Lymphocytic thyroiditis presenting as a unilateral painful goitre.

Lymphocytic thyroiditis is a rare cause of painful goitre. An unusual case of lymphocytic thyroiditis causing unilateral severe pain of the thyroid not responding to medical treatment is presented and discussed.

Bartter's syndrome in two successive generations of a Saudi family.

Bartter's syndrome (BS) is characterized by primary renal tubular hypokalemic metabolic alkalosis, hyperreninemia, hyperaldosteronism and normal blood pressure. The parents and siblings of a BS patient were evaluated for renal tubular function. The father and all 9 siblings of the patient had biochemical features of BS. His mother, a first cousin of his father, had hypokalemia and hyperkaluria but no other features of BS and could have been a 'carrier'. The mother and all 9 siblings were asymptomatic. Including the patient, hypomagnesemia was present in 8 of 12 family members. Therapy with a combination of potassium chloride and magnesium increased the serum potassium and magnesium levels to within normal limits. The familial occurrence in BS is well known, and reports of the disorder in siblings and the first generation of children of consanguineous marriages and normal parents have been taken to suggest an autosomal recessive inheritance. One affected parent and involvement of all siblings of the patient raise the possibility of an autosomal dominant inheritance in the present family.

Thyroid cancer coexisting with Hashimoto's thyroiditis at King Khalid University Hospital, Saudi Arabia.

A retrospective record review was performed on all patients with thyroid carcinoma treated at King Khalid University Hospital (KKUH) during the period 1985 to 1993. Eighty one cases were identified of which 10 patients had coexistent Hashimoto's thyroiditis documented histologically. Of these ten patients, nine were females with a mean age of 32.2 years. There was one male aged 55 years. Five patients were treated with near total thyroidectomy while the others had subtotal thyroidectomy. The relationship between thyroid carcinoma and Hashimoto's thyroiditis continues to be a controversial subject. This relationship is discussed including the epidemiological and therapeutic implications of the coexistence of these two pathologies.

The pattern of diabetic nephropathy among Saudi patients with noninsulin-dependent diabetes mellitus.

There were no studies on the different stages of diabetic nephropathy in Saudi Arabia, particularly the earliest stages. We have therefore investigated the frequency of occurrence of varying degrees of proteinuria including microalbuminuria in noninsulin-dependent diabetes mellitus (NIDDM) Saudi patients as well as the correlation of varying degrees of proteinuria with other diabetic complications and risk factors. One hundred and twenty-five NIDDM patients were studied. Fifty-seven were males and 68 were females. Their mean age was 49.8 +/- 10 years with a mean duration of diabetes of 9.48 +/- 6 years. The mean of HbA1c was 10.3 +/- 2.6%, serum creatinine was 76.7 +/- 23 mmol/L, creatinine clearance 94.3 mL/min, glomerular filtration rate 129.7 +/- 44 and effective renal plasma flow was 496.5 +/- 153. The pattern of proteinuria group was as follows: nephrotic range proteinuria 5.6%, clinical proteinuria 30.4%, microalbuminuria 16.8%. Hypertension and retinopathy were present in 36.8% and 37% of the patients respectively. A significant correlation was found between the presence of hypertension, duration of diabetes and development of diabetic nephropathy. Similarly, a significant correlation was found between retinopathy and the degree of proteinuria. In conclusion, the pattern of diabetic nephropathy in the Saudi NIDDM patients is similar to that in the Western world. Hypertension and duration of diabetes mellitus are important risk factors in the development of diabetic nephropathy. There is a good correlation between retinopathy and the degree of proteinuria.

Post partum thyroiditis in Saudi women.

