Performance of European Thyroid Imaging Reporting and Data System in Stratifying Malignancy Risk of Thyroid Nodules: A Prospective Study.

Background: There is a limited number of studies reporting the performance of European Thyroid Imaging Reporting and Data System (EU-TIRADS) guideline in identifying thyroid nodule malignancy. We aimed to evaluate diagnostic accuracy of EU-TIRADS regardless of thyroid nodule size. Methods: During August 2019-November 2021, subjects with thyroid nodules were prospectively included. Sonographic characteristics were recorded and scored as per EU-TIRADS guideline. Finally, fine-needle aspiration (FNA) was performed, and cytological findings were reported. Results: Totally, 1266 thyroid nodules from 984 subjects were assessed, of which 295 nodules were smaller than 10 mm and 971 nodules were 10 mm or larger. Among nodules <10 mm, prevalence rates of malignancy for EU-TIRADS classes 2-5 were 0.0%, 3.7%, 20.6%, and 40.9%, respectively; these rates among nodules ≥10 mm were 2.3%, 4.0%, 19.3%, and 43.2%, respectively. The accuracy values of EU-TIRADS class 5 and EU-TIRADS class 4 or 5 in diagnosis of malignancy for nodules <10 mm were 86.4% and 79.7%, respectively; these rates for nodules ≥10 mm were 83.8% and 76.3%, respectively. Hypoechogenicity, microcalcification, ill-defined and irregular margins were predictors for malignancy regardless of thyroid nodule size. Conclusion: EU-TIRADS could provide an acceptable malignancy risk stratification that is helpful for better distinguishing benignity from malignancy, as well as preventing unnecessary FNA biopsies, in thyroid nodules irrespective of their size.

The efficacy of melatonin against radiotoxicity of iodine-131 and its response to treatment in hyperthyroid patients: a randomized controlled trial.

BACKGROUND: Since melatonin is a non-toxic compound with proven radioprotective effects, we aimed to investigate its efficacy in an in-vivo setting in hyperthyroid patients who are treated with iodine-131. This double-blind placebo-controlled study was conducted on hyperthyroid patients referred to nuclear medicine centers in Babol, Iran. We excluded patients suffering from hypertension treated with warfarin, autoimmune diseases, genetic diseases, cancers, smokers, chemical wounded, radiology and radiotherapy workers, and those who were treated with chemotherapy agents. Patients were randomly assigned to receive a capsule containing 300 mg of melatonin powder or a placebo. Just before receiving iodine-131, blood samples were taken from individuals. All 52 female patients received 10 to 20 mCi iodine-131 for treating hyperthyroidism. A second blood sample was taken one hour after the administration of iodine-131. MATERIAL AND METHODS: To determine the chromosomal damages before and after receiving radioiodine, we performed the cytokinesis- block micronucleus assay. Also, at phase 2, 6 months follow-up was performed, in which patients' positive responses to treatment were compared. RESULTS: The findings of this study indicate that the difference in micronucleus formation between the placebo and melatonin groups is not significant. However, a significant difference in the 6 months follow-up revealed that 61.5% and 85.7% of patients had a positive response to treatment in the placebo and melatonin groups, respectively. CONCLUSIONS: As one of the first studies dealing with the human in-vivo assessment on the radioprotective effects of melatonin, it was concluded that melatonin has a non-significant positive impact on reducing the rate of chromosomal damages in hyperthyroid patients treated with iodine-131. Nevertheless, the outcome of treatment was significantly higher by melatonin compared to the placebo group.

Different sonographic features of peripheral thyroid nodule calcification and risk of malignancy: a prospective observational study.

PURPOSE: To investigate the association of peripheral calcification, as well as its sonographic features, with thyroid nodule malignancy. MATERIAL AND METHODS: This study was prospectively conducted during 2015-2020 on patients diagnosed with thyroid nodule undergoing ultrasound-guided fine-needle aspiration in Shahid Beheshti teaching hospital or private offices in Babol, northern Iran. The ultrasonographic characteristics of the nodules, as well as the cytological findings, were recorded. Regression analysis was used to assess the relationship between sonographic results and malignancy. We also used receiver operator characteristics (ROC) analysis to estimate the ability of ultrasound to predict the characteristic features of malignancy, as estimated by the area under the curve (AUC). RESULTS: A total of 1857 thyroid nodules were finally included, of which 84 were peripherally calcified nodules. There was a significant positive association between the nodule malignancy and peripheral calcification (OR = 2.23, 95% CI: 1.13-4.35). In the nodules with peripheral calcification, significant positive associations were seen between malignancy and lobulated margin (OR = 3.85, 95% CI: 1.02-14.54) and solid composition (OR = 4.05, 95% CI: 0.99-16.53). The ROC analysis indicated that AUC for lobulated margin and solid composition was 63.8% and 66.5%, respectively, in predicting malignant thyroid nodules. CONCLUSION: The findings showed that peripheral calcification on sonography can be a potential indicator of malignant thyroid nodules. Also, the presence of lobulated margin and/or solid composition, besides peripheral calcification, can be helpful in better distinguishing malignant from benign nodules.

