Masoud Amini

Introduction: Thyroidectomy is a surgical method for the management of benign and malignant thyroid disease. Thyroidectomy may cause significant complications including hypocalcemia and recurrent laryngeal nerve injury. Permanent complications after thyroid surgery pose significant costs for healthcare system, as patients require lifelong alternative treatments and healthcare facilities. Objectives: The purpose of this study was to evaluate the incidence and risk factors for permanent complications following thyroidectomy. Patients and Methods: A total of 204 consecutive patients who underwent thyroid surgery between 2017 and 2018 were included in this prospective study. The patients were followed for 12 months after surgery and clinical and biochemical data were recorded. Results: The incidence of transient and permanent hypocalcemia was 46.8% and 6.38%, respectively. Transient hoarseness affected 30.3% of patients and 2.1% had recurrent laryngeal nerve paralysis as detected by video laryngoscopy 12 months after surgery. Surgeons volume was significantly related to the presence of permanent hypocalcemia (P=0.003). In comparison to high-volume-surgeons, intermediate-volume-surgeons had an odds ratio of 5.25 (P=0.042) for permanent complications. Conclusion: Hypocalcaemia remained the most common long-term complication of thyroid surgery. High volume surgeons had lower complication rates and better outcomes. In this regard, methods for improving surgical performance are worthy of investigation.

To evaluate the effect of magnesium supplementation on insulin resistance and cardiovascular markers in people with prediabetes. A 12 week double-blind placebo-controlled randomized clinical trial was conducted at Isfahan Endocrine and Metabolism Research Center, Iran, on people with prediabetes (n = 86) to compare the effects of magnesium oxide 250 mg/day versus a placebo on anthropometric indices, blood pressure, fasting glucose, insulin, HOMA-IR index, C-reactive protein, uric acid and lipid profile. Both groups had similar distributions of anthropometric and biochemical variables at baseline. Those who received magnesium supplementation had significantly higher levels of HDL-cholesterol compared to the placebo group at the end of the study (49.7 ± 10.9 vs 43.6 ± 7.2 mg/dL, P = 0.003). The mean changes of HOMA-IR index, total cholesterol, LDL-cholesterol, triglyceride, uric acid and C-reactive protein levels as well as anthropometric indices and blood pressure in supplemented and placebo groups did not differ significantly. Magnesium supplementation increased HDL-cholesterol levels in people with prediabetes. However, other cardiometabolic markers were not improved by magnesium supplementation at the above dosage and duration.

Current reference values for thyroid function tests are derived from data from different ethnicities and geographical areas. In this article, we aim to select criteria from the guidelines proposed by the National Academy of Clinical Biochemistry (NACB) and to determine the TSH and T4 reference limits in the iodine-sufficient area of Isfahan, a metropolitan city in Iran. This study was conducted within the framework of "Isfahan Thyroid Study (ITS)", an ongoing prospective cohort that started in 2006 (n=2523) until 2011 (n=711) and included participants above the age of twenty. We measured TSH, total T4, thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb). Recruitment was based on the NACB criteria, 1899 participants were included in 2006(58.5% male) and 377 in 2011(62.3% male). The mean± SD age was 39.66 ±12.71 and 48.96±12.35 years in 2006 and 2011, respectively. The mean± SD for TSH was 2.0±1.19 and 2.11±1.11 mU/L and T4 was 6.67±1.47 and 8.3±2.95 μg /dl in 2006 and 2011, respectively. In 2006, the 2.5th percentile of serum TSH levels was 0.4 mU/L (males: 0.4 mU/L, females: 0.5 mU/L) and the 97.5th percentile of serum TSH was 4.96 mU/L (males: 4.72 mU/L, females: 5. 3 mU/L). In 2011, the 2.5th percentile of serum TSH levels was 0.7 mU/L (males: 0.6 mU/L, females: 0.77 mU/L) and 97.5th percentiles of serum TSH was 4.9 mU/L (males: 5.7 mU/L, females: 5. 57 mU/L). This study determined age and sex specific TSH and T4 reference ranges in the Isfahanian population, which could theoretically enable clinicians to classify patients more accurately. (www.actabiomedica.it).

Background: The Isfahan Thyroid Cohort Study (ITCS) is one of the few population-based epidemiological studies in Iran that investigates the prevalence and incidence of thyroid disorders including hypothyroidism, hyperthyroidism, goiter, nodule, and iodine status. Methods: This cohort is located in Isfahan, Iran. The first phase was initiated in 2006 with 2523 participants (1275 males, 1248 females). The participants were selected using multi-stage cluster sampling from the general residents of Isfahan, Iran. The study had two phases (2006 and 2011) and its third stage is planned for 2020–2021. Results: The prevalence of thyroid function states was euthyroid (89.3%, 95% CI: 88%–90%), overt hypothyroidism (2.8%, 95% CI: 2%‒3%), subclinical hypothyroidism (5.8%, 95% CI: 4%–6%), overt hyperthyroidism (0.8%, 95% CI: 0.4%‒1%), and subclinical hyperthyroidism (0.99%, 95% CI: 0.6%–1%). Hypothyroidism and hyperthyroidism were significantly associated with goiter. The incidence of thyroid dysfunction was reported as follows: overt hypothyroidism (2.7, 95% CI: 1.6–3.7), subclinical hypothyroidism (20.6, 95% CI: 18–23), overt hyperthyroidism (1.9, 95% CI: 1–2.7) and subclinical hyperthyroidism (2.7, 95% CI: 1.6–3.7) per 1000 (person-year). Conclusion: We assessed the prevalence and incidence of thyroid disorders in Isfahan in the first and second phase, respectively. We are conducting the third phase of the ITCS in order to study the associations between thyroid peroxidase antibody (TPOAb) level and environmental factors such as infection.