Two hundred and seventy seven Saudi women were prospectively evaluated post-partum to determine the frequency of post-partum thyroiditis. Four to six weeks after delivery, 12 (4.3%) had positive antimicrosomal antibodies and 8 (2.9%) had positive antithyroglobulin antibodies. At 6-8 weeks post-partum, out of 82 subjects followed up, 4 (4.9%) had positive antimicrosoMal antibodies and 1 (1.2%) had positive antithyroglobulin antibodies. At 8-12 weeks post-partum, out of 70 subjects, antimicrosomal antibodies were detected in 5 (3.5%) subjects and antithyroglobulin in 2 (1.4%). Their routine thyroid function tests (T3, T4, and TSH) remained within the normal range. There was no clinical evidence of hyper- or hypothyroidism in any of the patients during the follow up. Post-partum thyroiditis, appears to be relatively uncommon in Saudi Arabia. It does not produce any clinical illness or cause significant subclinical thyroid dysfunction.

Diabetes mellitus in Saudi Arabia: The clinical pattern and complications in 1,000 patients.

A retrospective and prospective study of 1,000 ambulatory and hospitalized diabetic patients was done in Riyadh, Saudi Arabia. Saudis completed 777 (77.7%) and non-Saudis 223 (22.3%). Sex distribution was equal among Saudis, males 389 (50.1%) and females 388 (49.9%), but non-Saudi males were predominant at 153 (68.6%), non-Saudi females 70 (31.4%) reflecting the preponderant male expatriate labor force. A proportion of different types of diabetes was: IDDM 115 (11.7%), non-obese non-insulin dependent diabetes mellitus (NIDDM) 405 (41.0%), obese NIDDM 412 (42.1%), and early onset non-insulin dependent diabetes (diagnosis under 30 years of age), 43 (4.4%). Regarding treatment, 388 (40.6%) received insulin followed by sulfonylurea, alone in 330 (33.5%), diet only 117 (12.0%), combination sulfonylurea and biguanide in 113 (11.6%), biguanide alone in 13 (1.3%) and insulin plus tablets in 7 (0.8%). Of 472 and 426 patients, 29.7% and 30.0% had elevated total cholesterol or triglycerides respectively, while 77.2% of 373 patients had elevated glycosylated hemoglobin (HbA1). At least once in 998 patients, diabetic ketoacidosis occurred in 7.6%.

The spectrum of echocardiographic abnormalities in hypothyroidism and the effect of hormonal treatment.

Cross-sectional echocardiography was used to identify and quantify different cardiac abnormalities in 85 patients with hypothyroidism. Pericardial effusion was the most common and was found in 32 patients (37.6%), while abnormal increase in left ventricular dimensions with impairment of function followed next in frequency (16.4%). Asymmetrical septal hypertrophy as well as segmental wall motion abnormality were each detected in 11.76%. Holosystolic prolapse of the mitral valve was present in only 4.7% of the cases. Different combinations of abnormalities were observed in a total of 22 patients (25.76%), and pericardial effusion was a constant finding. Some of the abnormalities were reversed with physiological thyroxin replacement, but abnormal wall motion remained unimproved.

Bone mineral content and bone mineral density values measured by single photon absorptiometry among healthy Saudi population.

Several noninvasive methods for assessing bone mass have emerged over the last two decades, namely, single photon absorptiometry (SPA), dual photon absorptiometry, and quantitative computerized tomography. These techniques have proved to be sensitive and reproducible, with absorptiometry causing minimal radiation exposure. Several studies on osteoporosis have shown that its frequency varies in different racial groups; for example, Hispanics and Blacks in the USA appear to be the least affected by osteoporosis. It was therefore important to establish the normal standard of measurements of bone mass among healthy Saudi population using SPA to be used for clinical applications such as predicting the risk of fractures, monitoring the response to therapy, and quantitating the severity of metabolic bone disease.

Ramadan fasting: Medical aspects in health and in disease.

Ramadan fasting is one of the Pillars of Islam. Its observance involves abstinence from eating and drinking from dawn until sunset during the entire holy month. The effects of Ramadan fasting on body physiology as well as on the different biochemical, hematological, and metabolic parameters are reviewed. Metabolic changes, when present, are mild and reversible. The effects of fasting on diabetes mellitus, treatment with nonsteroidal antiinflammatory agents, and anticoagulation therapy are discussed.

Iodide concentrations in Saudi waters: A cause for concern.

