مجله غدد درون ریز و متابولیسم ایران
سال هفتم شماره 1 (پیاپی 25، بهار 1384)

The present study was conducted after 10 years of Universal Salt Iodization (USI) in Iran, to assess goiter prevalence in Gorgan.

From April to June 2003, 1400 (500 female and 900 male) children aged 7-11 years, from 12 randomly selected schools in Gorgan, were enrolled for goiter assessment by palpation. Morning spot samples were obtained from 101 female and 82 male children for urinary iodine concentration (UIC) by digestion method.

Goiter was detected in 370 (26. 4%), 173 (34. 6%) female, and 197 (21. 9%) male children. Goiter rates in 9, 10, and 11-year females were 31, 37, and 52%, which were higher than those seen in males, of the same age, being 17. 2, 20, and 23. 3% (p values < 0. 012, < 0. 003, and < 0. 0001), respectively. The greatest odds ratio (95% confidence interval [95%CI]) was obtained in 11 year-old children (odds ratio 4. 7, 95%CI 2. 71-8.). Median (range 95%CI) UIC level in children was 190 (20-600, 190-230) µg/L. Corresponding values in males were 220 (30-590, 212-261) µg/L and in females were 170 (20-600, 190-230) µg/L, respectively (p = 0. 001). UIC < 50 and < 100 µg/L was present in 4 (2. 2%) and 16 (8.7%) goitrous children. UIC < 100 µg/L was more prevalent in 10-11 year-old girls than in boys of the same age (p=0.02) or in younger girls (p = 0. 03). Among goitrous children, 86 (47%) had UIC ≥ 200 µg/L. Nine (22%) of 10-11 year-old goitrous females had UIC < 100 µg/L.

According to UIC values, Gorgan is considered an iodine sufficient area, but it seems that some 10-11 year old females are at risk low iodine intake. Assessment of goiter, iodine intake, and hormonal changes in adolescents are recommended.

The issue of hypothyroidism following thyroidectomy is still under debate. Currently all patients receive thyroid hormones while most of them really do not require such treatment. This study looks at the incidence of hypothyroidism among patients who underwent thyroidectomy in a major referral hospital and examines possible risk factors.

102 patients who underwent thyroidectomy in Shariati Hospital were investigated for their thyroid function profile on five occasions: just before surgery and after surgery and then three times, on a 3-monthly interval, for one year. All patients whose tests indicated hypothyroidism, were given hormone replacement therapy. The treatment continued for 3 months after normalization of the tests.

Thirty men and 72 women were included in this study. Mean age of participants was 39±13.6 years (males: 40.5±14.2 and females: 38.4±5.1 years). Thirty-six patients developed hypothyroidism (35.2%) occurring on an average 5±3.2 months after surgery. Increased weight, operation type, histopathologic type (Grave's disease and adenomatous goiter), underlying diseases (Grave's disease and toxic multinodular goiter) and their duration, lymphocytic infiltration and use of levothyroxine before surgery were found to be associated with the incidence of hypothyroidism. On the contrary, no association between the occurrence of hypothyroidism and gender, grade of thyromegaly, post-surgical complications or immediate pre-surgical TSH level was seen.

The investigation can serve as a pilot study for more extensive studies examing the issue in the future. Indicators such as Grave's disease and lymphocytic infiltration in pathologic specimens may be used to predict the occurrence of hypothyroidism in patients undergoing thyroidectomy and limit the unnecessary usage of thyroid hormones.

