Tehran University Medical Journal

An overview on hyperthyroidism: pathogenesis, diagnosis ,management, complications and prognosis: a review article

Mahsa Abbaszadeh

Hyperthyroidism is one of the most important endocrine disorders, characterized by increased activity of the thyroid gland and excessive production of thyroid hormones. These hormones play a key role in regulating the body’s metabolism; therefore, their excess leads to a wide range of clinical manifestations. The most common symptoms include anxiety, restlessness, weight loss despite normal or even increased appetite, palpitations, excessive sweating, fine tremors of the hands, sleep disturbances, and heat intolerance. Some patients may also experience mood changes such as irritability and nervousness. On physical examination, rapid tendon reflexes, tachycardia, moist and thin skin, and in many cases the presence of goiter (thyroid enlargement) may be observed. The condition is more common in women than men and is most frequently seen between the ages of 20 and 50 years. Once hyperthyroidism is confirmed, the underlying cause of thyrotoxicosis must be determined. The most common cause is Graves’ disease, an autoimmune disorder that leads to diffuse thyroid enlargement and overproduction of hormones. Toxic multinodular goiter and solitary toxic adenoma are other important causes. For definitive diagnosis, blood tests measuring TSH, T3, and T4 are essential. In hyperthyroidism, TSH is typically suppressed while T3 and T4 are elevated. In addition to laboratory testing, thyroid ultrasound can help evaluate the structure of the gland, and a thyroid radioactive iodine uptake scan can further differentiate between different causes and determine disease activity. Several treatment options are available for managing hyperthyroidism. Antithyroid drugs such as methimazole or propylthiouracil inhibit the synthesis of thyroid hormones. Beta-blockers are often prescribed to control cardiovascular symptoms and reduce palpitations. Radioactive iodine therapy is a common and effective method that destroys the overactive thyroid tissue. In rare cases, or when other treatments fail, thyroidectomy (surgical removal of part or all of the thyroid gland) may be required. Overall, hyperthyroidism is a manageable condition, but it requires accurate diagnosis, careful selection of therapy, and close follow-up with a specialist. Patient cooperation and adherence to treatment play a crucial role in controlling symptoms and preventing long-term complications. This review will focus on describing the symptoms, causes, diagnostic methods, and treatment options.

The role of artificial intelligence in glaucoma: a review article

Mohammad Reza Mehrabi Bahar

Artificial intelligence (AI) has emerged as a transformative force in modern medicine, with ophthalmology standing at the forefront of its clinical integration. Among ophthalmic disorders, glaucoma—a leading cause of irreversible blindness worldwide—presents unique opportunities and challenges for AI-based solutions due to its chronic, progressive nature and reliance on multimodal data, including structural and functional assessments. This review article offers a comprehensive synthesis of the current and emerging roles of AI in the detection, monitoring, and management of glaucoma. AI algorithms, particularly deep learning and machine learning models, have demonstrated exceptional capabilities in interpreting fundus photographs, optical coherence tomography (OCT) images, and visual field data to identify glaucomatous damage. These systems often approach or even exceed the diagnostic performance of human experts. Moreover, AI has shown significant promise in facilitating large-scale population-based screening, improving early detection rates, and addressing disparities in access to subspecialty care, particularly in low-resource and remote settings. In the monitoring of disease progression, AI tools are being developed to detect subtle structural or functional changes over time, predict future visual outcomes, and support more precise and individualized treatment decisions. Despite these advancements, the widespread clinical adoption of AI in glaucoma care faces several critical barriers. Key limitations include poor generalizability of models across diverse populations, imaging devices, and clinical settings; scarcity of well-annotated, high-quality, and demographically representative datasets; and a lack of transparency and interpretability in algorithmic decision-making—commonly referred to as the “black box” problem. Ethical concerns, regulatory uncertainty, integration challenges within existing healthcare infrastructures, and medico-legal accountability also require thoughtful resolution before AI can be reliably deployed in clinical practice. This review critically evaluates the strengths, limitations, and real-world potential of AI technologies in glaucoma. It provides clinicians, researchers, and healthcare policymakers with a balanced and up-to-date perspective, highlighting promising avenues for future research, including explainable AI, federated learning, multi-modal data integration, and longitudinal validation studies. By fostering a deeper understanding of both the opportunities and challenges associated with AI, this article aims to guide the responsible, equitable, and evidence-based integration of AI into comprehensive glaucoma care.

