مجله غدد درون ریز و متابولیسم ایران
سال دوازدهم شماره 5 (پیاپی 53، دی 1389)

The aim of this article is to review current information documented on antithyroid drug induced vasculitis.

MEDLINE was searched for studies between 1960 and 2009 with the key words “antithyroid drugs and vasculitis”, “antithyroid drugs and diffuse alveolar hemorrhage”, and “antithyroid drugs and glumerolonephritis”.

Ninety-two articles met the selection criteria. The data obtained showed that 15 to 46% of patients treated with propylthiouracil (PTU) developed anti-neutrophil cytoplasmic antibody (ANCA), in contrast to 0 to 3% of the patients treated with methimazole (MMI), the former being the most often reported for causing vasculitis, a disease seen most commonly in association with Graves’ disease. Signs of PTU-induced vasculitis include fever, malaise, anemia, lymphadenopathy, skin lesions, arthralgia, hematuria/proteinuria, diffuse alveolar hemorrhage (DAH), pleural effusion, and crescentic glomerulonephritis. Once PTU-induced vasculitis is determined, the simple withdrawal of PTU usually causes resolution of the symptoms within 1-4 weeks. Overall prognosis of antithyroid drug-induced vasculitis is much better than that of primary vasculitis.

Antithyroid medications such as PTU can induce (ANCA)-associated vasculitis. Its pathogenesis might be multifactorial. Diagnosis is based on the relationship between clinical vasculitis, and the antithyroid drugs prescribed, and the excluding of any other medical states that mimic vasculitis. After the diagnosis, antithyroid drugs should be discontinued immediately, and the prognosis is usually good.

The major complication of radioiodine therapy for thyrotoxicosis is hypoth-yroidism, the long-term management of which is often problematic. In this study, the long-term effects of continuous methimazole (MMI) therapy are investigated.

One hundred and thirty-two patients, aged between 36-66 years, with Graves recurrence, were semi randomly randomized in 2 groups for continuous antithyroid and radioiodine treatment. The number of thyroid dysfunctions in each patient were recorded and serum TSH, FT4, Anti TPO, TRAb, FBS, HOMA IR, and lipid profiles were measured. Bone mineral density and echocar-diography were performed.

There was no significant differences in age, duration of symptoms and thyroid function between the 2 groups. No serious complications occurred in the MMI group and no difference in any of parameters was seen between groups 1 and 2. Goiter rate and anti TPO concentration were higher in group 1 than in group 2. Serum triglycerides and cholesterol were increased in group 2 as compared to group 1. Bone mineral density was more reduced in group 2, especially in the spine. Echocardiography showed diastolic dysfunction in group 2 as compared to group 1. Some parameters in neuro-pschyciatric evaluation were significantly better in the MMI group, as compared to the radioiodine one.

Considering it is a safe treatment and has fewer complications, methimazole is another option for patients with recurrent Graves', who do not wish to use radioiodine.

The aim of this study was to estimate the prevalence of overweight and obesity and physical fitness in Shiraz adolescents. This cross-sectional study was performed on 808 (boys) students, 14-16 years old. The subjects were selected via a step wise random sampling. Height and weight of the subjects were measured by standard methods and body mass index (BMI) was calculated. Overweight and obesity were defined on the 85th and 95th percentiles of BMI for age and sex, respectively, as proposed by CDC. Physical fitness of the subjects were measured by sit-up, modified pull-up, sit-and-reach, 540 m running, 45 m running and 4 × 9 m shuttle run test. The prevalences of overweight in 14, 15 and 16 year old students were 13.4%, 9.2% and 7.8% respectively and the prevalences of obesity were 7.8%, 5.9% and 4.4% respectively. The results showed that the physical fitness had a tendency to decrease as body fat percent and BMI increased. The prevalence of overweight and obesity in Shiraz adolescents are higher than in some other areas of the Iran and the world and obesity increases among adolescents during the early years. There were inverse relationships between physical fitness levels with body fat percent and BMI, findings that emphasize exercise for overweight and obese adolescents.