Thyroid nodules are common clinical problems, their importance being due to the possibility of malignancy. Fine needle aspiration cytology-FNAC is widely accepted as a simple, safe and accurate test in the assessment of nodular thyroid disease. Several studies based on different methodologies have reported different sensitivity, specificity, positive and negative predictive values and diagnostic accuracy for thyroid FNAC. In this retrospective study, 1397 FNAC cases (1242 female, 155 male, F/M=8) with an age range of 7-85 years, were reviewed for an 8-year duration in the pathology department of the Bandar-Abbas Medical School. The cytologic results were categorized in 5 groups: inadequate, suboptimal, benign, malignant and suspicious. In 101 cases (88 female, 13 male, F/M=7) with age range of 17-70 years, slides of thyroidectomy specimens were prepared. Evaluation of FNAC specimens, revealed 11.3% nondiagnostic cases(including inadequate 5.4% and suboptimal specimens 5.9%). Other cytologic groups were: benign- 75.2%, malignant- 3.8% and suspicious nodules- 9.7%. Final histopathologic diagnoses were benign in 65.3% and malignant in 34.7% of nodule specimens. The most common benign lesions were adenomatous and colloid goiter and the most common malignancy was papillary carcinoma. For evaluation of diagnostic value of thyroid FNAC, malignant and suspicious cases were considered as positive cytologic results and final malignant diagnoses (excluding occult papillary thyroid carcinoma) as positive histopathologic results. The sensitivity of thyroid FNAC was 91%, specificity 67%, positive and negative predictive values 58% and 94% respectively and the diagnostic accuracy 75%. FNAC has an acceptable diagnostic accuracy in the assessment of thyroid nodules and screening of patients for thyroidectomy but in areas with high prevalence of follicular lesions, because of the limitation of FNAC to differentiate follicular lesions, specificity and positive predictive value are decreased. FNAC however is useful only as an adjunct to clinical judgment and not as a replacement.

Thyroid nodules are frequent occurrences, and whenever diagnosed, it is necessary to rule out of malignancy. Valuable diagnostic methods in this field are sonography and fine needle aspiration. In this study while investigating these two methods, we compared them with postsurgical pathologic findings. This is a cross sectional, descriptive-analytical study. Data for this study has been collected during 3 years from 2000 to 2002 in Alzahra hospital of Isfahan university. In 96 palpable thyroid nodules, the correlation between color doppler sonography and fine needle aspiration with postsurgical pathology results were compared. The correlation, sensitivity and specificity were calculated. Out of 96 cases, in 64 cases (66. 6%) the results for sonography and FNA were similar to those of postsurgical pathology. In 79 cases (82. 3%), the sonography results were similar to those of postsurgical pathology. In 72 cases (75%) the results of cytology were similar to those of pathology. Regarding neoplastic lesions the rates of association of the two methods, sonography and cytology, with results after surgery are respectively 17. 7% and 23. 9%. Regarding non-neoplastic lesions, the rates of association for sonograply and cytology with postsurgical pathology are respectively 64. 5% and 51%. Cytologic methods cannot be used to differentiate between adenomatoid goiters and follicular neoplasms, whereas color doppler sonography shows the peripheral hypoechoic halo of capsule, and the number of lesions, and can differentiate the two entities.

Obesity is one of the most important public health problems of adolescents in developed countries. Recently, the prevalence of obesity has increased dramatically among adolescents of developing countries as a result of changes in life style and rapid urbanization of societies. As data on the prevalence of obesity in adolescents is very sparse in Iran, the present study was conducted between 2000-2001 in high school girls, aged 14-17 years, living in Lahijan to determine the relationship between obesity and fat distribution with food consumption patterns. In this descriptive-analytical study, 400 students were selected by random stratified sampling from 12 schools. Data were collected on demographic status, 24-hour dietary recall, food habits and food frequency questionnaires for all subjects. Weight, height, waist and hip circumferences were measured and BMI and WHR were calculated. BMIs at or above the 85th and 95th percentiles for age and sex (based on WHO standard) were classified as overweight and obese, respectively. Also, WHR of 0. 8 or greater was considered as central obesity. Data were analysed by the SPSS program and independent t-test, chi-square, Pearson correlation and ANOVA tests. The prevalences of obesity and overweight were 5. 3% and 14. 8%, respectively. 21. 5% of subjects and 66. 7% of obese girls had a central pattern of fat distribution. Mean energy, carbohydrate and fat intakes were significantly higher for overweight/obese girls than for under weight and normal weight girls (p<0. 0001). Results showed that an increase in the consumption of fattening and refined foods plays an important role in increasing energy consumption and prevalence of obesity in adolescents. Also, in obese adolescents, fat deposition occurs in the body’s central regions. Considering that central obesity has been associated with an increased risk of cardiovascular disease, hypertension and diabetes, more attention must be paid to improving the nutritional status and initiating changes in dietary patterns of adolescents through policy making and nutritional education.

