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Introduction: During the history of internal medicine Goiter has always been at the center of attention as one of the most important endemic disorders. It is estimated that about one billion people around the globe are affected with Goiter. Iran is recognized as an cndemic area for Goiter. The aim of this study was to reveal the pattern of distribution of different thyroid disorders in-patients with Goiter in Markazi Province.
Material and methods: It was a descriptive-cross-sectional study that enrolled 2138 patients with Goiter who were selected randomly and by categorized sampling (F=1542, M=596) TSH serum titers were checked for screening and if abnormal, detailed thyroid function tests were done. We used Radon ELISA Kits previously checked with RIA in our study. Patients were first examined for Goiter and graded if Goiter was found, and if it was nodular, the patient was referred for sonography, thyroid scan and FNA. Then the patients were further evaluated based on clinical findings and laboratory results for various thyroid disorders.
Results: In this study we evaluated 2138 pts with Goiter (72% (1542)=F, 28% (596)=M) from which 83.1% had a simple Goiter, 6.94% were hypothyroid, 3.36% had subclinical hypothyroidism. 4.8% were hypothyroid, and 1.17% had subclinical hypothyroidism.
13 pts (0.7%) had nodular Goiter that in one case it was diagnosed as papillary carcinoma. Three patients had coid nodules and the rest had multiple warm nodular or diffuse Goiters. In 44.3% of cases Goiter was in grade IA and in 34% cases it was graded as IB. Goiter was the most prevalence (32.5%) in 10-19 age group and it was least prevalence (2.1%) in pts over 70.
Conclusion: Goiter is endemic in Markazi Province, but its prevalence in the children of recent decade is declining and in previous decades, clinical and subclinical forms of hypothyroidism and hypothyroidism are more prevalent.

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Introduction: POEMS is a rare systemic disease. This syndrome is usually associated with multiple mylom and skin changes. By now, it has been reported two cases of this disease in Iran.
Case: The patient was a 53 years old male who had history of hospitalization for recurrent pulmonary infections. Additionally, he had history of hyperthyroidism and idoide treatment. In the last presentation, he was hospitalized because of low back pain. Bone marrow aspiration findings showed that the cause of low back pain is multiple mylom. In abdominal computed tomagraphy, splenomegaly was cleared that all of these systemic findings are representatives of multiple mylom and POEMS syndrome.
Conclusion: In this study a POEMS syndrome patient that suffering from hyperthyroidism was introduced.

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Background: Oetection of congenital hypothyroidism (CH) in Arak has begun since 2006. The aim of this study was to investigate on recall rate (RR) and the incidence of this disease in Arak. Materials and Methods: In this descriptive study, according to the national screening program for CH in Iran, heel blood samples of 3-5 day- old neonates were taken on special filter paper and TSH values were measuned using ELISA method. TSH values bigger than 5mu/lit were recalled and thyroid function tests (TSH, T4 and T3RUP) were done on venous blood samples and assayed using ELISA method. Neonates with TSH values >10 mu/lit, T4<6.5 ug/dl were viewed as patients. Data related to neonates born up to the end of March 2009 were recorded in special forms. Results: Of 25685 screened neonates, 608 newborns were recalled. RR was estimated to be 2.36%. TSH values in 3.78% were less than 5, in 83.55% between 5-9.9, in 7.56% between 10-19.9 and in 5.09% more than or equal to 20. Eighty six neonates had CH (1/300 live births). Disease rate in recalled neonates was 14.2%. In 80.26 percent of neonates, sampling was done between 3-5 days while the times of sampling in 18.5 and 1.1 percents of the newborns were in days 6-21 and after day 22, respectively. Conclusion: The incidence of CH in Arak is remarkably higher than national and international rates. RR in Arak is higher than the national but lower than the international rates. Also, the ratio of the disease to the recalled neonates is low.

