Persistent hyperparathyroidism secondary to ectopic parathyroid adenoma in lung: Case report

Primary hyperparathyroidism (PHPT) is the most prevalent cause of hypercalcemia, affecting 0.3% of the population. The only curative procedure is parathyroidectomy. Persistent PHPT occurs in 4.7 percent of patients, even in the most skilled hands. Ectopic adenomas are challenging to localize before and during surgery and frequently result in persistent PHPT. We presented a case with persistent PHPT due to lung parathyroid adenoma that was successfully resected with video-assisted thoracoscopic surgery. A 55-year-old female patient was admitted to our endocrinology clinic with persistent PHPT after four neck explorations over 16 years. The last 99m Tc-MIBI scintigraphy with SPECT showed nothing suggestive of parathyroid adenoma, neither in the neck nor the mediastinum, but a solitary nodule as an incidental finding was reported in the lower lobe of the right lung, which was highly probable for a parathyroid adenoma in a fluorodeoxyglucose PET scan. Pathological examination ruled out parathyromatosis and lung malignancy; despite its location outside the anticipated embryonic pathway, pathology revealed the presence of an ectopic parathyroid adenoma. After the surgery, serum parathyroid hormone and calcium levels decreased, and hypoparathyroidism was corrected with calcium carbonate and calcitriol

Subclinical thyroid dysfunction and incident diabetes:a systematic review and an individual participant data analysis of prospective cohort studies

Objective: Few prospective studies have assessed whether individuals with subclinical thyroid dysfunction are more likely to develop diabetes, with conflicting results. In this study, we conducted a systematic review of the literature and an individual participant data analysis of multiple prospective cohorts to investigate the association between subclinical thyroid dysfunction and incident diabetes.Methods: We performed a systematic review of the literature in Medline, Embase, and the Cochrane Library from inception to February 11, 2022. A two-stage individual participant data analysis was conducted to compare participants with subclinical hypothyroidism and subclinical hyperthyroidism vs euthyroidism at baseline and the adjusted risk of developing diabetes at follow-up.Results: Among 61 178 adults from 18 studies, 49% were females, mean age was 58 years, and mean follow-up time was 8.2 years. At the last available follow-up, there was no association between subclinical hypothyroidism and incidence of diabetes (odds ratio (OR) = 1.02, 95% CI: 0.88-1.17, I2 = 0%) or subclinical hyperthyroidism and incidence of diabetes (OR = 1.03, 95% CI: 0.82-1.30, I2 = 0%), in age- and sex-adjusted analyses. Time-to-event analysis showed similar results (hazard ratio for subclinical hypothyroidism: 0.98, 95% CI: 0.87-1.11; hazard ratio for subclinical hyperthyroidism: 1.07, 95% CI: 0.88-1.29). The results were robust in all sub-group and sensitivity analyses.Conclusions: This is the largest systematic review and individual participant data analysis to date investigating the prospective association between subclinical thyroid dysfunction and diabetes. We did not find an association between subclinical thyroid dysfunction and incident diabetes. Our results do not support screening patients with subclinical thyroid dysfunction for diabetes.Significance statement: Evidence is conflicting regarding whether an association exists between subclinical thyroid dysfunction and incident diabetes. We therefore aimed to investigate whether individuals with subclinical thyroid dysfunction are more prone to develop diabetes in the long run as compared to euthyroid individuals. We included data from 18 international cohort studies with 61 178 adults and a mean follow-up time of 8.2 years. We did not find an association between subclinical hypothyroidism or subclinical hyperthyroidism at baseline and incident diabetes at follow-up. Our results have clinical implications as they neither support screening patients with subclinical thyroid dysfunction for diabetes nor treating them in the hope of preventing diabetes in the future.</p

The effect of metformin therapy on serum thyrotropin and free thyroxine concentrations in patients with type 2 diabetes: a meta-analysis