Aim: Although, the effectiveness of metformin in diabetes treatment is well established, its preventive effect in the development of diabetes is still unclear in real world. We aimed to determine the effectiveness of metformin therapy as a single preventive agent in patients with prediabetes in a cohort study (IDPS). Study Design: In this prospective observational study. Place and Duration of Study: Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Methodology: We included 410 patients with prediabetes (168 metformin user, 242 non-users), who participated in IDPS. To determine the association between metformin use and incidence of type 2 diabetes, Cox proportional hazard method, Kaplan-Meier and log Rank test were used. Results: In fully adjusted model for all confounders, significant hazard ratio (HR) for staying prediabetes rather than returning to normal was detected in male group of metformin non-user (HR: 2·41 [95% CI 1.01-5.79]; PConclusion: This study evidenced that males and patients with IFG & IGT who had not used metformin are at higher risk to staying prediabetes than returning to normal.

This study compared mortality rates and decline in life expectancy of Iranian patients with type 2 diabetes (T2DM) with the general population. A retrospective study of 2451 patients with T2DM was conducted in the Isfahan Endocrine and Metabolism Research Center, Iran, between 1992 and 2010. The mean (SD) of diabetes duration and median (Q1,Q3) of follow-up period were 15.5(8.0) and 8(5, 10) years. The main outcome was all-cause mortality. 732(29.87%) of patients died during the follow-up. Overall mortality rates (95%CI) per 1000 person-years in men and women were 56.3(52.0–62.1) and 27.3(24.5–30.4), respectively. The relative risks (95%CI) of all-cause mortality in males vs. females with T2DM aged 45–49, 50–54, 55–59, 60–64, 65–69, 70–74 were [3.02(1.49–6.11) vs. 2.09(0.96–4.57)], [4.05(2.73–6.01) vs. 2.29(1.52–3.45)], [4.13(3.26–5.24) vs. 1.70(1.23–2.35)], [2.42(1.90–3.07) vs. 1.82(1.46–2.27)], [2.36(2.02–2.76) vs. 1.49(1.25–1.78)] and [1.71(1.50–1.95) vs. 1.04(0.88–1.23)] times more than the general population, respectively. Men and women living with diabetes lost an average of 13.2(6.3) and 13.9(6.0) life-years from the year of diagnosis, respectively (p = 0.101). The estimated life-years lost were greater in younger patients and a gradual decline was observed with increasing the age at diagnosis. In conclusion, Iranians with diabetes had higher risk of death and lower life expectancy compared to the general population.

Objective: Thyroid dysfunction, a common complication of pregnancy, is associated with adverse obstetric and neonatal consequences. This study aimed to determine the effect of TSH levels on early pregnancy outcome in a prospective population‐based cohort study.Design and methods: The serum TSH, free thyroxine, free triiodothyronine, thyroid peroxidase antibody levels and urinary iodine concentration of 418 pregnant women in their first trimester of pregnancy were measured. According to the American Thyroid Association (ATA) and the local reference ranges for TSH, women were divided into two groups of 0.1‐2.5, >2.5 mIU/L and 0.2‐4.6, >4.6 mIU/L. The risk of spontaneous abortion (SA) was calculated for each group.Results: Spontaneous abortion was detected in 7.2% (n = 30) of total 418 pregnancies. Women with TSH levels > 2.5 mIU/L had an increased risk of SA, compared to women with TSH levels of 0.1‐2.5 mIU/L (relative risk [RR] 3.719, 95% confidence interval [CI]:1.713‐8.074). The risk of SA was increased in women with TSH levels > 4.6 mIU/L (RR 5.939, 95% CI: 1.711‐20.620). The rate of SA was increased by 78% for every unit increase in standard deviation of TSH concentration (RR 1.35, 95% CI: 1.09‐1.70). The rate of miscarriages in the treated group by levothyroxine was 9.8% (n = 6) compared to 28.6% (n = 8) in the untreated group (P = 0.024).Conclusions: Our finding suggests that the upper limit for the TSH normal range should be redefined to <2.5 mIU/L during the first trimester of gestation. The local upper limit was 4.6 mIU/L, consistent with 4.0 mIU/L cut‐off value recommended by the ATA.

Probiotics and/or prebiotics could be a promising approach to improve metabolic disorders by favorably modifying the gut microbial composition.