The comparison of accuracy of ultrasonographic features versus ultrasound-guided fine-needle aspiration cytology in diagnosis of malignant thyroid nodules.

PURPOSE: To compare the diagnostic accuracy of sonographic features with ultrasound-guided fine-needle aspiration (FNA) cytology in the detection of malignant thyroid nodules. METHODS: This analytical cross-sectional study was conducted on patients with the diagnosis of thyroid nodule, who underwent ultrasound-guided FNA in Shahid Beheshti teaching hospital, Babol, northern Iran, between 2015 and 2017. The characteristics of the nodules obtained from ultrasonography were recorded. Regression analysis was used to assess the relation between sonographic findings and malignancy. We also used a receiver operator characteristics analysis to estimate the ability of ultrasound to predict the characteristic features of malignancy, as estimated by the area under the curve. RESULTS: In total, 898 thyroid nodules were included in the study, of which 55 (6.1%) were malignant and 843 (93.9%) were benign. There were significant positive associations between malignancy and hypoechogenicity [odds ratio (OR) 3.577, 95% confidence interval (CI) 2.045-6.256], fine calcification (OR 5.849, 95% CI 2.642-12.949), irregular margin (OR 4.366, 95% CI 2.284-8.345) and taller-than-wide shape (OR 5.199, 95% CI 2.125-12.721). The overall accuracies of hypoechogenicity, irregular margin, taller-than-wide shape and fine calcification were 0.804, 0.729, 0.705 and 0.575, respectively. CONCLUSION: According to the present study, the use of ultrasonography (along with ultrasound-guided FNA) is very effective in the diagnosis, follow-up, and indication for surgery of a thyroid nodule.

Investigating the Relationship between Magnesium levels and Diabetes Mellitus in Pregnant Women.

Gestational diabetes mellitus (GDM) is defined as one of the three main types of diabetes mellitus (DM). It is established that GDM is associated with exceeding nutrient losses owing to glycosuria. Magnesium (Mg), as one of the essential micronutrients for fetus development, acts as the main cofactor in most enzymatic processes. The aim of this study was to measure serum and cellular levels of Mg, albumin, creatinine, and total protein to further clarify the relationship between these components and DM in pregnant women. Blood samples were obtained from 387 pregnant women. The participants were classified into four groups based on their type of diabetes, namely GDM (n=96), DM (n=44), at high-risk of DM (n=122), and healthy controls (n=125). All participants' fasting blood sugar (FBS), creatinine, albumin, Mg, and total protein in the serum levels and red blood cell Mg (RBC-Mg) were measured during 24-28 weeks of gestation. Groups were compared for possible association between DM and abortion, gravidity, and parity. The serum levels of creatinine, FBS, albumin, Mg, and RBC-Mg were statistically different among four groups (P =0.001). Significant lower levels of RBC- Mg was observed in all studied groups in comparison with controls. Given a positive correlation between DM and abortion, it seems that decreased levels of RBC-Mg and serum albumin can increase the risk of abortion in pregnant women. Our data demonstrated significant alterations in albumin, Mg, and creatinine concentrations in women with DM or those at high risk of DM during their gestational age. It seems that the measurement of these biochemical parameters might be helpful for preventing the complications, and improving pregnancy outcomes complicated with DM.

Assessing the Levels of L-Carnitine and Total Antioxidant Capacity in Adults With Newly Diagnosed and Long-Standing Type 2 Diabetes.