Over the last 20 years various studies have been conducted investigating the effect of zinc supplementation on breast milk zinc status the relation however between zinc supplementation and breast milk zinc concentration, specially in areas with marginal zinc deficiency and its effect on growth trends of breast-fed infant is not yet clear. Our aim is to determine the effect of zinc supplementation during the first 6 months of lactation on maternal plasma and breast milk zinc status and the growth trend of these breast-fed infants. This study was a double blinded field trial that was performed in Yazd city. 139 lactating mothers between 5th the 10th day after delivery were randomly categorized in two groups zinc (ZS) and placebo supplemented (P). ZS group received two zinc sulphate capsules weekly, each containing 50 mg zinc element. Blood samples were obtained at the 1st and 6th month of lactation and milk samples were collected monthly up to the 6th month postpartum. Infant anthropometric measurements and the mother’s 24 dietary recalls were also recorded monthly. Milk and plasma zinc concentrations were analyzed by the atomic absorption spectrophotometer method. Data was processed by Spss Win software. Overall maternal compliance for intake of capsules was 92.9% and corresponding figures for the ZS and P groups were 91.1 and 94.4% respectively. The means of mother plasma zinc in the ZS group at 1st and 6th month of lactation were 124.9±52.8 (X ± SD) and 121±27.1 μg /dl (p=0.38) respectively and corresponding means for the P group 134±49. 1 and 115.6±23 μg /dl (p=0.005). The means of milk zinc concentration from months 1-6 in the Z group were 310±138, 226±84, 182±79, 159±73, 111±54, and 118±64 μg /dl respectively and corresponding means for P group were 322±161, 212±90, 152±69, 129±57, 103±66, and 109±70 respectively. The mean monthly milk zinc in each group had a descending trend, but the rate of this decline in the P group had a higher slope than did the ZS group, so that differences between two the groups in the 3rd and 4th months of lactation were significant. Daily zinc and energy intakes for mothers in the Z group were 97% and 76.5% correspinding recommended daily allowonces (RDA) respectively and the corresponding figures for P group were 99% and 74%. In infants of the ZS group 28.3% and in those of the P group, 26.4% of zinc RDA were obtained. In general, during the first 6 months of lactation, infants of the ZS group were 3.6 cm taller than infants of the P group. The relative risk for stunted malnutrition in the two groups after the 3rd month was significant. In this study, zinc supplementation for lactating women increased plasma and milk zinc concentration and linear growth velocity. Therefore, zinc supplementation in the first 6 months of lactation, especially in marginally zinc deficienct areas, can be recommended.

The aim of this study is to determine the prevalence of obesity and overweight in adolescents and changes in prevalence of obesity among an adult population in Shiraz.

From January 2001 to April 2002, a cross sectional study was conducted with a sample population (n: 4048) aged 13-99 years consisting of 803 adolescents (13-18 years) and 3245 adults (> 18 years), selected by systematic random sampling anthropometric measurements including height and weight were taken. BMI was calculated and prevalences of obesity and over weight were determined for each sex by age groups.

Of the study population, 2. 9% of adolescents were obese and 11.3% were over weight. The prevalences of adult obesity and over weight were 11.7% and 33.3% respectively. The means for body mass index were 20.63.8 and 19.43. 4 for girls and boys respectively and 23. 8%±3.8% for men and 25. 3%3.6% for women. The prevalences of obesity and over weight are significantly higher among women obese women and men were more likely to be between 50-59 years of age and the among over weight men and women, a higher percentage were in the 40-49 year group.

This report showed a high percentage of over weight in adolescents the prevalence of obesity among adults has increased in southern Iran from several years ago. Intervention strategies and programs for weight reduction and control should be made a high public health priority.

