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136. A cancer of undetermined significance: Incidental thyroid carcinoma. Diagn Cytopathol. 2018

Evranos B, Polat SB, Cuhaci FN, Baser H, Topaloglu O, Kilicarslan A, Kilic M, Ersoy R, Cakir B.
Uluslararası Yayınlar 2018 Nov 29. doi: 10.1002/dc.24117.
ABSTRACT
ABSTRACT
INTRODUCTION:
The incidence of thyroid cancer is increasing which can be attributed in part to improved
ultrasonography (US) methods and increased detection of incidental thyroid carcinomas (ITC).
We aimed to compare ITC with nonincidental thyroid carcinomas (NITC) in this study.
METHODS:
Retrospective analyses of 906 individual patients who were operated for benign and malignant
thyroid disease and had a final histopathological diagnosis of thyroid carcinoma were enrolled in
this study. Preoperative US examination and fine needle aspiration (FNA) biopsy results were
evaluated. The tumor foci in thyroidectomy specimens that were not represented in preoperative
US or FNA reports were classified as ITC. The tumor foci that match with the lesions defined in
US or FNA results were classified as NITC.
RESULTS:
Final histology revealed ITC in 326 patients (36%) and NITC in 580 patients (64% Mean age
was 51.7±11.11 in ITC group and 48.15±13.1 in NITC group (P<.001). In NITC group 322
(55.5%) of the patients were operated for suspicious cytology while only 29 (8.9%) of the
patients in the ITC group were operated because of this indication (P<.001). There were 1301
cancer foci in histopathology specimens. Among all these cancer foci, 434 (33.3%) were
detected incidentally and 867 (66.7%) were detected non-incidentally. About 779 (89.9%) of
nonincidental cancer foci were papillary cancer (PTC), while all of the incidental cancer foci
were PTC. Mean size was 13mm in NITC group and it was 3 mm in the ITC group and differed
significantly between the groups (P<.001). Tumor size was ≤1cm in 35.2% of the patients with
NITC while 98.5% of patients with ITC had tumor ≤1cm. The occurrence of multinodularity was
higher in ITC than the NITC group (P<001). Median TSH level was higher in patients with
NITC than ITC while both were in the reference range (1.53 vs 1.03 μIU/mL, P<.001). The
frequency of thyroiditis detected by US, and thyroid peroxidase antibody and thyroglobulin
antibody positivities were similar in patients with ITC and NITC (P=.2, P=.86, and P=.26,
respectively). The frequencies of capsular invasion (29.1% vs 7.9%), extrathyroidal extension
(13% vs 4.2%), multifocality (35.8% vs 24.2%), non-complete resection (9.2% vs 1.8%), and
lymph node metastasis (9.5% vs 1.8%) were significantly higher in the NITC group (P<.001, for
each). Persistent/recurrent disease in patients with NITC was more frequent than patients with
ITC (P=.004). This outcome was similar for cancers measuring ≤1cm (P=.001).
CONCLUSION:
ITC is often encountered in older patients and frequently determined in early stages with more
favorable histopathological features and better prognosis.

135. The diagnostic value of parathyroid hormone washout in primary hyperparathyroidism patients with negative or equivocal 99 m Tc-MIBI results. Diagn Cytopathol. 2018

Aydın C, Polat SB, Dellal FD, Kaya C, Dogan HT, Turkolmez S, Kılıç M, Ersoy R, Çakır B.
Uluslararası Yayınlar 2018 Nov 21. doi: 10.1002/dc.24065.
ABSTRACT
ABSTRACT
BACKGROUND AND OBJECTIVES:
The accurate identification of hyper functioning parathyroid gland is needed for definitive
surgical treatment in primary hyperparathyroidism. Ultrasonography and 99mTechnetium
sestamibi scintigraphy are the two most used methods with varying sensitivities. This study
aimed to assess the value of parathyroid hormone (PTH) assay in preoperative ultrasound guided
fine needle aspiration (FNA)-PTH washout fluid to verify the correct localisation of lesions with
negative or inconclusive scintigraphy results.
METHODS:
We evaluated data of 28 lesions in 21 patients who underwent US-guided parathyroid fine-
needle aspiration (FNA) with PTH washout, retrospectively. The PTH washout results and the
reports of parathyroid surgery and imaging studies were reviewed.
RESULTS:
Of operated 28 lesions 23 had positive and 5 had negative washout results. The median FNA-
PTH washout was 2315.5 pg/ ml (min-max: 12.3-6978pg/ ml). The calculated sensitivity of
FNA-PTH washout was 85.7% and the specifity was 28.6%. The positive and negative predictive
values were 78.3% and 40.0%, respectively.
CONCLUSIONS:
FNA-PTH can be used to establish the nature of the lesion, discriminate parathyroid gland from
thyroid lesions or cervical lymph nodes, improving the surgical outcomes. It can be used to
localise parathyroid lesions preoperatively when negative or discordant ultrasound and
scintigraphy findings are obtained.

134. Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes mellitus (TEMD study). Diabetes Res Clin Pract. 2018

Sonmez A, Haymana C, Bayram F, Salman S, Dizdar OS, Gurkan E, Kargili Carlıoglu A, Barcin C, Sabuncu T, Satman I, TEMD Study Group.
Uluslararası Yayınlar 2018 Dec;146:138-147. doi: 10.1016/j.diabres.2018.09.010. Epub 2018 Sep 20.
ABSTRACT
ABSTRACT
AIMS:
Turkey has the highest prevalence of diabetes in Europe. It is therefore essential to know the
overall cardiovascular risk and reveal the predictors of metabolic control in Turkish adults
with diabetes mellitus.
METHODS:
A nationwide, multicenter survey consecutively enrolled patients who were under follow up for
at least a year. Optimal control was defined as HbA1c<7%, home arterial blood pressure
(ABP)<135/85mmHg, or LDL-C<100 mg/dL. Achieving all parameters indicated
triple metabolic control.
RESULTS:
HbA1c levels of patients (n=5211) were 8.6±1.9% (71±22mmol/mol) and 7.7±1.7%
(61±19mmol/mol), in Type 1 and Type 2 diabetes, respectively. Glycemic control was achieved
in 15.3% and 40.2%, and triple metabolic control was achieved in 5.5% and 10.1%, respectively.
Only 1.5% of patients met all the criteria of being non-obese, non-smoker, exercising, and under
triple metabolic control. Low education level was a significant predictor of
poor glycemic control in both groups.
CONCLUSIONS:
Few patients with Type 2, and even fewer with Type 1 diabetes have optimal metabolic control
in Turkey. TEMD study will provide evidence-based information to policy makers to focus more
on the quality and sustainability of diabetes care in order to reduce the national burden of the
disease.

133. The effects of radioactive iodine therapy on ovarian reserve: A prospective pilot study 2018

Evranos B, Faki S, Polat SB, Bestepe N, Ünlü Ersoy R, Cakir B
Uluslararası Yayınlar Thyroid. 2018 Aug 29. doi: 10.1089/thy.2018.0129.
ABSTRACT

INTRODUCTION:

Thyroid carcinoma is the most common endocrine malignancy. Surgery is the standard therapeutic approach for patients with differentiated thyroid carcinoma (DTC), followed by radioiodine (RAI) therapy (if needed). For women with DTC, the effects of RAI therapy on gonadal and reproductive function are an important consideration. We aimed to evaluate the effects of RAI therapy on ovarian function.

MATERIALS AND METHODS:

A total of 33 premenopausal women were enrolled in this study. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and anti-Müllerian hormone (AMH) levels during the early follicular phase were measured before and 3, 6, and 12 months after RAI therapy. The Friedman and Wilcoxon tests were used to detect the changes in FSH, AMH, LH, and estradiol levels induced by RAI therapy over time.

RESULTS:

The patient ages ranged from 21 to 38 years, with a mean age of 31.15 ± 4.83 years. The median follow-up was 19 (4-26) months. The median AMH levels were 3.25 (0.32-17.42), 1 (0.01-3.93), 1.13 (0.08-6.12), and 1.37 (0.09-6.1) ng/mL before and at 3, 6, and 12 months after RAI therapy, respectively. The median FSH levels were 6.6 (3.78-15.5), 5.83 (4.19-35.36), 7.71 (4.24-16.25), and 7.04 (4.93-19.96) mIU/mL before and at 3, 6, and 12 months after RAI therapy, respectively. The AMH levels were higher before than after RAI therapy (P = 0.001). The AMH levels did not differ significantly among the three time points (P > 0.05). The FSH, LH, and estradiol levels were similar before and after RAI therapy (P > 0.05).

CONCLUSION:

AMH is considered an important marker of ovarian reserve. Ovarian reserve decreased after RAI therapy. More attention may be needed when considering RAI therapy for patients with reduced ovarian reserve.

132 . Role of calcium-sensing receptor, Galectin-3, Cyclin D1, and Ki-67 immunohistochemistry to favor in the diagnosis of parathyroid carcinoma 2017

Sungu N, Dogan HT, Kiliçarslan A, Kiliç M, Polat S, Tokaç M, Akbaba S, Parlak Ö, Balci S, Ögüt B, Çakir B
Uluslararası Yayınlar Indian J Pathol Microbiol, 2018 Jan-Mar;61(1):22-26. doi: 10.4103/IJPM.IJPM_85_17
ABSTRACT
Background:
As histopathological findings of parathyroid carcinoma are not certain, the diagnosis of tumors
with degenerative changes may be difficult. In these cases, immunohistochemical markers are
beneficial. We aimed to research the acceptability of calcium‑sensing receptor (CaSR),
Galactin‑3,
Cyclin D1, and Ki‑67 as helpful markers in parathyroid tumors in cases which are difficult to
diagnose.
Materials and Methods: Those cases who had been diagnosed with atypical parathyroid
adenoma and parathyroid carcinoma between 2010 and 2015 were reevaluated.
İmmunohistochemical markers were applied to this cases.
Results: About 21 cases were parathyroid adenoma, 14 were atypical adenoma, and 10 cases
were parathyroid carcinoma. According to the immunohistochemical results, global loss of CaSR
staining was seen in 50% (5/10) of the patients with carcinoma while there was no loss of
staining
in those with parathyroid adenoma (P = 0,001). Global loss of CaSR staining was found in only
one out of 14 cases with atypical adenoma. The expression of Galactin‑3 was found to be
positive in 40% (4/10) of carcinoma cases, 71.4% (10/14) of those with atypical adenoma, and
14.3% (3/21) of those with adenoma (P = 0,002). Cyclin D1 expression was determined to be
positive in 70% (7/10) of patients with carcinoma, 71.4% (10/14) of atypical adenoma cases, and
23.8% (5/21) of those with adenoma. The Ki‑67 proliferation index was seen to be above 5% in
50% (5/10) of carcinoma cases and 35,7% (5/14) of those with atypical adenoma.
Conclusion: In these studies, it has been emphasized that the global loss of CaSR staining was
used as a negative marker in the diagnosis of carcinoma. In this study, we have also confirmed
that the global loss of CaSR staining is a useful marker to determine potential increased
malignancy.
KEY WORDS: Atypical parathyroid adenoma, calcium‑sensing receptor,
parathyroid adenoma, parathyroid carcinoma

131. The Variation of Disulfides in the Progression of Type 2 Diabetes Mellitus 2017

Ergin Merve, Aydın Cevdet,Yurt E.Feyza, Cakir Bekir, Erel Ozcan
Uluslararası Yayınlar Experimental and Clinical Endocrinology Diabetes, 2018, Doi: 10.1055/s-0044-100376
ABSTRACT
ABSTRACT
Diabetes is a common disorder, and many studies have shown that patients with diabetes mellitus
have increased thrombotic complications including arterial and venous thromboses. Poorly
controlled diabetes increases the risk of thrombosis. Recent reports have shown that a shortened
activated partial thromboplastin time (APTT) and increased fibrinogen levels indicate a
procoagulant condition. In this study, we evaluated the differences in global coagulation test
values such as APTT, prothrombin time (PT), or fibrinogen levels, between well and poorly
controlled diabetes. Three hundred forty-nine patients with type 2 diabetes mellitus were
included. APTT, PT, fibrinogen, fasting plasma glucose (FPG), postprandial plasma glucose
(PPG), complete blood
count (CBC), serum lipids, and HbA1c have been measured. Those with APTT <22 s and PT
<10.5 s were identified. Furthermore, patients were divided into two groups based on HbA1c
levels as follows: regulated diabetic group (HbA1c ≤7.0 %) and dysregulated diabetic group
(HbA1c >7.0 %). No significant differences were found between the two groups in terms of
shortened APTT (<22 s), PT (<10.5 s), or fibrinogen levels. Although inexpensive and widely
available, global coagulation assays such as APTT, PT, and fibrinogen levels did not prove
useful for evaluating hypercoagulable states in patients with diabetes.
 
Keywords Diabetes Mellitus . APTT . PT . Fibrinogen

130. Association between preoperative thyrotrophin and clinicopathological and aggressive features of papillary thyroid cancer. Endocrine. 2017

Tam Abbas Ali, Ozdemir Didem, Aydın Cevdet, Bestepe Nagihan, Ulusoy Serap, Sungu Nuran, Ersoy Reyhan, Cakir Bekir
Uluslararası Yayınlar Endocrine. 2018 Mar;59(3):565-572. doi: 10.1007/s12020-018-1523-6. Epub 2018 Jan 27.
ABSTRACT
ABSTRACT
Objective:
The aim of this study was to determine the incidence of Post Partum Thyroiditis (PPT) at first
month postpartum.
Methodology: Fifty pregnant subjects were included. Control group was composed of 50
women who did not give birth in the recent year. Blood samples were obtained once in the
control group and twice -at the third trimester and the first month postpartum-in the pregnant
group.
Results: PPT occurred at first month postpartum in 3 of 50 pregnant women. The incidence of
PPT at first month postpartum was 6%. Among the pregnant group, there was a statistically
significant increase in the Anti-TPO and Anti-Tg levels within the first month postpartum
compared to the ones in the third trimester. Also, all patients who experienced PPT were positive
for Anti-TPO and Anti-Tg.
Conclusions: In our opinion, it will be useful to evaluate particularly the pregnants with positive
thyroid auto-antibodies in early postpartum period.
KEY WORDS: Postpartum thyroiditis, Anti-thyroid peroxidase, Anti- thyroglobuline, thyroid
dysfunctions.

129 . Rate of malignancy in exophytic thyroid nodules. 2017

Fatma Dilek Dellal, Husniye Baser, Dilek Arpaci, Abbas Ali Tam, Didem Ozdemir, Aydan Kilicarslan, Ersin Gurkan Dumlu, Reyhan Ersoy and Bekir Cakir
Uluslararası Yayınlar Iranian Journal of Radiology: April 2017, 14 (2); e41141. DOI: 10.5812/iranjradiol.41141
ABSTRACT
ABSTRACT
Background:
There are ultrasonography (US) features suggested to be associated with a higher risk of
malignancy in thyroid nodules. However, exophytic appearence of thyroid nodules has not been
studied previously. Objectives: To evaluate US features, and cytological and histopathological
findings in exophytic thyroid nodules.
Patients and Methods: Patients with an exophytic thyroid nodule who underwent fine needle
aspiration biopsy (FNAB) between January and July 2015 were evaluated prospectively.
Demographical data, US features, and cytology results were noted and histopathological findings
were determined in operated patients. The results were compared with non-exophytic nodules of
age and sex matched patients.
Results: Data of 253 exophytic nodules in 247 patients and 529 non-exophytic nodules in 357
patients were analyzed. Hypoechogenity, mixed texture, and absence of peripheral halo were
significantly higher in exophytic nodules (P < 0.001, P < 0.001, and P = 0.018, respectively).
Nondiagnostic, atypia of undetermined significance/follicular lesion of undetermined
significance and suspicious for malignancy cytology results were significantly higher in
exophytic nodules (P = 0.002, P < 0.001 and P < 0.001 respectively). 6.7% of exophytic nodules
and 1.9% of non-exophytic nodules had malignant cytology (P = 0.001). Histopathologically, 35
(47.9%) of 73 exophytic nodules and 18 (24.3%) of 74 non-exophytic nodules were malignant (P
< 0.01). Capsular invasion was higher in the malignant exophytic group (53.5% vs 14.3%, P =
0.027). US features other than hypoechoic pattern which was higher in the malignant group were
similar in benign and malignant exophytic nodules.
Conclusions: Exophytic nodules seem to carry a higher rate of malignancy both cytologically
and histopathologically. Suspicous US features except hypoechoic pattern were not higher in
malignant compared to benign exophytic nodules.
Keywords: Exophytic Appearance, Thyroid Nodule, Cytology, Histopathology, Thyroid
Ultrasonography

128. Should multifocal papillary thyroid carcinomas classified as T1A with a tumor diameter sum of 1 to 2 centimeters be reclassified as T1B? 2017

Tam Abbas Ali, Ozdemir Didem, Ogmen Evranos Berna, Faki Sevgul, Dumlu E.Gurkan, Yazgan Kılıc Aylin, Ersoy Reyhan, Cakir Bekir
Uluslararası Yayınlar Endocr Pract. 2017 May;23(5):526-535. doi: 10.4158/EP161488.OR. Epub 2017 Feb 3.
ABSTRACT
Objective:
Considering the diameter of the largest tumor while determining T stage in multifocal
papillary thyroid microcarcinomas (PTMCs) might cause underestimation of tumoral stage.
We aimed to investigate the effect of total tumor diameter (TTD) on tumor node metastasis
(TNM) classification in multifocal T1a PTMCs.
Methods:
T1 tumors were grouped as T1a or T1b according to 7th TNM edition. For patients with
multifocal T1a, TTD (the sum of the maximal diameter of each focus) was calculated, and
these patients were further subgrouped as TTD ≤1 cm or TTD 1 to 2 cm.
Results:
There were 724 patients with T1 tumors. Multifocality was observed in 150 (28.5%) of 527
patients with T1a and 84 (42.6%) of 197 patients with T1b tumors (P<.001). Lymph node
metastasis (LNM), thyroid capsule invasion, and lymphovascular invasion were significantly
higher in T1b compared to T1a (P<.001, P<.001, and P = .015, respectively). There were 8
(1.5%) patients with persistence but not any with recurrence in the T1a group. Persistence and
recurrence were observed in 3 (1.5%) and 5 (2.5%) patients in the T1b group, respectively.
Among 150 T1a patients with multifocal tumors, TTD was ≤1 cm in 89 (59.3%) and 1 to 2
cm in 61 (40.7%) patients. Number of tumor foci, LNM, and thyroid capsule invasion were
significantly higher in multifocal T1a patients with TTD 1 to 2 cm compared to with TTD ≤1
cm (P<.001, P = .032, P = .014, respectively).
Conclusion:
TTD might be used as a parameter to determine patients at higher risk for persistence, and
T1a multifocal PTMCs with TTD 1 to 2 cm can be reclassified as T1b.

127. Comparative analysis of diagnostic adequacy rate between aspiration and nonaspiration techniques of fine-needle cytology in patients with thyroid cancer and ultrasonographically suspicious cervical lymph nodes 2017

Aydın Cevdet, Dellal Fatma Dilek, Tam Abbas Ali, Ogmen Berna, Kılıcarslan Aydan, Topaloglu Oya, Ersoy Reyhan, Cakir Bekir
Uluslararası Yayınlar Diagnostic Cytopathology, 2017, 45(10), 889-894., Doi: 10.1002/dc.23793
ABSTRACT
ABSTRACT
Background:
We aimed to compare nonaspiration (NAS) and aspiration (AS) techniques in the evaluation
of fine-needle cytology of lymph node (FNC-LN) in terms of diagnostic adequacy of
cytologic material.
Methods:
One hundred and twenty-three superficial cervical LNs in 75 patients who underwent NAS
and AS-FNC-LN in the same visit were evaluated. Cytological results were categorized as
diagnostic and nondiagnostic.
Results:
The rates of malignancy were 13.8% in AS versus 16.3% in NAS technique, whereas
nondiagnostic cytology was detected in 43.1% and 25.2%, respectively (P5.549 and P<.01).
Conclusions:
The diagnostic adequacy rate in NAS-FNC-LN was significantly higher than ASFNC-LN.
However, NAS technique seems to be more simple and comfortable. We suggest both NAS
and AS-FNC-LN in cytologic evaluation of suspicious cervical LNs until the diagnostic
accuracy is determined with prospective studies.
 
KEYWORDS
aspiration, diagnostic adequacy rate, fine-needle cytology, nonaspiration, suspicious lymph
node

126. Comparison of thyroid fine needle aspiration biopsy results before and after implementation of Bethesda classification 2017

Ozdemir Didem, Bestepe Nagihan, Faki Sevgul, Kılicarslan Aydan, Parlak Omer, Ersoy Reyhan, Cakir Bekir.
Uluslararası Yayınlar 2017 Oct;28(5):400-406. doi: 10.1111/cyt.12437. Epub 2017 Jul 20
ABSTRACT
Objective:
The Bethesda classification was introduced in 2008 to provide standardisation in the
evaluation of thyroid fine needle aspiration cytology (FNAC). We compared the diagnostic
value of pre-Bethesda and Bethesda classification systems in the differentiation of benign and
malignant thyroid nodules.
Methods:
Medical records of patients who underwent a thyroidectomy between June 2007 and June
2014 were reviewed retrospectively. Nodules evaluated with FNAC before March 2010 were
classified as pre-Bethesda (non-diagnostic, benign, indeterminate, suspicious for malignancy
and malignant), and those evaluated after March 2010 were considered Bethesda (non-
diagnostic, benign, atypia of undetermined significance/follicular lesion of undetermined
significance, follicular neoplasia/suspicious for follicular neoplasia, suspicious for
malignancy and malignant). Sensitivity, specificity, positive predictive value (PPV), negative
predictive value (NPV) and accuracy of the two classification systems were calculated.
Results:
There were 1810 nodules in the pre-Bethesda and 5115 nodules in the Bethesda group. The
non-diagnostic rate was significantly higher, and benign and suspicious for malignancy rates
were lower in Bethesda compared with the pre-Bethesda group (P<.001 for each). When
benign cytology was considered negative, and indeterminate, follicular neoplasia/suspicious
for follicular neoplasia, suspicious for malignancy and malignant cytologies were considered
positive, results for pre-Bethesda and Bethesda were as follows: sensitivity, 78.9% and
78.5%; specificity,86.6% and 97.0%; PPV, 42.8% and 72.6%; NPV, 97% and 97.8%; and
accuracy,85.7% and 95.3%, respectively.
Conclusions:
Among operated nodules, percentages of benign and suspicious for malignancy cytologies
decreased, and percentages of non-diagnostic and uncertain cytologies increased with the
implementation of Bethesda. The diagnostic value of FNAC seems to have increased with the
use of Bethesda classification.
 
KEYWORDS
Bethesda, diagnostic value, fine needle aspiration biopsy, pre-Bethesda

125. Is ultrasonographically detected nodule diameter concordant with pathological tumor size ? 2017

Bilginer M.Cuneyt, Ozdemir Didem, Baser Husniye, Dogan Tatlı Hayriye, Yalcın Abdussamed, Ersoy Reyhan, Cakir Bekir.
Uluslararası Yayınlar Int J Surg. 2017 Jun;42:95-102. doi: 10.1016/j.ijsu.2017.04.054. Epub 2017 Apr 29.
ABSTRACT
ABSTRACT
Introduction:
We aimed to compare preoperative ultrasonographical and postoperative histopathological
diameters of differentiated thyroid cancer (DTC) lesions and investigate possible factors that
can predict the discordance between two measurements.
Methods:
Data of patients with histopathologically confirmed DTC were reviewed retrospectively.
Nodules evaluated by preoperative US were matched with histopathologically examined
nodules. Incidental tumors and nodules that can not be matched in US and histopathology
reports were excluded. Preoperative US diameter and postoperative histopathological size
were compared and percentage difference between two measurements was calculated for each
lesion.
Results:
There were 607 DTC foci in 562 patients. Mean US diameter was significantly higher than
histopathological diameter (21.0±15.6 mm vs 17.3 1± .6, p < 0.001). US diameter was higher
than tumor size in 444 (73.1%), equal in 15 (2.5%) and lower in 148 (24.4%) nodules.
Marginal irregularity was observed in 253 (57%) lesions with US diameter > tumor size and
108 (73%) lesions with US diameter < tumor size (p = 0.010). Rate of nodules with peripheral
halo was higher in lesions with US diameter > tumor size (30.6% vs 20.3%, p = 0.015). In
nodules with US diameter > tumor size, percentage difference was lower in nodules with
microcalcification (p = 0.020) and higher in cytologically benign nodules (p < 0.001). Among
nodules with US diameter < tumor size, <1 cm nodules had significantly higher percentage
difference compared to 1–1.9, 2–3.9 and ≥ 4 cm nodules (p = 0.005).
Conclusion:
Ultrasonographically determined diameter is higher than histopathologically determined size
in a considerable ratio of DTCs. It might be helpful to consider this discordance while
deciding surgical extent in these patients.

124. Thyroid malignancy risk in different clinical thyroid diseases 2017

Dirikoç Ahmet, Fakı Sevgül, Başer Hüsniye, Özdemir Didem, Aydın Cevdet, Ersoy Reyhan, Kılıç Mehmet, Kılıçaraslan Aydan, Çakır Bekir.
Uluslararası Yayınlar Turk J Med Sci., 2017, 13;47(5):1509-1519
ABSTRACT
ABSTRACT
BACKGROUND/AIM:
To evaluate the malignancy risk of thyroid nodules in different clinical thyroid diseases.
MATERIALS AND METHODS:
Patients who underwent thyroidectomy between 2007 and 2014 were grouped as euthyroid,
hypothyroid, and hyperthyroid. Further classification was made depending on the presence of
solitary/multiple thyroid nodules.
RESULTS:
Among 2870 patients, 1719 (59.9%) were euthyroid, 962 (33.5%) were hyperthyroid, and 189
(6.6%) were hypothyroid. Overall malignancy was detected in 980 (34.1%) patients.
Malignancy rates were 42.1%, 42.9%, and 18.3% in the euthyroid, hypothyroid, and
hyperthyroid groups, respectively (P < 0.001). A total 41.4% of patients with euthyroid
nodular goiter (ENG) and 46.3% of patients with euthyroid multinodular goiter (EMNG) had
thyroid malignancy (P = 0.169). Mean tumor size and capsular and vascular invasion were
significantly lower in EMNG than in ENG. Among hypothyroid patients, 45.7% with solitary
and 42.2% with multiple nodules were malignant (P = 0.705). When toxic nodular goiter and
toxic multinodular goiter were analyzed together, malignancy rate was 24.7% (104/421), and
when Graves with nodule/nodules was considered, it was 19.7% (59/299).
CONCLUSION:
In hypothyroid or euthyroid patients who underwent thyroidectomy, malignancy rate was
higher than 40%, and was lower in hyperthyroid patients. Patients with multiple nodules carry
a similar risk of malignancy as patients with solitary nodules, independent of the functional
status.
 
