مجله غدد درون ریز و متابولیسم ایران
سال چهارم شماره 3 (پیاپی 15، پائیز 1381)

Screening for congenital hypothyroidism (CH) was re-established in Iran in 1998 following elimination of iodine deficiency. The incidence of CH and its etiologic factors in addition to some demographic features of the screened neonates were assessed. From 21 February 1998 to 21 June 2001 cord blood spot samples from 8 hospitals and a rural birth center were collected and tested for TSH measurement using a two-site IRMA method. TSH values  20 mU/mL were recalled. The diagnosis of CH was confirmed using age adjusted reference values for serum TSH and T4 levels and replacement L-T4 therapy, 10-15 g/kg/d, started promptly. Out of 20107 screened neonates 256 had cord TSH values 20 U/mL (recall rate: 1.3%) and 22 showed hypothyroidism (1: 914 live births). Median iodine excretion levels of 50 recalled neonates and 47 mothers were 37.5 and 21 g/dl, respectively. History of drugs and dietary goitrogens was negative. 15 out of 21 CH neonates had parental consanguinity. The odds ratio of CH occurrence in blood-related to non-related marriages was 6.9 (95% CI = 1.82-25.87) and the risk of CH in consanguineous marriages was 0.0036. Thyroid dysgenesis occurred in 10 neonates 1: 2011 births. There is a high incidence of CH and thyroid dysgenesis in Islamic Republic of Iran. Consanguineous marriages could be considered a probable causative factor for the increased incidence of CH in the study.

Increased prevalence of thyroid cancer has been noted in patients with a previous history of radiotherapy of the head and neck region in childhood. According to previous research, radiotherapy for Tinea Capitis was used for 30 years (1945-1975) in Khorasan province. This study has tried to evaluate the prevalence of benign and malignant thyroid nodules and to detect and treat affected patients earlier to prevent further complications and costs. Using mass media, we recalled all patients with history of radiotherapy for Tinea Capitis in childhood. A questionnaire was filled out for each patient and thyroid examination, thyroid scan and thyroid sonography were performed. Fine needle aspiration biopsy (FNAB) was done if a thyroid nodule larger than 1 cm was palpable. Serum TSH was measured in all patients. Also thyroid surgery was recommended for all patients with thyroid nodules of more than 1 cm. A control group were selected from a group of patients referred for non thyroidal sonography to the radiology department of Ghaem Hospital. These patients also were evaluated by clinical examination and thyroid sonography. We studied 180 patients with a mean age of 47.5 years and 127, age and sex matched controls. Thyroid nodules were palpable in 45.5% of patients and 7% of controls (p<0.01). Ultrasonography also detected thyroid nodules in 51.2% of patients and 26.1% of the controls (p<0.01). The largest mean diameter of nodules were 24.8 mm in patients and 10.8 mm in the control group (p<0.001). 73.1% of patients agreed to FNAB and 5% of them had suspicious cytology results. No suspicious or malignant results were noted in the control group. Twenty-seven patients (33.7%) were operated. Pathological results were benign in 89.9% and malignant in 11.1% of patients. This study showed that thyroid nodules and thyroid neoplasm were significantly more frequent in patients in comparison with control group, the thyroid nodules being larger in size in the patient group. Thyroid neoplasms were more frequent among younger patients with a latent period (from radiotherapy) of less than 40 years. Aggressive evaluation is recommended in these groups.

Considering existing controversies regarding an association between vitiligo and thyroid dysfunction, this study was conducted among patients afflicted with vitiligo and a control group in Tehran-2001.

This was an analytical case-control study carried out on 30 individuals of whom those whose disease had begun, at least one year ago, were registered as cases and some information such as age, sex, duration and rate of skin involvement, also symptoms and signs of thyroid disease was documented. Thirty individuals referring to dermatology clinics for complications other than vitiligo were considered as the control group (age and sex were matched with patient\'s group). Both patients and control groups were assessed for T3, T4, TSH, T3RU and FTI was calculated. Then hypo-hyper- and euthyroids were determined based on FTI and T3 (For T3 Hyperthyroidism) levels and findings were analyzed by statistical methods (T test, chi-square, fisher test).