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Background: Spontaneous rupture of tendon is a rare disease that often occurs following an underlying disease or drug usage. However, the association of this condition with primary hyperparathyroidism has rarely been reported. Case: In a case-study, two cases of spontaneous tendon rupture associated with primary hyperparathyroidism are reviewed. The first one is a middle-aged woman that due to bilateral patellar tendon rupture is operated for secondary repair and augmentation of tendons. The second one is a middle-aged man with unilateral triceps brachii tendon rupture who has been operated for primary tendon repair. Conclusion: Since paramount force is needed for tendon rupture, in spontaneous tendon rupture cases, patient evaluation for detecting underlying diseases and drug usage is necessary. In cases that the history of an underlying disease is not indicated, evaluation of serum level concentrations of Ca, P, ALP, and PTH is recommended for contraindication of primary hyperparathyroidism.

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Background: Major depression is one of the most prevalent psychiatric diseases, whereas schizophrenia is one of the worst human diseases. Therefore, finding low-cost treatment methods with few side effects can be of great help to patients. The present study was done to compare the serum levels of vitamin D, parathyroid hormone, calcium, and phosphorous in individuals with major depression and schizophrenics with healthy subjects. Materials and Methods: In this cross-sectional study, serum levels of vitamin D, parathyroid hormone, calcium, and phosphorous were assessed in 100 major depressive, 100 schizophrenic, and 100 healthy subjects. Subjects with a history of renal failure, hepatic failure, parathyroid disease, and consumption of vitamin D, parathyroid hormone, calcium, and phosphorous supplements were excluded from the study. SPSS software version 15 was used for data analysis. Results: Depression was accompanied with decreased serum levels of vitamin D and increased serum levels of parathyroid hormone (p>0.001, p=0.01), but there was not a significant difference between depression and healthy subjects in calcium and phosphorous serum levels (p=0.69, p=0.15). Schizophrenia presented a significant correlation with decreased serum levels of vitamin D and phosphorous (p>0.001, p=0.01), but there was not a significant difference between schizophrenic and healthy subjects in calcium and parathyroid hormone serum levels (p=0.47, p=0.67). Conclusion: Since depression and schizophrenia are accompanied by decreased serum level of vitamin D, consumption of supplementary vitamin D can be helpful in the treatment of these patients.

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Background: Localization of ectopic parathyroid glands is one of the most sophisticated challenges in endocrine surgery and there is considerable controversy regarding the suitable approach to localize ectopic parathyroid glands and indications for using different modalities. The failure of the first operation leads to pain, scar, and financial burden of the following operation. Case: The patient was a 39-year-old woman hospitalized with hematuria as the main complaint and noticing the presentation of hypercalcemia in the initial tests underwent more thorough examination. Ultrasonography and 99mTc sestamibi scan helped us to localize the ectopic parathyroid gland in an anterior mediastinum and treat the patient in a one stage operation. Conclusion: Paying careful attention to the symptoms and signs, considering all differential diagnoses, and using appropriate diagnostic methods can be helpful in the diagnosis of rare syndromes.

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Background: Metastasis or compress effect of adjacent tumors and thyroid neoplasms are the most common causes for airway obstruction which may lead to emergent intubation or tracheostomy due to respiratory distress. Case: A 61 year-old, female patient with history of papillary cell carcinoma with metastasis to lung, trachea and vocal cords was referred to our hospital with complaint of dyspnea. In the early hours of hospital admission the patient suffered from attacks of apnea and gasping, and initial efforts to control the airway were performed immediately which were not successful. Then it was decided to perform broncoscopy and tracheostomy to provide a safe airway. Conclusion: In the absence of adequate equipment and emergency respiratory situation, it is better to provide a secure airway immediately. For this purpose, we can use low depth of anesthesia without use of muscle relaxants.