Key words: Thyroid cancer, thyroid functions, thyroid nodule

123. Can ratio of the biggest tumor diameter to total tumor diameter be a new parameter in the differential diagnosis of agressive and favorable multifocal papillary thyroid microcarcinoma? 2017

Tam Abbas Ali, Özdemir Didem, Çuhacı Neslihan, Başer Hüsniye, Dirikoç Ahmet, Aydın Cevdet, Kılıç Yazgan Aylin, Ersoy Reyhan, Çakır Bekir
Uluslararası Yayınlar Oral Oncology (2017), 65:1-7.
ABSTRACT
ABSTRACT
OBJECTIVES:
In this study, we aimed to evaluate the usefulness of a new parameter–ratio of the biggest
tumor diameter to total tumor diameter- for the differentiation of agressive and favorable
papillary thyroid microcarcinomas (PTMC).
MATERIALS AND METHODS:
The diameter of the biggest tumor focus was taken as the primary tumor diameter.Total tumor
diameter was calculated as the sum of the maximal diameter of each lesion. Ratio of primary
tumor diameter to total tumor diameter was defined as tumor diameter ratio (TDR). Positive
and negative predictive value, sensitivity and specificity of TDR to predict capsular invasion,
extrathyroidal extension (ETE) and lymph node metastasis (LNM) were determined.
RESULTS:
Mean TDR was significantly lower in multifocal PTMC patients with capsular invasion, ETE,
lymphovascular invasion and LNM compared to patients without these features. The
sensitivities of TDR for the detection of LNM, ETE and capsular invasion were 100%, 100%
and 94.2%, respectively. Specificity of TDR was 86.2% for LNM, 88% for ETE and 94.7%
for capsular invasion. Best cut off values of TDR that can predict capsular invasion, ETE and
LNM in multifocal PTMC were 0.62, 0.57 and 0.56, respectively. Multifocal papillary thyroid
carcinoma patients with capsular invasion, ETE and LNM had significantly lower mean TDR
when compared to ones without these features.
CONCLUSION:
Decreased TDR was associated with capsular invasion, ETE and LNM in patients with
multifocal PTMC and PTC. This new parameter might be particularly helpful for the
detection of aggressive behavior in multifocal PTMCs.

122. Thyroid FNAC containing hürthle cells and hürthle-like cells 2017

Yazgan Aylin, Balcı Serdar, Dincer Nazmiye, Ersoy P.Eren, Tuzun Dilek, Ersoy Reyhan, Irkkan Cigdem, Cakir Bekir, Guler Gulnur
Uluslararası Yayınlar A study of 128 cases. J Cytol. 2016 Oct-Dec;33(4):214-219. doi: 10.4103/0970-9371.190447
ABSTRACT
ABSTRACT
Aim:
It is a diagnostic challenge to differentiate benign and malignant cytology in the presence of
Hürthle cells. In our previous study, it was determined that in fine needle aspirations (FNA),
the malignancy outcome of the Hürthle cells containing group tend to be papillary thyroid
carcinoma (PTC) in a higher percentage. The most common misinterpretation is caused by
PTC cells with large cytoplasm‑like Hürthle cells. The aim of this study is to predict
histologic outcome of the nodules, which have Hürthle cells in FNA according to cytological,
clinical features, and BRAFV600E mutation status.
Materials and Methods:
Detailed cytological features of 128 cases were compared with histopathological diagnosis.
The analysis of BRAFV600E mutation of the PTC cases were performed by real‑time
polymerase chain reaction.
Results:
The neoplastic outcome was increased statistically significantly with younger age (P = 0.020),
increase in cellular dyshesion (P = 0.016), presence of nuclear budding (P = 0.046), and
granular chromatin (P = 0.003). Nuclear budding (P = 0.014), granular chromatin (P = 0.012),
and hypoechoic nodules in ultrasonography (P = 0.011) were significant independent factors
for the increase in the malignancy risk. Increased lymphocytes (P = 0.015) and colloid were
related to non‑neoplastic outcome. According to the surgical outcome, more than half of the
malign cases were PTC (74%). BRAFV600E mutation was detected in 27.8% of the PTC
cases.
Conclusion:
PTC cases containing Hürthle cell‑like cells may lead to diagnostic errors. Nuclear budding
and granular chromatin of Hürthle cells are significant, remarkable findings to predict the
outcome of neoplasm and malignancy.
Key words: Hürthle cell; fine needle aspiration; thyroid

121 . Differentiated thyroid cancer in patients with prolactinoma 2016

Tam AA, Kaya C, Aydın C, Ersoy R, Çakır B.
Uluslararası Yayınlar Turk J Med Sci (2016) 46: 1360-1365. © TÜBİTAK doi:10.3906/sag-1501-58
ABSTRACT
BACKGROUND/AIM:
Increasing evidence is available about the role of prolactin in the development of various
cancers. The purpose of this study is to evaluate the frequency of thyroid cancer
in patients with prolactinoma followed at a single site.
 
MATERIALS AND METHODS:
The medical records of 182 patients diagnosed with prolactinoma were reviewed
retrospectively. Serum prolactin, antithyroglobulin, antithyroid peroxidase antibody, thyroid-
stimulating hormone, free T4, and free T3 values and pituitary gland magnetic resonance
imaging and thyroid ultrasound reports were evaluated.
 
RESULTS:
Forty-five (39.5%) patients were found to have a thyroid nodule (13 solitary, 32 multiple).
Ten patients were administered a thyroidectomy, and differentiated thyroid cancer (DTC) was
detected in 6 of these patients (6/114, 5.3%). One patient had lung metastasis. The control
group consisted of 113 individuals (101 females, 12 males with a mean age of 32.1 ± 9.1). In
the ultrasound reports, 28 of these individuals (24.8%) had a thyroid nodule (5 solitary, 23
multiple), and one individual (1/113, 0.8%) had DTC.
 
CONCLUSION:
When compared to the control group, thyroid volume and thyroid nodularity were
significantly higher in patients with prolactinoma (P < 0.001, P = 0.018, respectively);
however, no statistically significant difference existed for the incidence of thyroid cancer (P =
0.196).

120. Evaluation of preoperative ultrasonographic and biochemical features of patients with aggressive parathyroid disease: is there a reliable predictive marker? 2016

Cakir B, Polat SB, Kilic M, Ozdemir D, Aydin C, Süngü N, Ersoy R.
Uluslararası Yayınlar Arch Endocrinol Metab. 2016 Nov 24:0. doi: 10.1590/2359-3997000000224. [Epub ahead of print] PubMed PMID: 27901181.
ABSTRACT
ABSTRACT
OBJECTIVE:
Parathyroid cancer (PC) represents < 1% of cases of PHPT. Tumors demonstrating atypical
histopathologic features and don't fulfill criteria for carcinoma are classified as atypical
adenomas (APA). The purpose of this study was to determine
a biochemical or ultrasonographic feature that can predict aggressive disease requiring more
extensive surgery and closer follow-up.
 
SUBJECTS AND METHODS:
Twenty eight patients operated for PHPT and diagnosed with atypical adenoma (23 patients)
or carcinoma (5 patients) were enrolled in this study. The control group consisted of
102 patients operated between the same dates and diagnosed with classical PA. Classical
adenomas, atypical adenomas, and carcinomas were compared according to
their biochemical and ultrasonographic parameters.
 
RESULTS:
Serum Ca levels were significantly higher in the PC group compared with the APA and
classical PA groups. Serum median PTH, Serum ALP and UCa was significantly higher in the
APA and carcinoma groups compared to the classical PA group. ROC analysis was made to
determine the best cut off values for predicting aggressive disease were 12.45 mg/dL, 265.05
pg/mL, 154.5 IU/l, 348.5 mg/day and 21.5 mm for Ca, PTH, ALP, UCa and the adenoma
diameter, respectively. Multivariate analysis showed that serum Ca, ALP and isoechoic/cystic
appearance were independent predictors for aggressive disease.
 
CONCLUSION:
Preoperatively high PTH, ALP, and UCa levels and large lesions with isoechoic or cystic
appearances may be predictive of atypical adenoma or carcinoma in patients being evaluated
for PHPT. In such cases, surgeons may prefer en bloc parathyroidectomy to minimally
invasive surgery.
 

119. Diagnostic accuracy of Thyroid Imaging Reporting and Data System in the prediction of malignancy in nodules with atypia and follicular lesion of undetermined significance cytologies 2016

Baser H, Cakir B, Topaloglu O, Alkan A, Polat SB, Dogan HT, Yazicioğlu MO, Aydin C, Ersoy R
Uluslararası Yayınlar Clin Endocrinol (Oxf). 2016 Nov 7. doi: 10.1111/cen.13274. [Epub ahead of print] PubMed PMID: 27911001
ABSTRACT
OBJECTIVE:
Thyroid Imaging Reporting and Data System (TIRADS) is a simple and
reliable reporting system for the prediction of malignancy. We aimed to determine the role of
TIRADS in the prediction of malignancy in subcategories of Bethesda Category
III, atypia of undetermined significance (AUS)
and follicular lesion of undetermined significance (FLUS).
 
DESIGN & PATIENTS:
A total of 461 nodules with AUS cytology in 450 patients and 179 nodules with FLUS
cytology in 168 patients were included. Ultrasonography (US) features and postoperative
histopathology results were documented. Every suspicious US feature was scored as 1 and 0
according to the presence or not, respectively. TIRADS category of each nodule was
determined.
 
RESULTS:
In AUS subcategory, histopathologically malignant nodules had significantly different
TIRADS categories compared to benign nodules (P = 0·001), but this was not the case in
FLUS subcategory (P = 0·121). In AUS group, malignant nodules had significantly higher
prevalance of microcalcification, hypoechogenicity and anteroposterior/transverse ratio than
benign ones (P < 0·001, P < 0·001 and P = 0·003, respectively) and TIRADS categories of 4c
and 5 were more frequent in malignant nodules (P < 0·05). Microcalcification,
hypoechogenicity and TIRADS were found to be associated with malignancy in multivariate
logistic regression analysis in this subcategory. TIRADS category ≥4c was associated
with malignancy (AUC ± SE: 0·584 ± 0·028). In FLUS subcategory, there was no significant
difference between histopathologically malignant and benign nodules with respect to
suspicious US features (P > 0·05, all).
 
CONCLUSION:
TIRADS seems to be useful in predicting malignancy and planning further management in the
AUS subcategory, but not quite so in the FLUS subcategory.

118. Is there any association between primary hyperparathyroidism and ocular changes, such as central corneal thickness, retinal thickness, and intraocular pressure? 2016

Baser H, Cuhaci N, Topaloglu O, Yulek F, Ugurlu N, Ersoy R, Cagil N, Cakir B
Uluslararası Yayınlar Endocrine. 2016 Mar;51(3):545-50. doi: 10.1007/s12020-015-0724-5. PubMed PMID: 26318316.
ABSTRACT
Ocular changes are commonly encountered in various endocrine disorders. However, only a
few studies have reported ocular changes in patients with primary hyperparathyroidism
(PHPT). Here, we examined the central corneal thickness (CCT), retinal thickness (RT), and
intraocular pressure (IOP), and their relationships with serum intact parathyroid hormone
(iPTH), calcium (Ca), and phosphorus (P) levels in patients with PHPT. Thirty-seven eyes of
37 PHPT patients were compared with 43 eyes of 43 age- and sex-matched normal subjects.
A detailed ophthalmologic examination, including CCT, RT, and IOP, was performed. CCT
and IOP in PHPT patients were significantly higher than controls (p = 0.024 and p = 0.038,
respectively). No statistically significant difference was detected in RT between the two
groups (p = 0.730). iPTH levels were positively correlated with CCT and IOP (r = 0.304, p =
0.006 and r = 0.249, p = 0.026, respectively). No significant correlation was found between
iPTH levels and RT (p > 0.05), and between serum Ca levels, and RT, CCT, and IOP (all, p >
0.05). While there was a negative correlation between serum P levels and CCT (r = -0.264, p
= 0.018), no correlation was observed between serum P levels, and RT and IOP (both, p >
0.05). Using multiple regression analyses, iPTH, serum Ca, and serum P levels were found to
have no significant associations with CCT, IOP, and RT (all, p > 0.05). There was no
significant association between PHPT, and CCT, RT, and IOP. We postulate that the
identification of ocular aspects of PHPT is significant, and further studies related to this
condition are required.

117. A new approach for standardization and increased accuracy of lymph node washout thyroglobulin in patients with differentiated thyroid carcinoma. 2016

Aydin C, Ozdemir D, Sacikara M, Polat SB, Yazgan AK, Turkolmez S, Onal ED, Ersoy R, Cakir B.
Uluslararası Yayınlar Diagn Cytopathol. 2016 Mar;44(3):177-86. doi: 10.1002/dc.23414. PubMed PMID: 26685703
ABSTRACT
BACKGROUND:
High values of fine needle aspiration washout thyroglobulin (FNAB-Tg) are diagnostic for
metastatic lesions of thyroid cancer. However, there is not a consensus on cutoff for high
FNAB-Tg level. In this study, we aimed to determine a more accurate and standardized
parameter for FNAB-Tg.
 
METHODS:
Ultrasonographically suspicious lymph nodes of patients with histopathologically
confirmed differentiated thyroid cancer or malignant/suspicion for malignancy cytology were
included. Tg washout was obtained by aspiration and nonaspiration fine needle biopsy
(nonaspiration-FNB). Simultaneous Tg was measured from serum. Aspiration
and washout procedures were also performed from whole blood and serum using syringes
and needles identical to ones used for lymph node biopsy.
 
RESULTS:
Data of 19 lesions in 17 patients who underwent lymph node dissection were analyzed.
Nonaspiration FNB-Tg, FNAB-Tg/whole blood washout-Tg, nonaspiration FNB-Tg/whole
blood washout-Tg, nonaspiration FNB-Tg/serum washout- Tg, nonaspiration FNB-Tg/serum
Tg ratios were significantly higher in malignant lymph nodes compared to benign ones.
Areas under the ROC curve for nonaspiration FNB-Tg, FNAB-Tg/whole blood washout-Tg,
FNAB-Tg/serum washout- Tg, nonaspiration FNB-Tg/whole blood washout-Tg,
nonaspiration FNB-Tg/serum washout- Tg, and nonaspiration FNB-Tg/serum Tg were
statistically significant for the discrimination of benign and malignant lymph nodes. Best
cutoff value for nonaspiration FNB-Tg was 4.21. Among ratios, best cutoff values were 5.40
for nonaspiration FNB-Tg/whole blood washout-Tg and 3.28 for nonaspiration FNB-
Tg/serum washout-Tg.
 
CONCLUSION:
For detection of malignant lymph nodes, determining ratios of nonaspiration FNB-Tg to
whole blood and/or serum washout-Tg might be a promising method to
increase accuracy and provide standardization of lymph node washout procedure.

116. An extremely rare case of thyroid malignancy from the non-Alpine region: Angiosarcoma. 2016

114. Bayır Ö, Yılmazer D, Ersoy R, Akca Y, Saylam G, Han Ü, Özdek A, Çakır B, Korkmaz MH
Uluslararası Yayınlar Int J Surg Case Rep. 2016;19:92-6. doi: 10.1016/j.ijscr.2015.12.028. PubMed PMID: 26741273; PubMed Central PMCID: PMC4756211.
ABSTRACT
INTRODUCTION:
Thyroid angiosarcoma is a rather rare malignancy featuring a poor prognosis, and which may
interfere with other aggressive thyroid tumors; it is usually seen in the Alpine region.
 
CASE PRESENTATION:
A 74-year- old male was referred to our center with complaints of progressive neck swelling
and dyspnea. He had multiple nodules featuring cystic degeneration and calcifications in
the thyroid gland, together with multiple lymphadenopathies of the neck region. Fine-needle
aspiration cytology (FNAC) confirmed the presence of anaplastic carcinoma. A total
thyroidectomy was performed. During the postoperative period, multiple drainage were
performed for recurrent hematomas, but hematoma development could not be prevented. On
postoperative day 7, the patient died due to multiple-system failure. Histopathological
investigation of the thyroidectomy specimen indicated that the lesion was an angiosarcoma.
 
DISCUSSION:
The cytological diagnosis of thyroid angiosarcoma is quite difficult. Extracapsular invasion
and distant organ metastasis during surgery are known as strong and negative prognostic
factors for thyroid angiosarcoma. Treatment is quite difficult, since this tumor is locally
aggressive, destructive, and features a high recurrence rate. In this case, since extracapsular
invasion, as well as lymph node and lung metastasis were present at the time of surgery; the
expected survival time was quite short.
 
CONCLUSION:
This case shows that during differential diagnosis, patients initially diagnosed with anaplastic
carcinoma via FNAC may actually present with angiosarcoma. It may be helpful to review
the treatment modalities for this cancer type, which has a rather poor prognosis and features
severe bleeding, as well as local and distant metastasis.

115. Concomitant thyroid lesions in patients with primary hyperparathyroidism 2016

Cuhaci N, Ozdemir D, Polat B, Arpacı D, Yıldırım N, Yazgan AK, Yalcın S, Kılıc M, Ersoy R, Cakir B
Uluslararası Yayınlar Asian J Surg. 2016 Jan 10. pii: S1015-9584(15)00143-8. doi: 10.1016/j.asjsur.2015.10.006. [Epub ahead of print] PubMed PMID: 26786663.
ABSTRACT
BACKGROUND:
Concomitant thyroid pathologies in patients with primary hyperparathyroidism (PHPT)
present a challenge in the clinical and surgical decision-making for these patients. In this
study, we aimed to evaluate concomitant thyroid pathologies in patients who underwent
operations for PHPT to determine the sensitivity (Sn) of neck ultrasonography (US) and
Tc99m sestamibi scintigraphy in detecting parathyroid adenoma. We also aimed to determine
the clinical impact of preoperative neck US in patients with PHPT.
 
METHODS:
One hundred thirty-eight patients with PHPT were included in this retrospective study. All
patients underwent preoperative Tc99m sestamibi scintigraphy and/or thyroid US. Nodules of
≥1 cm or <1 cm with suspicious US features underwent fine needle aspiration biopsy
(FNAB).
 
RESULTS:
Preoperative thyroid US revealed that 93.5% of patients with PHPT had thyroid abnormalities
and 66.7% of patients had at least one thyroid nodule. Postoperative histopathology results
showed that 79.2% of patients had benign thyroid disease and 20.8% of patients had
malignant thyroid disease. In the detection of parathyroid adenoma, US had 89.1% Sn and
Tc99m sestamibi scintigraphy had 82.6% Sn.
 
CONCLUSION:
We recommend the routine use of US in combination with Tc99m sestamibi scintigraphy,
especially in endemic goiter regions, to detect any concomitant thyroid disease and thus
determine the best surgical strategy for patients with PHPT.

114. Evaluation of biochemical and clinical markers of endothelial dysfunction and their correlation with urinary albumin excretion in patients with type 1 diabetes mellitus. Arch Endocrinol Metab 2016

Polat SB, Ugurlu N, Aslan N, Cuhaci N, Ersoy R, Cakir B
Uluslararası Yayınlar Arch Endocrinol Metab. 2016 Apr;60(2):117-24. doi: 10.1590/2359-3997000000116. PubMed PMID: 26886090.
ABSTRACT
Objective Endothelial dysfunction (ED) plays an important role in the pathogenesis of
diabetic nephropathy. The purpose of the study was to determine flow mediated endothelial
dependent vasodilatation (FMD) measurements and serum soluble (s) endothelin-1 (ET-1),
intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule (VCAM-1)
levels in patients with type 1 diabetes mellitus (T1DM) with or without increased urinary
albumin excretion (UAE) and compare them with the healthy controls. Subjects and methods
Seventy three patients with T1DM were enrolled. Patients were divided into two subgroups
according to microalbumin measurements in 24-hr urine collections. The diabetic patients
without microalbuminuria (41 patients) were defined as Group I and those with
microalbuminuria (32 patients) were defined as group II. A hundred age and sex matched
healthy subjects participated as the control group (Group III). Serum sET-1, sICAM-1,
sVCAM-1 levels and FMD measurements were determined in all participants. Results Median
FMD measurement was significantly lower in the diabetic groups compared with the control
group (6.6, 6.4 and 7.8% in Group I, II and III, respectively) (p < 0.05). FMD was negatively
correlated with age (p = 0.042). Median serum sICAM-1 level was higher in the patient
groups compared to the control group (p < 0.05). Median serum sVCAM-1 level was higher
in the group of patients with increased albuminuria compared to the normoalbuinuric and the
control group (p < 0.05). Serum sVCAM-1 level was found to be positively correlated with
degree of urinary albumin excretion (p < 0.001). Conclusion We assume that sVCAM-1 may
be used as a predictive marker for risk stratification for nephropathy development and
progression.

113. Mean platelet volume in patients with prolactinoma. Arch Endocrinol Metab 2016

Tam AA, Kaya C, Başer H, Ersoy R, Çakır B.
Uluslararası Yayınlar Arch Endocrinol Metab. 2016 Aug;60(4):319-22. doi: 10.1590/2359-3997000000054. PubMed PMID: 26886093
ABSTRACT
OBJECTIVE:
Prolactin is a multifunctional pituitary hormone. The effect of prolactin on platelet activation
is not well understood. Prolactinomas are the most common type of pituitary adenomas, and
they are medically responsive to dopamine agonists. Mean platelet volume (MPV) is a marker
of platelet function and activation. The aim of this study was to evaluate MPV values before
and 6 months of cabergoline treatment when normoprolactinemia was achieved.
 
SUBJECTS AND METHODS:
A total of 101 newly diagnosed prolactinoma patients and 102 healthy control subjects were
included in the study. Patients with hematological disorders that affect MPV and those on
medications were excluded. Prolactin, platelet count and MPV levels were recorded before
and 6 months after the initiation of cabergoline treatment (0.5 to 1 mg, two times a week).
 
RESULTS:
There was no significant difference in platelet count and MPV before and after 6 months of
treatment with cabergoline in patients with prolactinoma compared with the control group (p
> 0.05).
 
CONCLUSION: Our results showed that MPV, a marker of platelet function, was unchanged
in patients with prolactinoma.

112. The role of postoperative Tc-99m pertechnetate scintigraphy in estimation of remnant mass and prediction of successful ablation in patients with differentiated thyroid cancer 2016

Ozdemir D, Cuhaci FN, Ozdemir E, Aydin C, Ersoy R, Turkolmez S, Cakir B.
Uluslararası Yayınlar Nucl Med Commun. 2016 Jun;37(6):640-5. doi: 10.1097/MNM.0000000000000492. PubMed PMID: 26895488
ABSTRACT
OBJECTIVE:
Surgery and radioactive iodine (RAI) ablation constitute the mainstay of the treatment of
differentiated thyroid carcinoma (DTC). In this study, we aimed to evaluate the diagnostic
value of postoperative early Tc-99m pertechnetate scanning to detect remnant thyroid tissue
and predict ablation success.
 
METHODS:
DTC patients evaluated with postoperative Tc-99m pertechnetate scintigraphy and treated
with RAI between January 2007 and December 2014 were recruited. The results of Tc-99m
pertechnetate scanning were compared with therapeutic I-131 whole-body scanning (TxWBS)
and diagnostic I-131 whole-body scanning (DxWBS) performed 6-9 months after RAI.
 
RESULTS:
There were 154 (21.5%) male and 563 (78.5%) female patients, with a mean age of
49.11±12.35 years. Postoperative Tc-99m pertechnetate scanning was positive in 499 patients
(69.6%) and negative in 218 (30.4%) patients. There were 673 (93.9%) patients with a
positive TxWBS scan and 44 (6.1%) patients with negative TxWBS scan. Considering
TxWBS as the standard test, sensitivity, specificity, positive predictive value, and negative
predictive value of Tc-99m pertechnetate scanning were 72.2, 70.5, 97.4, and 14.2%,
respectively. DxWBS was positive in 57 (9.0%) and negative in 564 (91%) patients. Ablation
dose was higher and preablation thyroglobulin was lower in patients with negative DxWBS
(P=0.001 and 0.04, respectively). Overall, 171 (92.9%) of 184 patients with negative Tc-99m
pertechnetate had negative DxWBS.
 
CONCLUSION:
Postoperative Tc-99m pertechnetate scintigraphy has a high positive predictive value to detect
remnant tissue in patients with DTC. Although negative Tc-99m pertechnetate scanning does
not indicate removal of all thyroid tissue, it is related to successful ablation in more than 90%
of patients.

111. Structural tendon changes in patients with acromegaly: assessment of Achilles tendon with sonoelastography 2016

Onal ED, Ipek A, Evranos B, Idilman IS, Cakir B, Ersoy R.
Uluslararası Yayınlar Med Ultrason. 2016 Mar;18(1):30-5. doi: 10.11152/mu.2013.2066.181.edo. PubMed PMID: 26962551.
ABSTRACT
AIMS:
To describe the sonoelastographic appearance of the Achilles tendon in
acromegalic patients and to determine whether the blood concentrations of growth hormone
(GH) and insulin-like growth factor (IGF-1) are associated with the various sonographic
elasticity types of Achilles tendons.
 
MATERIAL AND METHODS:
Eighty-four Achilles tendons of 42 acromegaly patients and 84 Achilles tendons of 42 healthy
volunteers were assessed with sonoelastography. The tendons were classified into two main
types according to the elasticity features: type 1 blue/green (hard tissue) and type 2 yellow/red
within green (intermediate-soft tissue). Two subtypes of these types were also defined.
According to the definition, the elasticity of the tissue was in a spectrum ranging from hard to
soft as the type progressed from 1a to 2b.
 