OBJECTIVES: This study is essentially a correlative study that examines the potential of reduced levels of L-carnitine (LC) when combined with the pathophysiology of type 2 diabetes. The aim of the study was to assess the levels of LC, total antioxidant capacity (TAOC), fasting blood sugar (FBS), triglycerides and cholesterol in people with newly diagnosed and long-standing type 2 diabetes and in healthy controls. METHODS: The study was done in 90 adult subjects, including 30 with newly diagnosed diabetes, 30 with long-standing type 2 diabetes and 30 healthy controls. Plasma samples were used to assay the biochemical parameters. RESULTS: In this study, both groups (newly diagnosed and long-standing type 2 diabetes) were significantly different in baseline characteristics, such as age, height, weight, body mass index, FBS, cholesterol and triglycerides, compared to the healthy controls. Plasma LC levels in patients with newly diagnosed and long-standing type 2 diabetes were significantly lower than in healthy controls (p<0.001). Also, the mean plasma TAOC level in the patients with newly diagnosed and long-standing type 2 diabetes was slightly lower than in the healthy controls. Nevertheless, TAOC levels were not significantly different across all the groups (p=0.87). The plasma LC levels were significantly positive when compared to the plasma TAOC levels (r=0.516), which means that an increase in LC levels is associated with an increase in TAOC levels. However, a negative correlation was observed between LC levels and FBS (r=-0.387), triglycerides (-0.159) and body mass indexes (r=-0.068). This means that a decrease in LC levels is associated with increases in FBS, triglyceride and body mass index levels. CONCLUSIONS: According to the effects of reduced LC levels on the metabolic profiles of patients with long-standing type 2 diabetes, setting the LC content value to prevent diabetes through the use of effective drugs or nutrition containing LC can be useful in managing diabetes.

Prevalence and severity of ocular involvement in Graves' disease according to sex and age: A clinical study from Babol, Iran.

BACKGROUND: Thyroid-associated eye disease (TED), previously known as Graves' ophthalmopathy is a cosmetically and functionally debilitating disease that is seen worldwide. The aim of this study was to evaluate the prevalence and clinical severity of ocular manifestations of Graves' disease according to sex, age and duration in northern Iran. METHODS: Between April 2011 and March 2012, 105 patients with Graves' disease, underwent ophthalmic examination, including ocular motility, exophthalmometry, intraocular pressure (IOP), slit lamp and fundoscopy. Patients received scores according to modified Werner's NO SPECS classification. RESULTS: Ocular involvement was found in 70 patients with established Graves's disease. The mean age was 35.0 years, (SD 13.0, range 15 to 69). The most common ocular findings were exophthalmometric proptosis of more than 20 mm (63.8%), lid lag (55.7%), lid retraction (52.8%) and tearing (38.6%). Almost 70% of patients had bilateral involvement. Elevated IOP was seen in 15 (25.4%) patients, and was significantly related to proptosis (P=0.007). More than half of the patients (n=36, 52.2%) had a modified Werner's NO SPECS score of 3.00. Clinical severity as shown by the increasing number of signs and symptoms per patient was correlated to increasing age (r=0.31, P=0.01) but not to gender (P=0.17). CONCLUSIONS: Both functional (ocular motility disorders, increased IOP) and cosmetic (proptosis, periorbital edema) sequels are common ocular presentations in patients with Graves' disease. Proptosis was the most common finding in this study and was associated with elevated IOP. Clinical severity was found to correlate to increasing age.

Efficacy of levothyroxine on benign thyroid nodule.

BACKGROUND: Suppressive therapy with levothyroxine for reducing the size of thyroid nodules has not been really accepted. The purpose of this study was to assess the effect of levothyroxine on the size of benign thyroid nodules. METHODS: Forty patients with confirmed benign nodule were randomly divided into two groups. Group I received 50g/day levothyroxine for six months but group II did not take it. Sonography was used to measure the dimensions of nodules before and after six months. TSH serum levels were measured before and after treatment. This clinical trial study was registered as IRCT 201103185692 N3. The data were collected and analyzed. RESULTS: The mean age of levothyroxine group was 41.57±9.41 and control group was 44.45±10.9 years (p=0.386). The TSH levels and longitudinal and transverse dimensions in both groups were similar (p>0.05). The TSH levels before and after treatment were 2±1.65 and 0.52±0.67 mUI/L (p=0.001). The Longitudinal and transverse dimensions before and after treatment in case group were 1.9±1.11, 1.90±1.15 and 1.44±0.90, 1.49±1.02 cm respectively (p=0.74, p=0.7, respectively) but in control group, were 2.19±1.32, 1.97±1.4 and 1.57±0.95, 1.26±0.7, respectively (p=0.35 and 0.1, respectively). CONCLUSION: The results show that suppressive therapy with levothyroxine lead no alteration in the size of benign nodules.

