International Journal of Endocrinology and Metabolism
Volume:5 Issue: 1, Mar 2007

Today, although screening tests for Gestational Diabetes Mellitus (GDM) are available, they are time-consuming and expensive; hence perform-ing tests that are cheaper but have higher sensi-tivity and specificity seems necessary. The aim of this study was to determine a cut off point of fasting plasma glucose (FPG) for screening GDM. In this clinical trial, 200 pregnant women aged ≥25 years referring to a perinatal clinic were selected. Inclusion criteria re-quired having one of the following risk factors: His-tory of recurrent abortion, GDM, pre-eclampsia, macrosomia, still birth, or diabetes mellitus(DM) in first degree family or pre gestational body mass index ≥25kg/m2. All participants underwent a 50 g glucose challenge test (GCT) between the 24th and 28th gestational week. If 1-hour plasma glu-cose was over 130 mg/dL, a 3-hour 100g oral glu-cose tolerance test (OGTT) was recommended. The diagnosis of GDM was made based on ADA recommendations. Of 200 participants, 65 women had posi-tive GCT, of which 58 (response rate 89%) were referred for 100g OGTT and 20 (10%) were di-agnosed with GDM. The under curve area for FPG of 0.85 and the FPG level of 91.5 mg/dL, showed highest sensitivity -80%, and specificity -92%, respectively in the diagnosis of GDM. Significant difference was observed between the GDM and normal groups for mean age, gravid-ity, parity and BMI (P<0.05). Fasting plasma glucose (FPG) ≥ 91.5 mg/dL has good sensitivity and specificity in the screening of GDM; since this is simpler and cheaper than the 50g GCT, it is recommended as a screening method for the diagnosis of GDM.

This research aimed at investigating the correla-tion between postprandial dyslipidemia and ca-rotid intimae-media thickness in people with dia-betes. In 28 diabetic patients and 22 age and sex- matched healthy adults, the carotid intimae-media thickness was measured using Doppler ultrasound. Blood glucose, total cholesterol, triglycerides, LDL and HLD choles-terol level were measured after overnight fasting and again 4 hours after a standard high-fat meal. The carotid intimae-media thickness of diabetic patients was greater than normal sub-jects (0.96±0.29 mm vs. 0.75±0.17 mm, respec-tively p=0.008). Diabetic patients showed post-prandial hypertriglyceridemia (P=0.03). In pa-tients with fasting hyperglycemia and postpran-dial hypertriglyceridemia, carotid intimae-media thickness was greater than in patients with nor-mal levels (p=0.04 and p=0.03 respectively). Postprandial hypertriglyceridemia and fasting hyperglycemia may be an independ-ent risk factor for early atherosclerosis and macrovascular disease in individuals with type 2 diabetes.

Hperemesis gravidarum occurs in about 1.5% of pregnancies and is more common in Asian than in white women. Many patients do not need anti thyroid drugs, except for those with severe nau-sea and vomiting and thyroid dysfunction after 18-20 weeks of pregnancy. The aim of the study was to determine the importance of routine as-sessment of thyroid function in pregnant women with hyperemesis gravidarum, especially those with clinical features of hyperthyroidism. 135 patients with hy-peremesis gravidarum admitted to an Ob-Gyn hospital were selected. After excluding criteria, 103 patients underwent investigations including thyroid function tests and β-hCG. 35 women were found to have abnormal thyroid function tests with FT4I 4.74 ± 0.54 and in another group (68 women) this was 2.9±0.39 (P<0.0001). B-hCG in first group was 59406±14899 mIU/mL and in second group was 6750±3476 mIU/mL (P<0.0001). In 5 patients, PTU was started due to severe signs and symptoms of hy-perthyroidism. Thyroid function tests were done for all of 35 patients after 4 weeks routine ther-apy for hyperemesis gravidarum. Thyroid func-tion tests normalized in 11 patients with hy-peremesis graridarum but remained abnormal in 22 patients hence; PTU was started and anti-TPO anti-body was measured; thyroid function tests were repeated monthly for all of them and PTU were adjusted accordingly. Means for duration and dose of therapy were 2.76 months and 60.63 mg/d for Anti-TPO negative and 5.33 months and 170 mg/d for Anti–TPO positive patients re-spectively. In our study, thyroid, dysfunction in hyperemesis gravidarum was 35%, with 20% of the patients needing anti-thyroid therapy. A female predominance among offspring of moth-ers with hyperemesis gravidarum was observed. Routine assessment of thyroid function is neces-sary for women with hyperemesis gravidarum especially in patients with clinical features of hyperthyroidism. PTU needs to be considered in hyperemesis gravidarum with severe weight loss, vomiting and biochemical hyperthyroid-ism.