Drug dependence, especially morphine addiction could markedly change the activity of the hypothalamic-hypophysial (H-H) axis. Thyroid secretion under the influence of H-H axis could play an important role in biological function. The present study was carried out to evaluate the effect of chronic consumption of morphine on thyroid function. For this purpose serum levels of T3, T4 and TSH were measured in male addicted rats. Male wistar rats were used for this investigation. We took the blood from the retroorbital plexus, and following separation of the serum from the blood, T3, T4, and TSH were measured by special kits using the Elisa method (control group, n=50). Control animals received morphine sulfate for 21 days. At the end of 21 days, T3, T4, and TSH were again measured and the levels now introduced as those of the addict group (chronic morphine consumption, n=50). Finally, the addict group were divided into physiologic and pharmacological (post naloxone treatment) withdrawal groups (n=25 for each group). We used naloxone (2 mg/kg, i.p.) for the induction of the pharmacologic withdrawal syndrome and physiologic withdrawal was induced 24 h following discontinuation of morphine consumption. After occurrence of withdrawal signs, again (the animal’s) blood was collected for the mentioned hormone assay. Another group (naloxone pre-treatment group, n=20) received naloxone before morphine consumption. In addicted animals, serum levels of T3 and T4 were decreased by 17. 83 and 39. 15%, respectively and T3UP was augmented to 18. 16%. Post-treatment with naloxone (pharmacological withdrawal) could significantly enhance the decreasing effect of morphine on T3. However, the increasing effect of morphine on T3UP was reduced by naloxone post-treatment. Pre-treatment of animals with naloxone had no significant effect on morphine influence on T3, T4, and TSH. The present study showed that the serum levels of T3 and T4 significantly decrease in chronic morphine consumption. Since no changes in TSH level were observed in addicted rats, factors other than H-H axis could affect the levels of the thyroid hormones. Considering the higher level of T3UP during morphine consumption, the increased synthesis of thyroid binding proteins may be responsible for lower levels of T3 and T4 in addicted rats.

In this study the effects of turpentine powder on the concentration of lipids and lipoproteins of rabbits (as an animal model for human studies) were studied. 30 healthy male rabbits were chosen and then randomly allocated into 6 groups. Different percents of turpentine powder (10% and 100%) and oil compounds like vegetable oil, cholesterol and animal oil were given to each group (5 rabbits each) separately. Blood serum lipid and lipoprotein levels were analysed using routine laboratory methods. Treatment with 10% and 100% turpentine powder had a significant decreasing effect on triglycerides, cholesterol, total lipid, VLDL- cholesterol and LDL- cholesterol (p<0.05) and a significantly increasing effect on HDL- cholesterol (p<0.05). Treatment with 10% vegetable oil had a significantly increasing effect on triglyceride, cholesterol and lipoproteins (LDL, VLDL and HDL) (p<0.05). Following treatment with 10% animal oil, the concentrations of HDL-cholesterol and total lipid decreased significantly (p<0. 05). After treatment with 1% cholesterol, the concentrations of triglycerides, HDL- cholesterol and VLDL-cholesterol significantly decreased (p<0.05), whereas, the concentration of cholesterol and LDL-cholesterol significantly increased (p<0.05). Treatment with turpentine powder has a significantly decreasing effect on the levels of serum lipids and lipoproteins (VLDL-cholesterol and LDL- cholesterol).

Characteristic presentations of MEN1 syndrome include the involvement of parathyroid glands, pancreas & pituitary. In addition to these presentations, adrenocortical lesions, carcinoids, lipoma and angiofibroma may also be seen in these patients. MEN1 could show a variety of clinical presentations in each stage of the disease. One such presentation is Cushings syndrome. Hypercortisolism in the base of MEN1 could be a result of pituitary or nonpituitary causes (adrenal & pancreatic lesions & carcinoid tumors). Thymic carcinoid is a rare malignancy. Although, 25% of all reported cases of this tumor are MEN1 related, as compared to other MEN1 related neoplasia, there is limited information on this condition. This paper describes a 44 year-old man with MEN1, an involvment of pancreas (insulinoma & gastrinoma), pituitary (prolactinoma) and hyperparathyroidism that in the progression of the disease involved in Cushing syndrome from the thymic carcinoid. This paper also reviews literature availabe on the etiology of Cushing’s syndrome.