Abstract Type 2 diabetes and thyroid function disorders are two common chronic endocrine disorders with the high prevalence in various populations. Metformin is well established as the first-line drug therapy for managing diabetes mellitus. In this meta-analysis, we aimed to determine the effect of metformin on serum TSH and FT4 concentrations in patients with type 2 diabetes. We searched PubMed, Scopus, web of science, Cochrane library, and google scholar to collect information on the effect of metformin on serum TSH and FT4 levels. Demographic and clinical information and serum TSH and FT4 concentrations before and after metformin treatment were extracted. Studies on patients over 18 years of age were included. A total of 11 studies including 1147 patients were selected for the final analysis. In hypothyroid patients, the TSH level decreased significantly after treatment with metformin (Hedges’s g:1.55, 95%CI 0.93–2.16, p-value < 0.001); FT4 level increased slightly after taking metformin, but the increase was not significant (Heddges’s g: − 0.30, 95%CI  − 0.90,0.31, p-value = 0.34). In euthyroid subjects, the slight decrease found in TSH and FT4 concentrations was not statistically significant. Metformin reduces TSH levels in hypothyroid patients; however, it has no effect on TSH levels in euthyroid patients. Metformin does not affect serum FT4 levels in euthyroid and hypothyroid patients

Continuous Adequate Iodine Supplementation in Fars Province: The 2007 Goiter and Urinary Iodine Excretion Survey in Schoolchildren

Background: The iodine deficiency elimination program thatbegan two decades ago resulted in Iran becoming an iodinedeficiency disorders free country in the Middle East region.The present study was performed to evaluate the adequacy ofiodine supplementation after 17 years of universal salt iodizationin Fars province.Methods: In a cross-sectional study, 1200 schoolchildren (480girls and 720 boys) aged 8 to10 years, were randomly selectedfrom Fars province and evaluated in 2007. Goiter prevalence,urinary iodine excretion, and iodine content of household saltswere measured and the data were compared with those obtainedin 1996 and 2001.Results: Total prevalence of goiter was 1.3% (CI: 0.53-2.47)and no grade 2 goiter was found. One-tenth of the childrenenrolled for goiter assessment, were randomly selected forurinary iodine measurement. The median urinary iodine inthese 120 schoolchildren was 159.4 μg/L (85.6-252.3), with14.8% having urinary iodine excretion less than 50 μg/L. 98%of households were using purified iodized salt. 70% of householdshad appropriate salt storage and none of the householdsalts contained less than 15 μg iodide.Conclusion: Goiter prevalence has significantly decreased inthe Fars province, 17 years after universal salt iodization. Themedian urinary iodine of schoolchildren was adequate as thatreported in 1996 and 2001, indicating a well established sustainableiodine deficiency elimination program in the province

Effects of Cinnamon Consumption on Glycemic Indicators, Advanced Glycation End Products, and Antioxidant Status in Type 2 Diabetic Patients

The aim of the current study was to determine the effect of a daily intake of three grams of cinnamon over eight weeks on glycemic indicators, advanced glycation end products, and antioxidant status in patients with type 2 diabetes. In a double-blind, randomized, placebo controlled clinical trial study, 44 patients with type 2 diabetes, aged 57 ± 8 years, were randomly assigned to take either a three g/day cinnamon supplement (n = 22) or a placebo (n = 22) for eight weeks. We measured the fasting blood glucose, insulin, hemoglobinbA1c, homeostasis model assessment for insulin resistance (HOMA-IR), carboxymethyl lysine, total antioxidant capacity, and malondialdehyde levels at the beginning and the end of the study. Thirty-nine patients (20 in the intervention group and 19 in the control group) completed the study. After an eight-week intervention, changes in the level of fasting blood glucose, insulin, hemoglobinbA1c, HOMA-IR, carboxymethyl lysine, total antioxidant capacity, and malondialdehyde were not significant in either group, nor were any significant differences between groups observed in these glycemic and inflammatory indicators at the end of the intervention. Our study revealed that cinnamon supplementation had no significant effects on glycemic and inflammatory indicators in patients with type 2 diabetes

Does motivational interviewing improve the weight management process in adolescents? Protocol for a systematic review and meta-analysis

