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Article
The Impact Of Thyroid Dysfunction And TSH On The Pathogenesis Of Gallstone And Its Composition
تأثير الهرمون المحفز للغدة الدرقية TSH واختلال الغدة الدرقية في أمراضية حصوة المرارة وتركيبها

Authors: Suaad L. Ibrahim --- Meison Abdulbary
Journal: kufa Journal for Nursing sciences مجلة الكوفة لعلوم التمريض ISSN: 22234055 Year: 2014 Volume: 4 Issue: 1 Pages: 225-229
Publisher: University of Kufa جامعة الكوفة

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Abstract

Objectives: to study the impact of thyroid stimulating hormone (TSH) levels and thyroid dysfunction on the pathogenesis of gallstones and their compositions. Methodology: a study is applied including measuring of TSH levels in serum blood of (100) patients with gallstones diagnosed by sonographically or current cholecystectomy ( from April 2009 – April 2011 )with regarded to the differences between sex of patients and predominated of gallstone type with age . The researcher used statistical analysis) Chi X2 test ( to the data.Results: the search results showed significant increase in the rate of pathogenesis in female, but TSH levels is higher in male than female (p < 0.001). And cholesterol gallstone type is predominated (p < 0.0001). Current results were stated that the thyroid dysfunction had a role in the formation of gallstones.Conclusion : there is a significant association between the gallstones and thyroid dysfunctionRecommendations: the study recommends that must handling and treatment the thyroid dysfunction and hormonal dysfunction especially TSH.

الأهداف : لمعرفة تأثير مستويات الهرمون المحفز للغدة الدرقية TSH واختلال الغدة الدرقية في أمراضية حصوة المرارة وتركيبها.منهجية البحث : أجريت دراسة تطبيقية شملت قياس مستوى TSH في مصل دم( 100) مصاب بحصى المرارة والتي تم تشخيصها عن طريق sonographically أو استئصال المرارة للفترة ( نيسان 2009 – نيسان 2011 ) .مع الأخذ بالنظر الاختلافات بين الجنسين وسيادة نوع الحصوة مع عمر المريض. واستخدم الباحثون التحليل الإحصائي Chi X2 test للبيانات المأخوذة.النتائج :أظهرت نتائج البحث ارتفاع معدل انتشار الإصابة في الإناث بينما كانت مستويات TSH عالية في الذكور أكثر من الإناث (p<0.001). وسيادة نوع حصوة الكولسترول(p<0.0001) . وهكذا أن النتائج الحالية تبين الخلل في الغدة الدرقية والذي لها دور في تشكيل حصى في المرارة. الاستنتاج : هناك علاقة معنوية بين حصوة المرارة وبين الخلل في الغدة الدرقية.التوصيات : توصي الدراسة بمعالجة الخلل في الغدة الدرقية والاختلال الهرموني وخاصة هرمون TSH.


Article
Does Hepatitis C Virus Infection is a Relevant Factor for Thyroid Dysfunction?

Authors: Saad Muhmood Hussain --- Abdul-Razak Sh. Hasan
Journal: Diyala Journal For Pure Science مجلة ديالى للعلوم الصرفة ISSN: 83732222 25189255 Year: 2010 Volume: 6 Issue: 3 Pages: 140-145
Publisher: Diyala University جامعة ديالى

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Background: Because hepatitis C virus can replicate in cells other than hepatocytes, more than 5% of infected patients develop during the course of the disease at least one extrahepatic manifestations.Objective: Determination of the seropositivity rate of anti-HCV antibody among patients with thyroid dysfunction in Diyala province.Materials and methods: The present study was conducted from September/2008 to October/2009. 122 patients who presented with abnormal thyroid function tests. 29 (23.3%) of them were males with mean age 35.4 ± 19.0 years and 93 (76.7% ) were females with mean age 37.5±11.5 years. Additionally, 117 normal healthy blood donors were included as control group, the mean age 32.3 ± 8.7 years. Anti-HCV antibody was detected by ELISA technique. Repeatedly positive sera were confirmed by immunoblot assay. Data were statistically analyzed.Results: The preliminary results showed that the anti-HCV seropositivity rate among patients was insignificantly higher than controls (1.6% and 0.8%) respectively. Male and female were equally infected (50%). The age of infected male was 56 years, while the age of infected female was 47 years. Conclusion: Hepatitis C virus infection is not a risk factor for the development of thyroid dysfunction.


