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Abstract: Thyroid nodules are present in up to 50 percent of adults in the fifth decade of their life. Patients are often treated with thyroxine in order to reduce the size of the nodule, but the efficacy of suppressive therapy with thyroxine remains uncertain. In this study, 62 patients with a benign cold thyroid nodule confirmed by biopsy and TC-99m pertechnetate scan, were randomly assigned in a double bline manner to receive placebo (n=30) or levothyroxine (n=32) for two years. High-resolution sonography was used to measure the size of the nodules before and 6,12 and 24 months after treatment. Suppression of thyrotropin release was confirmed in both groups by one session administration of thyrotropin-releasing hormone 1.5 months after treatment and TSH measurements 1.5 months after treatment and then every 3 months. After 24 months of therapy, diameter or volume of the cold nodules in the levothyroxine group did not significantly decrease as compared with the placebo group. We conclude that suppressive therapy with levothyroxine was not effective in reducing the size of thyroid nodule within 24 months, despite effective suppression of thyrotropin release.

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Abstract: Diabetic osteopenia is a recognized but neglected complication of diabetes mellitus. Most studies have reported low BMD values in type 1, but the BMD results in type 2 is often conflicting. Considering the high prevalence of diabetes type 2 and the importance of osteopenia in postmenopausal women together with its socioeconomic and health burdens, we designed a controlled study of BMD in postmenopausal diabetic women. Proximal femoral and lumbar BMD findings in the subjects were compared to the healthy postmenopausal controls. BMD results from 65 postmenopausal women, aged 45-65 years old, with diabetes type 2 were compared with 65 age matched controls. BMD at proximal femur (neck, ward, trochanter) and lumbar spine (L2-L4) was performed using DEXA. Subjects were categorized as “diabetic – non osteopenic” (or high BMD) and “diabetic osteopenic – osteoporotic” (or low BMD) based on whether their femoral neck T-score were above or below –1, respectively. Serum levels of FBS, 2hpp glucose, HbA1C, Ca, Ph, alkaline phosphatase, urinary Ca and Na were also assessed between two subgroups. Mean BMD value of ward area in diabetic women was 0.644±0.165 g/cm2 vs. 0.705±0.138 g/cm2 in controls (P<0.03). Trochanteric mean BMD in cases was 0.658±0.21g/cm2 vs. 0.737±0.99 in controls (P=0.01). But at femoral neck and lumbar spine no significant difference was seen between two groups. The osteoporotic subgroup of diabetic patients showed higher levels of HbA1C, alkaline phosphase and 24h urinary Ca and Na, but lower levels of serum Ca and Ph, however, the differences did not reach statistical significance. Estrogen consumption was more common in high BMD patients (P=0.05). There was no significant difference between the case and control groups in respect of absent vertebral fractures in the course of recent five years. Age and span of time following menopause, appear to be major risk factors for osteopenia in diabetic patients. Despite higher body mass index in diabetes and considering the protective role of obesity on bone mass, there seems to be a significant decrease in ward and trochanteric BMD values in diabetic patients, indicating that factors other than obesity could affect their BMDs.

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Introduction: Gestational diabetes mellitus (GDM) is a disorder of carbohydrate metabolism, first diagnosed during pregnancy. This study aims to determine the prevalence of GDM in young pregnant women. Materials and Methods: Two thousand one hundred pregnant women referred to five university hospital clinics, 1043 under 25 years old. Previously known diabetic patients were excluded from the study. Universal screening was performed with a 50 gram 1-hour glucose challenge test (GCT). Those with plasma glucose levels ≥ 130 mg/dL underwent a 100 gram 3-hour glucose tolerance test to diagnose GDM according to Carpenter and Coustan criteria. Family and obstetric histories were taken followed by a complete physical examination. Results: Among the 1209 young pregnant women (mean age±SD 20.97± 2.1, years), 27 (2.23%) were detected to have GDM (mean age ±SD 21.11±1.85 years). Of the GDM patients, 14.81% were obese, 22.22% had glycosuria. Among GDM patients, 16 (59.25%) did not have any recognized risk factors. Conclusion: High prevalence of gestational diabetes mellitus in young Iranian pregnant women may suggest revision of the appropriateness of criteria for GDM screening.

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Introduction: Foot problem in diabetic patients is one of the most common and serious chronic complications and is considered to be a consequence of peripheral neuropathy, peripheral vascular disease and immunopathy. The aim of this study was to compare the efficacy of local epidermal growth factors (EGF) and placebo therapy to facilitate wound healing in diabetics with foot ulcer. Material and Methods: This study was a single-blind placebo-controlled trial. Thirty diabetic patients (14 females and 16 males, aged 27-77 years) were treated with EGF and 10 diabetic patients (3 females and 7 males, aged 32-75 years) with placebo. Both groups received debridement, scrubbing with normal saline, systemic antibiotic therapy and bandage with EGF or placebo daily and were followed for 4 weeks. Ulcer closure (%) was calculated by use of an equation [(Final - initial-size)/Initial size] × 100. Results: After 4 weeks, mean closure was significantly higher in EGF group compared with placebo (71.2% Vs 48.9%, p<0.03). 100% closure was observed in 7 patients (with 30 ulcers) from EGF group and in one patient (with 12 ulcers) from placebo group. EGF showed a greater efficacy in ulcer healing (RR=3.4, 95%CI: 1.84-13.61). Conclusion: This study showed that EGF was significantly superior to placebo in ulcer healing. As a result, use of EGF appears to be helpful to diabetics with foot ulcers.

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Introduction: Quantitative Ultrasound (QUS) is a noninvasive and inexpensive portable method for bone mineral densitometry (BMD). QUS measures some other parameters like elasticity and microarchitecture in addition to BMD. This study designed to determine the normal values of QUS parameters (SOS, BUA and SI) of the calcaneus in a normal population of Tehran. Materials and Methods: BMDs of the heel in 259 normal men and women, 20 - 76 Y/O (participant of the Iranian Multicenter Osteoporosis Study (IMOS) were assessed using Achilles+ (a QUS device from Lunar corp.) After assessment of normal values, Stiffness Index (SI) percentiles ( 2.5, 50, 97.5) in men and women were established. Results: Mean values of SOS, BUA and SI in women were s36/75±1527/25, 121/42±15/1, 94/46±17/92 respectively and in men were 1553/63±43/20, 127/80± 13/09, 100/19±18/77 respectively. Mean of SI in men and women 20 - 40 Y /0, had no significant difference with reference data used for QUS device. On the other hand there was a good correlation between diagnostic groups in reference values and results of our study (K= 0/875). Relation between age and sex and QUS parameters was significant. Conclusion: Results of this study show a good correlation between normal values of QUS of an Iranian population in this study and reference values of the American and European populations.