Samples of tap water and drinking mineral water from different regions of Saudi Arabia were analyzed for iodide content. Low iodide concentrations were found in all samples. This finding may reflect an overall low iodide content in the soil and consequently also in locally grown food, which could predispose to endemic goiter. In the absence of data on the prevalence of endemic goiter, we recommend the routine use of iodized salt in Saudi Arabia.

Pattern of diabetic foot lesions in Saudi Arabia: Experience from King Khalid University Hospital, Riyadh.

A retrospective study was carried out to estimate the magnitude and pattern of foot lesions seen in diabetics living in Saudi Arabia. A review of the records of 1010 diabetic patients seen at King Khalid University Hospital, Riyadh, revealed an overall prevalence of 10.4% for diabetic foot lesions. Of these, 88 patients were further characterized; 55 (62.5%) were males and 33 (37.5%) were females. Seventy-five patients (85.2%) were Saudis and 13 (14.8%) were non-Saudis. The average age was 58 years. Eighty-five patients had type 2 diabetes and three had type 1. The spectrum of foot lesions included: 10 cases of cellulitis, 33 cases of ulcers, 29 cases of gangrene, and 16 cases of abscess. Evidence of peripheral vascular disease was present in 48 patients (54.5%) while peripheral neuropathy was found in 43 (48.8%). Surgical debridement with prolonged dressing was done in 58 patients (66%) while amputation was performed in 30 (34.1%). The average hospitalization was 6.8 weeks. Diabetic foot lesions constitute a major complication of this disease in Saudi Arabia. The high amputation rate is a source of concern and improved techniques are urgently needed to reduce this serious outcome.

Hashimoto's thyroiditis presenting as hot and cold nodules.

A case of Hashimoto's thyroiditis is presented. I-123 thyroid scintigraphy demonstrated a hot nodule in the left lobe and a cold nodule in the right, which was well visualized by Tl-201 imaging. This unusual scintigraphic appearance is demonstrated, and its possible explanation discussed.

Diagnostic algorithm for atrial fibrillation caused by occult hyperthyroidism.

Occult hyperthyroidism, a subclinical thyrotoxic state, is not readily identifiable clinically or through routine thyroid function tests. "Idiopathic" atrial fibrillation may be a manifestation of occult hyperthyroidism in the elderly. A normal response on a TRH stimulation test excludes this diagnosis. A blunted TSH response, coupled with elevation of free thyroid hormones and a high radioactive iodine uptake, will settle the diagnosis. Patients with occult hyperthyroidism frequently have toxic adenomas or nonpalpable nodular goiters, and treatment is best achieved with radioactive iodine ablation.

Prolapse of the mitral valve in hyperthyroid patients in Saudi Arabia.

Eighty-two patients (60 females and 22 males) who were under treatment for hyperthyroidism at the King Saud University affiliated hospitals in Riyadh, Saudi Arabia, were evaluated by M-mode and cross-sectional echocardiography for the presence of mitral valve prolapse. Sixty-seven patients (51 females and 16 males) had diffuse toxic goitre while 15 of them (9 females and 6 males) had nodular toxic goitre. The overall frequency of prolapse was 37.8% (31 of 82) and the frequency was similar for both sexes, being 38.3% in females and 36.3% in males. Prolapse was associated with both diffuse toxic goitre (overall frequency 35.8%) and nodular toxic goitre (overall frequency 46.6%); and the highest frequency was in females with nodular toxic goitre (55.5%). Out of the total of 31 patients with prolapse, early systolic and holosystolic prolapse were each present in 12 patients, while mid-to-late systolic prolapse was found in 7 patients. Cross-sectional echocardiography demonstrated prolapse in 16 cases, the M-mode was positive in 5 cases while the two methods confirmed it in 10 patients. The prevalence of prolapse of the mitral valve in otherwise healthy Saudi subjects has previously been found to be 12-15%. This study has confirmed a high frequency of prolapse in hyperthyroid patients and has demonstrated that sex, ethnic or racial origin and type of hyperthyroidism are not determinants of this association.