RESULTS: The mean thickness of Achilles tendons in patients with acromegaly was
significantly higher compared with healthy Achilles tendons (5.1+/-0.7 mm vs. 4.4+/-0.5,
p<0.001), and patients with active disease had thicker Achilles tendons (5.5+/-0.8 mm vs.
4.8+/-0.5 mm in inactive disease, p=0.003). A significantly higher proportion
of acromegaly patients had type 2 sonoelastographic appearance of
the Achilles tendon (124/252 third; 49.2% vs. 81/252 third; 32.1%, p=0.0001). Activity status
of acromegaly and GH/IGF-I levels were similar in patients with different types of elasticity
(p>0.05).
 
CONCLUSIONS: Sonoelastography revealed structural changes in the tendinous tissue
of patients with acromegaly, but it was not sensitive enough to reflect changes in the serum
levels of GH/IGF-1.

110. Higher TSH can be used as an additional risk factor in prediction of malignancy in euthyroid thyroid nodules evaluated by cytology based on Bethesda system 2016

Baser H, Topaloglu O, Tam AA, Evranos B, Alkan A, Sungu N, Dumlu EG, Ersoy R, Cakir B.
Uluslararası Yayınlar Endocrine. 2016 Aug;53(2):520-9. doi: 10.1007/s12020-016-0919-4. PubMed PMID: 26972701
ABSTRACT
Recently, it has been suggested that thyrotropin (TSH) concentration can be used as a marker
for prediction of thyroid malignancy. In this study, we aimed to investigate the association
between TSH levels and prediction of malignancy in euthyroid patients with
different Bethesda categories. The data of 1433 euthyroid patients with
3206 thyroid nodules who underwent thyroidectomy were screened retrospectively. The
preoperative cytology results, thyroid function tests, thyroid autoantibodies, and presence of
histopathological Hashimoto's thyroiditis (HT) were recorded. Of the 1433 patients, 585
(40.8 %) had malignant and 848 (59.2 %) had benign histopathology. Malignant group had
smaller nodule size, elevated TSH levels, and higher rate of presence of HT compared to
benign group (p < 0.001, all). Cytology results of 3206 nodules were as follows: 832
nondiagnostic (ND), 1666 benign, 392 atypia of undetermined significance/follicular lesion of
undetermined significance (AUS/FLUS), 68 follicular neoplasm/suspicious for follicular
neoplasm (FN/SFN), 133 suspicious for malignancy (SM), and 115 malignant. Both SM and
malignant cytology groups had higher TSH levels than other 4 Bethesda categories (p < 0.05,
all). Benign cytology group had significantly lower TSH levels compared to
other cytology groups (p < 0.05, all). Patients with malignant final histopathology in ND and
AUS/FLUS cytology groups had significantly higher TSH levels compared to patients with
benign final histopathology (p < 0.05, all). Moreover, TSH levels showed to increase
from Bethesda categories II to VI. In addition to cytology, higher TSH levels can be used as a
supplementary marker in prediction of malignancy in certain Bethesda categories.

109. Thyroid Disorders in Young Females with Polycystic Ovary Syndrome and Correlation of Thyroid Volume with Certain Hormonal Parameters 2016

Polat SB, Oğuz O, Sacikara M, Cuhaci FN, Evranos B, Ersoy R, Cakir B.
Uluslararası Yayınlar J Reprod Med. 2016 Jan-Feb;61(1-2):27-32. PubMed PMID: 26995885.
ABSTRACT
OBJECTIVE:
To investigate the prevalance of hypothyroidism, thyroid autoimmunity, and ultrasonographic
features in polycystic ovarysyndrome (PCOS) patients and compare them with a control
group, and to detect correlation of thyroid volume [TV] with luteinizing hormone (LH),
insulin-like growth factor binding protein-3 (IGFBP-3), and IGF-1 in patients with PCOS.
 
STUDY DESIGN:
Seventy PCOS patients' and 84 age-matched controls were enrolled. The patient and control
groups were compared according to hormonal parameters, anthropometric measures, TV,
echogenicity on ultrasonogram, and autoimmunity. We also investigated
the correlation between TV and homeostasis model assessment (HOMA), serum LH, IGF-1
and IGFBP-3 levels in the PCOS group.
 
RESULTS:
Body mass index (BMI), Ferriman Gallwey score, fasting insulin level, DHEAS, total and
free testosterone, LH, TV, and IGFBP-3 levels were significantly higher in PCOS patients as
compared to control group. TV was similar in patients with or without insulin resistance
diagnosed with HOMA-estimated insulin resistance (IR). There was no difference in
prevalence of hypothyroidism or ultrasonographic features in the groups. We have detected a
positive and significant correlation between TV and BMI. We have found that there was no
meaningful correlation between the TV and serum IGF-1 levels, whereas TV was positively
correlated with serum LH.
 
CONCLUSION:
We could not find any correlation between TV and IGF-1, but the most likely etiology of the
increased TV in PCOS appears to be related to elevated LH levels in those patients.

108. Association of multifocality, tumor number, and total tumor diameter with clinicopathological features in papillary thyroid cancer 2016

Tam AA, Özdemir D, Çuhacı N, Başer H, Aydın C, Yazgan AK, Ersoy R, Çakır B.
Uluslararası Yayınlar Endocrine. 2016 Sep;53(3):774-83. doi: 10.1007/s12020-016-0955-0. PubMed PMID: 27090526.
ABSTRACT
Tumor multifocality is not an unusual finding in papillary thyroid carcinoma (PTC), but its
clinical significance is controversial. In this study, we aimed to evaluate impact
of multifocality, tumor number, and total tumor diameter on clinicopathological features of
PTC. Medical records of 912 patients who underwent thyroidectomy and diagnosed with PTC
were reviewed retrospectively. Patients were grouped into four according to number of
tumoral foci: N1 (1 focus), N2 (2 foci), N3 (3 foci), and N4 (≥4 foci). The diameter of the
largest tumor was considered the primary tumor diameter (PTD),
and total tumor diameter (TTD) was calculated as the sum of the maximal diameter of each
lesion in multicentric tumors. Patients were further classified into subgroups according to
PTD and TTD. Multifocal PTC was found in 308 (33.8 %) patients. Capsular invasion,
extrathyroidal extension, and lymph node metastasis were significantly higher in patients with
multifocal tumors compared to patients with unifocal PTC. As the number of tumor increased,
extrathyroidal extension and lymph node metastasis also increased (p = 0.034 and p = 0.004,
respectively). The risk of lymph node metastasis was 2.287 (OR = 2.287, p = 0.036) times
higher in N3 and 3.449 (OR = 3.449, p = 0.001) times higher in N4 compared to N1. Capsular
invasion, extrathyroidal extension, and lymph node metastasis were significantly higher in
multifocal patients with PTD ≤10 mm and TTD >10 mm than unifocal patients
with tumor diameter ≤10 mm (p < 0.001, p < 0.001 and p = 0.001, respectively). There was no
significant difference in terms of these parameters in multifocal patients with PTD ≤10 mm
and TTD >10 mm and unifocal patients with tumor diameter >10 mm. In this study,
increased tumor number was associated with higher rates of capsular invasion, extrathyroidal
extension, and lymph node metastasis. In a patient with multifocal papillary microcarcinoma,
TTD >10 mm confers a similar risk of aggressive histopathological behavior with unifocal
PTC greater than 10 mm.

107. Malignancy risk and false-negative rate of fine needle aspiration cytology in thyroid nodules ≥4.0 cm. 2016

Bestepe N, Ozdemir D, Tam AA, Dellal FD, Kilicarslan A, Parlak O, Ersoy R, Cakir B.
Uluslararası Yayınlar Surgery. 2016 Aug;160(2):405-12. doi: 10.1016/j.surg.2016.03.019. PubMed PMID: 27157121
ABSTRACT
BACKGROUND:
We aimed to evaluate malignancy rate and to determine false negativity
of fine needle aspiration biopsy (FNAB) in thyroid nodules ≥4.0 cm.
 
METHODS:
The medical records of patients who underwent thyroidectomy between January 2007 and
December 2014 were reviewed. Demographic and clinical data as well as preoperative
ultrasonography findings were analyzed. The nodules in these patients were grouped as
≥4.0 cm and <4.0 cm according to ultrasonography measurements. Nodules <4.0 cm were
further divided into 1.0-3.9 cm and <1.0 cm. Histopathologically malignant nodules with
preoperative benign cytology were defined as having false-negative FNAB.
 
RESULTS:
There were 1,008 nodules that measured ≥4.0 cm, 4,013 nodules that measured 1.0-3.9 cm,
and 540 that measured nodules <1.0 cm. Based on histopathologic findings, 8.5%, 10.2%, and
25.6% of nodules ≥4.0 cm, 1.0-3.9 cm, and <1.0 cm were malignant, respectively (P < .001).
There was no significant difference between 1.0-3.9- cm and ≥4.0-cm nodules with respect
to malignancy (P = .108). False-negativity rates were 4.7% in nodules ≥4.0 cm, 2.2%
in nodules measuring 1.0-3.9 cm, and 4.8% in <1.0-cm nodules. Nodules measuring
<1.0 cm and ≥4.0 cm had similar false-negativity rates (P = .93), while 1.0-3.9-
cm nodules had statistically lower false-negativity rates than those found in the other two
groups (P = .03 and P < .001, respectively).
 
CONCLUSION: Of the nodules that were operatively excised, nodules ≥4.0 cm had a
similar risk of malignancy as nodules 1.0-3.9 cm. The rate of false-negative FNAB
in nodules ≥4.0 cm was twice as high as in nodules 1.0-3.9 cm; however, we do not think it is
high enough to recommend a routine operation when cytology results are benign.

106. The correlation of sodium iodide symporter and BRAF(V600E) mutation in classical variant papillary thyroid carcinoma 2016

Yazgan A, Yıldırım N, Gözalan A, Gümüştaş S, Kılıçarslan A, Balci S, Aydın C, Ersoy R, Cakir B, Güler G
Uluslararası Yayınlar Ann Diagn Pathol. 2016 Jun;22:58-62. doi: 10.1016/j.anndiagpath.2016.04.002. PubMed PMID: 27180062.
ABSTRACT
BRAF(V600E) mutation was analyzed by real-time polymerase chain reaction in 96
consecutive cases with classical variant papillarythyroid cancer, and immunohistochemical
staining of Na+/I- symporter (NIS) protein was evaluated. Localization (intracellular or
membranous), density, and the intensity of cytoplasmic staining were characterized
semiquantitatively. Extrathyroidal invasion, surgical margin positivity, and lymph node
metastasis were compared with BRAF(V600E) mutation and NIS expression. Eighty-eight
patients who had at least 24-month follow-up were also included in survival
analysis. BRAF(V600E) mutation was determined in 78.1% (75/96) and functional NIS
activity in 74% (71/96) of the cases. There were statistically significant differences in mean
ages between BRAF(V600E) mutation-positive (48.6) and BRAF(V600E) mutation-negative
cases (37.3; Levene test, P=.419; Student t test, P=.001). The surgical margin positivity
(46.7%) and extrathyroidal extension percentage (54.7%) in the BRAF(V600E) mutation-
positive group were higher than the negative (28.6% and 33.3%, respectively) group, without
statistical significance (P=.138 and P=.084, respectively). Functional NIS activity was higher
in BRAF(V600E) mutation-positive cases (78.1%) than mutation-negative ones (57.1%;
P=.047). The possibility of moderate and intense cytoplasmic staining
in BRAF(V600E) mutation-positive cases (72%) was 6.3 times higher than the possibility of
weak staining (28%) in the mutation-positive cases (95% confidence interval, 2.2-18.8;
P=.001). Functional NIS expression is higher in patients
with classical variant papillary thyroid cancer with BRAF(V600E) mutation. However, the
clinical features were not found to be associated with NIS expression. There may be different
mechanisms determining the outcome of therapy.

105. Gigantomastia and Macroprolactinemia Responding to Cabergoline Treatment: A Case Report and Mini review of the Literature 2016

Dellal FD, Ozdemir D, Aydin C, Kaya G, Ersoy R, Cakir B.
Uluslararası Yayınlar Case Rep Endocrinol 2016;2016:3576024. doi: 10.1155/2016/3576024. PubMed PMID: 27195157; PubMed Central PMCID: PMC4852364.
ABSTRACT
Background:
Macroprolactinemia is defined as predominance of high molecular weight prolactin forms in
the circulation. Although macroprolactin is considered as a biologically inactive molecule,
some authorities suggest treatment in symptomatic cases. Gigantomastia is defined as excess
breast tissue and most cases in the literature were treated by surgical intervention.
 
Case:
A 44-year- old woman was admitted to our clinic with gigantomastia and galactorrhea. The
patient had a demand for surgical therapy. In laboratory examination, she had
hyperprolactinemia and macroprolactinemia. Pituitary imaging revealed 6 mm microadenoma
in right side of the hypophysis. Since she was symptomatic, cabergolin treatment was started.
Macroprolactin became negative, breast circumference decreased significantly, and
galactorrhea resolved after treatment.
 
Conclusion:
Gigantomastia might be the presenting symptom in patients with macroprolactinemia. In these
patients medical treatment with cabergoline may be used initially as an alternative to surgical
approach.

104. Comparing Clinicopathologic and Radiographic Findings Between TT-UMP, Classical, and Non-Encapsulated Follicular Variants of Papillary Thyroid Carcinomas 2016

Baser H, Topaloglu O, Tam AA, Alkan A, Kilicarslan A, Ersoy R, Cakir B
Uluslararası Yayınlar Endocr Pathol. 2016 Sep;27(3):233-42. doi: 10.1007/s12022-016-9437-4. PubMed PMID:27256097
ABSTRACT
Thyroid tumors of uncertain malignant potential (TT-UMP) comprise an accepted subgroup
of follicular-patterned thyroid tumors for which benignancy or malignancy cannot be
precisely assessed. We aimed to evaluate the demographic characteristics, ultrasound
(US) findings, and cytological results of patients with TT-UMP and compare these findings to
a classical variant of papillary thyroid carcinoma (CV-PTC) and non-
encapsulated follicular variant of PTC (NEFV-PTC) patients; we also evaluated the
immunohistochemical characteristics of patients with TT-UMP. Twenty-four patients
with TT-UMP, 672 with CV-PTC, and 132 with NEFV-PTC were included in the study.
Mean longitudinal nodule size and median nodule volume were higher in the TT-UMP group
than in the CV-PTC and NEFV-PTC groups (p < 0.001 and p < 0.001 for CV-PTC; p < 0.001
and p = 0.008 for NEFV-PTC). The presence of halo and peripheral vascularization was
observed more frequently in the TT-UMP group than in the CV-PTC group (p = 0.002 and
p = 0.024). Benign and follicular neoplasm/suspicious for follicular neoplasm cytological
results were higher in the TT-UMP group than in the CV-PTC group (p = 0.030 and
p = 0.001). US findings were similar between TT-UMP and NEFV-PTC groups (all, p > 0.05).
However, none of the patients with TT-UMP were called malignant; 105 patients (31.2 %) of
CV-PTC and 11 patients (9.5 %) of NEFV-PTC (infiltrative FV) were classified as malignant
cytologically. Tumor size was higher in the TT-UMP group than in the CV-PTC and NEFV-
PTC groups (p < 0.001 and p = 0.006). In the TT-UMP group, positive expression of HBME-
1, CK-19, and Gal-3 was found in 50, 33.3, and 25 % of patients, respectively. This study
demonstrated that none of the TT-UMP patients were evaluated as malignant in preoperative
cytology. However, patients with TT-UMP had higher nodule and tumor sizes than CV-PTC
and NEFV-PTC patients; US features were similar between NEFV-PTC and TT-
UMP patients.

103. Evaluation of Silent Myocardial Ischemia with Single-Photon Emission Computed Tomography/Computed Tomography in Asymptomatic Subjects with Diabetes and Pre-Diabetes 2016

Özdemir E, Burçak Polat Ş, Yıldırım N, Türkölmez Ş, Ersoy R, Durmaz T, Keleş T, Bozkurt E, Çakır B
Uluslararası Yayınlar Mol Imaging Radionucl Ther. 2016 Jun 5;25(2):70-8. doi: 10.4274/mirt.24633. PubMed PMID: 27277323; PubMed Central PMCID: PMC5096623.
ABSTRACT
OBJECTIVE:
The aim of this study was to disclose the prevalence of myocardial ischemia, as detected by
adenosine stress myocardial perfusion imaging (MPI) with hybrid single-
photon emission computed tomography/computed tomography (SPECT/CT),
in asymptomatic diabetic and pre-diabetic patients and to find out whether ischemia predicted
the occurrence of adverse cardiac/cerebrovascular events (ACCE) at follow-up.
METHODS:
Forty-three diabetic and thirty-five pre-diabetic asymptomatic patients without any history of
coronary artery disease, underwent MPI and were followed-up for a 12.8±2.2 (8-19) months
for the occurrence of ACCE. Baseline variables that would predict the presence
of ischemia and the value of ischemia on MPI for predicting the occurrence of ACCE at
follow-up were evaluated by logistic regression analysis.
RESULTS: Ischemia was detected in ten (23.3%) of the diabetic and in four (11.4%) of the
pre-diabetic patients. The presence of diabetes was the only independent predictor
of myocardial ischemia [odds ratio (OR): 12.31, 95% confidence interval (CI): 1.83-82.66;
p<0.01]. During 12.8±2.2 (8-19) months of follow-up, ACCE was observed in five out of 78
(6.4%) patients. Patients with ischemia were significantly more likely to have ACCE during
follow-up as compared to those with normal MPI scans (event rates: 21.4% vs. 3.1%, OR:
8.455 95% CI: 1.264-56.562, p=0.038).
CONCLUSION: Myocardial ischemia as detected by adenosine stress SPECT/CT in a
population of asymptomatic patients with diabetes mellitus or pre-diabetes appeared to predict
the occurrence of ACCE at follow-up.

102. Comparison of Early Total Thyroidectomy with Antithyroid Treatment in Patients with Moderate-Severe Graves' Orbitopathy: A Randomized Prospective Trial. 2016

Erdoğan MF, Demir Ö, Ersoy RÜ, Gül K, Aydoğan Bİ, Üç ZA, Mete T, Ertek S Ünlütürk U, Çakır B, Aral Y, Güler S, Güllü S, Çorapçıoğlu D, Dağdelen S, Erdoğan G.
Uluslararası Yayınlar Eur Thyroid J. 2016 Jul;5(2):106-11. doi: 10.1159/000444796. PubMed PMID: 27493884; PubMed Central PMCID: PMC4949371.
ABSTRACT
BACKGROUND:
The optimal therapeutic choice for Graves' hyperthyroidism in the presence of moderate-
severe Graves' orbitopathy (GO) remains controversial.
OBJECTIVES:
We aimed to compare GO course in patients with moderate-severe GO treated
with early total thyroidectomy (TTx) versus antithyroid drug (ATD) regimens, in
a prospective, randomized manner.
METHODS:
Forty-two patients with moderate- severe GO were enrolled. A total of 4.5 g of pulse
corticosteroids were given intravenously to all patients before randomization. Patients in the
first group were given TTx, whereas patients in the second group were treated with ATDs.
TSH was kept between 0.4 and 1 mIU/l. The clinical course of GO was evaluated with
proptosis, lid aperture, clinical activity score (CAS), and diplopia.
RESULTS:
Eighteen and 24 patients were randomized to the TTx and ATD groups, respectively. Thyroid
autoantibodies decreased significantly, and there were significant improvements in proptosis,
lid aperture, and CAS in the TTx group. While in the ATD group the decrement in thyroid
autoantibodies was not significant, there were significant improvements in proptosis and
CAS. When the TTx group was compared with the ATD group, anti-TPO, anti-Tg, and TSH-
receptor antibodies were significantly decreased in the TTx group (p < 0.01), but there was no
significant difference with respect to proptosis, lid aperture, CAS, and diplopia between the
two groups during a median (min.-max.) follow-up period of 60 months (36-72).
CONCLUSION:
Although no definitive conclusions could be drawn from the study, mainly due to limited
power, early TTx and the ATD treatment regimens, followed by intravenous pulse
corticosteroid therapy, seemed to be equally effective on the course of GO in this relatively
small group of patients with moderate-severe GO during a median (min.-max.) follow-up
period of 60 months (36-72).

101. Bethesda classification is a valuable guide for fine needle aspiration reports and highly predictive especially for diagnosing aggressive variants of papillary thyroid carcinoma 2016

Evranos B, Polat SB, Baser H, Ozdemir D, Kilicarslan A, Yalcin A, Ersoy R, Cakir B
Uluslararası Yayınlar Cytopathology. 2016 Sep 25. doi: 10.1111/cyt.12384. [Epub ahead of print] PubMed PMID: 27666595
ABSTRACT
BACKGROUND:
A fine needle aspiration biopsy (FNAB) is the most valuable diagnostic procedure for pre-
operative discrimination of benign and malignant nodules. The Bethesda System for
Reporting Thyroid Cytopathology provides standardised reporting and cytomorphological
criteria in aspiration smears. The aim of the present study was to determine malignancy rates
in nodules with different cytology results and evaluate the diagnostic value
of Bethesda for variants of papillary thyroid carcinoma (PTC).
MATERIALS AND METHODS:
A retrospective analysis of 2534 cases with 5784 thyroid nodules, who underwent FNAB
followed by surgery, were included in this study. FNAB was performed with ultrasonography
guidance. Cytological diagnoses were classified as: non-diagnostic (ND), benign, atypia of
undetermined significance/follicular lesions of undetermined significance (AUS/FLUS),
follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), suspicious for malignancy
(SUS) and malignant. Histopathological diagnoses were classified into four groups: benign,
PTC, follicular thyroid cancer and other types of thyroid cancer (including
medullary thyroid cancer, undifferentiated thyroid cancer and thyroid tumours of uncertain
malignant potential). Cases with PTC were further divided into four categories: conventional
variant, follicular variant, aggressive variants (tall cell, diffuse sclerosing and columnar
variant) and other variants (oncocytic, solid/trabecular and warthin-like variants). FNAB
results were compared with histopathological results.
RESULTS:
Malignancy rates were 6.3%, 3.2%, 20.7%, 33.3%, 74.2% and 95.6% in the nodules with ND,
benign, AUS/FLUS, FN/SFN, SUS and malignant cytology results, respectively. Pre-
operative cytology was malignant or SUS in 56.6% of conventional, 24.3% of follicular, 92%
of aggressive and 41.7% of other variants of histopathologically confirmed PTC. The
difference between the groups was significant (P < 0.001).
CONCLUSION:
The Bethesda classification is a reliable indicator of malignancy in nodules with different
cytology results and seems to be very effective in predicting the malignancy for the nodules
diagnosed with aggressive variant PTC on the final histological examination.

100. Hypocalcemia development in patients operated for primary hyperparathyroidism: Can it be predicted preoperatively? 2016

Kaya C, Tam AA, Dirikoç A, Kılıçyazgan A, Kılıç M, Türkölmez Ş, Ersoy R, Çakır B.
Uluslararası Yayınlar Arch Endocrinol Metab. 2016 Oct;60(5):465-471. doi: 10.1590/2359-3997000000207. PubMed PMID: 27737322.
ABSTRACT
OBJECTIVE:
Primary hyperparathyroidism (PHP) is a common endocrine disease, and its most effective
treatment is surgery. Postoperative hypocalcemia is a morbidity of parathyroid surgeries, and
it may extend hospitalization durations. The purpose of this study is to determine the
predictive factors related to the development of hypocalcemia and hungry bone syndrome
(HBS) in patients who underwent parathyroidectomy for PHP.
 
MATERIALS AND METHODS:
Laboratory data comprising parathyroid hormone (PTH), calcium, phosphate, 25-OHD,
albumin, magnesium, alkaline phosphatase (ALP), blood urea nitrogen (BUN), and thyroid
stimulating hormone (TSH) of the patients were recorded preoperatively, on the 1st and 4th
days postoperatively, and in the 6th postoperative month, and their neck ultrasound (US) and
bone densitometry data were also recorded.
 
RESULTS:
Hypocalcemia was seen in 63 patients (38.4%) on the 1st day after parathyroidectomy.
Ten patients (6.1%) had permanent hypocalcemia in the 6th month after surgery. Out of
the patients who underwent parathyroidectomy for PHP, 22 (13.4%) had HBS. The incidence
of postoperative hypocalcemia was higher in patients who underwent parathyroidectomy for
PHP, who had parathyroid hyperplasia, and who had osteoporosis. Preoperative PTH, ALP,
and BUN values were higher in those patients who developed HBS. Furthermore, HBS was
more common in patients who had osteoporosis, who had parathyroid hyperplasia, and who
underwent thyroidectomy simultaneously with parathyroidectomy.
 
CONCLUSIONS:
As a result, patients who have the risk factors for development of hypocalcemia and HBS
should be monitored more attentively during the perioperative period.