Each study group consisted of 30 people (73% female, 27% male) with a mean age of 31.7±11.4 in patient group and 31.7±11.2 in control group. Duration of disease was 8.3 ± 2.4 years and rate of skin involvement was 22.4 ± 12.5 % only one of them showing signs and symptoms of hyperthyroidism. T3 levels were 1.5 ± 0.54 ng/dl in the patient group and 1.4 ± 0.47 ng/ dl in control group. T4 level was 8.8 ± 2.8 in the patient group and 7.53 ± 0.32 µg/dl in the control group. TSH level was 0.75 ± 0.5 in the patient group and 0.81 ± 0.5 µ unit /ml in the control group. T3RU in the patient group was 31.2 ± 3.2 % and in control group was 29.8 ± 4.2% and FTI 2.8 ± 0.97 in patient group and 2.5 ± 0.55 in the control group. Based on FTI, there are 16.6% thyroid dysfunctions among patients with vitiligo consisting of 10% hyperthyroidism and 6.6% hyperthyroidism. There was no T3 hyperthyroidism, based on T3 levels. In the control group there were no cases of thyroid dysfunction.

This study demonstrated that vitiligo seems to have an association with thyroid dysfunctions (hypo & hyperthyroidism). To confirm this, further studies with larger sample sizes and complementary lab tests are recommended. In future, patients with vitiligo will be evaluated for thyroid dysfunctions in a periodical manner and if necessary be treated to prevent occurence of complications of thyroid disease.

Diagnosis of thyroid lesions at the time of operation can help the physician in decision making to select appropriate treatment and to prevent total thyroidectoy and its complications. Using intraoperative cytology and frozen section prepare this opportunity. The main aim of this study is the assessment of the diagnostic value study of intra operative cytology (IOC) as an alternative to Frozen section (FS) in thyroid lesions. This is a cross-sectional study, conducted in 2000, on 126 thyroidectomy specimens in Alzahra hospital. 3 slides, one by frozen section, one by touch print after fixation, and another by paraffin section (PS) were prepared. FS and IOC results were compared with those of PS. Sensitivity and specificity of FS for neoplastic lesions were 79, 97%, and for nonneoplastic lesions 97% and 79%. The validity of FS for neoplastic and nonneoplastic lesions was 77 percent. Sensitivity and specificity of IOC for neoplastic were 79, 91% and for nonneoplastic lesions 91 and 79%, and validity for neoplastic and nonneoplastic 71 and 73% respectively. FS and IOC have equal sensitivity and specificity in diagnosis of neoplastic and nonneoplatic lesions and FS can be replaced by IOC.

Hypertension in one of the aggravating factors for cardiovascular complications among diabetics, which in turn leads to increased mortality among these patients. This study investigated the annual and 5-year incidence rate of hypertension in type 2 diabetic patients referring to Isfahan Endocrine and Metabolism Research Center (IEMRC).

In a prospective study, all type 2 diabetic patients with normal blood pressure, who were referred to IEMRC in 1995, underwent investigation. Age, sex, weight, height, serum cholesterol, triglycerides and HbA1c and urine protein were measured and the results recorded in addition to the history of smoking and the duration of diabetes. All measurements (including blood pressure, ophthalmologic exam) were repeated every 6 months for 5 years.

Of 770 patients, 174 (23%) were excluded because of high blood pressure at their first visit. The 5-year incidence rate was 41.5%. The mean±SD of BMI and age in hypertensive vs normotensive patients were 27.8±3.8 vs 26.2±3.8 kg/m2 (p<0.05), 52.6±10 vs 45.6±10 years (p<0.05), respectively. Differences observed among other variables were not significant. Presence of retinopathy and proteinuria at base line causes significant increase in the 5-year incidence of hypertension.