This study aims at determining the trends of the prevalence of overweight and hypertension among adolescents in three cross-sectional surveys of Tehran Lipid and Glucose Study (TLGS). We analyzed the data of adolescents, aged 10-19 years, obtained in the three surveys of the TLGS; survey 1, 1999-2001(n=3010, 47.2% boys); survey 2, 2002-5(n=1107, 48.4% boys), and survey 3, 2006-8 (n=1090, 46.6% boys). At risk for overweight and overweight were defined according to Iranian BMI percentiles. Hypertension was defined according to the fourth report on the Diagnosis, Evaluation and Treatment of High Blood Pressure (BP), American Academy of Pediatrics and charts of the Centers for Disease Control and Prevention. Mean BMI of adolescents increased from 20.1(4.3) in survey 1 to 21.6(4.7) kg/m2 in survey 3(P<0.001). The adjusted prevalence of at risk for overweight, in the first and third surveys of study increased respectively from 12.8% to 18.5% (P<0.001) and the prevalence of overweight increased from 6.4 to 12.7% respectively (P<0.001). The mean systolic BP and diastolic BP decreased from 105(11), 71.4(9.2) in the first survey to 100(12), 65.4(9.8) mmHg in the third, respectively (P<0.001). The prevalence of high systolic BP and diastolic BP decreased from 3 and 7.9% in 1999-2001 to 1.3 and 3% in 2006-8, respectively. The age adjusted means of SBP and DBP increased respectively in underweight, normal, at risk for overweight and overweight adolescents (P<0.01). The increment of "overweight prevalence" was greater than "at risk for overweight". The prevalence of high systolic and diastolic BP decreased over the three surveys.

Non-alcoholic fatty liver disease(NAFLD) is a denomination that encompasses clinical and pathological spectrums, ranging from simple steatosis to Non-alcoholic steatohepatitis (NASH), fibrosis and cirrhosis. Considering the importance of obesity as a risk factor of this disease and oxidative stress, as an effective factor in pathogenesis, coupled with inflamation and its progression to non-alcoholic steatohepatitis, this study was conducted to investigate the rate of overweight and obesity and oxidative stress status in patients with nonalcoholic fatty liver disease. In this case-control study, 50 NAFLD patients and 48 healthy controls were enrolled. Antropometric measurements were taken, according to standard protocol. Serum hepatic enzymes, lipid profile and total antioxidant capacity (TAC) were determined by the auto analyzer and Serum malondialdehyde (MDA) was measured by the feluorimetry method. Data was analyzed by SPSS (version 11.5), and statistical tests such as T-test and Chi-square were used. Correlations were performed using Pearson's correlation coefficient. Mean BMI was significantly higher in NAFLD patients, compared to controls. There was no significant difference between the two groups in relation to mean serum levels of MDA (p=0.1). In contrast, the mean serum levels of TAC was significantly lower in patients than in controls (p=0.02). Based on this study, combating overweight and obesity seems to be a preventive strategy for healthy people, thereby forestalling the progression of this disease. Furthermore, considering the lower level of TAC in NAFLD patients, the use of antioxidant-rich foods and supplements can be therapeutically valuable.

Short stature is one of the common problems in children. One of the common forms of short stature is Constitutional. Usually early diagnosis and treatment is worthwhile. We studied children with Constitutional short stature who came to the out-patient clinic of Pediatric Endocrinology in Loghman hospital between 2002 and 2008. Their final height has evaluated after puberty. SDS for the first and final height of the patients and their parent's height was calculated. Forty-nine patients (35 boys and 14 girls) were studied. Mean chronological age at the time of referral was 13.4±1.4 years, mean delay of the bone age 2.6±1.4 years, mean height 141.9±7.5 cm, mean SDS of the first height -2.69±0.69, mean parental height 163.8±3.9 cm and SDS for parental height was -0.85±0.47. Mean age at the time of evaluating final height was 18.7±0.5 years and mean SDS for the final height was -1.23±0.89 cm. All patients in our study reached their excepted final height. In this study final height of 9 patients (18.4%) was over 2 standard deviation lower than the mean of the community. Although, all of the patients reached to the normal range of final height, it was in the lower limit of the range. It seems medical interventions could be implemented for patients, whose first height was much lower than the mean.

