International Journal of Endocrinology and Metabolism
Volume:8 Issue: 1, Mar 2010

In this study, the cost-benefit of a screening program based on the rial, the unit of currency used, was analyzed. The intelligence quotient (IQ), and height and weight were evaluated as indices for a population of children suffering from congenital hypothyroidism (CH). The total cost for the screening program, including hormone tests, diagnosis, medicine, treatments and care was identified and calculated up to the age of seventy years and this was compared to the costs related to training and caring for patients suffering from mental retardation, who had not been screened. The screening test was done using S&S filter paper and thyroid stimulating hormone (TSH) was determined by the ELISA test.The future costs and benefits with an annual rate of 3% discount of their current value was estimated. To evaluate the effectiveness of the screening program, IQs of 32 patients were identified and compared to 36 healthy children between 2004-2005. The IQs were evaluated according to "Good Enough" and "Proteus Maze" tests. During 2008, 1165169 of 12489136 newborns (51% male, 49% female) underwent screening for CH, 92% cover-age of all newborns for that year. Four percent of recalled infants, with TSH>5 were subjected to diagnostic tests (T4, TSH, T3RU) and finally 2745 patients were identified. Benefit to cost ratios, based on a 3% annual discount rate, were 22, 41, 32, 34, 47 and 60 times lower, respectively. No significant differences were found with regard to diferences in IQ scores between cases and controls (cases: 105±19.3, controls: 111±19.4), height (cases: 106±0.7, controls: 102±4.9 cm) and weight (cases: 15.6±4.6, control 15.3±3.2 kg). The national Newborn Screening (NBS) program for CH has been successful and quite effective in Iran. The method not only has economical advantages but also reduces capital expenditures and preserves normal IQ of the patients under treatment and prevents mental retardation and growth complications.

Hypocalcaemia is one of the more acute complications of total thyroidectomy and occurs after parathyroid injury during surgery. The aim of this study is to assess the incidence rate and risk factors of transient and permanent hypocalcae¬mia in patients who had undergone total thyroi¬dectomy, due to malignant thyroid diseases and to determine the value of parathyroid gland au¬totranplantation in thyroid cancer surgeries. Sixty-five patients, di¬agnosed with thyroid malignancy, who were treated by total thyroidectomy with or without radical neck dissection between 2002 and 2006, were studied retrospectively. Of patients 60% were female (mean age 39.5910.24 years) and 40% were male (mean age 42.11 11.93 years). Complications of total thyroidectomy, perma¬nent and transient hypocalcaemia in particular, were studied. In eleven patients, parathyroids were transplanted within fibers of sternoclei¬domastoid and deltoid muscles. Tran¬sient hypocalcaemia occurred in 18 patients and was treated by intravenous and oral calcium supplements. None of patients progressed to permanent hypocalcaemia. Temporary recurrent laryngeal nerve paresis occurred in 2% of pa¬tients but there was no case of paralysis. There was a significant difference in hypocalcaemia occurrence between patients, who had just total thyroidectomy and those who underwent thy¬roidectomyt with neck dissection (p=0.01). Hypocalcaemia after total thyroi¬dectomy is a serious and dangerous complica-tion, requiring prompt diagnosis and proper treatment. Parathyroid gland transplantation for an injured or incidentally removed parathyroid, between fibers of sternocleidomastoid or deltoid muscles, can prevent the occurrence of perma¬nent hypocalcaemia.

This study aimed at assessing the frequency of latent autoimmune diabetes of adults (LADA) and its laboratory and clinical characteristics at the Diabetic Center of Latakia, Syria. Based on glutamic acid decarboxylase autoantibodies positivity, a population of 254 type 2 diabetic males and females, aged 35 to 75 years, were subdivided and studied in terms of the laboratory and clinical characteristics. Glutamic acid decarboxylase autoantibodies (GADAs) were positive (GADA+) in 45 diabetic patients versus 209 type 2 diabetics with GADA negative (GADA-). In both subgroups, GADA+ and GADA-, no significant differences were observed in terms of anthropometric and clinical features except for body mass index (BMI) which was significantly lower in GADA+ subgroup (27.6±4.8 vs. 29.8±5.9; P= 0.02). Significant poor glycemic control was detected in terms of fasting blood sugar (FBS) (221.6±77.9 vs 182±66.7; P=0.001), glucosuria (60% vs. 41.6%; P=0.025), and ketonuria (22.2% vs. 3.8%; P<0.0001) in LADA patients (GADA+) versus type 2 diabetic patients (GADA-). By subdividing the studied sample into tertiles of type 2 diabetes, GADA- <5 IU/ml, GADA+ ≤50 IU/ml, and GADA+ >50 IU/ml, the tertile with high GADA titers (>50 IU/ml) presented significantly low BMI (P=0.012) and c-peptide levels (P<0.002) in comparison with type 2 and GADA≤ 50 IU/ml tertiles. Overall the prevalence of LADA was 17.7% in the type 2 diabetics studied. LADA patients showed similar laboratory and clinical features as type 2 diabetics, except for low BMI levels and poor glycemic control.