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Background:Noticing the side effects associated with chemical drugs, using natural medicinal plants has gained more prominence recently. Physalis alkekengi extract is a medicinal plant belonging to Solanaceae family which similar to most drugs used in traditional medicine, despite possessing a multitude of medicinal properties, has not received sufficient attention. The aim of the present study was to briefly review the effects of Physalis alkekengi extract on the concentration of thyroid hormones, blood cholesterol, some plasma biochemical factors, liver function, immune system, and sexual hormones. Due to the extensive usage of Physalis alkekengi extract in traditional medicine, determining its advantages and possible side effects is of great physiologic and pharmacologic significance. Physalis alkekengi extract due to the presence of such effective substances as alkaloids, lycopene, glucocorticoids, alcoholic agents, and a large amount of vitamin C as well as antioxidant properties can play a significant role in changes in body homeostasis. This study dealt with the function and effect of Physalis alkekengi extract on different body organs through using proper keywords and extensive online search through electronic databases and credible sources. The results of this mini-review showed that Physalis alkekengi extract can bring about various significant changes in different body organs that have not been properly recognized. Therefore, further and more extensive studies should be done on this plant.

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Background: Subclinical hypothyroidism is the compensatory stage before overt hypothyroidism. In overt hypothyroidism, risk of ischemic heart disease increases due to elevation of lipoprotein (a) as atherogenic agent, but evidence for subclinical hypothyroidism is one of the controversial issues in researches. According to the atherogenic lipoprotein (a) and other serum lipids, this study is conducted to compare the serum lipoprotein (a) and other serum lipids in patients with subclinical hypothyroidism and euthyroidism.

Materials and Methods: In this descriptive - analytic study, 90 persons (60 with subclinical hypothyroidism and 30 euthyroid state) are participated and these referred to Imam Reza and Taleghani Hospitals which are located in Kermanshah. The sampling method is selected with available sampling methods. After differentiating data by age, sex and underlying disease (liver, kidney, drugs), then they were subjected to determination lipoprotein (a) and other serum lipids profile tests.

Results: In both cases and controls, 16/7% were men and 83/3% were women. Based on results, there is no significant difference between serum lipoprotein (a), triglycerides, cholesterol, HDL and LDL in both statistical groups (p>0.05). Also there is no association between lipoprotein (a) and other serum lipids (p>0.05).

Conclusion: Serum levels of lipoprotein (a) and other serum lipids in young patients with normal weight with subclinical hypothyroidism is not increase, thus it can be concluded early treatment is not necessary for them.

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background: Early detection and treatment are crucial to prevent mental retardation in congenital Hypothyroidism (CH). The aim of this study was to evaluating of screening program of CH in Markazi Province.

Materials and Methods: In cross sectional descriptive study we used recorded data in Markazi province health center. From 2006 to 2012,127112 newborns were screened by measurement of serum TSH level by heel prick. Neonates who had blood TSH&ge5MIU/L were recalled for more evaluation. Neonates with confirmed hypothyroidism underwent treatment.

Results: From127112 screened neonates, 414 were diagnosed as CH patients (both permanent and transient). The prevalence of CH was . Recall rate was 4.8%. In 94.4% of patients, treatment were begun before the 40th day of life. The coverage percent in the province was 100% from the second year of the program.

Conclusion: Recall rate and the incidence of CH were higher than those in other studies, both in Iran and other countries. The mean age of treatment initiation and coverage percent were in favorable range.

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Background: Fluoxetine or Prozac is a serotonin reuptake inhibitor (SSRI). Considering the importance of this drug for the treatment of neurological disorder, such as anorexia and depression its side effects on the endocrine axis of body are of significance. Hence, the present study was conducted to evaluate the effects of fluoxetine on cortisol and thyroid hormone levels and body weight in male rates.

Materials and Methods: In this experimental study, 30 adult male rats (230±20 gr BW) were randomly divided into 3 equal groups: sham, control and treatment. Rats in the control group were kept in normal conditions in animal house, whereas treatment and sham groups were, respectively, injected 32 mg/kg BW of fluoxetine and 0.9 ml of normal saline (i.p) for 35 days. During this time, body weight of all animal was measured and after 35 days, blood was collected by heart puncture and separation of serums to evaluate T3, T4, fT3, fT4, and cortisol hormones through RIA method. The results were statisticaly evaluated by one-way ANOVA test.

