A qualitative research method was used to analyse interviews with patients and care givers. Mock-ups were developed first and designed with features of user-driven and self-care models of care. The mock-ups also had adaptation features, such as for control of the disease, ability to cure self, and family support. The portal prototype was developed iteratively by building on the mock-ups and evaluated through interviews. The features and elements of the mock-ups and the portal prototype were evaluated in an outpatient diabetes clinic in Mashhad. RESULTS: Thirty-three participants were involved in the study. The evaluation of the mock-ups resulted in two themes and seven categories: 1) self-care improvement, including self-care requirements and self-management, and 2) educational usefulness, including medical information, information mode, mobility, interaction, and efficiency. The mock-up evaluation was used as a basis for designing a portal prototype. Next, the portal prototype was evaluated, and three categories emerged from the interview data: 1) user experience, 2) functionality, and 3) interactivity. Participants were not able to prioritise between the two care models. Some functionalities of the portal could benefit from the development within a cultural context to determine differences to the best way to present material. CONCLUSIONS: A portal prototype has been designed to include two care models to support self-management and functionalities that support aspects of culture-specific diabetes self-care. This study provides guidance on developing an internet-enabled educational portal, aimed at providing support for patients in their social context.

Are certain factors involved in calcium metabolism associated with temporomandibular disorders?

Objective: The aim of the present study was to investigate whether there is an association between serum concentrations of calcium, phosphate, alkaline phosphatase, parathyroid hormone (PTH), and vitamin D and temporomandibular disorders (TMDs).Methods: In this case-control study, 51 patients with TMDs (28 patients with TMJ clicking, 5 patients with muscular disorders, and 18 osteoarthritis patients) and 29 healthy subjects within the age range of 20-50 years as the control group, were referred to the laboratory for calcium, phosphate, alkaline phosphatase, PTH, and vitamin D (25 OHD) analysis tests. The TMJ status of all participants was examined according to RDC-TMD criteria by a prosthodontist who is an expert in TMDs. The results were analyzed with Fisher's precise test.Results: No statistically significant difference was observed between TMD patients and healthy subjects.Conclusion: Serum concentrations of calcium, phosphate, alkaline phosphatase, PTH, and vitamin D are not associated with TMDs.

"Comparison of thyroid volume, TSH, free t4 and the prevalence of thyroid nodules in obese and non-obese subjects and correlation of these parameters with insulin resistance status".

BACKGROUND: To compare thyroid volume, thyroid stimulating hormone (TSH), free t4 and the prevalence of thyroid nodules between obese and non-obese subjects. Also, the association between BMI and insulin resistance status with various parameters of thyroid gland was evaluated. METHODS: Fifty-two patients with obesity and 38 volunteers aged 20-50 years with normal body mass index (BMI), were enrolled in this cross-sectional study. Patients with diabetes, history of thyroid disorders, and patients, who were taking medications that influence their blood glucose or insulin levels or modified thyroid function tests, were excluded. TSH, free t4, insulin and glucose and thyroid sonography were carried out and the results compared between two groups. P<0.05 was considered as significant. RESULTS: Thyroid volume was higher (p<0.001) and free t4 was lower (p<0.001) in patients with obesity but there was no difference in TSH between groups. Prevalence of thyroid nodules was 15.7% and 10.8% in obese and non-obese groups, respectively (p=0.51). Frequency of nodules was significantly higher in insulin resistant than non- insulin resistant subjects (22% vs.2%, p=0.01). BMI was associated with thyroid volume (r=0.44, p<0.001) and free t4 (r=-0.35, p=0.001). HOMA-IR (homeostatic model assessment for insulin resistance) had no correlation with thyroid volume (p=0.38), but associated with free t4 (r=-0.25, p=0.01). CONCLUSION: Free T4 was lower and volume of thyroid was higher in obese subjects, but TSH and frequency of thyroid nodules had no significant difference between obese and non-obese counterparts. Insulin resistant individuals had more nodules but thyroid volume was mainly associated with BMI.

Pattern visual evoked potential in hypothyroid patients.

