مجله غدد درون ریز و متابولیسم ایران
سال دهم شماره 5 (پیاپی 41، دی 1387)

To determine the clinical traits of subjects with isolated impaired glucose tolerance (isolated-IGT) defined as fasting plasma glucose (FPG)<100 mg/dl and 2-hour plasma glucose (2h-PG) between 140 mg/dl and 200 mg/dl. In this cross-sectional study, we evaluated the data and results of oral glucose tolerance test (OGTT) from 8212 participants of the Tehran Lipid and Glucose Study (4742 women and 3470 men) aged≥20 years, without diabetes. Logistic regression models for having isolated-IGT were developed among 7012 subjects with FPG<100 mg/dl to predict isolated-IGT. The overall prevalence of IGT was 13.6% (n=1120) of these subjects, 59.6% (n=668) were isolated-IGT. In the clinical model, the adjusted odds ratios (OR) for having isolated-IGT were statistically significant for age≥40 years (2.6), hypertension (1.9), overweight (1.7) or obesity (2.2), family history of diabetes (1.3), and female gender (1.2). Adding the lipid profiles to the clinical model increased the area under the receiver-operating characteristics curve (AUC) only slightly (72.5% vs. 71.4%, P=0.001). The other clinical model including waist circumference had similar predictive power compared to the clinical model including female gender (AUC: 71.7 vs. 71.4, P=0.15). This analysis showed that in Tehranian adults with FPG<100 mg/dl, female gender, older age, family history of diabetes, overweight and obesity, and hypertension were significantly associated with a higher likelihood of isolated-IGT OGTT should hence be recommended in subjects with the above mentioned characteristics.

The aim of the present study was to assess the diagnostic accuracy of the modified ATP III and IDF definitions of the metablic syndrome in identifying of insulin resistant individuals by HOMA_IR and to assess levels of agreement between these definitions and insulin resistance. The sample consisted of 347 nondiabetic subjects from the TLGS population (140 men and 207 women aged 27-87 years). The reference standard for insulin resistance was determined by HOMA-IR and insulin resistance was defined as HOMA-IR≥2.5. According to ATP III and IDF criteria 38.9%, 45% had metabolic syndrome respectively. The sensitivity and specificity of ATP III was 52.3% and 65% respectively, and this was 60% and 59% for IDF criteria respectively. Kappa agreement between modified ATP III and IDF with HOMA-IR was 0.14 and 0.15. Based on the area under the receiver operating characteristic curve constructed by counting metabolic syndrome components as recommended by modified ATP III and IDF diagnostic accuracy was fair. When each component of metabolic syndrome measures were considered as continous traits, waist circumference and fasting plasma glucose each separately had diagnostic accuracy equal or grater than at all the metabolic syndrome as a whole by ATP III and IDF criteria. ATP III and IDF definition, have low sensitivities for detecting insulin resistance and there is poor agreement between those criteria and insulin resistance. Measuring just waist circumference and fasting plasma glucose is simpler and may provide greater accuracy for identifying insulin resistance.

Syndrome X or metabolic syndrome is a collection of risk factors which can lead to diabetes and cardiovascular diseases and result in death. Considering the important role of oxidative stress in causing the complications of this syndrome, the aim of this study was to investigate the effect of vitamin E supplementation on insulin resistance and associated risk factors in patients with metabolic syndrome. A randomized double blind placebo controlled clinical trial with parallel design was conducted on 70 metabolic syndrome patients, 29-57 years old, who were randomly divided into two groups one using 400 mg vitamin E (n=35), and group 2- given placebos (n=35) for 3 months 24 hour dietary recalls were completed in the beginning, and end of first, second and third months for each patient. Serum glucose and lipoprotein by enzymatic, Insulin by RIA, uric acid and CRP by colorimetric, insulin resistance by HOMA-IR methods were measured. For statistical analyses, student’s t-test, paired t-test, chi square and ANOVA were used. There was significant difference in systolic and also diastolic blood pressure at the end of study in the vitamin E group compared to initial values (p=0.00, p=0.09 respectively). In this group, systolic blood pressure, serum glucose and triglycerides (TG) had significant decrease at the end of the study compared to the control (p= 0.003, p= 0.02, p= 0.04 respectively). Serum glucose, TG, insulin and insulin resistance had significant differences in the vitamin E group at the end of study compared to the beginning (p=0.03, p=0.01, p=0.03, p=0.04) Serum TG, glucose and insulin were 221.08±59.54, 114.07±9.64, and 8.3±1.6 at the beginning and 197.65±56.77, 101.05±9.7 and 7.48±1.55, respectively at the end of study. In metabolic syndrome patients, 400 mg vitamin E for 3 months had benetical effects on blood pressure, TG, glucose, insulin and insulin resistance.