The incidence of hypertension in type 2 diabetic patients is higher in our society as compared with that seen in other studies. Age, duration of the diabetes and BMI affect the incidence of hypertension. Retinopathy and proteinuria are important risk factors of hypertension among our patients.

Type 1 diabetes is believed to be an autoimmune disease. Pancreatic islet cell destruction occurs by infiltration of T lymphocytes. BCG vaccine modulates the development of type 1 diabetes in animal models. Based upon the studies in animals and man a clinical trial using a single dose of BCG vaccine was carried out in newly diagnosed type 1 diabetic patients. Ten newly diagnosed type 1 diabetic patients 4-14 years of age, were enrolled in this study. All patients had been vaccinated with BCG at birth. PPD positive patients and those with other autoimmune diseases were excluded from this study. Single dose of BCG (0.1 ml of 1 mg/ml) was administered intracutaneously to all patients. Ten newly diagnosed type 1 diabetic patients matched for age and sex were also followed as the control group. All patients were followed with fasting blood sugar, HbA1c and the needed insulin per kg of body weight for nine months. There was no significant difference in fasting sugar, insulin dose & HbA1c levels at any time between the BCG-vaccinated and control groups. Our study does not support the effect of BCG therapy in this group of diabetic patients.

Congenital adrenal hyperplasia (CAH) is due to a group of enzymatic defects in the synthesis of cortisol from cholesterol. To review all the files, patients with CAH who were referred to us between 1968 to 2001 were studied. Diagnosis was based on measurement of 24-hour urine 17 ketosteroids and pregnanetriol, 17 hydroxycorticosteroids (Porter Silber method). Thereafter it made using the assessment of serum 17OH-progesterone, serum cortisol, ACTH, aldosterone, Plasma renin activity, dehydroepiandrosterone sulfate and androstenedione by radioimmunoassay method. Of 433 patients (270 girls, 163 boys), 347 (80.1%) (226 girls, 121 boys) were diagnosed as having 21 hydroxylase deficiency (21OHD) 260 (75%) were salt waster, 76 (22%) had simple virilizing and 11 girls (3%) had late onset type. Sixty-three (14.5%) had 11 hydroxylase deficiencie, 11 (2.5%) had 3βhydroxysteroid dehydrogenase deficiency, 3 (0.7%) lipoid adrenal hyperplasia, 5 girls (1.2%) 17-hydroxylase deficiency and 4 patients (0.9%) had hyperreninemic hypoaldosteronism. Parental consanguinity was reported in 134 (61%) of 218. Family occurrence was noticed in 79 (43%) of 184 patients. Twenty-one of 85 patients had no virilization, 11 had grade 5 of Prader staging. Three patients with grade 4 virilism had normal electrolytes and high PRA, compatible with simple virilizing type of 21OHD. Two patients have had pregnancy. Final Height (FH) was 184 cm in the affected boys and 168 cm in the girls. Mortality rate reduced from 10% in 1985 to 1% thereafter, mostly due to providing guidelines for stress confrontation, to the patients. The most common type of CAH is the salt wasting type of 21OHD. FH became completely normal with good control of the disease and the mortality rate decreased after giving stress guidelines to the parents.

This article reports the cliniopathologic findings of an unusual case of granulosa cell tumor with androgenic manifestations in a 16-year-old girl. The patient presented with a 2-year history of amenorrhea. Physical examination revealed an increase in facial, chest and abdominal hair with breast atrophy and horseness of voice. Pelvic ultrasound demonstrated a 87x85x66mm left adnexal cyst. Plasma testosterone and 17-hydroxy progesterone levels were elevated. She underwent an exploratory laparotomy in which a left ovarian tumor, 8cm in diameter was found and extracted. Microscopic examination of the tumor revealed the typical features of a granulosa cell tumor of the ovary. Two months after surgery, plasma testosterone and 17-hydroxy progesterone levels were within the normal range and the patient had a regular menstrual cycle. To our knowledge, this represents the first case of a granulosa cell tumor with androgenic manifestations reported in Iranian literature.