The gastric peptide ghrelin, an endogenous ligand for growth-hormone secretagogue receptor, in its acylated form induces a positive energy balance, increase in food intake and adiposity.This study aimed at determining the effects of treadmill exercise training on fundus Ghrelin mRNA expression, fundus, and plasma acylated Ghrelin concentration in rats. Thirty-six adult Wistar male rats (12-14 weeks old, 200-220g) were randomly divided into the experimental 1 (EX1) (n=16) and experimental 2 (EX2, n=20) groups with further division into control (n=8 and 10) and training (n=8 and 10) groups. Training groups were given exercise on a motor-driven treadmill (28 m/min, 0% grade, 60 min, 5 days/week for 8 weeks). Rats in EX1 were further divided into four groups; fed-control (FEC), fed-trained (FET), fast-control (FAT) and fast-trained (FAT). Twenty-four hours after last training session, the fundus was excised and frozen in liquid nitrogen for extraction of ghrelin mRNA. Fundus and plasma acylated ghrelin, growth hormone (GH), insulin, cortisol, lipids, and glucose were also measured. Ghrelin mRNA expression was significantly (P=0.002) higher in fasted rats and lower in trained-rats, in whom a non significant increase was observed in resting plasma acylated Ghrelin, GH, insulin, liver glycogen and lower free fatty acids concentrations and muscle glycogen. Plasma cortisol, triglycerides (TG), total choles-Correspondence: Mehdi Hedayati, Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran E-mail: Hedayati@endocrine.ac.irterol (TC) was remained unchanged. Interestingly, fundus acylated ghrelin was significantly (P=0.031) lower in trained rats. The data obtained showed that treadmill exercise reduced ghrelin expression and its acylated levels in the fundus of trained rats and a higher plasma acylated ghrelin could be released from other source (s).

Identifying genetic polymorphisms as risk factors for complex diseases can facilitate their prevention, diagnosis, and prognosis. The purpose of this study is to assess the association between Apo AIV polymorphism and lipid factors based on high density lipoprotein cholesterol (HDL-C) levels in a population of the Tehran Lipid and Glucose Study (TLGS). A total of 181 elderly TLGS subjects with Combined HDLC/low density lipoprotein-Cholesterol (LDL-C) phenotype were investigated. The distributions of a polymorphic site in the apolipoprotein gene APO AIV and its relationship with total cholesterol, LDL-C, HDL-C, and triglycerides were investigated in subjects with LDL-C> 121 mg/dL and HDL-C< 40 mg/dL (case group) and those with LDL-C< 90 mg/dL and HDL-C> 50 (controls). All the variables studied in the case and control groups were statistically different. At the APO AIV locus the G360T polymorphism at codon 360 showed a significant impact on total cholesterol (G: 211±1.16 vs, T: 228±1.20 mg/dL p 0.038) concentration in the case group and on Apo CIII (G: 157±66.9 vs, T: 83.18±17.1 mg/dL p <0001) level in the controls. These associations remained after adjustment for age, sex and smoking (P values: P Chol: 0.028 and P Apo CIII: 0.021). Difference in the apolipoprotein AIV (G360T) polymorphism in the two groups with the combined HDL/LDL-C phenotype indicates that this phenotype can be a selective phenotype for genetic analysis in this field.

Marked changes in maternal thyroid activity occur in pregnancy and during labor. The present study investigates the effect of labor on thyroid function and the role of thyroid hormones during this process. Thyroid function was studied in 64 pregnant primigravida women. The study group comprised of 32 full term pregnant women scheduled for spontaneous vaginal delivery, while the control group included 32 pregnant women at around 32 weeks of gestation. Serum total T3 (TT3), total T4 (TT4) & thyrotropin (TSH) were estimated by high-sensitive radioimmunoassay. In the study group, blood samples were obtained during various phases of labor; Phase A: onset of labor; Phase B: within 2 hours of delivery of placenta and membranes and phase C: 24-48 hours after delivery (immediate puerperium). Mean age of the study group was 23.46±3.07 years, and that of controls was 23±2.8 years. In Phase A, serum TT3 & TSH levels were significantly higher than in controls [1.479±0.52 vs 1.248±0.3 ng/mL & 3 (0.9-6.5) vs 1.2 (0.4-3) μIU/mL respectively; P< 0.05]. In Phase B, there were fall in levels of TT3, TT4, but TSH decreased significantly [1.8(0.6-6) vs 3 (0.9-6.5) μIU/mL; P< 0.05]. In Phase C, TT3 showed significant fall [1.117±0.39 vs 1.421±0.4 ng/mL; P< 0.05]. All the values of thyroid function test were within normal range in controls & study group in all phases. All alterations, the significant rise in TT3 in Phase A, and the fall in phase C and the significant rise in TSH in Phase A and the fall in Phase B, seen during labor seemed to be need based and was significantly influenced by stress present during labor.

Reported here is a case of pheochromocytoma arising from an accessory adrenal gland. This tumor did not have significant clinical symptoms related to pheochromocytoma. The chief complaint was intermittent left upper quadrant pain. Scintigraphy of the abdomen identified normal bilateral adrenal glands, and a 56×63 mm tumor, adjacent the distal part of pancreas. The resected tumor was located between pancreas and spleen and was composed of normal adrenalortical tissue and pheochromocytoma. Immunohistoche-mical staining of tumor for KI67, chromogranin A, NSE, S100 and AE1 was positive. Pheochromocytomas, arising from an accessory adrenal gland, may lack some of the typical characteristics of such tumors and have rarely been reported.

Medullary thyroid carcinoma (MTC), comprising 5-10% of all cancers, is a rare malignancy which frequently spreads to cervical lymph nodes. Occurring in both the sporadic and familial forms, the latter accounts for 20-25% of cases, while the former is considered the most frequent type. We report a case of metastatic MTC presented with cervical lymphadenopathy in a patient without evidences of MTC in thyroid gland.