Results: Taking fluoxetine for 35 days significantly decreased the level (p&le0.05) in serum concentrations of Ft3, fT4, T4 and cortisol hormones compared to the control and sham groups. However, no significant differences were observed in the serum concentration of T3 hormone in treatment group compared to the the control group. The drug also caused a significant decrease in the average weight of rats in the treatment group compared to the control group (p&le 0.05).

Conclusion: By affecting the activity of different levels of hypothalamus-pituitary-adrenal hormones axis, fluoxetin decreases the level of cortisol hormones. It also reduces the activity of the thyroid gland this is probably due to the increased prolactin secretion through inhibiting TRH secretion and reducing the production of TSH and thyroid hormones

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Background: Thyroid nodules are common. 4-7% of adults have a palpable nodule and up to 50-70% of nodules are detected in high-resolution sonography. Thyroid nodules in women are 4 times greater than men and the rate of thyroid cancer in women is 3:1 compared to men, and is the sixth most common cancer in women. Epidemiological findings and experimental evidences show that sex hormones, especially estrogen, may have effect on this gland and its neoplasm. The aim of this study was to investigate the association between rs1256049 polymorphism in the estrogen receptor beta gene with thyroid nodular disease.

Materials and Methods: In this case-control study, 146 Patients with nodular thyroid and 151 health individuals were referred to Amiralmomenin hospital of Arak were recruited in study. Diagnosis is based on by ultrasonography and was confirmed by an endocrinologist. Genomic DNA was extracted from EDTA treated whole blood .The genotypes were determined using tetra-amplification refractory mutation system-polymerase chain reaction (T-ARMS-PCR) and analyzed by statistical methods.

Results: The frequency of CC, TC and TT genotypes in case group 136(93.2%), 10(6.8%) and 0(0%) and in the control group 139(92.1%), 12(7.9%) and 0(0%) were obtained respectively. No statistically significant association (p=0.72) was observed between nodular thyroid disease and rs1256049 polymorphism.

Conclusion: Our findings showed no significant association between rs1256049 polymorphism and nodular thyroid disease. For best deduction, it is recommended that this study be done in other populations.

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Abstract

Background: Vitamin D was recognized with protective effects on nerve cells of Parkinson’s patients. The relationship between several VDR gene polymorphisms and age and risk of the disease was determined. Also, the relationship between VDR gene FOKI genotypes and PD was specified. The main goal of this study is to evaluate the relationship between polymorphic loci of FokI, TaqI, BsmI, ApaI and serum factor related to vitamin D metabolism in Isfahan population.

Materials and Methods: Case- control study of 125 Parkinson’s patients with their matched control individuals has been investigated based on Parkinson's disease brain bank criteria of Great Britain. After receiving consent, serum levels were measured. The genetic material was isolated by Miller protocol and polymorphisms has been analyzed and confirmed by repeated PCR-RFLP.

Results: Comparing the five serum factors between healthy subjects and patients with Parkinson's disease, we have  shown a significant reduction in the levels of calcium, ALP and PTH (p<0.01). However, none of the levels of vitamin D and phosphate show any kind of significant relationship between patients and control subjects. Concentration of blood serumic factors including calcium and PTH showed p-values less than 0.01 between Parkinson's patients and control subjects according to different genotypes containing FokI-F allele,ApaI-A allele and BsmI-b allele .

Conclusion: The result of this study showed that each of FokI and ApaI recessive alleles can influence serum calcium and parathyroid hormone between healthy individuals and Parkinson's patients significantly.

