International Journal of Endocrinology and Metabolism
Volume:9 Issue: 4, Sep 2011

In Iran, congenital hypothyroidism (CH) screening programs to prevent mental retardation have been started recently. In this national program, all neonates with thyroid-stimulating hormone (TSH) level ≥ 5mIU/L are required to be recalled for a confirmatory test (venous sampling). This study was designed to investigate the incidence of CH and the patient recall rate on the basis of the above mentioned cutoff value for TSH and to compare the results with those obtained in other studies.Patients and According to the screening protocol for CH, we assessed neonates born from February 2007 to January 2008 and registered details on the birth date, sex, birth weight, maternal gestational age, and parental consanguinity. TSH was measured from heel-prick blood samples obtained from neonates aged between 3 and 7 days. Neonates showing a TSH level of ≥ 5mIU/L were recalled for undergoing confirmatory tests. Among 18008 neonates screened for CH, 730 (4.1%) were recalled (TSH, ≥ 5mIU/L). Out of the recalled neonates, 96% were full-term neonates with a mean age of 5.0 ± 3.2 days and a mean TSH level of 8.6 ± 11.4mIU/L. CH was detected in 20 (2.7%) recalled neonates (incidence ratio of 1 in 895 live births) and subclinical hypothyroidism in 45 (6.1%) recalled neonates (incidence ratio of 1 in 398 live births). Investigations have shown that Asian and Iranian neonates show a high CH prevalence. The recall rate in our study on the basis of the TSH cutoff value of more than 5mIU/L was higher (4%) than that in other studies. Therefore, in addition to emphasizing the importance of neonatal screening, we suggest that the cutoff level of TSH in the national screening program be reassessed and revised to reduce the recall rate for neonates.

Postpartum thyroiditis can have negative impacts on the lives of mothers and infants. The prevalence of this disorder has been shown to be dramatically different in various geographic regions. Despite its importance, there are still no standard recommendations for the screening of this disorder. Thus, determining the prevalence of this disorder is an important factor in decisions regarding universal screening. This study was performed in order to evaluate the prevalence of postpartum thyroiditis in the northeast region of Iran.Patients and Mothers who brought their children to 3 health centers for vaccinations at 2–3 months, 4–5 months, and 6–7 months after delivery were included in this study. Blood sampling was performed in order to determine the random blood sugar, thyroid-stimulating hormone, triiodothyronin radioimmunoassay (RIA), tetraiodothyronin RIA, anti-thyroglobulin, and anti-thyroid peroxidase levels. A total of 842 women with a mean ± standard deviation age of 26.17 ± 5.7 years completed the study, with 20.3% seen at 2–3 months after delivery, 32.4% seen at 4–5 months after delivery, and 46.9% seen at 6–7 months after delivery. A total of 63 mothers (7.5%) developed postpartum thyroiditis. Of these, 44 (5.2%) of the participants proved to have hyperthyroidism and 19 (2.3%) had hypothyroidism. Thus, 779 (91.9%) mothers were euthyroid at the time of the study. We did not find any correlations between a family history of thyroid disorder, breast feeding, age, or the gender of the infants with postpartum thyroiditis occurrence. Postpartum thyroiditis is relatively common in the northeast region of Iran. Screening policies may help to detect these patients sooner.

In 1983, Daponte et al. first reported an increase in the peripheral white blood cell (WBCs) counts of prostate cancer patients treated with estramustine phosphate (EMP) therapy. In order to confirm Daponte’s observation, we reviewed the clinical data of prostate cancer patients treated with EMP. We also examined the association between WBC counts and 17β-estradiol levels throughout the duration of the EMP therapy.Patients and The study population comprised of 66 prostate cancer patients who were being treated with EMP. The complete blood count with a differential WBC count and the levels of serum 17β-estradiol and C-reactive protein measured during the therapy were compared with the baseline levels. The correlation between serum 17β-estradiol level and WBC count was calculated using the Pearson correlation test. We observed that the total WBC and the neutrophil counts were significantly elevated during the therapy. The serum 17β-estradiol level significantly correlated with the WBC count (r2 = 0.031, P = 0.002). The granulocyte colony-stimulating factor levels measured during therapy were approximately 2-fold higher than the upper limit and decreased after cessation of the treatment (P = 0.037). We successfully confirmed Daponte’s observation. The increase in WBC counts was possibly attributable to elevated serum 17β-estradiol levels.