Article
A Cross-Sectional Study To Evaluate The Prevalence Of Thyroid Disorders Between Diabetic Patients In Hilla City

Author: Manar Mohammed Hassan Al-Murshidi
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 1 Pages: 154 -159
Publisher: Babylon University جامعة بابل

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Abstract

The aim of the present study was to evaluate the frequency of thyroid dysfunctions between diabetic patients. 150,36 diabetic and non-diabetic subjects,respectively were included in the study. they underwent a laboratory diagnosis for T3,T4,TSH and blood sugar tests.and a demographic data (weight ,height ,age, duration of diabetes ,hypertension, kidney and liver dysfunction) were obtained from them. Results revealed that there was a disturbance in thyroid hormone concentrations among diabetic patients ,The most frequently thyroid dysfunction was subclinical hypothyroidismas there was a decrease in thyroid hormone (T4)concentration.the study concluded that there was a prevalence of thyroid dysfunction among diabetic patient especially among type 2 DM patients as it was high with subclinicalhy pothyroidism.


Article
Cpitn in Iraqi Females with Thyroid Dysfunction

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Abstract

Background: Changes in thyroid function have significant health consequences onhuman beings. Women's risk of developing thyroid problems is seven times thatof men. The associations between periodontal diseases and thyroid dysfunctionhad received great attention in periodontal literature in last few decades. In theonly few studies that conducted in Iraq, the concentration was primarily directedtoward oral health status and dental treatment needs while the periodontaltreatment needs have been omitted. This omission is definitely due to absence ofimplementation of CPITN in these studies.Aim of the study: to estimate the periodontal health status and periodontal treatmentneed among Iraqi females with thyroid dysfunction.Material and methods: sample of this study consist of 225 adult Iraqi femalesallocated into three comparable groups. Group A (patients with hypothyroidism),Group B (patients with hyperthyroidism) and Group C (control group). CPITN,CAL & TN indices were recorded and the data were analyzed statistically usingSPSS program.Results: generally, healthy women found to have better periodontal health and lessclinical attachment loss compared to those with thyroid dysfunction but theseresults was not significant for all CPITN scores. On the other hand all populationsample were found to need periodontal treatment in different levels.Conclusion: Thyroid dysfunction in its both types (hypothyroidism &hyperthyroidism) has its impact on periodontal health status, but this impact stillin need of more extensive researches to expand our knowledge about this vitalsubject.


Article
Thyroid Dysfunction during Pregnancy

Authors: Ula Salah Jumaa --- Zahraa Abdulaali Mohammad Hassan
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2018 Volume: 11 Issue: 1 Pages: 3894-3902
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Pregnancy is the time of hormonal changes which may result in endocrine disorders. Thyroid disorders are common clinical problem during pregnancy in which subclinical hypothyroidism is the most common thyroid disorders. Maternal thyroid dysfunction may result in short-term and long- term harm to the mother and child. Objective: To study the prevalence of thyroid disorder during pregnancy and to follow the correlation between (TSH, FT3, and FT4) with BMI Materials and Method: A cross sectional study involved 120 pregnant women in second and third trimester (apparently normal) between (19-42) years. The participants were collected randomly from outpatient unit of Al-Zahraa teaching hospital in AL-Najaf AL-Ashraf, detailed history and data for pregnant women were recorded (including maternal age, gestational age ,medical history of thyroid disease and history of abortion and infertility) .Pregnant women with history of thyroid disease were excluded from the study. Serum TSH, FT3 and FT4 were measured for all pregnant women participated in study Results: The prevalence of thyroid disorder during pregnancy was 20.8% out of which 20(16.6%) had SCH and 2(1.6%) had OH. Hyperthyroidism detected in 3(2.5%) pregnant women all of them had subclinical hyperthyroidism. and there was a positive correlation between TSH, FT3 with BMI and negative correlation of FT4 with BMI, also maternal age don’t affect thyroid function status significantly (p value < 0.05).and there was no significant relation between thyroid disorder and history of abortion or infertility (p value < 0.05) Conclusion There is a high prevalence of hypothyroidism during pregnancy and the majority is subclinical hypothyroidism .BMI was correlated positively with TSH and FT3 and negatively with FT4.