99. Malignancy is associated with microcalcification and higher AP/T ratio in ultrasonography, but not with Hashimoto's thyroiditis in histopathology in patients with thyroid nodules evaluated as Bethesda Category III (AUS/FLUS) in cytology 2016

Topaloglu O, Baser H, Cuhaci FN, Sungu N, Yalcin A, Ersoy R, Cakir B.
Uluslararası Yayınlar Endocrine. 2016 Oct;54(1):156-168. PubMed PMID: 27172917
ABSTRACT
The predictors of malignancy are important for the decision of appropriate management in
nodules with atypia of undetermined significance/follicular lesion of undetermined
significance (AUS/FLUS). Our aim was to determine the ultrasonographical, clinical, and
biochemical predictors of malignancy in these patients. A total of 427 patients with
cytologically Bethesda Category III (AUS/FLUS) thyroid nodules were included in this
retrospective study. We divided the nodules into two subgroups according to the
histopathology as benign and malignant, and compared the preoperative ultrasonographical,
clinical, and biochemical findings. In overall, 427 patients with 449 AUS/FLUS nodules who
had undergone surgery, the rate of malignancy was 23.4 % (105/449). When evaluated
separately, the rate of malignancy was 25.8 % in nodules with AUS (82/318) and 17.6 % in
nodules with FLUS (23/131) (p = 0.061). The vast majority of malignant specimens in
histopathology consisted of papillary thyroid carcinoma (PTC) (n = 91, 86.7 %). Preoperative
ultrasonographic features of 105 malignant nodules in histopathology were compared with the
344 benign nodules in histopathology. Anteroposterior/Transverse (AP/T) ratio was
significantly higher in malignant group compared to benign group (p = 0.013). In multiple
logistic analysis, we found that higher AP/T ratio and microcalcification were independently
associated with malignancy (p < 0.05). The malignancy-associated cut-off value of AP/T ratio
at maximum sensitivity and specificity was ≥0.81. We did not find any correlation between
malignancy and Hashimoto's thyroiditis in histopathology in multivariate analysis (p > 0.05).
In Bethesda Category III nodules with higher AP/T ratio and microcalcification, surgery
might be considered as a first therapeutic option instead of repeat fine-needle aspiration
biopsy or observation.

98. Clinicopathological features of thyroid cancer in the elderly compared to younger counterparts: single-center experience 2016

Dellal FD, Özdemir D, Tam AA, Baser H, Tatli Dogan H, Parlak O, Ersoy R, Cakir B.
Uluslararası Yayınlar J Endocrinol Invest. 2016 Nov 24. [Epub ahead of print] PubMed PMID: 27885512
ABSTRACT

 PURPOSE:

The incidence of thyroid cancer is increased in elderly patients. It tends to be larger and have
more aggressive characteristics in these patients. Our aim was to
compare features of thyroid carcinoma in geriatric and non-geriatric patients.
METHODS:
In total, 933 patients with thyroid cancer were retrospectively reviewed. Thyroid functions,
ultrasonography features of malignant nodules, cytological and histopathological findings and
the rates of recurrence and persistence were compared in patients ≥65 and <65 years old.
RESULTS:
There were 153 malignant foci in 109 (11.7%) patients ≥65 and 1185 malignant foci in 824
(88.3%) patients <65 years old. Mean nodule diameter was significantly higher in geriatric
patients (p = 0.008). Most of the ultrasonographical features of malignant nodules were
similar in two groups. Hypoechoic halo was observed in 16.4 and 28.6% of malignant nodules
in geriatric and non-geriatric group, respectively (p = 0.034). There was no significant
difference in cytological diagnosis. Histopathologically, tumor diameter, rates of
microcarcinomas and incidentality were similar. Of all cancer types, 88.8% in geriatric and
93.9% in non-geriatric group were papillary thyroid cancer (p = 0.028). Hurthle
cell cancer constituted 3.9 and 1.1% of carcinomas in geriatric and non-geriatric patients,
respectively (p = 0.015); 2.0 and 0.2% of tumors in geriatric and non-geriatric group were
anaplastic, respectively (p = 0.012). Capsular and vascular invasion, extrathyroidal extension,
persistence and recurrence rates were similar.
CONCLUSIONS:
Rates of anaplastic cancer and Hurthle cell cancer which is known to have worser prognosis
among other differentiated thyroid cancers are increased in geriatric ages. Cytological
evaluation of thyroid nodules should strongly be considered due to increased tendency for
aggressive tumor types in these patients.

97. Does glycemic regulation affect hypercoagulable states in diabetic patients? 2015

Arpaci Dilek, Saglam Fatma, Ozdemir Didem, Ersoy reyhan, Cakir Bekir
Uluslararası Yayınlar International Journal of Diabetes in Developing Countries, November 2015, Volume 35, Supplement 3, pp 512–515
ABSTRACT 97. Does glycemic regulation affect hypercoagulable states in diabetic patients?
Diabetes is a common disorder, and many studies have shown that patients with diabetes mellitus
have increased thrombotic complications including arterial and venous thromboses. Poorly
controlled diabetes increases the risk of thrombosis. Recent reports have shown that a shortened
activated partial thromboplastin time (APTT) and increased fibrinogen levels indicate a
procoagulant condition. In this study, we evaluated the differences in global coagulation test
values such as APTT, prothrombin time (PT), or fibrinogen levels, between well and poorly
controlled diabetes. Three hundred forty-nine patients with type 2 diabetes mellitus were
included. APTT, PT, fibrinogen, fasting plasma glucose (FPG), postprandial plasma glucose
(PPG), complete blood
count (CBC), serum lipids, and HbA1c have been measured. Those with APTT <22 s and PT
<10.5 s were identified. Furthermore, patients were divided into two groups based on HbA1c
levels as follows: regulated diabetic group (HbA1c ≤7.0 %) and dysregulated diabetic group
(HbA1c >7.0 %). No significant differences were found between the two groups in terms of
shortened APTT (<22 s), PT (<10.5 s), or fibrinogen levels. Although inexpensive and widely
available, global coagulation assays such as APTT, PT, and fibrinogen levels did not prove
useful for evaluating hypercoagulable states in patients with diabetes.
 
Keywords Diabetes Mellitus . APTT . PT . Fibrinogen

96. Importance of ectopic thyroid tissue detected in the midline of the neck: single center experience 2015

Oguz A, Tuzun D, Ozdemir E, Ersoy R, Yazgan AK, Cakir B.
Uluslararası Yayınlar Arch Endocrinol Metab. 2015 Aug 28;60(3):231-5. doi: 10.1590/2359-3997000000073. PubMed PMID: 26331224
ABSTRACT
OBJECTIVE:
Ectopic thyroid tissue (ETT) is a rare abnormality of the thyroid gland and the true prevalence
and importance is not known. The aim of this study was to evaluate ultrasonography (US)
guided fine needle aspiration biposy (FNAB) results, sonographic features, and frequency of
ETT detected in the midline of the neck.
 
SUBJECTS AND METHODS:
Five thousand five hundred and twenty outpatients who were referred to our thyroid clinic
between September 2010 and April 2012 and underwent thyroid US, were retrospectively
analyzed. Patients with ETT, detected in the midline of the neck in US were included in the
study. Thyroid functions, sonographic features, and US guided FNAB results were evaluated.
 
RESULTS:
There were 81 (81.8%) female and 18 (18.2%) male patients with a mean age of 50.9 ± 11.7.
The ETT in the midline was present in 1.79% (99/5,520) of the patients. In the majority of the
patients, benign sonographic features (isoechoic, regular margin, type 1 vascularization)
were detected. There were 92 (92.9%) patients with a previous history of thyroidectomy and
all were histopathologically benign. In 7 (7.1%) patients, there was no history
of thyroid operation. FNAB results of ETT were benign.
 
CONCLUSION:
This study evaluated the importance of ETT detected incidentally in the midline of the neck.
Especially in patients with a history of thyroidectomy, the thyroid masses in the midline of
the neck can be found as incidental with imaging methods. Our results suggests that the
incidence of malignancy in this group is much lower than orthotopic thyroid nodules and they
are often benign.

95. Serum testosterone does not affect bone mineral density in postmenopausal women 2015

Arpaci D, Saglam F, Cuhaci FN, Ozdemir D, Ersoy R, Cakir B
Uluslararası Yayınlar Arch Endocrinol Metab. 2015 Aug;59(4):292-6. doi: 10.1590/2359-3997000000085. PubMed PMID: 26331315.
ABSTRACT
OBJECTIVE:
The purpose of the present study was to investigate the correlation between serum
testosterone levels and bone mineral density (BMD) in postmenopausal women.
 
MATERIALS AND METHODS:
The study group was made up of postmenopausal women admitted to our tertiary center.
Serum calcium, phosphorus, albumin, parathyroid hormone (PTH), thyrotropin (TSH), 25-OH
vitamin D, and total testosterone concentrations were measured. Subjects were categorized
into three groups regarding bone mineral density (BMD) values: normal (n = 22), osteopenia
(n = 21), and osteoporosis (n = 21). Subjects were also categorized into three groups
according to serum testosterone levels: low testosterone (n = 10), normal testosterone (n =
42), and high testosterone (n = 12).
 
RESULTS:
No significant difference was found for serum testosterone, TSH, calcium, phosphorus,
albumin, PTH, and 25-hydroxyvitamin D levels among patients with normal BMD,
osteopenia, and osteoporosis (p > 0.05). Lumbar spine, total femur, femoral neck,
trochanteric, intertrochanteric, and Ward's triangle BMD values were similar for the different
testosterone levels (p > 0.05).
 
CONCLUSION:
There was no correlation between serum testosterone levels and patient age, body-mass index,
or any measured BMD values. Given the findings in our study, which failed to demonstrate a
statistically significant relationship between testosterone and BMD, adjustment of other risk
factors for osteoporosis might have a more distinctive effect in this setting.

94. Real-time sonoelastography and ultrasound evaluation of the Achilles tendon in patients with diabetes with or without foot ulcers: a cross sectional study 2015

Evranos B, Idilman I, Ipek A, Polat SB, Cakir B, Ersoy R
Uluslararası Yayınlar J Diabetes Complications. 2015 Nov-Dec;29(8):1124-9. doi: 10.1016/j.jdiacomp.2015.08.012. PubMed PMID: 26382616.
ABSTRACT
BACKGROUND:
Diabetes mellitus (DM) is an endocrine disease characterized by metabolic abnormalities and
long-term complications. The Achilles tendon (AT) plays an important role
in foot biomechanics. We aimed to investigate the effect of DM on the Achilles tendon, which
may contribute to long-term complications in the foot-ankle complex.
 
METHODS:
Seventy-eight patients with diabetes, with (35 patients, group I) or without (43 patients, group
II) foot ulcers were recruited from the endocrinology clinic. Thirty-three age-, gender-, and
BMI-matched healthy individuals were selected as controls. All participants
underwent ultrasonography and sonoelastography of their AT in order to evaluate Achilles
tendon thickness (ATT) and stiffness (ATS). Each patient was also tested for fasting plasma
glucose (FPG) and glycosylated hemoglobin (HbA1C) as a measure of diabetes control. Other
chronic complications were also evaluated in all patients with diabetes.
 
RESULTS:
The AT was significantly thicker in group I compared to group II and the controls. HbA1C,
FPG, and duration of diabetes were higher in group I. We observed that ATT was positively
correlated with neuropathy, retinopathy, nephropathy, peripheral arterial disease and coronary
arterial disease in group II while this correlation was not detected in group I. ATS was
reduced in group I more than group II and control groups.
 
CONCLUSION:
Changes in the structure of the AT may precede foot ankle disorders in patients with diabetes.
This is the first study that reported the results of sonoelastosonography of AT
in patients with diabetes and revealed the correlation between ATT and other chronic
complications of diabetes.

93. Effect of Intraoperative Valsalva Maneuver Application on Bleeding Point Detection and Postoperative Drainage After Thyroidectomy Surgeries 2015

Tokaç M, Dumlu EG, Bozkurt B, Öcal H, Aydın C, Yalçın A, Çakır B, Kılıç M
Uluslararası Yayınlar Int Surg. 2015 Jun;100(6):994-8. doi: 10.9738/INTSURG-D-15-00002.1. PubMed PMID: 26414819; PubMed Central PMCID: PMC4587529.
ABSTRACT
The purpose of this paper was to analyze the effect of Valsalva maneuver application before
finalizing thyroidectomy operations on the identification of bleeding points and
postoperational drainage. One hundred patients (age range, 24-76 years) with multinodular
goiter, recurrent multinodular goiter, toxic diffuse multinodular goiter, or papillary thyroid
cancer were included in the study and were divided into 2 groups of 50 randomly. Both
groups underwent thyroidectomy operation, only 1 group
received intraoperative Valsalvamaneuver application (twice, 30 seconds of 30-cm PEEP).
The size of the thyroid gland, the duration of operation, hospital stay, and drain usage were
reported. Postoperational occurrences of drainage, hematoma, reoperation, and additional
complications were compared between the groups. Valsalva maneuver application helped to
identify minor bleeding points in 32% of the cases. There was no significant difference
between the study groups regarding the thyroid gland size, operation duration, hospital stay,
and the duration of drain usage (P > 0.05 for all). The amount of drainage as well as the
frequencies of hematoma, reoperation, and further complications was not significantly
different between the study groups (P > 0.05 for
all). Intraoperative application of Valsalvamaneuver is only useful to detect
minor bleeding points in some patients during thyroidectomy operations, but it had
no effect on the duration of postoperative drain usage, the amount of drainage, and risk of
hematoma. Therefore, intraoperative application of Valsalvamaneuver has no
beneficial effect on postoperative hemorrhagic complication after thyroidectomy operations.

92. Correlation of normal thyroid ultrasonography with thyroid tests 2015

Tam AA, Kaya C, Üçler R, Dirikoç A, Ersoy R, Çakır B.
Uluslararası Yayınlar Quant Imaging Med Surg. 2015 Aug;5(4):569-74. doi: 10.3978/j.issn.2223-4292.2015.08.06. PubMed PMID: 26435920; PubMed Central PMCID: PMC4559976.
ABSTRACT
BACKGROUND:
Thyroid disorders are frequently seen in the community. Thyroid ultrasonography (US) is
commonly used in the diagnosis of thyroid diseases. The relationship between heterogeneous
echogenicity of thyroid gland and thyroid tests are well known.
 
METHODS:
The aim of this study is to evaluate the correlation of normal US with the thyroid tests. A total
of 681 individuals were enrolled in the study. Individuals were separated into two groups as
normal (group 1) and hypoechoic (group 2) according to the echogenicity in US. Subjects
with nodular thyroid lesions were excluded from the study. Thyroid stimulating hormone
(TSH), free T4 (fT4), thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody
(TgAb) values were recorded in both groups and thyroid stimulating hormone receptor
antibody (TRAb) was recorded in individuals with low TSH.
 
RESULTS:
86.1% of individuals in group 1 had normal TSH, 93.7% had normal thyroid antibodies and in
77.6% of individuals, all thyroid tests performed were normal. In the 6.9% of the group 2, all
reviewed thyroid tests were normal (P<0.001).
 
CONCLUSIONS: Our study shows that US is correlated with normal thyroid function tests
and is a valuable tool in the prediction of normal thyroid function.

91. Nonclassical Congenital Adrenal Hyperplasia and Pregnancy 2015

Cuhaci N, Aydın C, Yesilyurt A, Pınarlı FA, Ersoy R, Cakir B.
Uluslararası Yayınlar Case Rep Endocrinol. 2015; 2015:296924. doi: 10.1155/2015/296924. PubMed PMID: 26558116; PubMed Central PMCID: PMC4618115.
ABSTRACT
Objective. The most common form of congenital adrenal hyperplasia (CAH) is 21-
hydroxylase (21-OH) deficiency due to mutation of the CYP21A2 gene. Patients with
nonclassical CAH (NC-CAH) are usually asymptomatic at birth and typically present in late
childhood, adolescence, or adulthood with symptoms of excessive androgen secretion.
Subfertility is relative in NC-CAH, but the incidence of spontaneous miscarriage is higher.
Here, we report a previously undiagnosed female who gave birth to a normal male child and is
planning to become pregnant again. Case Report. A 32-year- old female was referred to our
clinic for obesity. Her medical history revealed that she had had three pregnancies. She was
planning to become pregnant again. Her laboratory results revealed that she had NC-CAH.
Since her husband is the son of her aunt and she had miscarriages and intrauterin exitus in her
history, their genetic analyses were performed. Conclusion. Since most patients with NC-
CAH have a severe mutation, these patients may give birth to a child with the classical CAH
(C-CAH) if their partner is also carrying a severe mutation. Females with NC-CAH who
desire pregnancy must be aware of the risk of having an infant with C-CAH.

90. Hashimoto's Thyroiditis Does Not Affect Ultrasonographical, Cytological, and Histopathological Features in Patients with Papillary Thyroid Carcinoma 2015

Baser H, Ozdemir D, Cuhaci N, Aydin C, Ersoy R, Kilicarslan A, Cakir B.
Uluslararası Yayınlar Endocr Pathol. 2015 Dec;26(4):356-64. doi: 10.1007/s12022-015-9401-8. PubMed PMID: 26481630.
ABSTRACT
The association between papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT)
is controversial. In this study, we aimed to compare preoperative thyroid functions,
ultrasonography (US) features, fine-needle aspiration biopsy (FNAB) results, and
histopathological characteristics of PTC in patients with and without HT. Data of 919 PTC
patients were reviewed retrospectively. The diagnosis of HT was based on histopathological
examination and patients were grouped as HT and non-HT. There were 1321 PTC lesions in
919 patients among which 317 (34.5 %) had coexistent HT. There were no significant
differences in nodule volume, longitudinal diameter, texture, echogenicity, marginal
regularity, presence of microcalcification and hypoechoic halo, and peripheral vascularization
in patients with and without HT (p > 0.05, for all parameters). Macrocalcification was
observed more frequently in the non-HT group (p = 0.021). FNAB results were similar in the
two groups (p = 0.105). Distribution of variants, capsule invasion, vascular invasion, and
extrathyroidal extension were observed with similar rates in the HT and non-HT groups.
Lymph node metastasis was significantly higher in patients without HT (p = 0.012). Of the
carcinomas, 66.1 % (n = 874) were papillary thyroid microcarcinoma (PTMC). Tumor size
was lower in PTMC lesions coexistent with HT (p = 0.026). We observed lower rates of
capsule invasion, extrathyroidal extension, and lymph node metastases in PTMC with HT
compared to without HT (p = 0.007, p = 0.003, and p = 0.015, respectively). This study
showed that US features, FNAB results, and histopathological findings of PTC lesions are not
influenced by the presence of HT. However, PTMC seems to be related with less aggressive
histopathological behavior in HT.

89. Effective treatment of severe pregnancy and lactation-related osteoporosis with teriparatide: case report and review of the literature 2015

Polat SB, Evranos B, Aydin C, Cuhaci N, Ersoy R, Cakir B.
Uluslararası Yayınlar Gynecol Endocrinol. 2015 Jul;31(7):522-5. doi: 10.3109/09513590.2015.1014787. PubMed PMID: 25893268
ABSTRACT
Pregnancy or lactation-related osteoporosis (PLO) is a very rare and debilitating condition
which is usually diagnosed during the last trimester of the pregnancy or early postpartum
period. Herein, we report a case with severe PLO and multiple vertebral compression
fractures that were successfully treated with teriparatide. Twenty-three- year-old female
patient was admitted to our clinic two months after her first spontaneous vaginal delivery with
the complaint of severe back pain. Bone mineral density was measured using dual energy X-
ray absorptiometry (DEXA), and low T- and Z-scores were observed in lumbar vertebrae. In
vertebral MRI, severe height loss was detected in thoracic (T) 5,7,10,11,12 vertebrae. After
exclusion of the other possible causes of OP, she was diagnosed to have PLO and the lactation
was stopped. She was treated with calcium 1000 mg/day, cholecalciferol 800 mg/day and
teriparatide 20 µg/day. At the 12th and 18th month of therapy, BMD was increased by 8% and
27%, respectively, at the lumbar spine and pain was completely relieved in few months. There
are pharmacological therapy modalities that can be used in PLO. Bisphosphonates are
effective, but there are some concerns that they accumulate in bone and may expose fetus in
subsequent pregnancies. Teriparatide is a strong candidate to be the optimal medical therapy
in severe cases since it is effective and safe.

88. The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy for thyroid nodules three centimeters or larger in size. Diagn Cytopathol 2015

Ucler R, Usluogulları CA, Tam AA, Ozdemir D, Balkan F, Yalcın S, Kıyak G, Ersoy PE, Guler G, Ersoy R, Cakır B.
Uluslararası Yayınlar Diagn Cytopathol. 2015 Aug;43(8):622-8. doi: 10.1002/dc.23289. PubMed PMID: 25914194.
ABSTRACT
BACKGROUND AND PURPOSE:
Whether under ultrasonography (US) guidance or not, fine-needle aspiration biopsy (FNAB) has some
limitations, particularly in larger nodules. In this study, we aimed to evaluate the diagnostic value of
US-guided fine-needle aspiration biopsy (US-FNAB) in thyroid nodules equal to or larger than 3 cm.
 
MATERIALS AND METHODS:
Data of 267 patients operated for nodular goiter in the period of January 2006 and March 2012 were
reviewed retrospectively. The study group (40 males, 104 females; mean age 42.3 ± 12.3, between 17
and 71) consisted of patients with nodules with a diameter of 3 cm or larger. Patients with nodules less
than 3 cm in diameter were considered as the control group (27 males, 96 females; mean age
44.4 ± 11.9, between 18 and 71).
 
RESULTS:
For nodules smaller than 3 cm, US-FNAB had an accuracy rate of 60% and a false negativity rate of
21.9%. In nodules equal to or larger than 3 cm, the accuracy rate of US-FNAB was 80%, with a false
negativity rate of 6.7%. Malignancy was observed in 16% of the study group and 42.3% of the control
group.
 
CONCLUSION:
This study showed that increased nodule diameter is not associated with limitations in the diagnostic
value of US-FNAB. We also found that the malignancy rate was smaller for larger nodules. This
finding reflects the importance of accurate and rational diagnostic work-up and clinical management
for detecting malignancy and surgical decision-making.

87. The Relationship between Epicardial Fat Thickness and Endothelial Dysfunction in Type I Diabetes Mellitus. Echocardiography 2015

Aslan AN, Keleş T, Ayhan H, Kasapkara HA, Akçay M, Durmaz T, Sarı C, Baştuğ S, Çakır B, Bozkurt E.
Uluslararası Yayınlar Dec;32(12):1745-53. doi: 10.1111/echo.12960. PubMed PMID: 25916257
ABSTRACT
BACKGROUND AND AIM:
Epicardial adipose tissue (EAT) is a new independent marker of coronary artery disease
(CAD). The aim of this study was to investigate the relationship between epicardial fat
thickness (EFT) and endothelial dysfunction (ED) in patients with type I diabetes mellitus
(TIDM).
 
METHODS AND RESULTS:
Seventy-six type I diabetic patients (diabetes duration 11.7 ± 8,1 years, aged 30.6 ± 10 years;
female/male: 38/38) and 36 healthy controls were enrolled into the study. Fasting plasma
glucose (FPG), lipid panel, glycosylated hemoglobin (HbA1C), high-sensitive C-reactive
protein (hsCRP), and fibrinogen levels were determined. EFT was measured via two-
dimensional (2D) M-mode echocardiography. Endothelial function was assessed as flow-
mediated dilatation (FMD) at the brachial artery using high-resolution ultrasound. EFT was
significantly higher in patients compared to controls (3.56 ± 0.48 mm vs. 3.03 ± 0.48 mm, P <
0.001). In addition, significant differences were observed between the patient and control
groups in terms of FMD (6.70% ± 1.63 vs. 9.99% ± 1.84, respectively, P < 0.001). EFT was
shown to be correlated negatively with FMD (r: -0.94, P < 0.001) and positively with hsCRP
(r: 0.41, P < 0.001) and fibrinogen (r: 0. 31, P = 0.007). Multiple regression analysis showed
EFT to be an independent factor influencing the endothelial function.
 
CONCLUSION:
There was inverse relationship between EFT and endothelial function in this study. EFT
measured easily by transthoracic echocardiography may be a useful parameter in the
assessment of patients with TIDM.

86. Epicardial fat thickness in patients with prediabetes and correlation with other cardiovascular risk markers. Intern Med. 2015

Arpaci D, Ugurlu BP, Aslan AN, Ersoy R, Akcay M, Cakir B
Uluslararası Yayınlar 2015;54(9):1009-14. doi: 10.2169/internalmedicine.54.3714. PubMed PMID: 25948339.
ABSTRACT
OBJECTIVE:
Prediabetes is a condition between a normal metabolic state and diabetes mellitus, which
includes impaired glucose tolerance (IGT), impaired fasting glucose (IFG), or both.
Prediabetes is related with undesirable cardiovascular outcomes. Epicardial fat thickness
(EFT) has been correlated with cardiovascular risk factors. We herein aimed to assess EFT in
prediabetic patients.
 
METHODS:
We evaluated 64 patients with prediabetes and 30 age- and gender-matched healthy subjects.
Demographic and anthropometric characteristics [age, sex, height, weight, body mass index
(BMI), and waist circumference (WC)] and laboratory findings [fasting plasma glucose
(FPG), postprandial plasma glucose (PPG), hemoglobin A1c (HbA1c), low density
lipoprotein (LDL), high density lipoprotein (HDL), and triglycerides (TG)] were assessed.
Transthoracic echocardiography was used to evaluate EFT.
 
RESULTS:
There were no significant differences between the case and control groups in terms of age,
gender, height, HDL, WC, systolic and diastolic blood pressure (SBP/DBP), or TG (p>0.05).
Body weight, BMI, FPG, LDL, and, in particular, EFT were found to be significantly higher
in the case group than control group (p<0.05). When compared with the control group, the
median EFT was significantly higher in all prediabetic subgroups (IGT or IFG, p<0.001).
However, no statistically significant difference was found between each case subgroup
(p=0.795). When groups were adjusted according to age, sex, WC, and BMI with covariance
test, the EFT remained increased in the prediabetes subgroups compared to the controls
(p<0.001).
 
CONCLUSION:
We found the EFT levels to be increased in all subgroups of prediabetic patients regardless of
FPG and HbA1c. Furthermore, EFT directly correlated with the patients' BMI and WC.

85. The relationship between microvascular complications and vitamin D deficiency in type 2 diabetes mellitus. BMC Endocr Disord. 2015

Usluogullari CA, Balkan F, Caner S, Ucler R, Kaya C, Ersoy R, Cakir B.
Uluslararası Yayınlar 2015 Jun 25;15:33. doi: 10.1186/s12902-015-0029-y. PubMed PMID: 26109389; PubMed Central PMCID: PMC4480442.
ABSTRACT
BACKGROUND:
Vitamin D deficiency is reported as a possible risk factor for the development of diabetes in
several epidemiologic studies. In this study, we investigated the frequency of 25-OH vitamin
D deficiency in type 2 diabetes mellitus and the relationship between 25-OH vitamin D
deficiency and the prevalence of microvascular complications.
 