PURPOSE: To investigate the functional integrity of visual pathway in hypothyroid patients by pattern visual evoked potential (PVEP). METHODS: We enrolled 36 female patients with history of hypothyroidism (18 overt and 18 subclinical) aged 20 to 60 years and 36 healthy women of similar age (control group). All subjects had a complete ophthalmic examination. For VEP testing, subjects were exposed to checks subtending a visual angle of 15 and 60 min of arc. RESULTS: For the 15 min of arc check size, the mean P100 latency was significantly delayed (113 milliseconds (ms)) and amplitude significantly reduced (9.2 microvolts (µv)) in the hypothyroidism group compared with controls (109.6 ms and 11.6 µv, respectively). For this 15' check size, the group differences were related to significantly increased latency and reduced amplitude of responses in the group with overt hypothyroidism compared with controls. There was no difference between the groups (hypothyroid vs control) with 60 min of arc check size. There was a significant correlation between severity of the disease and PVEP component. CONCLUSIONS: In conclusion, low levels of circulating hypothyroid hormone are associated with delay in the pattern VEP to small check sizes. This CNS involvement worsens in patients with greater severity and duration of hypothyroidism.

Feasibility and safety of minimally invasive radioguided parathyroidectomy using very low intraoperative dose of Tc-99m MIBI.

BACKGROUND: Surgical resection of the abnormal parathyroid glands is the only curative treatment for primary hyperparathyroidism (PHPT). Radioguided parathyroidectomy with technetium-99m (TC-99m) sestamibi has been successfully used in patients with PHPT. This study was designed to evaluate the results of a series of patients with PHPT who underwent minimally invasive radioguided parathyroidectomy (MIRP) using very low dose (1 mCi) of TC-99m sestamibi (MIBI) without application of intraoperative parathyroid hormone (PTH) assay or frozen section analysis. METHODS: Eighty-seven patients with PHPT were prospectively studied from November 2012 to January 2015. Following neck ultrasound (US) and MIBI scan concordant for single gland disease, patients underwent MIRP using a handheld gamma probe. The technique involved injecting of 1 mCi MIBI in the operative room before the beginning of the intervention. All patients were followed up for a minimum of 6 months postoperatively. RESULTS: MIRP was successfully performed in 86 out of 87 patients (98.85%). The Gamma probe was particularly useful in detection of ectopic parathyroid adenomas in upper mediastinum. Mean operative time was 23.95 ± 7.982 min and mean hospital stay was 1.44 ± 0.604 days. No major surgical complications were recorded. CONCLUSIONS: The MIRP technique using very low dose (1 mCi) of Tc-99m MIBI without intraoperative PTH assay and frozen section analysis resulted in excellent cure rate for PHPT. This technique involves a radiation exposure to patients and surgical staffs 20 times lower than conventional MIRP using 20 mCi Tc-99m MIBI. Besides, patients with PHPT due to ectopic parathyroid adenoma may especially benefit from MIRP.

The Relation of Carotid Arteries' Intima-Media Thickness With Snoring and Obstructive Sleep Apnea in Type 2 Diabetes Patients.

In recent decades, the relation of carotid artery intima-media thickness (IMT) as a marker of atherosclerosis with snoring and sleep disorders has been drawing attention. The aim of this study was to evaluate the relation of carotid arteries IMT with snoring in type 2 diabetic patients. This cross-sectional study was performed on type 2 diabetes patients referring to Mashhad University of Medical Sciences' clinics. The stop Bang, Epworth sleepiness scale, and Stanford questionnaires were used for evaluation of daily sleepiness and snoring. For assessment of carotid artery thickness, Madison X8 ultrasound with 10 MHz superficial probes was utilized. The data were entered into SPSS software, and then the ANOVA test with Turkey, chi-square comparison technique, and Kruskal Wallis with Mann-Whitney U technique was used. The level of significance was considered P≤0.05. In total 80 patients (37 snorers and 43 non-snorers) entered the study. The mean carotid artery IMT in the group of snoring patients (0.72±0.17) was significantly higher than non-snorers (0.56±0.17) (P<0.001). Frequency of daily based on Stanford and ESS questionnaires was 23.8% and 39.2%. The association of sleepiness and snoring was confirmed by Stanford and ESS questionnaires with P=0.026 and P=0.007. Patients with higher risk of apnea had higher thickness of the mean carotid artery IMT (P<0.001). The mean carotid artery IMT had a positive significant relation with age (P=0.002), serum creatinine level (P<0.002), blood cholesterol (P=0.02) and HbAIC level (P=0.04). Findings of this study provides evidence on the relation of carotid artery IMT in diabetic patients with snoring independent of other effective factors. Also, results showed that snoring is associated with increased daily sleepiness and patients with higher risk of apnea had higher thickness of the mean carotid artery IMT.

Insulin resistance and endocrine-metabolic abnormalities in polycystic ovarian syndrome: Comparison between obese and non-obese PCOS patients.