The incidence of shivering and nausea with the use of bupivacaine versus bupivacaine-sufentanil combination in women undergoing elective cesarean section under spinal anesthesia

Background: Spinal anesthesia is a common method for elective cesarean sections; however, complications such as shivering and nausea may affect postoperative recovery quality. Bupivacaine is a standard drug used in this procedure, but its combination with opioids like sufentanil may have beneficial effects in reducing these complications. This study aimed to compare the incidence of shivering and nausea in women undergoing elective cesarean section who received either bupivacaine alone or a bupivacaine-sufentanil combination.
Methods: The present study was a double-blind randomized clinical trial conducted over a 6-month period from April 2021 to October 2021 on 30 patients undergoing elective cesarean section with spinal anesthesia at Motahari Hospital in Jahrom city. Patients were randomly assigned using a random number table into two groups: bupivacaine alone and bupivacaine-sufentanil combination. The frequency of nausea, vomiting, and shivering was recorded at different time points: before spinal anesthesia, after spinal anesthesia, 3 minutes before delivery, immediately after delivery, at 15, 30, and 45 minutes, upon recovery room admission, and upon discharge from recovery. The data analysis was performed using descriptive statistics indicators (frequency, percentage, mean, and standard deviation) and inferential statistical tests (t-test, Mann-Whitney, chi-square and Friedman) using SPSS software version 21. A significance level of p < 0.05 was considered.
Results: In the bupivacaine-sufentanil group, the highest frequency of shivering occurred at 30 minutes post-spinal anesthesia (20%) and upon recovery room admission (26.7%). In the bupivacaine-alone group, the highest frequency was observed upon recovery room admission (33.3%) and at discharge from recovery (26.7%). The highest nausea frequency was 33.3% in the bupivacaine-sufentanil group and 40% in the bupivacaine group at 3 minutes before delivery. However, no statistically significant difference was found between the two groups at different time points.
Conclusion: The present study showed that adding low-dose sufentanil to bupivacaine in spinal anesthesia protocols, while potentially having minor clinical effects on certain complications, did not lead to a significant difference in the incidence of shivering and nausea. Therefore, for more precise clinical decision-making regarding drug combinations in regional anesthesia, further studies with larger sample sizes and different drug dosages are recommended.

Study of the prevalence of thyroid disorders in patients with breast cancer

Tahereh Parsajam

Background: Thyroid hormones play a key role in the development of various organs of the body. The breast and thyroid are hormone-responsive organs that are closely related to changes in endocrine activity and glandular diseases. Breast cancer is the most common cancer in women and the second leading cause of cancer-related death. Due to the inconsistencies in the relationship between breast cancer and thyroid diseases and the lack of regional data, the present study was designed and conducted with the aim of investigating the prevalence of various thyroid disorders in patients with breast cancer and its relationship with the type of breast cancer and age.
Methods: In this prospective study, we examined 50 women with breast cancer who had undergone surgery after surgery. The location of this study was Imam Reza Hospital in Kermanshah and the duration of this study was 12 months from the beginning of March 2023 to the end of March 2024. Patient information included: age, histopathological type of cancer, and thyroid test results including serum TSH, FT4, and ATPO levels, were recorded and reviewed.
Results: Based on the results obtained, it was shown that the average age of people with thyroid disorders in patients with breast cancer was 42.88 and the standard deviation was 11.313. Also, there was no significant difference between the age of people and thyroid disorders in patients with breast cancer (P-value < 0.89). In the study of thyroid disorders in patients with breast cancer, it was shown that there was a significant relationship between patients with breast cancer and the amount of TSH and the amount of FT4. This means that people with breast cancer had an increase in the amount of TSH and the amount of FT4. However, there was no significant relationship between patients with breast cancer and the amount of ATPO (P-value < 0.319).
Conclusion: Thyroid disorders are more prevalent in patients with breast cancer than in the normal population, and given the relationship between the types of thyroid disorders and the type of breast cancer histopathology, these results can be used and screening methods can be used more effectively in those who have risk factors for breast cancer for early diagnosis and treatment of the disease.