METHODS:
In this retrospective study, we evaluated the medical records of 557 patients with type 2
diabetes admitted to the Endocrinology Outpatient Clinic from January to March 2010 and
112 healthy controls randomly selected from individuals admitted to the hospital for a check-
up and who had a laboratory result for serum 25-OH vitamin D concentrations at screening.
The levels of 25-OH vitamin D in patients with type 2 diabetes and the relationship between
25-OH vitamin D deficiency and microvascular complications were investigated.
 
RESULTS:
No significant difference in serum 25-OH vitamin D concentrations was observed between
the diabetic and control groups. No correlation was observed between HbA1C and serum 25-
OH vitamin D levels. Serum 25-OH vitamin D levels were lower in diabetic patients with
nephropathy, and patients not using any medication, i.e., those treated with dietary changes
alone, had a higher prevalence of nephropathy.
 
CONCLUSION:
Vitamin D deficiency is more common in diabetic patients with nephropathy. When
microvascular complications were evaluated, vitamin D levels were found to be lower in
patients in whom these complications were more severe. Vitamin D deficiency is therefore
associated with microvascular complications in diabetic patients.

84. Thyroid Nodules With 2 Prior Inadequate Fine-Needle Aspiration Results: Effect Of Increasing The Diameter Of The Needle. Endocr Pract. 2015

Ucler R, Kaya C, Çuhacı N, Tam AA, Usluogulları CA, Balkan F, Ersoy R, Cakır B.
Uluslararası Yayınlar 2015 Jun;21(6):595-603. doi: 10.4158/EP14482.OR. PubMed PMID: 26135960.
ABSTRACT
OBJECTIVE:
The major limitation of ultrasound-guided fine-needle aspiration biopsy (US-FNAB)
procedures of thyroid nodules are the cytologically nondiagnostic results. The role of
increasing the diameter of the needle in the third FNAB (FNAB#3) due to inadequate
cytology has as yet not been investigated. The aim of the present study was to evaluate
whether increasing the needle diameter could improve the cytologic sampling of thyroid
nodules following 2 previous nondiagnostic US-FNAB results.
 
METHODS:
Between July 2012 and December 2012, 140 consecutive patients with 2 prior nondiagnostic
US-FNAB results were enrolled in this prospective investigation. Group 22G consisted of 70
patients (78.5% women; mean age, 52 years) having nodules examined with a 22-gauge (G)
needle. Group 27G consisted of 70 patients (75.7% women; mean age, 53 years) having
nodules examined with a 27-G needle.
 
RESULTS:
The rate of nondiagnostic FNAB results was 42.8% (30 of 70) in group 22G and 64.3% (45
of 70) in group 27G, which was a significant difference (P = .011). The large-bore (22 G)
needle was found to be statistically significantly superior compared with the small-bore (27
G) needle in diagnostic ability for predominantly solid (P = .014), irregular (P = .013), and
halo-free (P = .021) nodules. The accuracy rate was 64.6 and 38% for large-bore (22 G) and
small-bore (27 G) needles, respectively.
 
CONCLUSION:
The results of our study showed that increasing the needle lumen diameter significantly
improves diagnostic performance in terms of adequate aspirated material and diagnostic
accuracy rate following 2 prior nondiagnostic US-FNABs.

83. Comparison of ultrasonography features and malignancy rate of toxic and nontoxic autonomous nodules: a preliminary study 2015

Dirikoc A, Polat SB, Kandemir Z, Aydin C, Ozdemir D, Dellal FD, Ersoy R, Cakir B.
Uluslararası Yayınlar Ann Nucl Med. 2015 Dec;29(10):883-9. doi: 10.1007/s12149-015-1018-y. PubMed PMID: 26272348
ABSTRACT
OBJECTIVE:
When a scintigraphically autonomous nodule does not produce thyroid hormones enough to suppress
serum thyrotrophin, it is generally defined as nontoxic autonomous nodule. In this study, we aimed to
compare clinical and ultrasonographical (US) features and cytological and histopathological results of
toxic and nontoxic autonomous nodules.
 
METHODS:
Patients who underwent thyroidectomy and were evaluated with technetium-99m- pertechnetate
scintigraphy preoperatively in our institution between May 2008 and December 2014 were identified
from medical records. Among these, treatment naïve patients with scintigraphically autonomous
thyroid nodules were chosen and classified into toxic (hyperthyroid) and nontoxic (euthyroid) groups.
The demographic data, preoperative US features of the nodules, fine needle aspiration biopsy and
histopathological results were analyzed.
 
RESULTS:
There were 170 (89.0%) patients with toxic and 21 (11.0%) patients with nontoxic autonomous
nodules. A total of 258 scintigraphically autonomous nodules were analyzed among which 227 were
clinically functional (toxic) and 31 were clinically euthyroid (nontoxic). Echogenity, texture, marginal
irregularity, presence of halo and macrocalcification were similar in toxic and nontoxic autonomous
nodules. Toxic autonomous nodules were significantly bigger and had a significantly higher rate of
microcalcification compared to nontoxic ones (p = 0.001 and p = 0.025, respectively). There was no
significant difference in terms of cytological diagnosis between toxic and nontoxic autonomous
nodules (p = 0.052). Atypia of undetermined significance/follicular lesion of undetermined
significance cytology was significantly higher in nontoxic group (p = 0.01). 20 (8.8%) of 227 toxic
and 2 (6.5%) of 31 nontoxic autonomous nodules were malignant (p = 0.59). Considering all nodules
regardless of the thyroid function, 8.5% of autonomous nodules was malignant.
 
CONCLUSION:
US features and malignancy potential of nontoxic autonomous nodules resemble toxic autonomous
nodules. Lower diameter suggests that they can represent a preliminary stage of toxic ones and have
potential of toxicity when get bigger in size. There is still a considerable risk of malignancy risk in
autonomous nodules whether toxic or not.

82. Electrophysiologic vestibular evaluation in type 2 diabetic and prediabetic patients: Air conduction ocular and cervical vestibular evoked myogenic potentials 2015

Konukseven O, Polat SB, Karahan S, Konukseven E, Ersoy R, Cakir B, Kutluhan A, Aksoy S.
Uluslararası Yayınlar Int J Audiol. 2014 Dec 22:1-8
ABSTRACT
Objective: Chronically increased blood glucose levels may affect the vestibular system by damaging cells and neural structures in diabetes mellitus (DM). We aimed to search the effects of neurovascular degeneration on the vestibular system in type 2 DM and prediabetic patients by using air-conducted ocular (oVEMP) and cervical (cVEMP) vestibular evoked myogenic potentials. Design: Prospective study. Study sample: Thirty diabetic, 30 prediabetic patients, and 31 age- and sex-matched controls having no peripheral or central vestibular disease, were enrolled. All participants were evaluated by audiovestibular tests, oVEMP, and cVEMP. Results: In the diabetic group, mean values of both oVEMP and cVEMP p1, n1 latencies were significantly longer compared to the prediabetic group and the control group, whereas latencies were similar in prediabetic and the control groups. Bilateral neural dysfunction was recognized in both tests and lateralization was not seen in VEMP asymmetric ratios. In the diabetic group, prevalence of pathological p1 and n1 latencies in oVEMP were 30.4% and 37.5%, whereas they were 53.7%, 59.3% in cVEMP, respectively. p1 latencies of cVEMP and oVEMP were positively correlated with HbA1c and fasting plasma glucose level in the diabetic group. Conclusion: Subclinical vestibular neuropathy can be a newly defined diabetes-related complication.

81. Cytomorphologic features and ultrasonographic characteristics of thyroid nodules with Hurthle cells. 2015

Tuzun D, Ersoy R, Yazgan AK, Kiyak G, Yalcin S, Cakir B.
Uluslararası Yayınlar Ann Diagn Pathol, 2015 Mar 6. pii: S1092-9134(15)00044-1. doi: 10.1016/j.anndiagpath.2015.03.002. [Epub ahead of print] PubMed PMID: 25804256
ABSTRACT

This study was designed to evaluate the ultrasonographic and histopathologic features of nodules composed predominantly of Hurthle cells detected during cytological examination. Fifty-seven patients with thyroid nodules composed predominantly of Hurthle cells on fine needle aspiration cytology were retrospectively analyzed. Patients were evaluated by thyroid ultrasonography (US), and biopsy samples taken by US-guided fine needle aspiration cytology were assessed histopathologically. There were 57 patients and 57 nodules with Hurthle cells in cytological examination; 49 (86%) were classified as Bethesda 1, and 8 (14%) were classified as Bethesda 3. Histopathologically, 45 (78.9%) nodules were benign and 12 (21.1%) were malignant. Nuclear groove, transgressing blood vessel, and absence of colloid were observed with a higher frequency in malignant nodules compared to benign nodules (P < .05). There were no specific morphological features (nodule echogenity, presence of microcalsification, presence of cystic areas, absence of halo, margin irregularity, and increased blood flow) predicting malignancy in the US evaluation of nodules including Hurthle cells. Nuclear groove, transgressing blood vessel, and absence of colloid on cytomorphological evaluation are indicative of malignancy in nodules containing Hurthle cells.

80. A retrospective analysis of prognostic factors predictive of lymph node metastasis and recurrence in thyroid papillary microcarcinoma 2015

Usluogulları CA, Onal ED, Ozdemir E, Ucler R, Kiyak G, Ersoy PE, Yalcin S, Güler G, Ersoy R, Cakir B.
Uluslararası Yayınlar Minerva Endocrinol. 2015, Mar, 40(1):15-22
ABSTRACT
ABSTRACT The literature is inconclusive concerning the prognostic factors and therapeutic management of papillary thyroid microcarcinoma (PTMC). Herein we report on our extensive experience with PTMC in relation to clinicopathological characteristics and prognostic factors.
In all, 248 patients that were diagnosed and treated for PTMC between 2007 and 2012 were retrospectively analyzed. Demographic and tumor characteristics at presentation, and recurrence during follow-up were noted.
Total thyroidectomy and radioactive iodine (RAI) ablation treatment were performed in all patients. Bilateral involvement, vascular and capsular invasion, extrathyroidal extension, and lymph node metastasis occurred significantly more frequently in patients with tumor size >5 mm (P< 0.05). Multivariate statistical analysis showed that a clinically suspected diagnosis (OR:0.095; P=0.043) and elevated thyroglobulin (TG) level (OR: 1.083; P=0.011; cutoff value ≥7.98 ngmL-1) were significant and independent risk factors for lymph node metastasis, with a sensitivity of 57% and specificity of 83%. After a median followup of 2 years (range:0.311 years), 10 (4%) of the 248 patients had recurrent disease. According to multivariate analysis, lymph node metastasis (OR: 51.4; P=0.003) was the only independent predictor of recurrence.
Our findings revealed that serum TG level and a clinically suspected diagnosis were risk factors for lymph node metastasis, while nodal metastasis was a predictor of recurrence.
 

79. Anti-Müllerian hormone as a marker of premature ovarian aging in autoimmune thyroid disease 2015

Saglam F, Onal ED, Ersoy R, Koca C, Ergin M, Erel O, Cakir B.
Uluslararası Yayınlar Gynecol Endocrinol. 2015 Feb;31(2):165-8
ABSTRACT

There is an increased incidence of autoimmune thyroid disease (AITD) in women with infertility. We hypothesized that serum anti-Müllerian hormone (AMH) levels will be lower in premenopausal women with AITD than controls. We evaluated ovarian reserve in women with AITD (n = 85) and healthy controls (n = 80), all <40 years old. Detailed data on reproductive history were obtained. Gonadotrophins, steroids, AMH, and inhibin B levels were measured during the follicular phase. The number of pregnancies as well as live births was lower in women with AITD (p < 0.01). No difference was observed in terms of FSH, estradiol, and inhibin B. AMH levels were lower in AITD women than in controls (1.16 + 0.17 versus 1.28 + 0.25 ng/ml, mean + SD, p = 0.001). According to the multiple regression analysis, even after age adjustment, AITD was significantly and independently affected AMH levels (t = 2.674, p = 0.008). Women with AITD seem to have a diminished ovarian follicular reserve and measurement of serum AMH level has the potential to be used to predict this comorbidity.

78. Topographic and Biomechanical Evaluation of Cornea in Patients With Acromegaly 2015

Altinkaynak H, Duru N, Ersoy R, Kalkan Akcay E, Ugurlu N, Cagil N, Cakir B.
Uluslararası Yayınlar Cornea. 2015 Jan; 34(1): 65-70
ABSTRACT
Purpose: The aim of this study was to compare topographic and biomechanical properties of corneas in patients with acromegaly with those of healthy individuals.
 
Methods: Thirty-five patients with acromegaly (study group) and 35 healthy individuals (control group) were enrolled in this prospective study. Topographic measurements, including central corneal thickness (CCT), mean keratometry (K) value, K1, K2, surface asymmetry index, corneal volume (CV), and anterior chamber depth in the right eye of each participant were obtained using a Scheimpflug camera with a Placido disc topographer (Sirius; Costruzione Strumenti Oftalmici). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOP), and Goldmann-corelated intraocular pressure (IOPg) were measured using Reichert Ocular Response Analyzer (Reichert Ophthalmic Instruments).
 
Results: Mean CCT, CV, CH, CRF, and IOPg values were higher in acromegalic eyes (549.3 ± 30.2 μm, 59.1 ± 3.1 μm, 11.3 ± 1.2 mm Hg, 11.3 ± 1.2 mm Hg, and 17.5 ± 2.9 mm Hg, respectively) than in healthy eyes (531.4 ± 33.6 μm, 57.4 ± 2.7 μm, 10.4 ± 1.2 mm Hg, 10.2 ± 1.6 mm Hg, and 14.8 ± 3.1 mm Hg, respectively; CCT, P = 0.042; CV, P = 0.032; CH, P = 0.044; CRF, P = 0.035; IOPg, P < 0.001).
Conclusions: CCT, CV, CH, CRF, IOPg, and IOP with Goldmann applanation tonometry were significantly higher in acromegalic eyes. These corneal topographic and biomechanical properties, disease duration, and disease status should be considered when planning corneal refractive surgery and determining accurate intraocular pressure in patients with acromegaly.
 

77. Evaluation of Retinal Nerve Fiber Layer Thickness in Acromegalic Patients Using Spectral-Domain Optical Coherence Tomography 2015

Duru N, Ersoy R, Altinkaynak H, Duru Z, Cağil N, Cakir B.
Uluslararası Yayınlar Semin Ophthalmol. 2014 Nov 7:1-6
ABSTRACT
Purpose: To evaluate retinal nerve fiber layer (RNFL) thickness in acromegalic patients. Methods: A study group of 29 patients with acromegaly and a control group of 38 age-matched healthy individuals were enrolled in a cross-sectional study. The study group was further divided by tumor size into two subgroups, a macroadenoma group and a microadenoma group. Serum growth hormone (GH) and insulin-like growth factor-1 (IGF-I) levels were detected at the time of ophthalmological examination in the study group. In both the study and control group, the RNFL thickness in the four quadrants was measured by optical coherence tomography. The relationship between GH and IGF-I levels and RNLF thickness was also evaluated. Results: The difference in mean RNLF thickness in all quadrants between the study and control groups was not statistically significant. In acromegalic patients with macroadenoma, the mean RNLF thickness of the inferior quadrant decreased significantly compared to both patients with microadenoma and healthy individuals (p = 0,032 and p = 0,046). GH and IGF-1 levels were not significantly correlated with the RNLF thickness in the study group. Conclusions: Excessive GH and IGF-1 levels do not affect the optic nerve or RNLF thickness, whereas the RNLF becomes thinner in the inferior quadrant in acromegalic patients with macroadenoma as a result of the chiasmal compression.

76. Day-night variations in thyroid stimulating hormone and its relation with clinical status and metabolic parameters in patients with cirrhosis of the liver 2015

Atalay R, Ersoy R, Demirezer AB, Akın FE, Polat SB, Cakir B, Ersoy O.
Uluslararası Yayınlar Endocrine. 2015 Apr; 48(3):942-8
ABSTRACT

To investigate day–night variations in thyroid stimulating hormone (TSH) and its relation with clinical status and metabolic parameters in patients with cirrhosis. Forty-one patients with negative thyroid antibodies and normal thyroid function tests who were diagnosed with cirrhosis were included. Thirty-five age- and gender-matched healthy subjects were included in control group.TSH, fT3, and fT4 levels, which were measured both in the morning and late evening. The difference between nocturnal TSH and morning TSH (ΔTSH) were compared between groups. Relation between Child-Turcotte-Pugh, model for End-Stage Liver Disease (MELD) and MELD-Na scores and levels of thyroid hormones, ΔTSH and serum sodium (Na) levels was investigated. Relation between ΔTSH and clinical status and metabolic parameters was also evaluated. The mean morning fT3, nocturnal fT3, nocturnal TSH, and ΔTSH levels were significantly lower, morning and nocturnal fT4 levels were higher in patients with cirrhosis (p < 0.001, p < 0.001, p = 0.004, p < 0.001, and p < 0.001).As the ROC analysis, day–night variation was detected to be impaired in the event that difference between nocturnal TSH level and morning TSH level was lower than 1 uIU/mL in patients with cirrhosis with a sensitivity of 92.7 % and specificity of 71.4 % (p < 0.001).A significant positive correlation was found between serum Na levels and fT3 in patients with cirrhosis (r = 0.479,p = 0.001), and a significant negative correlation was found between the severity of clinical status and low levels of fT3 in patients with cirrhosis (p < 0.001).Nocturnal TSH increase does not occur in cases of cirrhosis without known thyroid disease and with normal thyroid function tests, which may be an early finding of impaired thyroid functions in patients with cirrhosis.

75 . Postpartum osteoporosis and vertebral fractures in two patients treated with enoxaparin during pregnancy 2014

Ozdemir D, Tam AA, Dirikoc A, Ersoy R, Cakir B.
Uluslararası Yayınlar Osteoporos Int. 2015 Jan; 26(1): 415-8
ABSTRACT

Postpartum osteoporosis (PPO) is a rare disease associated with pregnancy and lactation period. Here, we report severe PPO and multiple vertebral compression fractures in two patients treated with enoxaparin—low-molecular-weight heparin (LMWH)—throughout their pregnancy. A 34-year-old woman who has delivered her second baby 3 months ago presented with severe low-back pain. She was treated with enoxaparin 40 mg/day for 8 months during her pregnancy. Dual-energy X-ray absorptiometry (DEXA) showed low T- and Z-scores in lumbar (L) vertebras. In magnetic resonance imaging (MRI), severe height losses in thoracic (T) 12, L1, and L2 vertebras were detected. She was diagnosed to have severe PPO and multiple vertebral compression fractures and was prescribed risedronate 35 mg/week, calcium, and vitamin D. The other patient was a 36-year-old woman diagnosed with PPO and vertebral fractures at the third week postpartum. She was also treated with enoxaparin 60 mg/day during her pregnancy. Severe osteoporosis in L vertebras and height losses indicative for compression fractures in T5–8, T11–12, and L2–5 vertebras were detected by DEXA and MRI, respectively. She was treated with calcitonin 200 U/day, calcium, and vitamin D. These findings suggest that vertebral compression fractures and PPO may be one of the causes of severe back pain in postpartum patients. Treatment with LMWH during pregnancy might be considered as a new risk factor for this rare condition.

74. Thyroid nodules and thyroid cancer in Graves' disease. 2014

Tam AA, Kaya C, Kılıç FB, Ersoy R, Çakır B.
Uluslararası Yayınlar Arq Bras Endocrinol Metabol, 2014 Dec;58(9):933-8
ABSTRACT
Objective
The frequency of thyroid nodules accompanying Graves’ disease and the risk of thyroid cancer in presence of accompanying nodules are controversial. The aim of this study was to evaluate the frequency of thyroid nodules and the risk of thyroid cancer in patients operated because of graves’ disease.
 
Subjects and methods
Five hundred and twenty-six patients in whom thyroidectomy was performed because of Graves’ disease between 2006 and 2013 were evaluated retrospectively. Patients who had received radioactive iodine treatment and external irradiation treatment in the neck region and who had had thyroid surgery previously were not included in the study.
 
Results
While accompanying thyroid nodule was present in 177 (33.6%) of 526 Graves’ patients, thyroid nodule was absent in 349 (66.4%) patients. Forty-two (8%) patients had thyroid cancer. The rate of thyroid cancer was 5.4% (n = 19) in the Graves’ patients who had no nodule, whereas it was 13% (n = 23) in the patients who had nodule. The risk of thyroid cancer increased significantly in presence of nodule (p = 0.003). Three patients had recurrence. No patient had distant metastasis. No patient died during the follow-up period.
 
Conclusions
Especially Graves’ patients who have been decided to be followed up should be evaluated carefully during the follow-up in terms of thyroid cancer which may accompany.
 

73. Evaluation of cytopathological findings in thyroid nodules with macrocalcification: macrocalcification is not innocent as it seems 2014

Arpaci D, Ozdemir D, Cuhaci N, Dirikoc A, Kilicyazgan A, Guler G, Ersoy R, Cakir B.
Uluslararası Yayınlar Arq Bras Endocrinol Metabol. 2014 Dec;58(9):939-45
ABSTRACT
Objective
Microcalcification is strongly correlated with papillary thyroid cancer. It is not clear whether macrocalcification is associated with malignancy. In this study, we aimed to assess the result of fine needle aspiration biopsies (FNAB) of thyroid nodules with macrocalcifications.
Subjects and methods
We retrospectively evaluated 269 patients (907 nodules). Macrocalcifications were classified as eggshell and parenchymal macrocalcification. FNAB results were divided into four groups: benign, malignant, suspicious for malignancy, and non-diagnostic.
 
Results
There were 79.9% female and 20.1% male and mean age was 56.9 years. Macrocalcification was detected in 46.3% nodules and 53.7% nodules had no macrocalcification. Parenchymal and eggshell macrocalcification were observed in 40.5% and 5.8% nodules, respectively. Cytologically, malignant and suspicious for malignancy rates were higher in nodules with macrocalcification compared to nodules without macrocalcification (p = 0.004 and p = 0.003, respectively). Benign and non-diagnostic cytology results were similar in two groups (p > 0.05). Nodules with eggshell calcification had higher rate of suspicious for malignancy and nodules with parenchymal macrocalcification had higher rates of malignant and suspicious for malignancy compared to those without macrocalcification (p = 0.01, p = 0.003 and p = 0.007, respectively).
 
Conclusions
Our findings suggest that macrocalcifications are not always benign and are not associated with increased nondiagnostic FNAB results. Macrocalcification, particularly the parenchymal type should be taken into consideration.
 

72. Anaplastic Cancer and Papillary Thyroid Cancer in the same Patient: Is it a Co-Incidence or a Process of Transformation? A case report 2014

Gulfem Kaya, Sefika Burcak Polat, Ersin Gurkan Dumlu, Hayriye Tatli, Reyhan Unlu Ersoy, Bekir Cakir.
Uluslararası Yayınlar A Case Report. Thyroid Disorders Ther 2014, 3:1
ABSTRACT
Anaplastic carcinoma of the thyroid gland is rare, but very aggressive, and the median survival is 3–5 months after establishing the diagnosis. The annual incidence in the USA is 1-2 cases per million populations. However, its incidence appears to be decreasing, while that of well-differentiated thyroid cancer is increasing. This report presents a patient with anaplastic thyroid cancer together with papillary carcinoma. A 62-year-old male visited our endocrinology clinic with a lump on the neck, palpable lymph nodes, and symptoms of compression. Fine-needle aspiration biopsies were inconclusive and he underwent surgery. Histopathology revealed intrathyroidal anaplastic carcinoma and papillary carcinoma in two distinct foci. Given the aggressive nature of the disease, there are few data on the tumor biology of anaplastic cancers; nevertheless, it is known that well-differentiated cancers of the thyroid gland can transform into anaplastic cancer. This results from point mutations in tumor suppressor genes due to previous radioactive iodine treatment or radiation exposure. It is not known whether de novo anaplastic cancers behave differently than those that evolved from differentiated cancers. By understanding the underlying pathophysiology of the disease, we can develop new therapies.

71. The evaluation of QT intervals during diagnosis and after follow-up in acromegaly patients 2014

Baser H, Akar Bayram N, Polat B, Evranos B, Ersoy R, Bozkurt E, Cakir B
Uluslararası Yayınlar Acta Med Port. 2014 Jul-Aug;27(4):428-32. Epub 2014 Aug 29. PubMed PMID: 25203949
ABSTRACT
INTRODUCTION:
It was aimed to calculate QT intervals in patients with acromegaly and to reveal its correlation between QT intervals, and growth hormone and insulin like growth factor-1.
 
MATERIAL AND METHODS:
Forty-one patients with acromegaly were enrolled into the study. Another 41 individuals with similar features, such as comorbid diseases, age and sex constituted the control group. The electrocardiographies of patients with acromegaly were evaluated at the baseline and after the follow-up. Only one electrocardiography was performed for controls. QT maximum, QT minimum, QT dispersion, corrected QT maximum, corrected QT minimum and corrected QT dispersion were calculated.
 
RESULTS:
Baseline QT maximum, QT dispersion, corrected QT maximum and corrected QT dispersion were significantly longer than the values of controls. Corrected QT maximum and corrected QT dispersion were significantly shorter after the follow-up, compared to the baseline in patients. QT maximum, QT dispersion, corrected QT maximum and corrected QT dispersion after the follow-up were not statistically different from the values of controls. Except the negative correlation between growth hormone and corrected QT dispersion in patients after the follow-up, no other correlation was detected between QT values and growth hormone or insulin like growth factor-1 levels. Corrected QT dispersion was found to be related with the disease duration in patients.
 
DISCUSSION:
For acromegaly patients, it is important to detect clinical predictors of cardiac arrhytmias. QT dispersion is considered a beneficial predictor for ventricular arrhytmias. When compared to controls, prolonged QT intervals were determined in our acromegalic patients.
 
CONCLUSION:
We consider that QT intervals may also be utilized in the evaluation of increased cardiovascular risk in patients with acromegaly.
 