Since the prevalence and severity of childhood obesity is increasing, understanding the effective factors for prevention of this disorder is important. A total of 513 students of both sexes in the first year of primary schools, were recruited in this cross-sectional study. They were chosen randomly from 19 regions (of the ministry of education) from Tehran city. Their weight and height were measured, and information on infant birth and feeding characteristics (birth order, birth weight, the type of feeding in infancy, the duration of exclusive breast feeding, the duration of breast feeding and formula feeding) activity levels, the timing of the introduction of complementary foods were obtained. Descriptive statistical methods such as frequency distribution table, c2 test and central and dispersion parameters were used to describe samples. Eight percent of the children were overweight and 11.7% were obese. There was no significant relation between the type of feeding (breast or formula feeding) and children's BMI. The duration of breast feeding was not significantly associated with children's BMI,. Children's BMI had a negative linear association with the duration of exclusive breast feeding (r=-0.151, P=0.0001). The duration of formula feeding was associated with children's BMI (r=0.108, P=0.007). Children's BMI had an inverse linear relation with the time of introduction of complementary foods (r=-0.128, P=0.002). This study shows the importance of duration of breast feeding in reducing the risk of childhood obesity.

Vitamin D deficiency is prevalent worldwide. Low 25 hydroxyvitamin D3 concentrations inversely associated with type 2 diabetes, metabolic syndrome and insulin resistance. The aim of this study was the evaluation of effects of oral 1, 25 (OH) 2D3(calcitriol) treatments on glycemic control and lipid profiles in patients with type 2 diabetes. Methods and Materials: This was an interventional study, conducted in Ghaem Hospital, Mashhad, Iran on 58 type 2 diabetic patients. Patients underwent calcitriol treatment with 0.5 microgram per day for 8 weeks. In all cases, clinical parameters including weight, systolic and diastolic blood pressure and laboratory parameters including levels of fasting blood glucose, insulin, lipid profile, calcium, phosphorous, HbA1C and insulin resistance (HOMA-IR) were measured, before and after the treatment period. The two sets of results were then compared with one another. Following treatment with calcitriol, FBS, HbA1C, Cholesterol, triglycerides and insulin resistance decreased but the changes were not significant (p>0.05). LDL and diastolic blood pressure decreased significantly after treatment with calcitriol. (p=0.02 and 0.04 respectively). Supplementation with active form of vitamin D did not have a significant effect on glycemic control but may be effective in control of hyperlipidemia and blood pressure in type 2 diabetic patients, findings which need to be confirmed in large randomized trials

In cross-sectional studies, low serum levels of 25-hydroxyvitamin D are associated with a higher prevalence of cardiovascular risk factors. This study aimed to determine whether vitamin D deficiency is related to cardiovascular disease. This nested case-control study was performed within the framework of a population-based Cohort study (Tehran Lipid and Glucose Study, TLGS) among male and female participants, aged 30 years or older (mean [SD] age, 56.7 [10.6] years), free of diagnosed cardiovascular disease at initial blood collection. Using risk set sampling, controls (n=251) were selected in a 1:1 ratio and matched for age, sex and date of blood collection. We measured serum 25-hydroxyvitamin D levels in serum specimens, kept at -80°C until assay. Median serum 25(OH)D was significantly lower in the CVD group than in controls (p<0.001). For 25(OH)D values of less than 10 ng/ml, compared with values more than 20 ng/ml (reference), the multivariable-adjusted OR (with 95% confidence intervals) for incident cardiovascular events was 3.21 (1.75-5.88). Low levels of 25(OH)D are independently associated with higher risk of cardiovascular events in a graded manner, even after adjustment for factors known to be associated with coronary artery disease.