Following detection of receptors for ghrelin and growth hormone (GH) in the cardiovascular system, different clinical trials have used ghrelin or GH for the treatment of cardiac patients. While some of these trials reported improvements in the patients’ situation, others reported deterioration. To clarify the contradictory outcomes, we designed this study to evaluate the circadian rhythms of acylated ghrelin, GH, and the related factors [Insulin-like Growth Factor-1 (IGF-1), Insulin-like Growth Factor Binding Proteins 1 and 3 (IGFBP-1 and IGFBP-3)], and leptin in patients with reduced ejection fraction (rEF).Patients and Ten patients with rEF and an equal number of healthy control subjects matched for age and gender participated in this study according to inclusion criteria. All participants were hospitalized in the cardiac care unit (CCU), under identical conditions during collection of blood (every 2 hours). Primary processing of samples was carried out immediately and the plasma was stored at -20ºC until evaluation of the aforementioned parameters using ELISA methods. Evaluation of the collected data showed that among aged participants only circulating leptin is gender-dependent, while the patients had significantly (P < 0.001) lower ghrelin, GH, IGF-1, and IGFBP-1, but a higher level of IGFBP-3 compared to the control group. In addition, except for GH that showed a mild circadian rhythm, the parameters we examined did not have a significant circadian rhythm. Correlation analysis of the data showed a positive correlation between ghrelin and GH or IGF-1, and significant negative or positive correlations between leptin and IGFBP-1, or IGFBP-3, respectively, in both groups. Here, for the first time, we show that circulating ghrelin, GH, and IGF-1 levels are reduced in the patients with rEF, and the condition of patients is deteriorated not only due to reduced IGF-1 but also due to reduction of IGFBP-1 or increase of IGFBP-3, which may be influenced by circulating leptin. Finally, disturbance of the balance between ghrelin/GH/IGF-1 and leptin may be the cause of rEF, and thus evaluation of these parameters could provide diagnostic as well as prognostic tools for the treatment of these patients

Transsphenoidal surgery (TSS) is the most effective treatment for acromegalic patients, and two major factors that have been suggested as useful predictors in assessing this therapy’s success are: tumor size and preoperative basal growth hormone (GH) levels. The aim of this study was to illustrate the relationship between some predictor factors and transsphenoidal surgery (TSS) outcomes and its remission rate.Patients and A total of 20 patients underwent TSS by 4 neurosurgeons in 4 university hospitals in Tehran and were followed up for 1 year. An oral glucose tolerance test was performed at 1 week after surgery and then 3, 6, and 12 months after surgery. Moreover, Insulin Growth Factor- 1 (IGF-1) was measured at 6 and 12 months after surgery. Initial remission was observed in 7 (35%) patients with a recurrence rate of 10%. The nonresponse rate was 55%. The analysis showed a significant relationship between IGF-1 and surgery outcome in the cured patients at 6 months after surgery (P = 0.005). No significant statistical relationship was found between tumor size and the TSS outcome (P = 0.696). Given the high failure and recurrence rates following TSS in Iran, it seems important to pay more attention to diagnosing the disease earlier and improving surgical methods.