BACKGROUND: Insulin resistance has an important role in pathophysiology of polycystic ovarian syndrome (PCOS). Yet there are certain controversies regarding the presence of insulin resistance in non-obese patients. OBJECTIVE: The aim was to compare the insulin resistance and various endocrine and metabolic abnormalities in obese and non-obese PCOS women. MATERIALS AND METHODS: In this cross-sectional study which was performed from 2007-2010, 115 PCOS patients, aged 16-45 years were enrolled. Seventy patients were obese (BMI ≥25) and 45 patients were non-obese (BMI <25). Presence of insulin resistance and endocrine-metabolic abnormalities were compared between two groups. Collected data were analyzed with SPSS version 16.0 and p<0.05 was considered as statistically significant. RESULTS: There was no significant difference in presence of insulin resistance (HOMA-IR >2.3) between two groups (p=0.357). Waist circumference (p<0.001), waist/hip ratio (p<0.001), systolic (p<0.001) and diastolic (p<0.001) blood pressures, fasting blood sugar (p=0.003) and insulin (p=0.011), HOMA-IR (p=0.004), total cholesterol (p=0.001) and triglyceride (p<0.001) were all significantly higher in obese PCOS patients. There was no significant difference in total testosterone (p=0.634) and androstenedione (p=0.736) between groups whereas Dehydroepiandrotendione sulfate (DHEAS) was significantly higher in non-obese PCOS women (p=0.018). There was no case of fatty liver and metabolic syndrome in non-obese patients, whereas they were seen in 31.3% and 39.4% of obese PCOS women, respectively. CONCLUSION: Our study showed that metabolic abnormalities are more prevalent in obese PCOS women, but adrenal axis activity that is reflected in higher levels of DHEAS was more commonly pronounced in our non-obese PCOS patients.

Serum triiodothyronine level as an indicator of inflammation in patients undergoing dialysis.

INTRODUCTION. It has been shown that inflammation affects thyroid function. In patients with end-stage renal disease, low plasma triiodothyronine (T3) may be an unsuspected expression of the inflammatory state of these patients. This study evaluated the correlation between T3 and high-sensitivity C-reactive protein (HSCRP) levels in patients on peritoneal dialysis (PD) and hemodialysis. MATERIALS AND METHODS. This is a cross-sectional study aiming at the correlation between T3 and HSCRP levels among 30 patients on PD, 30 patients on hemodialysis, and 20 healthy individuals. Serum levels of HSCRP, T3, thyroxine (T4), thyroid stimulating hormone, T3 resin uptake, and free T3 index (FT3I) and free T4 index (FT4I) were compared between the three groups. RESULTS. There were no significant differences between hemodialysis and PD patients in respect to T3, T4, FT3I, and FT4I. In PD and hemodialysis patients, T3 and FT3I were lower than in controls (P < .001), but there was no significant difference between PD and hemodialysis patients. T3 resin uptake and thyroid stimulating hormone differed significantly between PD and hemodialysis patients. There was a significant inverse correlation between HSCRP and T3 and FT3I among hemodialysis patients (P = .04); however, there was no such correlations in PD patients. CONCLUSIONS. The relationship between T3 and HSCRP suggests that inflammation might be involved in the low T3 syndrome in hemodialysis patients, but we did not find a significant correlation between T3 and HSCRP levels in patients on peritoneal dialysis.

Vascular pattern and spectral parameters of power Doppler ultrasound as predictors of malignancy risk in thyroid nodules.

INTRODUCTION: Determination whether spectral Doppler ultrasound parameters, including resistance index (RI) and pulsatility index (PI), or vascular pattern can be used to distinguish malignant from benign thyroid nodules. MATERIALS AND METHODS: We prospectively examined 85 thyroid nodules in patients undergoing surgery. The flow pattern seen via power Doppler examination was ranked for each nodule on a scale of 0 to 4 as follows: absent, perinodular alone, mixed with perinodular prominency, mixed with intranodular prominency, and exclusively intranodular, respectively. For each nodule, the RI and PI values were recorded as the average of the recordings obtained. Pathological examination were used as a proof of final diagnosis to categorize all nodules as benign or malignant. RESULTS: The malignant nodules had a mean RI of 0.72 +/- 0.13. These values were significantly higher than those associated with benign nodules (0.60 +/- 0.08) (P = .000). Malignant nodules had a mean PI of 1.15 +/- 0.33 that were also significantly different from those associated with benign nodules (0.91 +/- 0.19) (P = .000). Shifting to intranodular vascularization had a significant correlation with malignancy (P = .001). CONCLUSION: Spectral parameter and vascular pattern are useful to distinguish malignant from benign thyroid nodules, especially for those with suspicious or undetermined fine-needle aspiration biopsy.