Empowerment in individuals with people diabetes is well researched. However, few researchers have focused specifically on the barriers to and facilitators of empowerment in Iranians with diabetes. Understanding the barriers and facilitators that affect the empowerment process could help health professionals to more effectively facilitate self-empowerment. A grounded theory research design was used with in-depth interviews to collect the data from a purposive sample of males and females aged 21-73 years. Data were collected between February and July 2007. Themes were identified using the early steps of the grounded theory data analysis. Common barriers to empowerment were similar to other chronic diseases viZ prolonged stress, negative view about diabetes, ineffective healthcare systems, poverty and illiteracy. Diabetes education, fear of diabete's complications, and hope for a better future also emerged as being crucial to empowerment. Facilitators specific to Iranians were the concept of the doctor as a holy man, accepting diabetes as God's will and the body as God's gift and support from peers and especially from daughters. Iranians with diabetes describe similar facilitators and barriers to empowerment quite similar to those as people from other countries as well as some specific to Iran. Empowerment is strongly affected by cultural and religious beliefs in Iran. Health professionals with deeper understanding of information about diabetic's lives and sources of strength could facilitate the process.

We conducted this controlled trial to investigate whether combined therapy with levothyroxine and liothyronine in primary hypothyroidism, would lead to improvements in general health, quality of life, psychological problems and metabolic changes. This study was a double blinded randomized control trial. Patients were invited to participate if they were between the ages of 18 and 60 years, and if they had been receiving treatment for primary hypothyroidism for at least 6 months, including a stable dose of levothyroxine for at least 3 months, and had normal serum thyroid hormone levels. Patients were randomized to receive combined levothyroxine plus liothyronine (patients in this group decreased their usual daily dose of levothyroxine by 50 μg and began taking 6.25 μg of liothyronine twice daily) or to continue their usual dose of levothyroxine. Treatment duration was 4 months. Weight, height, heart rate, blood pressure, total Cholesterol, LDL, HDL, Triglycerides, serum TSH, total T4, and total T3 levels were measured before and after of study. All patients completed the General Health Questionnaire -28 (GHQ-28) before and after the trial. Seventy-one participants were randomized into the 2 groups, and 60 completed the study. In the combined therapy group, serum T4 levels fell and serum T3 levels rose (P<.001), although both levels remained within normal limits. Serum TSH levels were similar in both groups at baseline and at 4 months. There were no differences between weight, heart rate, blood pressure and lipid profiles of two groups. For the GHQ-28, the overall score was similar but the anxiety/insomnia subscale was significantly higher (indicating worse psychological well-being) for combined treatment compared with T4 alone (P=0.037). The only biochemical change was the expected rise in serum T3 levels and fall in serum T4 in the combined therapy group, because the blood samples were drawn only 1-2 hour after the morning dose of liothyronine. In conclusion, we found no evidence that combined T4/T3 replacement, resulted in improved well-being, general health, quality of life and lipid profile compared with T4 alone. T4 should remain the standard treatment for hypothyroidism.

The effect of thyroid hormones on all stages of the development of central nervous system has been documented in different studies. Postpartum thyroiditis (PPT) is associated with high titers of TPO-Ab during pregnancy. Thyroid autoimmunity in pregnancy results in reduction of serum free thyroxin level, even in the presence of normal thyroid function. This study was conducted to evaluate the effect of PPT on the thyroid function and cognitive development of the offspring. In this prospective cohort study, conducted between December 2007 and March 2008, children born to mothers who had developed postpartum thyroiditis after delivery and those mothers who had not, were included in this study. Blood and urine samples were obtained from all children and blood samples were drawn from their mothers. All children underwent 7 cognitive tests in a clinical psychology laboratory. We enrolled 124 children for the study, 55 cases (children of mothers with PPT) and 69 controls (children of mothers without PPT). Average age of cases was 9.5±1.4 and in controls was 9.4±0.1 (P=0.2). No difference was noted between the two groups for baseline characteristics which might have affected their neurodevelopment. Mean scores for total IQ, performance IQ, and verbal IQ in cases and controls were as follows: 115± 10 vs. 116±12, 113±11 vs. 116±12, and 113±12 vs. 113±13, respectively (P=0.5). There was no difference between the results of the other tests (CPT, WCST, PRM Test, SWM Test, MFVP Test, SOC) in the two groups. No difference was noted between the thyroid function of the two groups. Prevalence of goiter, thyroid function, cognitive development, and intelligence quotient of children born to mothers who later develop postpartum thyroiditis are similar to those of normal children. Postpartum thyroiditis in mother is not a threat for the newborn.

Thyroid nodules are common and surgery is the usual treatment. One of the common complications after thyroid surgery is keloid formation in front of the neck which is an important cosmetic problem. Nodular goiter is a common disorder of thyroid and its common treatment is surgery. Considering the fact that with clinical evaluation and FNA, the risk of malignancy in these cases is low a non aggressive approach to this complication is necessary. This study aims to evaluate of the effectiveness of percutaneous laser photocoagulation (PLP) in reducing the volume of benign thyroid nodules. In this case-controlled clinical trial, 39 female euthyroid patients with solitary solid benign thyroid nodules were enrolled 18 patients were treated with ultrasound guided percutaneous laser photocoagulation, and 21 patients were included in the control group. PLP was performed by diode surgical laser with 1-3 watt output for 123-1019 seconds. All patients were followed up for 3 months. After PLP, mean nodule volume decreased from a baseline value of 26.3 ± 23 mL to 15.1 ± 13 at 3 months. Mean nodule volume reduction in comparison with baseline was 42.72%. Compressive symptoms showed relative decrease. No serious complication was seen, nor was any keloid or scar observed in the front of the neck. PLP can be a minimally invasive effective alternative treatment for symptomatic benign solitary solid thyroid nodules in patients not suitable for surgery.