Postmenopausal women are at risk for skeletal bone loss and periodontitis, which results in tooth loss. Pathogenesis of both processes involves osteoclast activation regulated by common cytokines. Where obesity has been shown to be associated with a higher prevalence of periodontitis, high body mass index, once considered to be protective against skeletal bone loss in postmenopausal women, is now being reconsidered as a potential risk for low bone density. The aim of this study was to investigate whether a correlation exists between BMI and periodontal parameters (plaque score, probing depth, and bleeding) in postmenopausal women with low bone density.Patients and In a population of Caucasian postmenopausal women (n = 56) with low bone density, BMI was measured, and a periodontal exam to measure periodontal parameters was completed. Participants also completed a questionnaire on exercise habits. In simple linear regression, BMI was correlated with PD but with no other periodontal factors. On average, an increase of one point in BMI resulted in an increase of 0.06 mm in PD. PD was significantly correlated with BMI, even after adjusting for exercise. BMI was not a significant factor in BOP in the simple regression case, but it became significant when adjusted for exercise. Furthermore, there was an interaction between BMI and exercise, which indicates that heavier subjects who did not exercise had higher BOP scales than heavy subjects who did exercise. Indeed, it appears that BMI was not much of a factor at all for subjects who exercised. The results of this investigation indicate a correlation between BMI and periodontitis in postmenopausal women and suggest that some interaction may exist between the metabolic state and alveolar bone level. These findings support the assertion that alveolar bone may function as an endocrine target organ

First described in a Japanese population in 1991, the Tako-Tsubo disease has recently been included among the primary acquired cardiomyopathies in the American Heart Association’s disease classifications. Tako-Tsubo cardiomyopathy (TTC) is a reversible, often misdiagnosed condition, as it can easily mimic acute coronary syndrome. It has indeed been estimated that TTC can represent 1 to 2% of patients who present with suspected acute coronary syndrome. The disease is especially common in women. In its typical presentation, the identifying characteristic of TTC is the systolic bulging of the heart’s apex with preserved contraction of basal myocardial segments. The acute left ventricular dysfunction, however, it is usually reversible, with contractile function usually recovering in a few weeks. The etiology of TTC is not completely clear. Many theories have been proposed, taking into account the role of hormone disturbances, acute toxic effects of catecholamines on cardiomyocytes, diffuse microvascular spasms, multivessel epicardial spasms, and acute myocarditis. Several researchers have suggested that TTC may occur as a rare complication of dysthyroidism. In particular, an acute hyperthyroid state has been proposed to be capable of triggering TTC, independently of its causes. Indeed, several cases of TTC associated with Graves’ disease, Hashimoto thyroiditis, or excess levothyroxine therapy have been reported in the medical literature. The mechanism by which dysthyroidism can trigger TTC, however, remains poorly understood. In this review we investigated the role of thyroid dysfunction as a possible trigger for TTC

Encephalopathy associated with autoimmune thyroid disease (EAATD) is a rare condition that may occur in patients with an autoimmune thyroid disease. The clinical presentation of EAATD is characterized by a variety of neurological and/or psychiatric alterations and can show up with focal signs secondary to stroke-like events or generalized symptoms. From a nosological, epidemiological, and diagnostic point of view, EAATD still remains a controversial disorder. Indeed, a widely accepted definition of EAATD has not yet been established, and the diagnosis of this condition is often difficult because of the heterogeneous clinical presentation, the number of possible non-specific manifestations, and poorly defined diagnostic criteria. These factors may inevitably affect the exact estimation of the prevalence of EAATD. From a clinical perspective, the course of EAATD is variable and ranges from response, often dramatic and rapid, to corticosteroids to no or partial response and requirement of other immunosuppressive treatments. Occasionally, spontaneous remission or adverse outcomes have also been reported. Here, we describe the case of a 52-year-old woman who presented with right facial and upper limb numbness and perioral tingling. The laboratory, radiological, and electrophysiological investigations revealed no relevant abnormalities from a neurological point of view. The investigations carried out during hospital admission incidentally disclosed a clinical picture compatible with Graves’ disease, including elevated levels of antithyroid antibodies. However, the cause of her stroke-like episode remained unclear, and the reported symptoms disappeared spontaneously in approximately 10 days. Finally, EAATD characterized by the spontaneous remission of the symptoms was diagnosed, and the patient did not show any relapse or reoccurrence of EAATD thereafter. This intriguing case allows us to focus on and discuss some of the most debatable aspects of EAATD, including its definition, diagnosis, and management.