Abstract Background Data on the effects of motivational interviewing (MI) on modifying unhealthy lifestyles and promoting weight status during childhood is controversial. Adolescents are more prone to assume higher personal responsibilities for behavioral changes. This study aims to investigate whether MI will improve weight management process in adolescents. Methods/design A systematic review will be conducted on clinical trials, assessing the effect of MI on weight management processes in adolescents, aged 10 to 19 years. The primary objective is to assess the efficacy of MI in controlling weight-related measures in overweight and obese adolescents. Secondary objectives are assessing the efficacy of MI on obesity-related behaviors and cognitive abilities considering heterogeneity in outcomes of primary studies in different MI settings. Main data sources include MEDLINE/PubMed, Scopus, Embase, Web of Science, Cochrane, and PsycINFO from 1980 to May, 2018, with no language restrictions. Study selection, data extraction, and risk of bias assessment will be performed by two independent reviewers. A meta-analysis will be conducted on relevant outcomes. Data will be analyzed for outcome of interest using the 95% confidence interval (CI) of an estimate for dichotomous outcomes and mean differences (MDs) for continious outcomes. Cochrane’s Q statistic and the I 2 statistic will be performed to evaluate the heterogeneity. Subgroup analysis and suitable analytical strategies will be conducted to identify the potential sources of heterogeneity. As we expect a high heterogeneity in our included studies, pooled risk ratios (RRs) and 95% CI will be calculated to estimate the overall effect sizes, using meta-regression models or finite mixture modeling through conducting random effect methods. GRADE system will be used to evaluate the certainty of evidence. We will also use subgroup analysis and the GRADE system to investigate the effect of methodological quality of primary studies on results of meta-analysis. Funnel plots and egger and beggs test and plot will be implemented to assess publication bias. Discussion The results of this systematic review will provide more insights regarding the effect of MI on weight management in adolescents and will be useful for future research and health promotion programs in this age group. Systematic review registration PROSPERO 2017:CRD42017069813

Development and validation of a continuous metabolic syndrome severity score in the Tehran Lipid and Glucose Study

Abstract Metabolic syndrome (MetS), defined as the coexistence of interrelated cardiometabolic risk factors, is limited by ignoring the severity of the disease and individuals with a pre-metabolic state. We aimed to develop the first age- and sex-specific continuous MetS severity score in the adult population using confirmatory factor analysis (CFA) based on the MetS components in the Middle East. Using data from the population-based Tehran Lipid and Glucose Study (TLGS) I and II datasets, we conducted CFA of the single factor MetS on 8933 adults (20–60 years old) totally, and in age and sex subgroups. We allowed for different factor loadings across the subgroups to formulate age- and sex-specific continuous MetS severity score equations. Thereafter, we validated these equations in the dataset of TLGS III participants. Triglyceride had the highest factor loading across age and sex subgroups, indicating the most correlation with MetS. Except for women aged 40–60 years, waist circumference was the second most significant factor contributing to MetS. Systolic blood pressure was more closely related to MetS in women than in men. Systolic blood pressure and fasting plasma glucose had the weakest correlation with MetS among the 40–60 age group. Moreover, as women age, the contribution of fasting plasma glucose to MetS tended to decline, while it remained relatively constant in men. The resulting MetS severity score was correlated with age and homeostasis model assessment of insulin resistance. Furthermore, the continuous MetS severity score well predicted the traditional MetS according to receiver operating characteristic analysis in the validation dataset. The age- and sex-specific continuous MetS severity score for the West Asian adult population provides a tangible quantitative measure of MetS enabling clinicians to screen and monitor the individuals at risk and assess their metabolic trends

Evaluating the Effect of Knowledge, Attitude, and Practice on Self-Management in Type 2 Diabetic Patients on Dialysis

Background. Type 2 diabetes is an increasingly common condition with several preventable microvascular complications such as kidney damage. Nephropathy is expensive to manage, especially as hospital dialysis treatment. Improving patients’ knowledge, attitude, and practice (KAP) toward their condition can achieve better control, delay complications, and improve their quality of life. This study evaluated the KAP and self-care behaviors of diabetic patients on dialysis and variables that affect it. Methods. This cross-sectional study was conducted at Shahid Beheshti academic hospitals of Tehran, Iran. Face-to-face interviews were held to fill five validated questionnaires: three evaluating KAP, one evaluating self-management, and one evaluating quality of life. Result. 117 diabetic patients on hemodialysis (42 females) with mean (SD) age of 68.70±9.26 years were enrolled in the survey. The scores for patient’s KAP, self-care, and quality of life were 59.90±11.23, 44.27±8.35, 45.06±12.87, 46.21±10.23, and 26.85±13.23, respectively. There was significant negative correlation between patients’ knowledge and attitude with their glycosylated hemoglobin level and their fasting blood sugar. There was significant correlation between patients’ knowledge and practice with their self-care activities. Conclusion. The present study suggests that patients’ KAP scores have a practical effect upon self-care behavior. This highlights the needs for effective diabetes education programs in developing countries like Iran