Keywords

pregnancy --- thyroid dysfunction --- BMI --- TSH --- FT3 --- FT4


Article
THE PREVALENCE OF THYROID DYSFUNCTION AMONG WOMEN WITH TYPE 2 DIABETES MELLITUS IN DUHOK
انتشار اختلال و ظيفة الغدة الدرقية لدى النساء المصابات بالنوع الثاني من مرضى السكري في دهوك

Author: SHERWAN F. SALIH شيروان فرمان صالح
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2015 Volume: 9 Issue: 2 Pages: 52-59
Publisher: University of Dohuk جامعة دهوك

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ABSTRACTBackground: Diabetes mellitus has become a major health problem worldwide, and iscommonly associated with thyroid dysfunction. The aim of the study was to evaluate theprevalence of thyroid dysfunction among type 2 diabetic women.Methods: A cross sectional study was conducted on 534 women with type 2 diabetesmellitus, in diabetes and endocrinology unit in Azadi Teaching Hospital, Duhok, from 1stFebruary to 30th of July, 2015. All the women were investigated for serum thyroidstimulating hormone, total T4, total T3, free T4, free T3, plasma glucose concentration andwhole blood HbA1c percentage. The correlation of the prevalence of thyroid dysfunctionwith age, HbA1c, duration of diabetes mellitus, blood pressure and body mass index weredone.Results: There was a high prevalence of thyroid dysfunction in women patients with type 2diabetes mellitus (24.2%). From this thyroid dysfunction, subclinical hypothyroidism (12%)and subclinical hyperthyroidism (9.6%) were most common. The higher incidence of thyroiddysfunction was found in women with age between 51 and 70 years, body mass index morethan 30 kg/m2.Conclusion: We concluded that all women patient with type 2 diabetes mellitus need aroutine measurement of the thyroid function tests and more specifically those women withadvanced age and high body mass index.

المقدمة: مرض السكري اصبحت واحدة من اهم المشاكل الصحية حول العالم, وهذا المرض مرتبط بشكل ملحوظ باختلال وظيفة الغدة الدرقية. الهدف من هذه الدراسة هي لتقييم انتشار اختلال وظيفة الغدة الدرقية لدى النساء المصابات بالنوع الثاني من مرض السكري.طرق البحث: اخذت دراسة مقطعية على 534 نساء مصابات بالنوع الثاني من مرض السكري في وحدة السكري والغدد الصماء في مستشفى ازادي التعليمي من الفترة ما بين الاول من شباط الى الثلاثون من تموز 2015. تم اخذ عينات الدم من كل النساء واجري لهن فحص TSH, total T4, total T3, free T4, free T3, , فحص السكر في الدم وفحص السكر التراكمي (HbA1c). تم ربط العلاقة ما بين انتشار اختلال وظيفة الغدة الدرقية مع العمر, HbA1c, مدة مرض السكري, ارتفاع ضغط الدم, مؤشر كتلة الجسم, محيط الخصر و اختلال الدهون.النتائج: وجدت نسبة انتشار عالية من اختلال وظيفة الغدة الدرقية لدى النساء المصابات بالنوع الثاني من مرض السكري (24.2%). من هذا الاختلال, كان قصور الغدة الدرقية دون السريري (12%) و فرط نشاط الغدة الدرقية دون السريري (9.6%) الاكثر شيوعا. وجد حدوث نسبة عالية من اختلال وظيفة الغدة الدرقية لدى النساء من عمر 51 الى 70 سنة او اللاتي مؤشر كتلة الجسم لديهن اكثر من ( kg/m230).الاستنتاج: استنتجنا ان كل النساء المصابات بالنوع الثاني من مرض السكري تحتاجن الى فحص هورمونات الغدة الدرقية خاصة المتقدمات بالعمر واللاتي مؤشر كتلة الجسم لديهن عالي.