70. Sheehan's syndrome co-existing with Graves' disease 2014

Arpaci D, Cuhaci N, Saglam F, Ersoy R, Cakir B.
Uluslararası Yayınlar Niger J Clin Pract, 2014 Sep-Oct;17(5):662-5. doi:10.4103/1119-3077.141447. PubMed PMID: 25244283
ABSTRACT

Sheehan's syndrome (SS), which is an important cause of hypopituitarism, is common in developing countries. The most common presentation is the absence of lactation and amenorrhea. Hypothyroidism rather than hyperthyroidism is the usual expected phenomenon in SS. Postpartum hyperthyroidism is also common and Graves' disease (GD) is an important cause of postpartum hyperthyroidism. Here we report a case of a 22-year-old female patient in our clinic presented symptoms of amenorrhea, lack of lactation, palpitations and sweating. Her physical examination revealed goiter, moist skin and proptosis. Her laboratory evaluation showed suppressed thyroid stimulating hormone, elevated levels of free thyroxine and free triiodothyronine. Thyroid antibodies were positive. Tec 99m thyroid scintigraphy results were gland hyperplasia and increased uptake consistent with GD. She gave birth 7 months ago; after delivery she had a history of prolonged bleeding, amenorrhea and inability to lactate. She had hypogonadotropic hypogonadism, hyperprolactinemia and growth hormone deficiency. Serum cortisol and adrenocorticotropic hormone levels were normal. Her magnetic resonance imaging was empty sella. Our diagnosis was GD co-existing with SS. GD with concomitant hypopituitarism is rare but has been described previously, but there are no reports of GD occurring with SS. In this case study, we report a patient with GD associated with SS.

69. Evaluation of postural parathyroid hormone change in patients with primary hyperparathyroidism. 2014

Aydin C, Polat SB, Dirikoc A, Ogmen B, Cuhaci N, Ersoy R, Cakir B
Uluslararası Yayınlar Int J Endocrinol, 2014;2014:628010. doi: 10.1155/2014/628010. Epub 2014 Sep 1. PubMed PMID: 25254042; PubMed Central PMCID: PMC4164425
ABSTRACT
Purpose. In the present study, we aimed to investigate postural change of PTH in normal individuals and in patients with primary hyperparathyroidism (PHPT). Methods. Twenty-two patients with PHPT and nine healthy controls were enrolled. Following 12 h of fast, patients stayed in recumbent position for an hour and PTH and total Ca measurements were performed at the 45th and 60th minutes of resting. Afterwards, the patients resumed an upright posture for an hour and again blood samples were taken at the 45th and 60th minutes of standing. Results. In the PHPT group, mean PTH was calculated as 153.9 pg/mL in the recumbent position while it was 206.3 during upright position (Δ change was 47.7) (P < 0.001). In the control group mean serum PTH was measured as 41.2 pg/mL in the recumbent position while it was 44.8 pg/mL in the upright position (Δ change was 1.7) (P = 0.11). In both groups, serum Ca was higher in the upright position compared to the recumbent position (P < 0.001). Conclusion. Postural change of serum PTH is significant only in PHPT group. Postural PTH test may give a clue to the clinician when the diagnosis of PHPT is equivocal.

68. Elastosonography scoring and strain index of thyroid nodules with Hurthle cells 2014

Tuzun D, Ersoy R, Kilicyazgan A, Kiyak G, Yalcin S, Cakir B.
Uluslararası Yayınlar Minerva Endocrinol. 2014 Oct 13. [Epub ahead of print] PubMed PMID: 25310014
ABSTRACT
PURPOSE: This study evaluated the effectiveness of elastosonography (ES) scoring and strain index (SI) in diagnosing patients with thyroid nodules composed primarily of Hurthle cells.
 
MATERIALS AND METHODS: This study retrospectively analyzed 57 patients with thyroid nodulescomposed predominantly of Hurthle cells on fine needle aspiration cytology (FNAC). Patients were evaluated by thyroid ultrasonography (US), ES scoring, SI, US guided FNAC, and histopathology.
 
RESULTS: Histopathologically, 12 (21.1%) nodules were malignant and 45 (78.9%) were benign. Mean age, sex distribution, thyroid function tests, and morphologic features on US were similar in the malignant and benign groups. Mean SI (40.98±31.28 vs 21.24±25.47, p=0.027) and thyroid peroxidaseantibody (anti--TPOab) positivity (p=0.004) were significantly higher in malignant than in benign nodules. Receiver operating curve (ROC) analysis showed that an SI cutoff of 10.326 had a sensitivity of 91.7% and a specificity of 49%, and an SI cut--off of 64.807 had a specificity of 91.1% and a sensitivity of 25%. The optimal SI cut--off value, 17.877, had a sensitivity of 66.7%, a specificity of 66.7%, a positive predictive value (PPV) of 34.8%, a negative predictive value (NPV) of 88.2%, and an area under the ROC curve of 73.1±0.074% (95% CI: 58.7--87.6.5%). The sensitivity, specificity, PPV, NPV and diagnostic accuracy of ES scoring were 41.6%, 91.1%, 55.5%, 85.4% and 80.7%, respectively.
 
CONCLUSION: This is the first study to investigate ES scoring and SI in nodules composed predominantly of Hurthle cells on FNAC. ES scoring and SI may add some contribution to ultrasonography in the characterization of thyroid nodules with Hurthle cells.
 

67. Relationship between aortic stiffness and the left ventricular function in patients with prediabetes 2014

Aslan AN, Ayhan H, Çiçek ÖF, Akçay M, Durmaz T, Keles T, Çakır B, Bozkurt E
Uluslararası Yayınlar Intern Med. 2014;53(14):1477-84
ABSTRACT

ABSTRACT

OBJECTIVE:

Several studies have shown that arterial stiffness and ventricular dysfunction are increased in individuals with type 2 diabetes. Aortic stiffness (AS) reflects the mechanical tension and elasticity of the aorta, and increased aortic stiffness is a risk factor for cardiovascular disease. The aim of this study was to evaluate the degree of aortic stiffness and its relationship with the left ventricular (LV) function in patients with prediabetes and healthy control subjects.

METHODS:

The study groups were composed of 50 patients with prediabetes and 47 healthy adults with similar demographic characteristics. The LV systolic and diastolic functions were assessed using standard two dimensional (2D) echocardiography, M-mode echocardiography, pulsed-wave (PW) echocardiography and tissue Doppler echocardiography. The degree of aortic strain and distensibility were calculated based on the aortic diameters measured on M-mode echocardiography at a level 3 cm above the aortic valve and the blood pressure values obtained on sphygmomanometry.

RESULTS:

There were significant differences between the prediabetic and control groups in the degree of aortic strain (4.7 ± 2.8% vs. 14.9 ± 4.5%; respectively, p<0.001) and distensibility (2.0 ± 1.5 vs. 6.8 ± 2.3; 10(-3) cm(2) dyn(-1), respectively, p<0.001). In addition, significant differences were observed between the patient and control groups in the parameters of the LV systolic and diastolic functions. The left atrial diameter was significantly larger in the prediabetics than in the controls (35.9 ± 3.9 vs. 33.7 ± 4.2; respectively, p=0.027).

CONCLUSION:

AS is increased in patients with prediabetes. In addition, there is a significant relationship between the degree of aortic stiffness and the LV function in this patient population. Therefore, the aortic elasticity parameters calculated on 2D echocardiography are useful for predicting early cardiovascular risks in prediabetics.

66. Urinary neopterin levels in patients with thyroid cancer. 2014

Inancli SS, Caner S, Balkan F, Tam AA, Guler G, Ersoy R, Cakir B.
Uluslararası Yayınlar Indian J Otolaryngol Head Neck Surg, 2014 Sep;66(3):302-8. doi: 10.1007/s12070-014-0710-x
ABSTRACT

 

Increased urinary neopterin concentrations have been described in many cancers. We aimed to evaluate the urinary neopterin levels in thyroid cancer. Sixty-nine patients with thyroid cancer, 76 patients with benign thyroid pathology and 33 healthy subjects were evaluated. First morning urine samples were collected from the patients and normal subjects for neopterin and creatinine measurement and stored at −80 °C until analysed. Neopterin levels were 149.3 (15.2–1,602.2) μmol/mol creatinine in the malignant group, 32 (5.2–275.6) μmol/mol creatinine in the benign group and 9.2 (2.7–78.7) μmol/mol creatinine in normal subjects (p ≤ 0.001). Urinary neopterin levels were significantly higher in patients with thyroid cancer than patients with benign thyroid pathologies and normal subjects. Also the patients with benign thyroid pathologies had a higher urinary neopterin level than the normal subjects. Malignant group was divided to two groups; patients with/without chronic thyroiditis (confirmed histologically). There were 22 (31.9 %) patients with and 47 (68.1 %) patients without chronic thyroiditis. Urinary levels of neopterin didn’t differ in both groups (168.6 (21.3–716.8) μmol/mol creatinine and 135.3 (15.2–1,602.2) μmol/mol creatinine respectively;p = 0.381). Urinary neopterin levels are high in thyroid cancer patients independently from the presence of chronic thyroiditis.

65. Do repeatedly nondiagnostic fine needle aspirations of thyroid nodules predict malignancy risk? 2014

Arpaci D, Ozdemir D, Cuhaci N, Kiyak G, Yalcin A, Akbaba S, Kilicyazgan A, Ersoy R, Cakir B.
Uluslararası Yayınlar Ann Diagn Pathol. 2014 Oct;18(5):297-300
ABSTRACT

Fine needle aspiration biopsy (FNAB) is a common, minimally invasive, cost-effective, and rapid method to manage thyroid nodules, but nondiagnostic FNAB (ND-FNAB) is still a common problem due to high prevalence (2%-20%). Our purpose in this study is to investigate risk of malignancy of repeating ND-FNABs and correlation between clinical and ultrasound findings. Our cohort study included 75 patients who had 2 or more times ND-FNABs and, finally, undergone surgical resection. We evaluated demographic, clinical, ultasonographic, and pathologic features. Fifty-seven patients were female, and 22 patients were male. Seventy-five patients' histopathologic results were 76% (n = 57) benign and 24% (n = 18) malignant. Of malignant nodules, 94.4% (n = 17) were papillary carcinoma, whereas 5.6% (n = 1) were follicular carcinoma. We did not find any predictive factor for malignancy and any differences associated with clinical and ultrasonographic features between benign and malignant nodules. Reaspiration followed by surgery for appropriate patients is recommended.

64. The Evaluation of QT Intervals During Diagnosis and After Follow-Up in Acromegaly Patients 2014

Baser H, Akar Bayram N, Polat B, Evranos B, Ersoy R, Bozkurt E, Cakir B
Uluslararası Yayınlar Acta Med Port. 2014 Jul-Aug;27(4):428-32
ABSTRACT
Introduction: It was aimed to calculate QT intervals in patients with acromegaly and to reveal its correlation between QT intervals, and growth hormone and insulin like growth factor-1.
 
Material and Methods: Forty-one patients with acromegaly were enrolled into the study. Another 41 individuals with similar features, such as comorbid diseases, age and sex constituted the control group. The electrocardiographies of patients with acromegaly were evaluated at the baseline and after the follow- up. Only one electrocardiography was performed for controls. QT maximum, QT minimum, QT dispersion, corrected QT maximum, corrected QT minimum and corrected QT dispersion were calculated.
 
Results: Baseline QT maximum, QT dispersion, corrected QT maximum and corrected QT dispersion were significantly longer than the values of controls. Corrected QT maximum and corrected QT dispersion were significantly shorter after the follow-up, compared to the baseline in patients. QT maximum, QT dispersion, corrected QT maximum and corrected QT dispersion after the follow-up were not statistically different from the values of controls. Except the negative correlation between growth hormone and corrected QT dispersion in patients after the follow-up, no other correlation was detected between QT values and growth hormone or insulin like growth factor-1 levels. Corrected QT dispersion was found to be related with the disease duration in patients.
 
Discussion: For acromegaly patients, it is important to detect clinical predictors of cardiac arrhytmias. QT dispersion is considered a beneficial predictor for ventricular arrhytmias. When compared to controls, prolonged QT intervals were determined in our acromegalic patients.
 
Conclusion: We consider that QT intervals may also be utilized in the evaluation of increased cardiovascular risk in patients with acromegaly.
 

63. Primary thyroid disorders in patients with endogenous hypercortisolism: an observational study 2014

Onal ED, Sacikara M, Saglam F, Ersoy R, Cakir B.
Uluslararası Yayınlar Int J Endocrinol. 2014;2014:732736. doi: 10.1155/2014/732736
ABSTRACT

Cushing’s syndrome (CS) may alter the performance of the hypothalamic-hypophyseal-thyroid axis. We searched for a relationship between hypercortisolism and primary thyroid disorders. The medical records of 40 patients with CS were retrospectively examined. Thyroid ultrasonography (USG), basal thyroid function test results (TFT), and antithyroglobulin and antithyroperoxidase antibodies were analyzed. In 80 control subjects, matched by age and gender with CS patients, thyroid USG, TFTs, and autoantibody panel were obtained. Among the CS patients, 17 had nodular goiter, versus 24 controls (42.5% versus 30%, P > 0.05). Among the twenty-five patients with an available TFT and autoantibody panel—before and after surgical curative treatment—autoantibody positivity was detected in 2 (8%) patients before and 3 (12%) after surgery (P = 0.48). Regarding TFT results, 1 (2.5%) patient had subclinical hyperthyroidism and 1 (2.5%) had subclinical hypothyroidism, whereas 1 (2.5%) control had hyperthyroidism. In total, 21 (52.5%) patients and 32 (40%) controls had ≥ 1 of the features of thyroid disorder, including goiter, positive thyroid autoantibody, and thyroid function abnormality; the difference was not significant (P > 0.05). The prevalence of primary thyroid disorders is not significantly increased in patients with CS.

62. Predictive role of nontumoral sodium iodide symporter activity and preoperative thyroid characteristics in remission process of thyroid cancer patients 2014

Yildirim-Poyraz N, Yazgan A, Ozdemir E, Gozalan A, Keskin M, Ersoy R, Turkolmez S, Cakir B.
Uluslararası Yayınlar Ann Nucl Med. 2014 Aug;28(7):623-31
ABSTRACT
Objective
The target of radioiodine ablation therapy (RIAT) after complete tumor removal is the nontumoral remnant tissue. We aimed to evaluate sodium iodide symporter (NIS) expression in nontumoral thyroid tissue in differentiated thyroid cancer (DTC) patients who have complete but delayed structural response (DSR) to RIAT after surgery. Preoperative thyroid characteristics such as volume and nontumoral histology were also investigated for both DSR and its control group as potential predictors of insufficient NIS activity in this study.
 
Methods
Total of 600 patients with postoperative remnant thyroid tissue and who were in remission after RIAT spontaneously, were included in the study. Patients with positive diagnostic whole body scan (DxWBS) with thyroid bed uptake and stimulated serum Tg level <2 ng/mL at first year visit after initial therapy were defined as DSR group. Immunohistochemical staining of NIS protein was performed on the nontumoral tissue sections from surgery and semi quantified in terms of density and intensity. DSR and its control group were also compared in terms of NIS expression, radioiodine (RAI) uptake on post-therapy scan and preoperative thyroid characteristics.
 
Results
When compared with the control group, the density and intensity of NIS expression as well as the intensity of RAI uptake were significantly lower in DSR group (p = 0.001). There were also significant differences between groups regarding preoperative thyroid characteristics; i.e. preoperative thyroid volumes were significantly higher and the presence of concurrent benign thyroid disease was significantly more common in DSR group (p = 0.035, p = 0.001). Hashimoto thyroiditis was 8.59 times higher (95 % CI; 2.31–31.96) and multinodular goiter was 7.50 times higher (95 % CI; 1.88–29.91) among DSR group when compared with the control group.
 
Conclusions
Our findings suggest that insufficient NIS activity in nontumoral thyroid tissue associates with DSR in DTC patients who have postoperative remnant tissue. Preoperative thyroid characteristics such as volume and concomitant benign thyroid disease may have an important role in predicting the complete response time to RIAT in these patients.
 

61. Evaluation of serum fibrinogen, plasminogen, α 2-anti-plasmin, and plasminogen activator inhibitor levels (PAI) and their correlation with presence of retinopathy in patients with type 1 DM 2014

Polat SB, Ugurlu N, Yulek F, Simavli H, Ersoy R, Cakir B, Erel O
Uluslararası Yayınlar J Diabetes Res. 2014;2014:317292
ABSTRACT

BACKGROUND: Diabetic retinopathy (DR) is the leading cause of blindness in the world. Retinopathy can still progress despite optimal metabolic control. The aim of the study was to determine whether different degrees of DR (proliferative or nonproliferative) were associated with abnormally modulated hemostatic parameters in patients with T1DM.

METHOD: 52 T1DM patients and 40 healthy controls were enrolled in the study. Patients were subdivided into three categories. Group I was defined as those without retinopathy, group II with NPRP, and group III with PRP. We compared these subgroups with each other and the control group (Group IV) according to the serum fibrinogen, plasminogen, alpha2-anti-plasmin ( α2-anti-plasmin), and PAI.

RESULTS: We detected that PAI-1, serum fibrinogen, and plasminogen levels were similar between the diabetic and control groups (P = 0.209, P = 0.224, and P = 0.244, resp.), whereas α2-anti-plasmin was higher in Groups I, II, and III compared to the control group (P < 0.01, P < 0.05, and P < 0.001, resp.). There was a positive correlation between serum α2-anti-plasmin and HbA1c levels (r = 0,268, P = 0.031).

CONCLUSION: To our knowledge there is scarce data in the literature about α2-anti-plasmin levels in type 1 diabetes. A positive correlation between α2-anti-plasmin with HbA1c suggests that fibrinolytic markers may improve with disease regulation and better glycemic control.

60. The Diagnostic Accuracy of Thyroid Nodule Fine-Needle Aspiration Cytology Following Thyroid Surgery: a Case-Control Study 2014

Onal ED, Saglam F, Sacikara M, Ersoy R, Guler G, Cakir B.
Uluslararası Yayınlar Endocr Pathol. 2014 Sep;25(3):297-301
ABSTRACT

Thyroid surgery may cause regional scarring and some degree of fibrotic process which may extend into the perithyroidal soft tissues. This may result in problems when collecting thyroid fine-needle aspiration biopsy (FNAB) samples and evaluating the cellular abnormalities. This study aimed to determine if a history of thyroid surgery is a risk factor for nondiagnostic (ND) FNAB results. Patients with ≥1 discrete nodular lesion of the thyroid who underwent FNAB were included. The patients with a history of thyroid surgery constituted group 1, and the others constituted group 2. The factors which may influence FNAB results, including age, gender, presence of Hashimoto’s thyroiditis, and ultrasound characteristics, were also evaluated. Group 1 included 123 patients with 200 nodules, and group 2 included 132 patients with 200 nodules. The two groups were similar with respect to demographic characteristics of the patients and ultrasonographic features of the nodules including diameter, content (cystic or solid), echogenicity, margin, and calcifications (P > 0.05). In all, 176 (44 %) of the participants had ND FNAB results. The median time interval between thyroid surgery and FNAB was 15 years [range, 1–45 years; interquartile range (IQR) 13 years]. Significantly more nodules in group 1 had ND FNAB results than in group 2 [98 (49 %) vs 78 (39 %), respectively, P = 0.028]. Multivariate analysis revealed that history of thyroid surgery was independently associated with ND FNAB [odds ratio (OR) 1.55, 95 % confidence interval (CI) 1–2.33, P = 0.033]. A history of thyroid surgery increases the risk of initial ND FNAB.

59. Choroidal Changes and Duration of Diabetes 2014

Yülek F, Uğurlu N, Onal ED, Kocamış SI, Cağıl N, Ersoy R, Cakır B.
Uluslararası Yayınlar Semin Ophthalmol. 2014 Mar;29(2):80-4
ABSTRACT
PURPOSE:
We investigate changes in macular choroidal thickness in eyes without diabetic retinopathy of patients with various durations of diabetes, using enhanced depth imaging optical coherence tomography (EDI OCT).
 
METHODS:
The 134 Type-2 diabetic patients who presented without diabetic retinopathy were prospectively imaged using EDI OCT on Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany) sd-OCT. The patients with diabetes were classified into three groups, according to the duration of diabetes: Group I (5-9 years, n = 63); Group II (10-14 years, n = 37); Group III (15-40 years, n = 34). The retinal and choroidal thickness was evaluated between these groups at central fovea and at the regions at 500-mm intervals up to 1500 mm temporal and nasal to the fovea.
 
RESULTS:
The central foveal retinal thickness was significantly different between groups (group I: 273.05 ± 19.51 µ, group II: 267.12 ± 20.78 µ, group III: 261.34 ± 22.27 µ; p = 0.04). The choroidal thickness measurements at central fovea, at 500, 1000, and 1500 micron intervals temporal and nasal to the center of the fovea were not significantly different between groups. The duration of diabetes was weakly correlated with choroidal thickness in all measured distances and they were not statistically significant. The central foveal choroidal thickness was weakly correlated with serum creatinine (r = -0.18, p = 0.03).
 
CONCLUSION:
Foveal retinal thickness was significantly decreased in patients with longer duration of diabetes. Duration of diabetes does not seem to be related to foveal chorodial thickness. On the other hand, the weak relation between creatinine and choroidal thickness may be evaluated further. The choroidal thickness changes that may be an early sign of nephropathy can be submitted to an easy, noninvasive scanning test at the same time.
 

58. Elastosonographic strain index in thyroid nodules with atypia of undetermined significance 2014

Cakir B, R. Ersoy, F.N. Cuhacı, C. Aydın, B. Polat, M. Kılıç, A. Yazgan
Uluslararası Yayınlar J Endocrinol Invest. 2014 Feb;37(2):127-33
ABSTRACT
Aim
In this study, we aimed to evaluate the diagnostic accuracy of elastosonography (ESG) scoring and strain ratio in patients who had atypia of undetermined significance (AUS) cytology and underwent surgery for thyroid nodules.
Materials and methods
250 patients were included in this study. They had at least one nodule in thyroid USG, underwent USG-guided FNAC according to the current guidelines and had AUS cytology according to the Bethesda system. Both elastosonographic color scoring and strain index were evaluated.
 
Results
A total of 270 nodules in 250 patients were evaluated. Histopathologically, 81 (30 %) nodules were malignant and 189 (70 %) were benign. According to the ESG, 10 (3.7 %) nodules were assigned a score of 1, while 13 (4.8 %) nodules were assigned a score of 5. All of the nodules with an ESG score of 1 were histopathologically benign and 92.3 % of the patients with ESG score 5 were in the malignant group. Median SI in the benign histopathologic group was significantly lower compared to malignant group [(2.58 (IQR = 2.35) vs. 14.54 (IQR = 10.71)]. The optimal SI cut-off value to distinguish between the benign and malignant nodules was 6.66, with a sensitivity of 98.77 % and specificity of 96.30 %.
 
Conclusion
Our study is one of the first studies evaluating the role of SI for discriminating malignant and benign nodules with AUS cytology. Malignant nodules had a significantly higher stiffness compared to benign ones and SI had high sensitivity, specificity, positive predictive value, negative predictive value and accuracy for these nodules. We think SI may be helpful for the presurgical selection of nodules with AUS cytology.
 

57. Gynecomastia: Clinical evaluation and management 2014

Cuhaci N, Polat SB, Evranos B, Ersoy R, Cakir B.
Uluslararası Yayınlar Indian J Endocrinol Metab. 2014 Mar;18(2):150-158
ABSTRACT

Gynecomastia is the benign enlargement of male breast glandular tissue and is the most common breast condition in males. At least 30% of males will be affected during their life. Since it causes anxiety, psychosocial discomfort and fear of breast cancer, early diagnostic evaluation is important and patients usually seek medical attention. Gynecomastia was reported to cause an imbalance between estrogen and androgen action or an increased estrogen to androgen ratio, due to increased estrogen production, decreased androgen production or both. Evaluation of gynecomastia must include a detailed medical history, clinical examination, specific blood tests, imaging and tissue sampling. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery. The main aim of any intervention is to relieve the symptoms and exclude other etiological factors.

56. Thyroid autoimmunity in patients with hyperprolactinemia: an observational study 2014

Onal ED, Saglam F, Sacikara M, Ersoy R, Cakir B.
Uluslararası Yayınlar Arq Bras Endocrinol Metabol. 2014 Feb;58(1):48-52
ABSTRACT
Objective: To establish whether there is a relationship between hyperprolactinemia and primary thyroid disorders, focusing on patients with autoimmune features.
 
Materials and methods: The medical records of 100 patients with hyperprolactinemia (HPRL) were retrospectively examined. Records of thyroid ultrasonography (USG), basal serum levels of thyroid stimulating hormone, circulating free thyroxine, free triiodothyronine, antithyroglobulin (anti-Tg), and antithyroperoxidase (anti-TPO) antibodies were analyzed. In 100 control subjects, matched by age and gender with HPRL patients, thyroid USG, thyroid function tests (TFTs), and autoantibody panel were obtained.
 
Results: The median PRL in patients was 93 ng/mL (range: 37-470). Twenty-five patients (25%) and 22 controls (22%) had positive anti-Tg and/or anti-TPO titers (P = 0.739). The median serum PRL was 98 (37-470) ng/mL in patients with positive thyroid autoantibodies, and 92 (40-470) ng/mL in patients who were negative (P = 0.975). Among the individuals with autoantibody positivity TFTs abnormalities were more frequent in HPRL patients (60%, out of 25 patients, 14 with subclinical hypothyroidism and one with hyperthyroidism) than in controls (9.1%, out of 22 patients, 2 with subclinical hyperthyroidism) (P < 0.001). Twenty-seven patients with HPRL and 31 controls had goiter (27 vs. 31%, P = 0.437). Forty-six patients (46%) and 50 (50%) controls had one or more of the features of thyroid disorder, which were goiter, positive thyroid autoantibody, and thyroid function abnormality (P = 0.888).
 
Conclusion: HPRL may be associated with more severe thyroid dysfunction in patients with thyroid autoimmunity.
 