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Introduction: Nowadays, due to the increasing spread of electronic devices and digital transmitters, the general public is exposed to electromagnetic waves with different wavelengths. According to the function of the thyroid gland on the metabolic actions of the body, the purpose of this study was to investigate the changes in the serum level of thyroid stimulating hormone after receiving short-term and long-term electromagnetic waves emitted from home Wi-Fi.
Methods: 60 rats in the weight range of 250-300 grams were randomly divided into 3 equal groups. The first group did not receive any waves. The second group was placed near Irancell's portable Wi-Fi device for 10 days,1 hour a day, and the third group was near Wi-Fi waves for 3 hours a day for a month. After one month, blood was taken from the mice and the serum level of thyroid stimulating hormone was measured.
Results: The data analysis showed that the serum level of thyroid stimulating hormone in the group that was exposed to medium-term Wi-Fi waves was significantly different from the control group, but the level of this hormone in the group that was exposed to the waves for a short period of time, it was not significant in comparison with the control group.
Conclusions: According to the present results, it is possible that electromagnetic waves lead to hormonal disorders in the body, and one of these disorders can be a change in the amount of thyroid stimulating hormone.

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Thyroid nodules are a common clinical finding. Recent attention has been drawn to the role of insulin resistance in their development.  While several studies have explored the link between metformin and insulin resistance, fewer have assessed its effects on thyroid nodules.  
This study examines the impact of metformin on thyroid nodule size and thyroid hormone levels.
The present study evaluate the effects of metformin on thyroid nodule size and thyroid hormones levels.

Methods:
A total of 240 euthyroid women with thyroid nodules were divided into four groups. Group 1 received 100 mcg of levothyroxine daily, Group 2 received metformin 500 mg twice daily, Group 3 received a combination of both drugs for three months, and Group 4 served as the control group with no treatment. Thyroid ultrasound was performed at baseline and after three months. Statistical analyses included the Kruskall–Wallis, Wilcoxon, and Chi-square tests, examined the differences of the size of thyroid nodules and the mean of thyroid hormones levels between groups, for each group and to compare the percentage of differences between the groups, respectively. Also P value less than 0.05 was considered meaningful.

Results:
Kruskall–Wallis test revealed no significant differences in thyroid hormone levels between the groups after treatment, except in the levothyroxine group. Wilcoxon test showed significant reductions in TSH and increases in T4 levels within the levothyroxine group. Additionally, thyroid nodule size significantly decreased in the levothyroxine and combination therapy groups, while metformin alone had no significant effect on the size of thyroid nodules.


Conclusion:
Metformin alone does not appear to reduce thyroid nodule size. Future studies with larger sample sizes and extended durations are necessary to validate these findings and further explore metformin’s role in thyroid nodule management.
 

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Background: Thyroid cancer is one of the most common types of endocrine malignancies. FASL is one of the most important apoptosis ligands expressed by tumor-infiltrating lymphocytes. This death ligand plays an important role in the elimination of cancer cells by inducing apoptosis in the Fas/FasL pathway, and its disruption induces tumorigenesis. This study investigated the association of the FASL gene polymorphism - INV2nt-124A/G (rs5030772) with the risk of thyroid cancer in the East Azerbaijan region.
Materials and Methods: In this case-control study, 115 patients with thyroid cancer and 125 healthy individuals without a family history of cancer from Tabriz city were studied. Five milliliters of peripheral blood were collected from each of these participants. Proteinase K method was used for DNA extraction and FASL gene polymorphism (rs5030772) was analyzed by ARMS-PCR technique. The results were analyzed using Javastat statistics package online software.
Results: The genotype frequencies of AA, AG and GG were 40.35%, 49.12% and 10.53% in patients and 41.6%, 52.8% and 5.6% in the control group, respectively. Genotypic and allelic frequencies did not show significant differences between the patient and control groups (p>0.05). By examining the clinicopathological characteristics of the patients, no significant relationship was seen between the clinical characteristics of the patients and the distribution of the genotypes of this polymorphism (p<0.05).
Conclusion: The results of this study indicate that the FASL gene polymorphism - INV2nt-124A/G (rs5030772) cannot be considered as a risk factor for thyroid cancer in the studied population in in East Azerbaijan province.