Article
STATUS OF SERUM ZINC LEVELS IN FEMALES WITH THYROID DYSFUNCTION
حالة مستويات مصل الزنك في الإناث المصاحب مع خلل في الغدة الدرقية

Authors: DHIA J. AL-TIMIMI ضياء التميمي --- KAJEEN R. HUSSEN كازين حسين --- SHERWAN F. SALIH شيروان فرمان صالح
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2019 Volume: 13 Issue: 1 Pages: 74-82
Publisher: University of Dohuk جامعة دهوك

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Abstract

Background: Low serum zinc levels have been connected to thyroid function in more than one way, but to date there is still arguments about the association between zinc deficiency and thyroid disease, particularly in females. The aim of this study was to assess status of serum zinc levels in a sample of females with thyroid dysfunction in comparison with those of normal thyroid function and to ascertain its association with thyroid hormone levels.Patients and Methods: A case control study was conducted on 225 females referred to the Endocrine Unit for definitive diagnosis of thyroid dysfunction and 100 females with normal thyroid function, serves as a control group.Results: The results revealed that the serum zinc levels were significantly lower inHypothyroid females(62.2±16.3µg/dl) as compared to hyperthyroid (80.5±13.9µg/dl) and controls (86.2±13.2 µg/dl) with p=0.001.The prevalence of severe zinc deficiency (<50 µg/dl) was found to be significantly higher in hypothyroid females (25.0%) as compared to hyperthyroid females (3.0%), p-value of 0.01, whereas none of the controls had severe zinc deficiency. In the hypothyroid group, positive correlations of zinc were observed with FreeT3 and FreeT4 (p=0.007, p<0.001, respectively) and a negative correlation was observed with thyroid stimulating hormone (TSH), p<0.001.In the overall studied subjects, negative correlation was also found for zinc with TSH (p< 0.001).We did not observe a significant correlation ofFT3, FT4 and TSH with zinc in controls or in hyperthyroid group.Conclusions: Decreased serum zinc levels may lead to hypothyroidism in females. Efforts to increase zinc status in this group may help correct abnormal levels of thyroid hormones.

الخلفية والأهداف: لقد تم ربط مستويات الخارصين المنخفضة في الدم بوظائف الغدة الدرقية في اكثر من طريقة واحدة.الهدف من الدراسة الحالية هو تقييم حالة مستويات الخارصين في مصل الدم لدى الاناث اللواتي يعانين من خلل في وظائيف الغدة الدرقية و تاكيد العلاقة مع هورمونات الغدة الدرقية . المواضيع و طرق البحث: تم اجراء الدراسة على 225 حالة من الاناث اللواتي حضرن وحدة الغدد الصماء للتشخيص النهائي من الخلل في وظيفة الغدة الدرقية و 100 من الاناث مع وظيفة الغدة الدرقية العادية بمثابة المجموعة الضابطة.النتائج: اظهرت النتائج ان مستويات الخارصين في مصل الدم كانت اقل بشكل ملحوظ في الاناث المصابين بخمول الغدة الدرقية (62.2±16.3ميكروغرام/ديسيليتر) بالمقارنة مع الاناث المصابين بزيادة نشاط الغدة الدرقية (80.5±13ميكروغرام/ديسيليتر) والاناث الاصحاء (86.2±13.2ميكروغرام/ديسيليتر) ,(P=0.001)تم العثور على انتشار نقص الخارصين الشديد (˃50ميكروغرام/ديسيليتر) لتكون اعلى بكثير لدى الاناث المصابين بخمول في الغدة الدرقيه (25%) بالمقارنة مع الاناث المصابين بزيادة نشاط الغدة الدرقية ( 3.0%), بينما لم تكن هناك اي حالة لنقص شديد للخاصين بين مجموعة الاصحاء.في المجموعة الخمول في الغدة الدرقية لوحظ ارتباط ايجابي من الخارصين مع هورمون الغدة النخامية .ولم تكن هناك ارتباط كبير بين الخارصين وكل من TSH ,FT3,FT4 في مجموعة الاصحاء ومجموعة زيادة نشاط الغدة.الاستنتاجات: انخفاض مستويات الزنك في الدم قد يؤدي إلى قصور الغدة الدرقية عند الإناث. قد تساعد الجهود المبذولة لزيادة حالة الزنك في هذه المجموعة على تصحيح مستويات غير طبيعية من هرمونات الغدة الدرقية