Ghrelin, an orexigenic peptide secreted from stomach mucosa, affects feeding behavior and plays an important role in energy balance and glucose homeostasis. Ample evidence indicates that resistance exercise is a key component of exercise recommendations for weight control. The purpose of the current study was to determine the effects of resistance training (4 weeks) on resting levels of plasma ghrelin, glucose, insulin and estrogen. Twenty-seven female college students, aged 22±1.54 years, height 162.66± 5.05 cm, BMI 20.76±1.86 kg/m2 and fat percent 20.95±2.08% (means ± SE) were randomized into two, the experimental (40% and 80% 1RM) and the control groups. Subjects performed circuit-resistance exercise protocol with 40% and 80% 1RM, 4 d/wk for 4 weeks. Blood samples were collected 24 hours before and 48 hours after the training program. One-way ANOVA revealed that although no significant differences were observed in circulating levels of plasma total ghrelin (P=0.88), glucose (P=0.1) and insulin (P=0.66) in the experimental group when compared to the control group, a significant negative correlation (R=-0.4, P=0.05) was found between plasma estrogen and total ghrelin levels. It seems that because of a non significant increase in plasma ghrelin levels in the present study, there was no weight change of subjects during the training program and the short duration of the training program. However, the total ghrelin sub-fractions, acylated and non acylated, may have changed.

Inflammation plays an essential role in the insulin resistance process, and chemokines, such as chemerin, seem to play a pivotal role in the pathogenesis of insulin resistance. In this study we examined the effects of 12 weeks strength training on serum chemerin, CRP and TNF-α level in association with cardiometabolic risk factors, (age: 45.25±4.3 yr, body mass index: 29.53±1.32 kg/m2) in subjects with the metabolic syndrome. Twenty-one subjects with the metabolic syndrome were randomly assigned to strength training (n= 11) and control (n= 10) groups. Strength training was performed 3 times weekly for 12 weeks. Body composition (computed tomography), metabolic and inflammatory parameters were measured prior to and after the intervention. After a 12 week strength training, fasting glucose, insulin resistance index (HOMA-IR), total cholesterol, LDL-cholesterol, triglycerides and abdominal fat (visceral fat) were significantly decreased (p<0.05). Concurrently, chemerin and CRP concentrations were significantly decreased in response to strength training (p<0.05), but TNF-α remained unchanged (p>0.05). This study demonstrated that 12 weeks of strength training caused an improvement in cardiometabolic risk factors in subjects with the metabolic syndrome, and this improvement was associated with decreased chemerin and CRP levels (inflammatory markers).

Diabetic ulcers especially foot ulcers and the delay in their healing is a major problem faced by most diabetic patients. Based on data available on the positive role of estrogen in accelerating wound healing, this research aimed at assessing the possible effect of topical estrogen on wound healing in diabetic rats. Sixty-six male wistar rats were divided into two groups (normal and diabetic) and each group was divided into 3 subgroups (control, sham and test). A circular full- thickness wound with a diameter of 1.5 cm was created on the backs of streptozotocin(stz)- induced diabetic and intact rats. In the test subgroup, the wounds were treated with a daily topical dose of 0.5 mg estrogen and in the sham subgroup, gentamicin ointment (dose 0.5 g) was used. The process of wound healing was assessed by macroscopic and microscopic studies on days 3, 5, 7, 14, 21, and 28. The macroscopic study, showed delays in healing of the diabetic group in comparison with the normal group and after the seventh day, wound healing showed considerable change in the test subgroup in both normal and diabetic rats (p<0.05). In the normal group microscopic study, the only parameter which did not show any differerence was granulation tissue organization; however increasing of neoangiogenesis and re-epithelization was observed in the test subgroup. Also, in the diabetic group, the estrogen receiving subgroup showed impressive improvement compared to the sham subgroup. Topical that estrogen can accelerate the process healing of diabetic wounds.