ACTA ENDOCRINOLOGICA (BUC)

Introduction. The present study aimed to introduce a new formula for classification of nodules in TI-RADS and describe ultrasonography features of benign and malignant thyroid nodules. Methods. This study was conducted on thyroid mass in 1033 patients. The incidence of malignancy for thyroid nodules was determined by selecting malignancy coefficients. Then the patients were first classified using conventional TI-RADS classification criteria and once again according to a new proposed formula. Results. Among ultrasonography features of thyroid nodules, the irregular shape (46.7%), unclear margin (47.3%), extension to the capsule (irregular and infiltrative margin) (85%), the marked hypo-echoic nodules (63.8%), micro-calcification (49%), and to have vertical axis (74.0%) were associated with high incidence of malignancy. Conclusion. According to the proposed new formula for TI-RADS, there are four coefficients of 7, 3, 1 and 0 for incidence of malignancy of each one of ultrasound findings that help to standardization and unifying of TIRADS classification. The incidence of malignancy in TIRADS classification according to the new proposed formula was achieved as follows: group 2: 0.0%, group 3: 0.7%, groups 4a, 4b, 4c: 16.7%, 43.4%, 68.5%, and group 5: 95.2%, respectively.

Background and Purpose. Fibroblast growth factor 21 (FGF21) has recently been identified as a metabolic regulator, but its physiological role is still not completely known. The aim of this study was to evaluate serum FGF21 levels in an Iranian population with type 2 diabetes. Materials and Methods. This cross-sectional study was conducted in patients with type 2 diabetes. All patients were evaluated for fasting serum levels of glucose, glycated hemoglobin (HbA1c), lipids, urea and creatinine. Participants were divided into two groups with poorly-controlled and wellcontrolled diabetes based on their HbA1c levels. Healthy nondiabetic subjects (matched with patients in terms of age, sex and body mass index [BMI]) were also recruited as control group. Serum FGF21 concentrations were determined in all subjects using ELISA. Results. Of the evaluated 141 subjects, 49 (34.8%) were categorized as having well-controlled diabetes, 66 (46.8%) had poorly-controlled diabetes, and there were 26 subjects in the normal control group. Mean serum FGF-21 concentration was 337.89±283.67 ng/L in the diabetic group and 237.25±43.22 ng/mL in the non-diabetic group (p<0.001). Mean serum FGF21 level was 237.25 ± 43.22 ng/mL in the control group, 309.81 ± 301.68 ng/mL in the well-controlled diabetic group, and 358.73 ± 269.98 ng/mL in the poorly controlled diabetic group. Serum FGF21 level in the poorly controlled diabetic group was significantly higher than that in the well-controlled diabetic and the healthy control groups (p=0.02) but there was no significant difference between the well-controlled and healthy groups. There was no significant association between serum FGF21 levels with lipid levels, presence of diabetic complications and BMI (p > 0.05). Conclusions. The present results suggested an association between elevated serum levels of FGF21 and poor control of diabetes. Future studies are warranted to elucidate the prognostic role of these elevated levels of FGF21 in diabetic subjects.

Objective. Gestational diabetes mellitus (GDM) is a common endocrine complication in pregnancy. There are few risk factors that clearly correlate with GDM. Fibroblast growth factor 21 (FGF21) is a metabolic hormone that can regulate glucose metabolism. It has been recognized that serum levels of FGF21 are significantly increased in diabetes and insulin resistance states. The objective of this study was to determine the serum FGF21 levels in women with GDM compared with non-GDM women and its correlation with insulin resistance. Methods. Thirty GDM patients and 60 healthy pregnant controls that matched for maternal and gestational age were selected. Women with previous history of GDM, hypertension, polycystic ovary syndrome, renal or liver failure and drug consumption with effects on glucose or insulin levels were excluded. FGF21 was determined and correlated with biochemical parameters of glucose metabolism and insulin resistance. Results. FGF21 concentration was significantly higher in GDM (264.5±196.2 ng/L) as compared with control groups (59.1±36.5ng/L). Correlation of FGF21 with insulin resistance was not significant. A cut-off 82.07 ng/L of FGF21 had sensitivity of 100% and specificity of 85% for prediction of GDM. Conclusion. FGF21 is increased in GDM and it is independent of insulin resistance. We suggest that FGF21 resistance could be directly involved in pathophysiology of GDM.