The prevalence of metabolic syndrome according to the Iranian Committee of Obesity and ATP III criteria in Babol, North of Iran.

BACKGROUND: Metabolic syndrome (MS) is highly significant due to its association to type 2 diabetes and cardiovascular diseases. The purpose of this study was to compare the prevalence of MS according to the report of the Iranian National Committee of Obesity criteria (INCO) versus Adult Treatment Panel III (ATPIII) in Babol, North of Iran. METHODS: Data obtained based on criteria ATP III from the Babol Lipid and Glucose Study (from July 2004 to September 2005) and were compared with the new INCO criteria 2010. The data were collected and analyzed. RESULTS: In total, 933 adult males and females were evaluated. According to ATP III criteria, the overall prevalence of metabolic syndrome was 23.7% (95% confidence interval: 21%-26.4%); 28.4% and 9.4% were females and males, respectively; however, the prevalence was 20.5% (95% confidence interval: 17.9%-23.1%) according to the INCO criteria, 22.5% and 15.7% were females and males, respectively. CONCLUSION: The new INCO criteria for the metabolic syndrome proclaimed by the Iranian Committee of Obesity estimated a lower prevalence of syndrome in comparison with ATP III criteria in Babol.

Risk factors of thyroid cancer in Babol, Northern Iran.

UNLABELLED: Background : Thyroid cancer is the most common endocrine malignancy. Several risk factors were found to play a role in thyroid cancer. The purpose of the study was to determine the risk factors for thyroid cancer, in Babol, north of Iran. METHOD: Eighty patients with thyroid cancer were selected as case group and 160 people living in the neighborhood of the patients as control group. Risk factors in both groups were collected and compared. The odds ratio (OR) as well as the marginal logistic regression model were used to estimate the possible risk factors. Result : X-ray exposure, radioactive exposure, family history of thyroid cancer, history of hyperthyroidism, hypothyroidism and thyroid resection were found to be the risk factors of thyroid cancer (p<0.05). Passion exposure, OCP user, history of hysterectomy, history of thyroid nodule were not correlated to thyroid cancer (p>0.05). CONCLUSION: History of goiter or other benign thyroid diseases are among the thyroid cancer risk factors in some community-based interventions to prevent or treat the disease in early stages are recommended in our region.

A successful management of aluminum phosphide intoxication.

BACKGROUND: Aluminum Phosphide or rice tablet is one of the most common pesticides which leads to accidental or intentional acute intoxication and finally death. In this paper, we describe a successful management of intoxication with rice tablet in a young girl. CASE PRESENTATION: A 14-year-old girl was admitted due to consumption of rice tablet. Gastric washing with two vials of sodium bicarbonate and discharge suction was done. In the first 24 hours, the patient underwent recurrent hydration, dopamine infusion with sodium bicarbonate, calcium, magnesium and amiodarone. On the second day of admission, the patient was transferred to intensive care unit (ICU) and five days later, she was discharged without liver or renal complications. CONCLUSION: Short interval between consumption of this tablet and start of the treatment and on time rescue to the patient can be some of the important factors to prevent early death in intoxication with this tablet.

Epidemiological characteristics of diabetic foot ulcer in Babol, north of Iran: a study on 450 cases.

BACKGROUND: Epidemiological characteristics of diabetic foot infection in our region are not clear. The purpose of this study was to determine the epidemiological features of diabetic foot infection in Babol, north of Iran. METHODS: From March, 2005 to April, 2010, the epidemiological features of 450 cases of diabetic foot infection treated in two main teaching hospitals of Babol Medical University were evaluated. Epidemiological data in these cases were determined, and collected data were analyzed. RESULTS: The mean age of these patients was 58.8±11.2 years. Two hundred ninety seven (66%) were females and 153 (34%) were males. Three hundred sixty nine patients (82%) had family history of diabetes mellitus (DM) and maternal inheritance was the most common pattern. Three hundred seventy eight patients (84%) were aware of suffering from DM and 297 (66%) were aware of the occurrence of foot ulcer but 86% were not familiar with the main risk factors for the development of diabetic foot infection. CONCLUSION: The results show that diabetic foot infections occur more often in females and the familiarity of the risk factor in this population is relatively low. Educating these patients for prevention of diabetic foot infection is recommended.