Article
Thyroid dysfunction in chronic myeloid leukemia patients on nilotinib

Authors: Khaleed J Khaleel --- Ahmed H. Matloob --- Abdalsalam Hatim
Journal: Iraq Joural of Hematology المجلة العراقية لامراض الدم ISSN: 20728069/25432702 Year: 2018 Volume: 7 Issue: 1 Pages: 33-38
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

BACKGROUND: The use of tyrosine kinase inhibitors has dramatically improved the prognosis ofchronic myeloid leukemia (CML). Nilotinib has been reported to be associated with hypothyroidismand hyperthyroidism.OBJECTIVES: The current study aims to evaluate the prevalence of thyroid dysfunction in a sampleof Iraqi patients with CML (chronic phase) treated with nilotinib and its possible association with gradeof other hematological parameters.PATIENTS AND METHODS: Thirty‑one patients with CML and the same number of healthy controlswere enrolled in this cross‑sectional study. All the patients were on nilotinib hydrochloride for at least6 months.RESULTS: Approximately 10% of the patients were having hypothyroidism and 3% were hyperthyroidwhile the rest (87%) were normal regarding thyroid function. There was a significant differencebetween the study and control group in thyroid stimulating hormone levels (P < 0.05) with the levelbeing higher in the study group.CONCLUSION: Thyroid dysfunction, particularly hypothyroidism is a clinically important


Article
Evaluation of some Biochemical parameters in serum patients with thyroid gland dysfunction

Author: Mohammad F. Hashim, Dawood S. Ail and Ahmad Y.Issa
Journal: basrah journal of science البصرة للعلوم ISSN: 18140343 Year: 2018 Volume: 36 Issue: 3C Pages: 42-51
Publisher: Basrah University جامعة البصرة

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Thyroid gland is one of the most important endocrine glands in the body that regulates a wide array of parameters such as lipid profiles, homocystein and malandialdehyde level. The present study included 50 patients with thyroid dysfunction and equal number matched healthy control. The results obtained from the present study, Have reported a significant increase in (TC, TG and LDL) level and significant decrease in level of HDL at (p<0.01) in the Hyperthyroidism patients compared with control. while in the hyperthyroidism the data in this study show significant decrease in the level of TG and LDL(P<0.01) and increase HDL level at (p<0.01) compared with control. While No significant difference was shown in TC level in hyperthyroidism. Furthermore, this study showed high significant for MDA level (p<0.01) in both hypo and hyperthyroidism compared with control . in this work, there was significantly increased (P<0.01) in serum HOMS in hypothyroidism compared with control, and no significantly in hyperthyroidism. Moreover , the results showed significant decrease TSH level and significant increase T4 and T3 at (P<0.01) in hyperthyroidism compared with control. the study has also reported significant elevation for TSH level and significant lower for T4 and T3 at (P<0.01) in hypothyroidism compared with control .


Article
The Effect of Thyroxine Treatment in Infertile Subclinical Hypothyroid Patients
تأثير العلاج هرمون الغدة الدرقية في المرضى العقيم متعلق بالقصور الدرقي تحت الإكلينيكي