This investigation aimed at evaluating the effect of iodine supplementation on the IDD impact indicators in a group of 571 hypothyroid iodine deficient schoolchildren. Values of levels obtained were compared with data from our previous 1989 study in these villages and results of the comparison showed that total goiter rate decreased by 42% in 1999. A significant decrease in grade 2 goiter concomitant with an increase in grade 1 goiter was seen, P<0.001. Serum T4, T3, TSH concentrations, urinary iodine level and IQ were normal in all children. Mean IQ was higher in children aged 6-10 years as compared to other age groups, P<0.05. Study shows that euthyroidism induced by administration of iodized oil in hypothyroid iodine deficient schoolchildren can be maintained following iodized salt consumption.

Risk indices have been developed to identify postmenopausal women at risk of low bone mineral density who need to undergo BMD test-ing. The aim of study was to compare perform-ance of three decision rules for identifying women with primary osteoporosis in an Iranian post-menopausal population. Three osteoporosis risk indices- the osteoporosis self assessment tool (OST), the osteoporosis risk assessment instru-ment (ORAI), and body weight criterion were calculated for 5573 out patients without risk fac-tors for secondary osteoporosis or receiving ac-tive bone medication. BMD at spine and femoral neck were measured via dual x-ray absorpti-omety. The sensitivity, specificity, positive pre-dictive value, negative predicative value and area under receiver operating characteristic curve to identify those with osteoporosis were deter-mined for each decision rule; these were then compared. The sensitivity of these risk indices ranged from 70% to 84/1% and specificity from 44.6 to 65.6%. The area under curve (ROC) in identifying patients with osteoporosis were sig-nificantly better for OST (0.75) and ORAI (0.74) compared with the body weight criteria (0.66). The negative predicative values ranged from 80 to 93%, while positive predication values ranged from 33 to 45%. Our data provide evidence for the application of OST, ORAI as useful clinical tools in making decision about which women need to be referred for BMD testing; more evidence however is needed to confirm validity of the body weight criterion. Of the three tools evalu-ated, the OST is the simplest and has the best potential for use in clinical practice.

Subclinical hypothyroidism (SCH) is defined as a normal serum FT4 and a high serum thyrotro-pin (TSH) concentration. Up to 30% of patients with SCH may have vague, non-specific symp-toms of hypothyroidism, but attempts to identify the patients on the basis of clinical finding have not been successful, so the diagnosis can only be made with laboratory testing. The causes of SCH are the same as those of overt hypothyroidism. Most patients have Hashimoto’s thyroiditis. The worldwide preva-lence of SCH ranges from 1-10%. A substantial proportion of patients with SCH develop overt hypothyroidism. Serum TSH concentration and positive antithyroid antibodies (ATA) are sig-nificant predictors of progression to clinical hy-pothyroidism. Some patients with SCH have some symptoms of hypothyroidism, while some studies show significant improvement in hypo-thyroid symptom scores and psychometric test-ing; others found no improvement in symptoms with levothyroxine therapy. There is consensus that SCH in pregnancy is a risk factor for poor developmental outcomes in the offspring and the condition should be treated in women who wish to become pregnant. There is also agreement that patients with SCH and TSH levels over 10 mU/L, or with goiter should be treated. Population-based screening for SCH is not warranted, but thyroid function should be tested in high risk groups, e.g. in women aged over 60 yr, persons with previous radiation therapy of thyroid gland or external radiation, those with previous thyroid surgery of thyroid dysfunction, type 1 diabetes mellitus pa-tients and those with a family history of auto-immune disease. Evidence documenting routine determination of TSH in pregnant women or women planning to become pregnant are insuf-ficient, and it would be reasonable to consider TSH measurement in those at high risk for thy-roid dysfunction.

Papillary thyroid carcinoma is the most common malignancy among females in Saudi Arabia and may present in an advanced stage and with dis-tant metastases, mostly to the lungs, comprising 32% of the recurrences. Airway invasion is a life-threatening complication of thyroid cancer. The differentiation between the clinical features of bronchial wall invasion versus those of an ob-structive endobronchial lesion deserves more at-tention. Endobronchial lesion may present with no symptoms. We report have a patient with papillary carcinoma of the thyroid associated with endobronchial metastases in the absence of other sites of tumor dissemination.

Thyrotoxicosis is often associated with liver and malfunction, often for long durations; some-times the liver function is substantially impaired for a longer period of time. The exact nature however of the relation between hepatic dys-function and thyrotoxicosis remains obscure. Presented here is a case report of liver cholesta-sis as a complication of thyrotoxicosis. A previously healthy 41-year-old man with thyrotoxicosis complicated with liver cholestasis is discussed. The patient reported had a typical thyro-toxicosis but following radioiodine treatment concomitantly developed jaundice and severe pruritus that required several weeks of treatment in hospital and took several months to disap-pear. In this report the therapeutical considera-tions as well as the pathogenetic possibilities are reviewed. The association observed is not common but may be severe and should be con-sidered in any case of thyrotoxicosis where a cholestatic condition develops.