A 5-year follow-up study of renal status in children with posterior urethral valve dysfunction

Hossein Amirzargar

Background: Posterior urethral valve (PUV) is recognized as one of the most frequent causes of obstructive uropathy in the pediatric population, particularly in male infants. This congenital anomaly leads to variable degrees of urinary outflow obstruction, which may result in progressive renal damage and deterioration of kidney function over time. Despite advances in diagnostic modalities and surgical interventions, infants and children affected by PUV continue to demonstrate suboptimal long term renal outcomes, with a considerable proportion developing chronic kidney disease (CKD). Understanding early predictors of adverse renal prognosis is essential to guide timely interventions and optimize follow up strategies. The present study aimed to assess the long term renal outcomes, over a minimum of five years, of patients with PUV treated at the Children’s Medical Center, and to investigate the role of preoperative serum creatinine levels as a predictor of future CKD in this patient group.
Methods: A cross sectional and retrospective study design was employed. The medical records of patients diagnosed with PUV between March 2011 and March 2016 who had at least five years of documented follow up were reviewed at the Children’s Medical Center in 2021. Data extracted included demographic characteristics, laboratory tests—particularly pre and post operative serum creatinine—ultrasound imaging results, surgical details, and follow up findings throughout the study period.
Results: Eighty one patients met the inclusion criteria, with a mean age at diagnosis of 105 days. At the five year follow up, the overall prevalence of CKD among these patients was estimated at approximately 9.9%. During the follow up period, one patient died due to kidney disease, one underwent kidney transplantation, and three required maintenance dialysis. Statistical analysis demonstrated that a preoperative creatinine level exceeding 1.15 mg/dL was strongly associated with the future development of CKD, showing 100% sensitivity and 75% specificity in predicting adverse long term renal outcomes.
Conclusion: This study underscores the persistent risk of CKD in children with PUV, even after surgical intervention. Regular and comprehensive monitoring of renal function remains vital in this high risk group. Preoperative serum creatinine may serve as a reliable, accessible, and clinically useful prognostic marker to identify patients who may benefit from closer follow up and proactive management strategies.

Evaluation of the relationship between changes in serum troponin level and asymptomatic hypotension during hemodialysis in patients with advanced renal failure

Omolbanin Taziki

Background: Asymptomatic hypotension is a common complication in patients undergoing hemodialysis, which can lead to serious consequences. Troponin I, as a biochemical marker for myocardial injury, may play a role in the diagnosis and management of this complication. This study aimed to investigate the relationship between serum troponin I level changes and asymptomatic hypotension in patients with advanced kidney failure undergoing hemodialysis.
Methods: In this cross-sectional study, 120 adult ESRD patients (aged 30–80 years) with an ejection fraction (EF) >50% who attended the hemodialysis unit of Shohada Tajrish Hospital over a 6-month period starting 15 January 2024 were enrolled. Demographic and clinical data were collected using a checklist. Serum troponin I levels were measured before and after dialysis, and patients' blood pressure was recorded throughout dialysis sessions. For quantitative variables, mean and standard deviation were reported; for qualitative variables, absolute and relative frequencies were presented. Statistical analysis was performed using the Paired t-test, Independent t-test, Pearson correlation coefficient, and their non-parametric equivalents as appropriate. A significance level of p < 0.05 was considered statistically significant.
.Results: A total of 120 patients were examined, with a mean age of 57.6 ± 7.1 years. The gender distribution was 67 males (55.8%) and 53 females (44.2%). The mean body mass index was 20.73 ± 0.98. Significant differences were found in mean blood pressure, heart rate, body weight, and changes before and after dialysis (P<0.05). These differences included a decrease in blood pressure, and body weight, an increase in heart rate, and an increase in troponin levels. No significant relationship was found between troponin changes before and after dialysis with age, gender, height, weight, body mass index, heart rate, average duration of dialysis, and other laboratory variables (P>0.05). However, a significant correlation was found between troponin changes and blood pressure changes, indicating that as troponin levels increased, the mean blood pressure of patients decreased.
Conclusion: The findings of this study indicate a significant relationship between increased serum troponin I levels and asymptomatic hypotension in patients with advanced kidney failure undergoing hemodialysis. These results may be useful in identifying at-risk patients and improving therapeutic management. Further research is needed to confirm this relationship and explore its underlying mechanisms.

The effect of dry needle on tissue repair of ligament injury in the acute stage of ankle sprain