Author: Hanan L. Sudek حنان لؤي صديق
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 / 24108057 Year: 2011 Volume: 53 Issue: 3 Pages: 343-347
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Sub-clinical hypothyroidism (SCTD) is most commonly an early stage of hypothyroidism. Although the condition may resolve or remain unchanged, within a few years in some patients, overt hypothyroidism may develop, with low free T4 levels as well as a raised thyroid stimulating hormone(TSH) level. In general thyroid dysfunction is a condition known to reduce the likelihood of pregnancy and to adversely affect pregnancy outcome. As screening for thyroid disease becomes more common, SCTD is being diagnosed more frequently in clinical practice. The aim of the study is to find out the effect of treating SCTD with thyroxin on the fertility status of the female patient. Patients and methods: Forty three infertile patients attending the infertility clinic at Baghdad teaching hospital were compared to 32 control un explained infertility women. After exact history and examination, hormonal analysis (T3 and T4, TSH, Prolactin and Progesterone) and ultrasound were done for patients and control, then the patients were randomly divided into 2 groups one group was given thyroxine treatment, the other group was given parlodel, and after 3 months the hormonal analysis and ultrasound were repeated and compared to the previous results. Results: Comparing the patient group to the control showed a significant increase in the TSH and prolactin level in patients group but the progesterone concentration was not significantly different between the groups. After giving thyroxine the group who received it showed significant reduction in prolactin and improvement in the dominant follicle size and progesterone level while the group who was given parlodel showed only significant reduction in prolactin with no significant increase in the other 2 parameters. Conclusion: TSH in subclinical hypothyroidisim is correlated positively with age and with the prolactin concentration. Treatment with thyroxine induces a significant improvement in the fertility statues including the significant decrease in prolacttin concentration and increase in the dominant follicle size and increase in the progesterone level compared to those given parlodel only. This makes it obvious that treating patients with SCTD have a significant reflection on their fertility and ability for future pregnancy.

خلفية: قصور الغدة الدرقية دون السريري (SCTD) هو الأكثر شيوعا في مرحلة مبكرة من الغدة الدرقية. على الرغم من أن الشرط قد حل أو لم تتغير، في غضون بضع سنوات في بعض المرضى، قد الغدة الدرقية علني تطوير، مع انخفاض مستويات T4 الحرة، فضلا عن تحفيز الغدة الدرقية التي أثيرت هرمون (TSH) مستوى. في الخلل في الغدة الدرقية العامة هي حالة تعرف للحد من احتمالات الحمل وتؤثر سلبا على نتيجة الحمل. كما فحص لأمراض الغدة الدرقية ويصبح أكثر شيوعا، ويجري تشخيص SCTD أكثر كثيرا في الممارسة السريرية. والهدف من هذه الدراسة هو معرفة تأثير علاج SCTD مع تيروكسينية عن حالة خصوبة المريضة.وتمت مقارنة المرضى الذين يعانون من العقم ثلاثة وأربعون حضور عيادة العقم في مستشفى بغداد التعليمي إلى 32 سيطرة الامم المتحدة وأوضحت النساء العقم: المرضى والأساليب. وقد تم القيام به بعد التاريخ المحدد وفحص وتحليل الهرمونات (، TSH T4 و T3، البرولاكتين والبروجستيرون)، والموجات فوق الصوتية لمرضى السرطان والسيطرة، ثم تم تقسيم المرضى عشوائيا إلى مجموعات 2 أعطيت مجموعة واحدة علاج هرمون الغدة الدرقية، وبالنظر إلى مجموعة أخرى parlodel ، وبعد 3 أشهر تكررت التحليل الهرمونية والموجات فوق الصوتية، وبالمقارنة مع النتائج السابقة.وأظهرت المقارنة بين مجموعة المرضى لمراقبة زيادة كبيرة في مستوى TSH والبرولاكتين في مجموعة من المرضى ولكن تركيز هرمون البروجسترون وكان لا تختلف كثيرا بين المجموعات: نتائج. بعد إعطاء هرمون الغدة الدرقية وأظهرت المجموعة التي تلقتها خفض كبير في البرولاكتين والتحسن في حجم الجريب المهيمن ومستوى هرمون البروجسترون في حين أن المجموعة التي أعطيت parlodel أظهرت انخفاض كبير في البرولاكتين فقط مع عدم وجود زيادة كبيرة في عدد المعلمات أخرى 2.والخلاصة: يرتبط TSH في hypothyroidisim تحت الإكلينيكي بشكل إيجابي مع التقدم في السن ومع تركيز البرولاكتين. العلاج مع هرمون الغدة الدرقية يؤدي الى تحسن كبير في الخصوبة التماثيل بما في ذلك انخفاض ملحوظ في تركيز prolacttin وزيادة في حجم المسام المهيمنة والزيادة في مستوى هرمون البروجسترون بالمقارنة مع تلك parlodel تعطى فقط. هذا يجعل من الواضح أن معالجة المرضى الذين يعانون من SCTD لها انعكاس كبير على خصوبتها وقدرتها على الحمل في المستقبل.

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