Morteza Talebi Doluee

Background: Ankle sprain is one of the most common sports injuries and accounts for 10 to 30 percent of sports injuries, especially in athletes. This injury can lead to pain, imbalance, and movement restriction, and therefore has a significant impact on athletes' performance. Therefore, the aim of this study was to investigate the effect of dry needling on tissue repair of ligamentous injury in the acute phase of ankle sprain.
Methods: This double-blind clinical trial study was conducted on 52 patients with ankle sprains at Imam Reza Hospital in 2023. Patients were divided into two groups: control and intervention. The control group received conventional treatment including medication and splints, while the intervention group received dry needling in addition to conventional treatments. Data analysis was performed using SPSS version 21 software and descriptive statistics and inferential statistical tests at a significance level of P<0.05.
Results: The results showed that the intervention group showed significant improvement in pain (P=0.002), activities of daily living (P<0.001), sports activities (P<0.001), plantar flexion (P=0.027), dorsiflexion (P=0.003), inversion (P=0.012), and edema (P=0.005) compared to the control group. However, there was no significant difference in symptom severity (P=0.752) and quality of life (P=0.348) between the two groups. Overall patient change analysis showed that most patients in the intervention group improved, while only 7.7% in the control group improved.
Conclusion: A combination of splinting, medication, and dry needling can be effective in improving pain, daily activities, exercise and recreation, range of motion, and edema in patients with ankle sprains. These findings can provide a basis for implementing new treatment protocols for the management of ankle sprains in athletes and other injured patients. It is recommended that further studies be conducted on the long-term effects of dry needling and other therapeutic interventions to further identify their potential to accelerate the recovery process in patients.

Evaluation and comparison of cognitive function in migraine patients with normal people in the community

Anahita Zoghi

Background: Migraine is a complex neurological disease that has affected hundreds of people of different ages and races. Migraine causes changes in the white matter and may cause cognitive changes in affected patients, but studies in this field are still limited and sometimes have contradictory results. The purpose of this study is investigate and compare cognitive function in patients with migraine.
Methods: In this case-control study, which was conducted with the aim of investigating and comparing cognitive function in migraine patients with the control group, cognitive function in migraine patients (with and without aura) referred to the Luqman Hospital clinic in the year 2023 were evaluated and compared with the healthy control group. Patient information was recorded in SPSSv.25 and analyzed.
Results: A gender difference was observed between the two groups, and women were significantly more in the migraine group (P-value: 0.003). This issue was also seen regarding age, and people with migraine were significantly older than normal people (33.91 ± 10.86 vs. 30.43 ± 7.89, P-value: 0.013). The visual score had a significant difference between the two groups (P-value: 0.001). In general, it was seen that the cognitive status score had a statistically significant difference between the two groups and it was lower in the migraine group (P-value<0.001).
Conclusion: It is concluded that migraine patients have some degree of cognitive impairment and this is not associated with migraine. Based on our findings, there is a significant difference in gender and level of education between normal individuals and migraineurs, and migraineurs are usually women and have lower education than normal individuals, which could be due to impaired quality of life due to migraine and cognitive impairment. The current study did not examine chronic migraine, but it was found that there was no difference in cognitive impairment between migraine with and without aura. Whether chronic migraine differs from other migraines in the incidence of cognitive impairment needs to be investigated in future studies.

Concurrence of familial mediterranean fever and inflammatory bowel disease in a seven-year-old girl with henoch-schönlein purpura: a case report

Niloofar Shashaani

Background: Immunoglobulin A (IgA) vasculitis or Henoch–Schönlein Purpura (HSP) is a systemic vasculitis of small vessels associated with IgA deposition. It is the most common Vasculitis in childhood and presents with a wide spectrum of clinical manifestations, most commonly palpable purpura, renal involvement, and arthritis. However, its manifestations are not limited to these organs and may also involve other systems of the body. The coexistence of Henoch–Schönlein purpura with other autoimmune and autoinflammatory diseases has been reported. In particular, its association with Familial Mediterranean Fever (FMF), Inflammatory Bowel Disease (IBD), and Behcet Disease (BD) has been observed in different studies. Patients with Familial Mediterranean Fever who develop Henoch–Schönlein purpura usually exhibit more severe and prolonged inflammatory symptoms. Therefore, reporting the co-occurrence of these diseases can provide a better understanding of the spectrum of clinical manifestations and diagnostic-therapeutic challenges.
Case Presentation: This case describes a 7-year-old girl with initial manifestations of Henoch–Schönlein purpura, who, due to severe gastrointestinal symptoms, underwent further evaluations. In the performed investigations, the coexistence of Familial Mediterranean Fever and Inflammatory Bowel Disease was diagnosed, and incomplete Behcet Disease was also considered. The patient was placed under appropriate medical treatment. Finally, the patient was controlled with appropriate medical treatment.
Conclusion: This report shows that in children with Henoch–Schönlein purpura, especially in severe and recurrent cases, the possibility of associated autoimmune and autoinflammatory diseases such as Familial Mediterranean Fever, Inflammatory Bowel Disease, and Behcet Disease should be considered. These associated diseases can play a key role in the course of appropriate treatment.

Strengthening Iran's primary health care for communicable diseases control: a letter to editor

Shabnam Afraz