55. Evaluation of left ventricle functions by tissue Doppler, strain, and strain rate echocardiography in patients with primary hyperparathyroidism 2014

Ozdemir D, Kalkan GY, Bayram NA, Onal ED, Ersoy R, Bozkurt E, Cakir B.
Uluslararası Yayınlar Endocrine. 2014 Nov;47(2):609-17
ABSTRACT

Cardiovascular morbidity and mortality are increased in patients with primary hyperparathyroidism (PHPT). We aimed to evaluate left ventricle systolic and diastolic functions with tissue Doppler imaging (TDI) and strain and strain rate echocardiography in patients with PHPT. Thirty-one patients with PHPT and 29 healthy controls were evaluated with conventional and pulse Doppler echocardiography, TDI and strain and strain rate echocardiography. Myocardial performance index (MPI) was calculated. Strain and peak systolic strain rate in mid and basal segments of lateral, anterior, inferior, and septal walls of left ventricle were determined. TDI showed similar late diastolic myocardial peak velocity in two groups. Peak systolic mitral annular velocity, early diastolic myocardial peak velocity, and ratio of early to late diastolic myocardial peak velocity were lower in PHPT patients (p = 0.01, p < 0.001 and p < 0.001, respectively). MPI calculated by TDI was 0.53 ± 0.15 in PHPT group and 0.44 ± 0.09 in control group (p = 0.013). Strain values were lower in mid and basal segments of septum, lateral and anterior walls, and basal segment of inferior wall in PHPT patients. Mean systolic strain was −20.88 ± 2.30 and −24.25 ± 2.13 in PHPT patients and control group, respectively (p < 0.001). Mean strain rate was lower in PHPT patients compared to control group (−1.38 ± 0.19 vs −1.57 ± 0.25) (p = 0.002). Patients with PHPT, but no cardiac symptoms or documented cardiovascular disease, have subclinical systolic and diastolic myocardial dysfunction. Evaluation of these patients with TDI and S and Sr echocardiography in addition to conventional echocardiography might be valuable to detect subclinical cardiac involvement.

54. Malignancy Rate of Thyroid Nodules Defined as Follicular Lesion of Undetermined Significance and Atypia of Undetermined Significance in Thyroid Cytopathology and Its Relation with Ultrasonographic Features 2014

Cuhaci N, Arpaci D, Uçler R, Yazgan AK, Kıyak G, Yalçin S, Ersoy PE, Güler G, Ersoy R, Cakir B.
Uluslararası Yayınlar Endocr Pathol. 2014 Sep;25(3):248-56
ABSTRACT

Fine-needle aspiration biopsy (FNAB) has been widely accepted as the most accurate, safe, and cost-effective method for evaluation of thyroid nodules. The most challenging category in FNAB is atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS). The Bethesda system (BS) recommends repeat FNAB in that category due to its low risk of malignancy. In our study, we aimed to investigate the malignancy rate of thyroid nodules of AUS and FLUS and whether there were different malignancy rates among the different patterns in this category, and to evaluate the presence of biochemical, clinical, and echographic features possibly predictive of malignancy related to AUS and FLUS. Data of 268 patients operated for AUS and FLUS cytology were screened retrospectively. Ultrasonographic features and thyroid function tests, thyroid antibodies, scintigraphy, and histopathological results were evaluated. Of the 268 patients’ results, 276 nodules are evaluated. Malignancy rates were 24.3 % in the AUS group, 19.8 % in the FLUS group, and 22.8 % in both groups. In the evaluation of all nodules, the predictive features of malignancy are hypoechogenicity and peripheral vascularization of the nodule. We determined that the malignancy rates in these nodules are higher than that in the literature rate. This high ratio may be due to the fact that we studied only patients who underwent surgery. The ultrasonographic features alone may be insufficient to predict the malignancy; therefore, all the clinical and ultrasonographic features must be considered in the evaluation of the thyroid nodules. In addition, we think that the recommended management of repeat FNAB in these groups must be reconsidered with the clinical and ultrasonographic features.

53. What is the effect of radio-iodine theraphy on Helicobacter Pylori infection? 2014

Usluoğulları CA, Onal ED, Ozdemir E, Caner S, Ersoy O, Ersoy R, Cakır B
Uluslararası Yayınlar Turk J Med Sci. (2014) 44: 520-523
ABSTRACT
BACKGROUND/AIM:
Helicobacter pylori is an important human pathogen associated with gastric and duodenal ulcers, gastric mucosa- associated lymphoid tissue lymphoma, and adenocarcinoma. Radioiodine (RAI) treatment plays an important role in the management of differentiated thyroid cancer and primary hyperthyroidism. It is known that during RAI treatment, a considerable amount is absorbed by the stomach as well. In this study we aimed to reveal any therapeutic impact of RAI on H. pylori infections.
 
MATERIALS AND METHODS:
Eighty-seven patients who were hospitalized for RAI treatment were consecutively included in this study. Of those, 76 patients had differentiated thyroid cancer and 11 had primary hyperthyroidism. The urea breath test (UBT) was performed on the day before RAI, and the test was repeated after 2 months.
 
RESULTS:
The dose of RAI was 115 ± 3.3 mCi (range: 100-150 mCi) in the patients with malignant disease and 22.7 ± 1.4 mCi (range: 20-30 mCi) in the remaining patients. Among the patients with differentiated thyroid cancer, 44 (57%) had positive and 32 (43%) had negative UBT tests prior to RAI. Four (36%) patients with hyperthyroidism had pretreatment positive UBT tests and 7 (64%) had negative tests. The results of UBT conducted 2 months after RAI therapy were identical in every patient, which means that none of the patients with positive UBT became UBT-negative (P = 1).
 
CONCLUSION:
RAI does not have any therapeutic effect on H. Ovlori infection.
 

52. Diagnostic value of 18F-FDG PET/CT in patients with TENIS syndrome: correlation with thyroglobulin levels 2014

Ozdemir E, Yildirim Poyraz N, Polat SB, Turkolmez S, Ersoy R, Cakir B.
Uluslararası Yayınlar Ann Nucl Med. 2014 Apr;28(3):241-7
ABSTRACT
Objective
The aim of the study was to disclose the place of 18F-FDG PET/CT to predict recurrent disease in patients with differentiated thyroid cancer (DTC), negative radioiodine whole-body scan (WBS) and high serum thyroglobulin (Tg).
 
Methods
Seventy-one patients who underwent total thyroidectomy followed by radioactive iodine ablation and had negative radioiodine WBS but elevated Tg levels underwent PET/CT. They were followed up for 6–50 months (median 23) for the occurence of recurrent disease as detected by either clinical findings, other imaging modalities or histopathological examination. The place of PET/CT findings at baseline to predict the presence of recurrent disease was evaluated. Correlation between PET/CT findings and Tg levels was examined and a threshold for Tg level above which the predictive value of PET/CT was highest was determined.
 
Results
PET/CT was positive for recurrent disease in 38 (53.5 %) patients. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of PET/CT to predict the occurence of recurrent disease at follow-up were 68.8, 78.3, 86.8, 54.5 and 71.9 %, respectively. The sensitivity, accuracy and PPV of PET/CT increased with increasing Tg levels. The highest diagnostic accuracy of PET/CT, with a sensitivity of 76.2 % and a specificity of 100 % to detect recurrent disease appeared to be at a Tg level greater than 29 ng/mL.
 
Conclusion
Our findings suggest that 18F-FDG-PET/CT is a valuable tool to predict the occurence of recurrent disease in patients with DTC, negative WBS and elevated Tg levels. PET/CT positivity has been shown to be strongly and positively correlated with Tg levels in this patient subset.
 

51. Is IL- 33 useful to detect early stage of renal failure? 2014

Caner S, Usluoğulları CA, Balkan F, Büyükcam F, Kaya C, Saçıkara M, Koca C, Ersoy R, Cakır B.
Uluslararası Yayınlar Ren Fail. 2014 Feb;36(1):78-80
ABSTRACT

IL-33 is a proinflammatory cytokine that is a member of IL-1 family. Previously the effect of IL-33 on kidney injury is showed in animal models. In this study, we searched if we can use IL-33 to show the early stage of kidney injury in diabetic patients. Three groups are identified: 26 patients in Group 1: Healthy group, that do not have any chronic diseases and not taking any medication; 42 patients in Group 2: DM (diabetes mellitus) group without any known kidney disease and with normal kidney functions; 32 patients in Group 3: DM + MA (microalbuminuria) group that are assumed to have nephropathy. IL-33 level of DM patient group is greater than healthy group; also IL-33 level of DM + MA patient group is greater than healthy group; but there is not any difference between DM and DM + MA group. The increase in IL-33 levels in diabetic nephropathy is not associated with kidney injury but the increase could be resulting because of diabetes. So IL-33 cannot be used in early recognition of diabetic nephropathy.

50. Diagnostic value of endoscopic ultrasonography for preoperative localization of parathyroid adenomas 2014

Ersoy R, Ersoy O, Ogmen BE, Polat SB, Kilic M, Yildirim N, Ozturk L, Cakir B.
Uluslararası Yayınlar Endocrine. 2014 Sep;47(1):221-6
ABSTRACT

The most common cause of primary hyperparathyroidism (PHPT) is a single, sporadic parathyroid adenoma. Ultrasonography (US) and (99m)Technetium methoxyisobutylisonitrile ((99m)Tc-MIBI) scintigraphy are the imaging methods most widely used to localize parathyroid adenomas. The purpose of the present study was to determine the diagnostic value and accuracy of endoscopic ultrasonography (EUS) for localizing parathyroid adenoma compared with those of US and (99m)Tc-MIBI scintigraphy. Forty-seven patients with a PHPT diagnosis and who were recommended for surgery were enrolled in this study. An endoscopist who was blinded to the previous US and (99m)Tc-MIBI scintigraphy results performed the EUS in each patient. Thirty-nine female and eight male patients with PHPT were evaluated. The presence of adenoma was confirmed by subsequent postsurgical pathology results. One case was excluded because the histopathological evaluation was compatible with a lymph node, although the lesion was detected using three different imaging modalities preoperatively. The locations of the parathyroid adenomas were correctly documented by US in 39 patients (84.7 %) by (99m)Tc-MIBI scintigraphy in 35 (76.0 %), and by EUS in 44 (95.6 %) of 46 patients. EUS located all 31 adenomas detected previously with US and (99m)Tc-MIBI scintigraphy. EUS also successfully located three adenomas that could not be identified by US and (99m)Tc-MIBI scintigraphy. The positive predictive value and diagnostic accuracy of EUS, US, and (99m)Tc-MIBI were 97.7, 97.7, and 95.6 %; 88.6, 97.5, and 86.9 %; and 77.7, 97.2, 76.0 %, respectively. EUS was preferred as the second step imaging tool for detecting parathyroid adenomas that could not be localized by US and (99m)Tc-MIBI scintigraphy.

49. Relationship Between Skin Diseases and Extracutaneous Complications of Diabetes Mellitus: Clinical Analysis of 750 Patients 2014

Demirseren DD, Emre S, Akoglu G, Arpacı D, Arman A, Metin A, Cakır B.
Uluslararası Yayınlar Am J Clin Dermatol. 2014, Feb;15(1):65-70.
ABSTRACT
Background
The relationship between skin diseases and extracutaneous complications in diabetes mellitus (DM) is unclear.
 
Objective
We aimed to investigate the relationship between skin disorders and diabetic neuropathy, nephropathy, and retinopathy in patients with DM.
 
Methods
A total of 750 patients with DM were prospectively enrolled. Demographic and clinical features, skin disorders, glycosylated hemoglobin (HbA1c) levels, and presence of nephropathy, neuropathy, and retinopathy were noted.
 
Results
Of the patients, 38.0 % had neuropathy, 23.3 % had nephropathy, and 22.9 % had retinopathy. Any skin disorder was present in 79.2 % (n = 594) of patients. The most common skin manifestations were cutaneous infections (47.5 %), xerosis (26.4 %), and inflammatory skin diseases (20.7 %). The frequency of cutaneous infections, fungal infections, diabetic foot, rubeosis faciei, and pigmented purpuric dermatitis was higher in patients with nephropathy than in those without nephropathy. Cutaneous infections, diabetic foot, rubeosis faciei, and diabetic dermopathy were more common in patients with neuropathy. Fungal infections, diabetic foot, rubeosis faciei, diabetic dermopathy, and pigmented purpuric dermatitis were more frequent in patients with retinopathy. Patients with HbA1c ≥8 mmol/mL had more skin disorders than those with HbA1c <8 mmol/mL (P < 0.05 for all).
 
Conclusion
Skin disorders may be clues to the presence of associated microvascular complications of DM.
 

48. Molecular Features of Follicular Variant Papillary Carcinoma of Thyroid: Comparison of Areas With or Without Classical Nuclear Features. 2014

Guney G, Tezel GG, Kosemehmetoglu K, Yilmaz E, Balci S, Ersoy R, Cakir B, Guler G.
Uluslararası Yayınlar Endocr Pathol, 2014 Sep;25(3):241-7
ABSTRACT

We aimed to compare the genetic background of different areas in follicular variant papillary thyroid carcinomas (FVPTC) with or without classical nuclear changes. Sixteen cases of FVPTC were included in our study. All tumors were well demarcated from surrounding thyroid tissue and had both areas with nuclear features (WNF) and areas without nuclear features (WONF) of papillary carcinoma. DNA is obtained by laser microdissection from WNF and WONF areas of each case. Point mutations for NRAS codon 61, HRAS codon 61, and BRAF were investigated by direct sequencing. In 11 cases, reverse transcription PCR was performed for the presence of PAX8-PPARɣ and RET/PTC1–3 gene rearrangements. Point mutation for NRAS codon 61 was also studied in 15 colloidal nodules. Seven cases (44 %) showed at least one mutation; two cases (13 %) revealed the same mutation in both WNF and WONF areas, while in the rest only WNF areas were mutated. None of the studied 11 cases demonstrated RET/PTC1–3 gene rearrangement and in only one case PAX8-PPARɣ gene rearrangement was found. Six cases (38 %) showed NRAS codon 61 mutation, involving only WNF areas in five cases and both WNF and WONF areas in one case. Neither HRAS codon 61 nor BRAF mutations were present. Fifteen colloidal nodules were also wild type for NRAS codon 61. Our findings suggest that NRAS codon 61 point mutations and PAX8-PPARɣ gene rearrangement play a role in the FVPTC pathogenesis and may be established before the morphological/phenotypical features fully develop.

47. Evaluation of central corneal and central retinal thicknesses and intraocular pressure in acromegaly patients 2014

Polat SB, Ugurlu N, Ersoy R, Oguz O, Duru N, Cakir B.
Uluslararası Yayınlar Pituitary. 2014 Aug;17(4):327-32
ABSTRACT
Introduction
Acromegaly is a disorder with increased morbidity which can involve many organs and the eye can be one of them which was investigated in few reports. Herein, we aimed to evaluate CCT, IOP and retinal thickness (RT), and their relationships with serum GH and IGF-1 levels and disease duration, in acromegaly patients. We compared the ocular parameters with those of a control group. This study included the largest number of patients of any comparable investigation to date.
 
Material and Method
We enrolled 30 acromegaly patients (15 male, 15 female and age: 48.4 ± 12.8 years) and 21 age and gender matched controls. All participants underwent complete hormonal and ophtalmological evaluation including central corneal thickness (CCT), retinal thickness (RT) and intraocular pressure (IOP) values.
 
Results
There were no significant differences in median right and left CCTs and mean CCT (p = 0.646,p = 0.667 and p = 0.384, respectively). Nor were there statistically significant differences in median right and left RT, or mean central RT, between the acromegaly and control groups (p = 0.977,p = 0.738 and p = 0.811, respectively). However median right, left and mean IOPs were found to be significantly higher in the acromegaly group, despite there being no difference in the CCT values (p = 0.011, p = 0.028 and p = 0.047, respectively). When we analyzed two subgroups of acromegaly patients (active/inactive), we found that the median right, left and mean CCTs and RTs, were not significantly different between the groups. Although there was a significant difference in IOP between the acromegaly and control groups, the two subgroups of acromegaly patients had similar IOPs (p = 0.400, p = 0.621 and p = 0.451 for right, left and mean IOPs, respectively). IOP was not found to be correlated with serum IGF-I, GH or disease duration in acromegaly patients.
 
Conclusion
Our study results suggest that acromegaly is associated with increased ocular pressures irrespective of disease activity. Therefore detailed ocular evaluation should be a routine component of the follow up visits of acromegaly patients.
 

46. Is there any association between insulin resistance and thyroid cancer?: a case control study 2014

Balkan F, Onal ED, Usluogullari A, Tuzun D, Ozdemir D, Inancli SS, Ersoy R, Cakir B.
Uluslararası Yayınlar Endocrine. 2014 Feb;45(1):55-60
ABSTRACT

Insulin stimulates proliferation of thyroid cells in culture. The presence of insulin resistance (IR) is associated with larger thyroid gland volume and an increased prevalence of thyroid nodules. The aim of this study was to investigate the presence of any possible association between IR and thyroid cancer. Forty-one patients with diffuse thyroid cancer (Group 1) were matched for age and gender with 41 patients with nodular goiter (Group 2). Both groups were compared in terms of frequency of IR, as estimated by the homeostasis model assessment, as well as other parameters of the metabolic syndrome (MetS). Fourteen patients (34.1 %) in each group had MetS. Twelve patients (29.3 %) in group 1 had IR compared to 10 (24.4 %) in group 2. Mean HOMA-IR scores in group 1 and 2 were 2.5 ± 2.2 and 1.8 ± 1.1, respectively. Thirty-two patients (78 %) in group 1 had a body mass index (BMI) of more than 25 compared to 33 patients (80.5 %) in group 2. The difference between groups with regard to HOMA-IR, the frequency of IR, BMI, and any of the parameters of MetS was statistically insignificant (p > 0.05). A subgroup analysis based on tumor size did not reveal a significant difference between patients with microcarcinoma (≤10 mm) and macrocarcinoma (>10 mm) in terms of any of the study parameters (p > 0.05). Neither MetS nor IR was a significant risk factor for thyroid cancer following logistic regression analysis (p > 0.05). IR is not more prevalent in patients with thyroid cancer. Some other pathologic mechanisms may be more prominent during thyroid carcinogenesis.

45. Hurthle cell presence alters the distribution and outcome of categories in the Bethesda system for reporting thyroid cytopathology 2014

Yazgan A, Balci S, Dincer N, Kiyak G, Tuzun D, Ersoy R, Cakir B, Guler G.
Uluslararası Yayınlar Cytopathology, 2014 Jun;25(3):185-9
ABSTRACT
Objectives
We aimed to determine whether the presence of Hürthle cells altered the distribution of categories in the Bethesda system for reporting thyroid cytopathology, or the expected neoplastic and malignant outcome.
 
Methods
Fine needle aspiration (FNA) cytology reports of Hürthle cells in a 2-year period were evaluated. The distribution of Bethesda system categories and the outcome at partial or complete thyroidectomy were compared for FNAs with and without Hürthle cells.
 
Results
Of 895 adequate FNAs with Hürthle cells, 764 (85.4%) were classified as benign, 86 (9.6%) as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 32 (3.6%) as follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 12 (1.3%) as suspicious for malignancy (SFM) and one (0.1%) as malignant. Of 10 359 adequate FNAs without Hürthle cells, 9707 (93.7%) were classified as benign, 412 (4.0%) as AUS/FLUS, 77 (0.7%) as FN/SFN, 93 (0.9%) as SFM and 70 (0.7%) as malignant. The distribution of categories in FNAs with and without Hürthle cells was significantly different (P < 0.001) as a result of a decrease in benign and an increase in AUS/FLUS and FN/SFN categories. Among 128 patients with and 582 without Hürthle cells undergoing surgery, the overall neoplastic and malignancy rates were higher in the former than in the latter group (27.3% versus 14.9%, P < 0.001; 21.1% versus 11.7%, P = 0.003; respectively). Although neoplastic and malignant rates were higher in the group with than without Hürthle cells in all categories, the differences were only significant for a neoplastic outcome of benign cytology (15.1% versus 6.0%, P = 0.0013) and a malignant outcome of FN/SFN cytology (63.6% versus 21.9%, P = 0.0108).
 
Conclusions
We found that the rates of AUS/FLUS and FN/SFN categories in the Bethesda system were higher when Hürthle cells were present. After surgery, neoplastic and malignant outcomes were significantly higher in the Hürthle cell group.
 

44. Cutaneous findings in patients with acromegaly 2013

Akoglu G, Metin A, Emre S, Ersoy R, Cakir B.
Uluslararası Yayınlar Acta Dermatovenerol Croat. 2013 Dec;21(4):224-9
ABSTRACT
Background: Acromegaly is a systemic syndrome caused by overproduction of growth hormone. The syndrome affects cutaneous, endocrine, cardiovascular, skeletal, and respiratory systems. Cutaneous manifestations of acromegaly are various, usually being the first presenting findings of the disease.
 
Methods: Dermatological examinations of 49 patients of acromegaly who were followed-up at a tertiary referral hospital.
 
Results: The study included 27 (55.1%) female and 22 (44.9%) male patients. The onset age of the disease was older in females than males (P =0.045). Most of the patients had acral enlargements, large triangular nose, coarse face, thickened lower lip, and prognathism. Fourteen patients (28.6%) had multiple cherry angiomas, 5 (10.2%) had varicose veins in lower limbs, and 2 (4.1%) had psoriasis.
Conclusion: A wide spectrum of cutaneous symptoms and features may be associated with acromegaly. A detailed dermatological examination of patients with acromegaly should be an essential component of systemic evaluation. Future prospective studies investigating the relationships between changes in skin signs, hormone levels, and response to treatments may help to understand the details of skin involvement in acromegaly.
 

43. Effects of serum calcium, phosphorus and parathyroid hormone concentrations on glucose metabolism in patients wıth asymptomatic primary hyperparathyroidism 2013

H. Baser, D. Tuzun, F. Saglam, A. Dirikoc, C. Aydin, R. Ersoy, B. Cakir
Uluslararası Yayınlar Acta Endocrinologica (Buc), vol. IX, no. 3, p. 377-384, 2013

42. The effect of physicians' awareness on influenza and pneumococcal vaccination rates and correlates of vaccination in patients with diabetes in Turkey: An epidemiological Study "diaVAX" 2013

Satman I, Akalin S, Cakir B, Altinel S, Study Group TD
Uluslararası Yayınlar Hum Vaccin Immunother. 2013 Dec;9(12):2618-26
ABSTRACT

We aimed to examine the effect of increased physician awareness on the rate and determinants of influenza and pneumococcal vaccinations in diabetic patients. Diabetic patients (n = 5682, mean [SD] age: 57.3 [11.6] years, 57% female) were enrolled by 44 physicians between Sept 2010 and Jan 2011. The physicians were initially questioned regarding vaccination practices, and then, they attended a training program. During the last five years, the physicians recommended influenza and pneumococcal vaccinations to 87.9% and 83.4% of the patients, respectively; however; only 27% of the patients received the influenza and 9.8% received the pneumococcal vaccines. One year after the training, the vaccination rates increased to 63.3% and 40.7%, respectively. The logistic regression models revealed that variables which increased the likelihood of having been vaccinated against influenza were: longer duration of diabetes, presence of hyperlipidemia and more use of concomitant medications whereas more use of anti-hyperglycemic medications was associated with increased odds of vaccination. On the other hand, older age, longer duration of diabetes and presence of a cardiovascular disease were variables which decreased the likelihood of having been vaccinated against pneumococcal disease during the past five years. However, during the study period, variables which decreased the odds of having been vaccinated included: older age and anti-hyperglycemic medications for influenza, and presence of hyperlipidemia and a family history of hypertension for pneumococcal disease. While variables which increased the likelihood of vaccination in the same period were: increased number of co-morbidities for influenza, and family history of diabetes for pneumococcal disease. We conclude that increased awareness of physicians may help improve vaccination rates against influenza and pneumococcal disease. However, diabetic patients with more severe health conditions are less likely to having been vaccinated. More structural/systematic vaccination programs are needed to increase the vaccination rates in patients with diabetes.

41. Correlation of thyroid fine-needle aspiration with final histopathology: a case series 2013

Gürkan Dumlu E, Kiyak G, Bozkurt B, Tokaç M, Polat B, Cakir B, Güler G, Kilic M
Uluslararası Yayınlar Minerva Chir. 2013 Apr;68(2):191-7
ABSTRACT

AIM: The aim of this study was to evaluate the correlation between preoperative thyroid fine-needle aspiration result and final histopathology in patients with thyroid nodules. METHODS: The medical records of 298 patients (mean age, 47.7±12.3 years; 79.5% females) who underwent fine-needle aspiration for thyroid nodules and who were operated and have final pathological diagnosis were retrospectively reviewed. For reporting fine-needle aspiration specimen pathology, the Bethesdathyroid fine-needle aspiration classification was used. Tyroglobulin (Tg) and anti-Tg and anti-thyroid peroxidase (anti-TPO) antibody levels were determined preoperatively. RESULTS: Thyroid noduleswere non-diagnostic, benign or atypia (Bethesda groups 1-3) in 76.8% of patients; and follicular neoplasm, suspicious for malignancy or malignant (Bethesda groups 4-6) in 23.1% of patients. Final pathology of surgery specimen was most commonly nodular goiter (36.6%) and papillary carcinoma(35.6%). Nodular goiter was significantly more prevalent in Bethesda 1 group while papillary carcinoma was more common in Bethesda 3 group (P<0.05). Tg level is significantly higher in thenodular goiter group (90.49±126.93 ng/mL), while anti-Tg and anti-TPO levels are significantly higher in the lymphocytic thyroiditis goiter group (229.77±494.42 U/mL and 282.86±360.77 U/mL, respectively) than the other pathology groups (P<0.05 for all). CONCLUSION: Papillary carcinoma is more common in Bethesda thyroid fine-needle aspiration classification 3 group. Therefore, preoperative fine-needle aspiration for thyroid nodules is predictive of final pathology and should be applied for diagnosis and follow-up.

40. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults 2013

Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, Karsidag K, Genc S, Telci A, Canbaz B, Turker F, Yilmaz T, Cakir B, Tuomilehto J; TURDEP-II Study Group
Uluslararası Yayınlar Eur J Epidemiol. 2013 Feb;28(2):169-80
ABSTRACT

There is concern about an emerging diabetes epidemic in Turkey. We aimed to determine the prevalence of diagnosed and undiagnosed diabetes, prediabetes and their 12-year trends and to identify risk factors for diabetes in the adult Turkish population. A cross-sectional, population-based survey, ‘TURDEP-II’ included 26,499 randomly sampled adults aged ≥ 20 years (response rate: 87 %). Fasting glucose and biochemical parameters were measured in all; then a OGTT was performed to identify diabetes and prediabetes in eligible participants. The prevalence of diabetes was 16.5 % (new 7.5 %), translating to 6.5 million adults with diabetes in Turkey. It was higher in women than men (p = 0.008). The age-standardized prevalence to the TURDEP-I population (performed in 1997–98) was 13.7 % (if same diagnostic definition was applied diabetes prevalence is calculated 11.4 %). The prevalence of isolated-IFG and impaired glucose tolerance (IGT), and combined prediabetes was 14.7, 7.9, and 8.2 %, respectively; and that of obesity 36 % and hypertension 31.4 %. Compared to TURDEP-I; the rate of increase for diabetes: 90 %, IGT: 106 %, obesity: 40 % and central obesity: 35 %, but hypertension decreased by 11 % during the last 12 years. In women age, waist, body mass index (BMI), hypertension, low education, and living environment; in men age, BMI, and hypertension were independently associated with an increased prevalence of diabetes. In women current smoking, and in men being single were associated with a reduced risk. These results from one of the largest nationally representative surveys carried out so far show that diabetes has rapidly become a major public health challenge in Turkey. The figures are alarming and underscore the urgent need for national programs to prevent diabetes, to manage the illness and thus prevent complications.

39. Prevalance of gestational diabetes mellitus in patients with gestational transient thyrotoxicosis 2013

Oguz A, Tuzun D, Ozdemir D, Baci Y, Ersoy R, Avsar AF, Cakir B.
Uluslararası Yayınlar Gynecol Endocrinol. 2013 Apr;29(4):336-9
ABSTRACT
OBJECTIVE:
To investigate prevalence of gestational diabetes mellitus (GDM) in patients with gestational transient thyroxicosis (GTT).
 
METHODS:
Fifty two patients with GTT and 100 age matched healthy pregnant women were included. Fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), LDL-cholesterol, HDL-cholesterol, triglyceride, thyrotrophin (TSH) and thyroid hormones were measured at thyrotoxic state in GTT patients and at 6-12th weeks of pregnancy in control group. Oral glucose tolerance test (OGTT) with 100 g glucose was performed and laboratory parameters were re-evaluated at 24-28th weeks of pregnancy in all subjects.
 
RESULTS:
Mean age of patients with GTT was 28.46 ± 5.45 and control group was 27.78 ± 3.75(p = 0.085). Patients with GTT had significantly higher HbA1c, LDL-cholesterol and HDL-cholesterol at 6-12th weeks of pregnancy (p < 0.01, p < 0.01 and p = 0.034, respectively). TSH was negatively correlated with HbA1c and LDL-cholesterol in thyrotoxic state in GTT patients (r = -0.393, p < 0.001 and r = -0.293, p < 0.001, respectively). OGTT showed GDM in 7 (13.5%) GTT patients and 4 (4%) healthy pregnants (p = 0.047). HbA1c, LDL-cholesterol and HDL-cholesterol were higher in GTT patients compared to healthy pregnants also at 24-28th weeks of pregnancy (p < 0.001, p < 0.001 and p = 0.024).
 
CONCLUSION:
Although GTT is known to be a transient state that can resolve spontaneously, it might have negative effect on carbohydrate metabolism like other causes of hyperthyroidism.
 

38. Effect of cabergoline on insulin sensitivity, inflammation, and carotid intima media thickness in patients with prolactinoma 2013

Inancli SS, Usluogullari A, Ustu Y, Caner S, Tam AA, Ersoy R, Cakir B.
Uluslararası Yayınlar Endocrine. 2013 Aug;44(1):193-9
ABSTRACT

The aim of this study was to evaluate the effect of Cabergoline on insulin sensitivity, inflammatory markers, and carotid intima media thickness in prolactinoma patients. Twenty-one female, newly diagnosed patients with prolactinoma were included in the study. None of the patients were treated previously. Cabergoline was given as treatment, starting with 0.5 mg/day and tapered necessarily. Blood samples were taken for prolactin, highly sensitive C-reactive protein, homocysteine, total cholesterol, low density lipoprotein (LDL) cholesterol, fasting glucose, insulin, and HOMA (homeostasis model assessment of insulin resistance) score was calculated, prior to and 6 months after starting treatment. The body mass index (BMI) was measured and carotid intima media thickness (CIMT) was evaluated for each patient prior to and 6 months after the treatment. The prolactin levels and LDL decreased significantly after cabergoline treatment. Insulin sensitivity improved independently from the decrease in prolactin levels and BMI. The significant decrease in homocysteine and hs-CRP was not related with the decrease in prolactin levels. The significant decrease in CIMT was independent from the decrease in prolactin levels, HOMA score, and BMI. Our data suggest that cabergoline treatment causes an improvement in insulin sensitivity and inflammatory markers and causes a decrease in CIMT independent from the decrease in prolactin, LDL cholesterol, and BMI. We conclude that short term cabergoline treatment can improve endothelial function independently from the changes in metabolic disturbances and inflammatory markers.

37. Follow-up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology 2013

Dincer N, Balci S, Yazgan A, Guney G, Ersoy R, Cakir B, Guler G.
Uluslararası Yayınlar Cytopathology. 2013 Dec;24(6):385-90
ABSTRACT
Objective:  To report our experience of atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) rate and outcome.
 
Methods:  Among 7658 patients with 19 569 nodules, 524 (2.7%) nodules were diagnosed as AUS/FLUS on fine needle aspiration (FNA). After exclusion of patients with simultaneous nodules that were suspicious for follicular neoplasm or malignancy or that were malignant, 368 (4.8%) patients were diagnosed as AUS/FLUS. The outcome of 146 patients who had undergone surgery or repeated fine needle aspirate at the time of preparation of this study was evaluated. The original FNAs were matched to repeated FNAs and thyroidectomy or diagnostic lobectomy specimens.
 
Results:  Seventy-two (19.6%) of the 368 patients had directly undergone surgery, either a lobectomy or a thyroidectomy: of these, 27 (37.5%) had neoplastic nodules (21 were malignant). Seventy-four (20.1%) of the 368 patients had repeat FNA. On second FNA, 47 of 74 (63.5%) were benign, three were suspicious for follicular neoplasm, one was malignant and 23 (31.1%) were non-diagnostic. Four patients had a third FNA: two were AUS/FLUS, one was malignant and one non-diagnostic. One patient had a fourth FNA, which was diagnosed as AUS/FLUS. Sixteen (21.6%) of 74 patients with repeat FNA had surgery: three of these had neoplastic nodules (two were malignant). Overall, 88 of the 368 (23.9%) patients had a thyroidectomy of which 30 (34.1%) were neoplastic and 23 (26.1%) malignant. The neoplastic rate for patients who were once diagnosed with AUS/FLUS was 8.2% and the malignancy rate 6.3%. The malignancy rate for patients on follow-up at the time we prepared the study was 15.7% (23/146); 222 remained on follow-up without surgery or repeat FNA or were managed elsewhere.
 
Conclusions:  Although in this category repeat FNA is expected rather than excision, we suggest evaluation of all AUS/FLUS patients in multidisciplinary meetings to decide management and recommend follow-up of all patients with this diagnosis.
 

36. The effect of the menstrual cycle, a sample of infradian rhythm on thyroid volume and blood flow in healhty women 2013

Oguz, A., M. Gumus, A. Ipek, D. Tuzun, K. Gul, R. Ersoy, B. Cakir.
Uluslararası Yayınlar Biological Rhythm Research, Biological Rhythm Research, 44 (1): 103-112, 2013
ABSTRACT

The aim of the present study was to determine alterations in thyroid blood flow parameters and thyroid volume (TV), measured at inferior thyroid artery (ITA), due to changes in sex hormones and thyroid stimulating hormone (TSH) at four different periods of menstrual cycle (MC) showing infradian rhythm in healthy women. Twenty-two women with regular MC were recruited. Individuals were assessed with hormone levels, and Doppler ultrasound (US) findings at days 3, 7, 14, and 21 of MC. Mean TSH, peak systolic velocity (PSV), resistance index (RI), pulsatile index (PI), and TV were statistically analyzed. Compared to days 3 and 7, significant increases were detected in TSH, TV, and PSV at day 14 (p = 0.005, p = 0.000, p = 0.014; and p = 0.021, p = 0.002, p = 0.021, respectively). No significant differences were found for PI at different periods of MC (p > 0.05). RI significantly decreased at days 14 and 21 when compared to day 3 (p = 0.020 andp = 0.015, respectively). Alterations occur in ITA blood flow parameters and TV along with TSH levels throughout the MC.

35. A rare cause of elevated liver enzymes: Addison’s disease 2013

Cuhaci, N., A.B. Demirezer, D. Ozdemir, R. Ersoy, O. Ersoy ve B. Cakir
Uluslararası Yayınlar Turk J Gastroenterol. 2013;24(1):76-7

34. Screening interval for celiac disease in patients with type 1 diabetes mellitus 2013

Onal ED, Saglam F, Ersoy R, Cakir B.
Uluslararası Yayınlar Eur J Intern Med. 2013 Dec;24 (8): 93

33. False-positive iodine-131 whole body scan due to a benign dermal lesion; intradermal nevus ((131)I uptake in a benign nevus) 2013

Yildirim-Poyraz N, Ozdemir E, Amutkan C, Adiyaman N, Kilinc S, Kandemir Z, Saglam F, Turkolmez S, Cakir B.
Uluslararası Yayınlar Ann Nucl Med. 2013 Oct;27(8):786-90
ABSTRACT

Whole body radioiodine scanning (WBS), along with plasma thyroglobulin level, remains a reference method for detecting residual or metastatic differentiated thyroid cancer, however, false-positive WBS is not uncommon. External contaminations by body secretions or excretions, inflammation, and cystic structures mimicking metastases in WBS have been reported. Various benign and malignant tumors having different histopathological natures accumulate radioiodine, but intradermal melanocytic nevus was not previously described in the literature, as far as we know. This report describes an unusual cause of false-positive WBS after radioablation therapy due to an intradermal nevus, and the possible mechanisms are discussed. 

32. Positive measles serology and new onset of type 1 diabetes presented with bilateral facial paralysis: a case report 2012

Onal ED., Burçak Polat, Gülfem Kaya, Orhan Deniz, R. Ersoy ve B. Cakir
Uluslararası Yayınlar Braz J Infect Dis. 2012 May-Jun;16(3):305-6.

31. Evaluation of serum Ghrelin levels in patients with hyperplastic gastric polyps 2012

Ersoy, O., R. Ersoy, F. E. Akın, A. B. Demirezer, Ş. Büyükaşık, E. Selvi, B. Çakır.
Uluslararası Yayınlar Turk J Gastroenterol. 2012;23(5):444-7
ABSTRACT

Background/aims: Ghrelin is a 28 amino acid peptide and the main source of serum ghrelin is the stomach. The aim of this study was to evaluate serum ghrelin levels in patients with hyperplastic gastric polyp.

Materials and Methods: Eighty patients (50 female, 30 male) were included in this study: 28 with hyperplastic gastric polyp, 20 with benign gastric ulcer and 32 with chronic active gastritis. Serum ghrelin levels were measured by radioimmunoassay method.

Results: Serum ghrelin level was significantly lower in patients with hyperplastic gastric polyp (1139.86±279.23 pg/ml) than in those with benign gastric ulcer (1362.45±335.35 pg/ml) and chronic active gastritis (1362.91±269.67 pg/ml) (p=0.016 and p=0.003, respectively). The benign gastric ulcer and chronic active gastritis groups had similar serum values (p=0.996). Serum ghrelin level was not affected by Helicobacter pylori, with levels of 1298.70±309.01 pg/ml and 1252.12±303.04 pg/ml in 56 positive and 24 negative patients, respectively (p=0.536). In the patients with hyperplastic gastric polyp, Helicobacter pylori infection was found to have no effect on serum ghrelin level (p=0.855).

Conclusions: Serum ghrelin levels of patients with hyperplastic gastric polyp were lower than in patients with benign gastric ulcer and chronic active gastritis. In patients with various benign stomach lesions, the presence of Helicobacter pylori does not seem to affect serum ghrelin levels.

30. Parathyroid incidentalomas detected during thyroid ultrasonography and effect of chronic thyroiditis on false positive parathyroid lesions 2012

Ozdemir, D., D. Arpaci, R. Ucler, N. Cuhaci, R. Ersoy, B. Cakir.
Uluslararası Yayınlar Endocrine, 2012 Dec;42(3):616-21
ABSTRACT

We aimed to determine the prevalence of parathyroid incidentalomas in patients referred for thyroid ultrasonography (US) and investigate the role of chronic thyroiditis on false positive lesions. Patients suspected to have parathyroid lesions during thyroid US were recorded prospectively between August 2009 and January 2010. Patients referred for parathyroid US and patients with known high serum calcium or parathyroid hormone (PTH) levels were excluded. Suspected parathyroid lesions were defined as hypoechoic, homogeneous, solid lesions with regular margins located outside the thyroid lobe, most commonly inferior to the thyroid gland. Thyroid US was performed in 6,528 patients. There were 78 patients (1.19 %) (73 female and 5 male) with suspected parathyroid lesion. The diagnosis of a true parathyroid adenoma was confirmed in 6 (7.69 %) patients. In patients with true adenoma, mean serum calcium, phosphorus, and PTH levels were 10.57 ± 0.48 mg/dl, 3.03 ± 0.52 mg/dl, and 182.91 ± 46.62 pg/ml, respectively. Among 72 patients with false positive parathyroid lesion, antithyroid peroxidase antibody was positive in 50 (69.4 %), antithyroglobulin antibody was positive in 46 (63.9 %), and one of these antibodies were positive in 59 (81.9 %) patients. Also, 46 (63.9 %) of these patients had thyroid dysfunctions (43 hypothyroidism and 3 hyperthyroidism) and 59 (81.9 %) had chronic thyroiditis ultrasonographically. Parathyroid incidentaloma was detected in 0.09 % of patients referred for thyroid US. The presence of clinically or ultrasonographically chronic thyroiditis might cause inadvertent interpretation of a hypoechoic lesion as a parathyroid pathology during thyroid US.

29. The incidence of postpartum thyroiditis at first month postpartum 2011

Husniye Baser, Salih Baser, Reyhan Ersoy, Yusuf Ergun, Gul Gursoy, Filiz Avsar, Bekir Cakir
Uluslararası Yayınlar Pak J Med Sci, October - December 2011, Vol. 27 No. 5, 1079-1082.
ABSTRACT
Objective:
The aim of this study was to determine the incidence of Post Partum Thyroiditis (PPT) at first
month postpartum.
Methodology: Fifty pregnant subjects were included. Control group was composed of 50
women who did not give birth in the recent year. Blood samples were obtained once in the
control group and twice -at the third trimester and the first month postpartum-in the pregnant
group.
Results: PPT occurred at first month postpartum in 3 of 50 pregnant women. The incidence of
PPT at first month postpartum was 6%. Among the pregnant group, there was a statistically
significant increase in the Anti-TPO and Anti-Tg levels within the first month postpartum
compared to the ones in the third trimester. Also, all patients who experienced PPT were positive
for Anti-TPO and Anti-Tg.
Conclusions: In our opinion, it will be useful to evaluate particularly the pregnants with positive
thyroid auto-antibodies in early postpartum period.
KEY WORDS: Postpartum thyroiditis, Anti-thyroid peroxidase, Anti- thyroglobuline, thyroid
dysfunctions.

28. Classical and follicular variant papillary thyroid carcinoma: comparison of clinical, ultrasonographical, cytological, and histopathological features in 444 patients 2011

Ozdemir D, Ersoy R, Cuhaci N, Arpaci D, Ersoy EP, Korukluoglu B, Guler G, Cakir B.
Uluslararası Yayınlar Endocr Pathol. Jun; 22(2):58-65, 2011
ABSTRACT

Follicular variant papillary thyroid carcinoma (FVPTC) is the most common variant of papillary thyroid carcinoma (PTC) after classical PTC (CPTC). In this study, we aimed to compare functional status, ultrasonographical features, cytological results, and histopathological characteristics of patients with CPTC and FVPTC. Preoperative thyroid functions, thyroid autoantibodies, ultrasonographical features, cytology, and histopathology results of 354 (79.9%) CPTC and 90 (20.3%) FVPTC patients were reviewed retrospectively. Sex distribution, mean age, thyroid autoantibody positivity, and thyroid dysfunctions were similar in two groups. Among 320 patients with preoperative ultrasonography (US) findings, a hypoechoic halo was observed more frequently (p = 0.003), and marginal irregularity was observed less commonly (p = 0.024) in FVPTC lesions. In CPTC, rate of malignant cytology (p = 0.001), and in FVPTC, rate of suspicious cytology (p < 0.001) were significantly higher. Histopathologically, mean tumor diameter was markedly higher in FVPTC compared to CPTC (16.89 ± 13.86 vs 10.64 ± 9.70 mm, p < 0.001), while capsular invasion and extrathyroidal spread were significantly lower in patients with FVPTC (p = 0.018 and p = 0.039, respectively). FVPTC tend to have more benign features in US and less malignant results in cytology. Higher tumor size in FVPTC might be explained by the recognition of clinical importance of these lesions after reaching particular sizes due to benign US features.

27. CA 19- 9 Level in Patients With Type 2 Diabetes Mellitus and Its Relation to the Metabolic Control and Microvascular Complications 2011

Gul K, S. Nas, D. Özdemir, M. Gumus, R. Ersoy ve B. Cakir
Uluslararası Yayınlar Am J Med Sci. Jan; 341(1):28-32, 2011
ABSTRACT
Introduction: The aim of this study is to compare CA 19-9 levels in patients with type 2 diabetes mellitus (DM) and healthy control group. The relation of CA 19-9 levels to metabolic control and microvascular complications in patients with diabetes was also investigated.
 
Methods: Three hundred forty patients with type 2 DM and age-, sex- and body mass index-matched 214 healthy controls group were included in the study. HbA1c, duration of DM and microvascular complications of DM were reviewed. CA 19-9 levels (normal range, 0–35 U/mL) were measured in all participants.
 
Results: Median CA 19-9 level was significantly higher in patients with diabetes compared with control group [19.5 U/mL (0–214.8 U/mL) versus 7.4 U/mL (0.4–47.0 U/mL)] (P < 0.001). Prevalence of high CA 19-9 levels in patients with diabetes was 31.2%, and CA 19-9 level was positively correlated with age, duration of diabetes, HbA1c and number of complications. Effects of duration of diabetes, HbA1c and diabetic nephropathy were still continuing in multiple linear regression analysis. Using regression coefficients of all variables in multiple regression analysis, this study tried to determine a new cutoff value for CA 19-9 level in patients with diabetes. The cutoff value at 97th percentile was 57.14 U/mL.
 
Conclusions: High CA 19-9 value in patients with diabetes may indicate the need for a careful evaluation of blood glucose regulation and investigation of complications. Defining a new cutoff value in these patients would prevent unnecessary laboratory or imaging procedures.
 

26. Diagnostic value of elastosonographically determined strain index in the differential diagnosis of benign and malignant thyroid nodules 2011

Cakir, B., C. Aydin, B. Korukluoglu, D. Ozdemir, C.I. Sisman, D. Tüzün, A. Oguz, G. Guler, G. Güney, A. Kuşdemir, S.Y. Sanisoglu, ve R. Ersoy
Uluslararası Yayınlar Endocrine. 2011 Feb;39(1):89-98
ABSTRACT

Elastosonography (ES) is a newly developed method that is used for the differential diagnosis of benign and malignant thyroid nodules. In different studies, ES scoring has been compared with histopathological findings, and sensitivity and specificity of the scoring were calculated. In this study, it determines the strain index (SI) as well as the ES to score thyroid nodules, and establishes the role for these parameters in the differential diagnosis of thyroid nodules using histopathological analysis as a reference standard. Real-time ES in transverse axis (TA) and longitudinal axis (LA) was performed in 391 nodules of 292 patients. ES scoring was made for all the nodules. SI in TA and LA was calculated for four times in each nodule and mean values were determined. The results were compared with final histopathological diagnoses. In histopathological examinations, 125 (31.97%) of 391 nodules were malignant and 266 (68.03%) were benign. Of these histopathologically benign nodules, 189 (%71.05) were also probably benign according to elastosonographic scoring (scores of 1, 2, or 3), while 77 (28.95%) were probably malignant (scores of 4 or 5). Among 125 histopathologically malignant nodules, 52 (41.60%) were probably benign and 73 (58.40%) were probably malignant according to elastosonographic scoring. There was a significant relation between scoring and histopathological findings (χ2 = 36.513; P < 0.001). Accordingly, sensitivity and specificity of ES scoring were 58.4 and 71.0%, respectively. ROC analysis value obtained for strain ratios in LA (AUC: 75.5%; P < 0.001) had a higher significance compared to ROC analysis value obtained for strain ratios in TA (AUC: 66.0%). Thus, ROC analysis evaluation was applied only for SI in LA. The optimal SI cut-off value in LA for all the nodules was found to be 16.709 (sensitivity: 73.4%, specificity: 70.0%) (AUC: 75.4 ± 0.03%; 70.2–80.5%). SI cut-off value corresponding to 90% sensitivity in this axis was 4.516 (specificity: 35.7%). Sensitivity and specificity of SI values that were determined according to morphological features of nodules in gray-scale ultrasonography were higher. For hypoechoic nodules with microcalcifications and without a halo, SI cut-off value, sensitivity, and specificity were 17.020, 84.3, and 81.1%, respectively. Our study is the first clinical-wide series study that measured, used, and compared the ES scoring and SI cut-off values for the differential diagnosis of benign and malignant thyroid nodules. This study indicates that measurement of SI with ES as a noninvasive procedure may be used as an adjunctive method to the conventional methods for the differential diagnosis of thyroid nodules.

25. Coexistent familial nonmultiple endocrine neoplasia medullary thyroid carcinoma and papillary thyroid carcinoma associated with RET polymorphism 2010

Gul K, Ozdemir D, Ugras S, Inancli SS, Ersoy R ve B. Cakir
Uluslararası Yayınlar Am J Med Sci, 340: 60-63, 2010
ABSTRACT

Familial nonmultiple endocrine neoplasia medullary thyroid cancer accounts for 10% to 15% of hereditary medullary thyroid carcinoma and is characterized by lack of accompanying endocrine or nonendocrine diseases. Simultaneous occurrence of medullary and papillary thyroid carcinoma in the same patient is rare and known as collision tumor. Here, the authors present familial nonmultiple endocrine neoplasia medullary thyroid cancer in 4 sisters, all having RET proto-oncogene polymorphism in exon 15 at codon 904 and 2 having additional polymorphism in exon 13 at codon 769. The index case had concomitant medullary and papillary thyroid carcinomas, which are suggested to be completely different tumors in terms of incidence, cell origin, histopathologic features and prognosis. Histopathologically, she also had Hashimoto thyroiditis in the remaining thyroid tissue and medullary thyroid carcinoma metastasis in 3 cervical lymph nodes. This case is the first in the literature to report coexistent familial nonmultiple endocrine neoplasia medullary thyroid cancer and papillary thyroid carcinoma related with a RET polymorphism (S904S in exon 15).

24 Are endogenously lower serum thyroid hormones new predictors for thyroid malignancy in addition to higher serum thyrotropin? 2010

Gul K, D. Ozdemir, A. Dirikoc, A. Oguz, D. Tuzun, H. Baser, R. Ersoy ve B. Cakir
Uluslararası Yayınlar Endocrine, 37: 253-260, 2010
ABSTRACT

It is well known that TSH plays a major role in the secretion of thyroid hormones, maintenance of thyroid specific gene expression, and gland growth. In this study, we aimed to evaluate association between tests of thyroid functions (fT3, fT4, TSH) and differentiated thyroid carcinoma. 441 patients operated for nodular goiter between 2005 and 2008 were analyzed. Thyroid functions were studied in the period of 1–30 days prior to surgery. In postoperative histopathological examination, differentiated thyroid carcinoma and benign thyroid disease were detected in 166 (37.6%) and 275 (62.4%) patients, respectively. Patients with thyroid malignancy had significantly lower serum fT3 (P = 0.001), lower fT4 (P = 0.022), and higher TSH levels (P < 0.001) compared to patients with benign disease, although all analytes were within the normal range. We subdivided by quartile serum fT3, fT4, and TSH in normal limits into three groups. The odds ratio (ORs) for the risk of thyroid cancer with a serum TSH between 0.63 and 1.67 μIU/ml and 1.68–4.00 μIU/ml, compared with a serum TSH between 0.40 and 0.62 μIU/ml were calculated as 2.60 (95% CIs 1.49–4.54) and 6.50 (95% CIs 3.51–12.03), respectively. There was also a greater risk of thyroid cancer in patients with fT3 levels of 1.57–3.00 pg/ml, compared with patients with fT3 levels of 3.89–4.71 pg/ml (OR 2.95, 95% CIs 1.68–5.20). For fT4, OR for the risk of thyroid cancer between 0.85 and 1.17 ng/dl compared with 1.48–1.78 ng/dl was 2.14 (95% CIs 1.22–3.74). In conclusion, lower fT3, fT4, and higher TSH concentrations within normal limits were related with increased thyroid cancer independent from sex and nodule type. Particularly, the association between lower fT3, fT4 levels and a diagnosis of thyroid cancer is a novel finding.

23. The association between thyroid carcinoma and hashimoto's thyroiditis: the ultrasonographic and histopathologic characteristics of malignant nodules 2010

Gul K, A. Dirikoc, G. Kiyak, P.E. Ersoy, N.S. Ugras, R. Ersoy, ve B. Cakir
Uluslararası Yayınlar Thyroid, 20:8, 873- 878, 2010
ABSTRACT
Background: Some but not all reports, particularly those of a retrospective nature, have noted an increased risk of carcinoma in thyroid nodules in patients with Hashimoto's thyroiditis (HT). Thyroid cancer (TC) in patients with HT, however, have been reported to have a better prognosis. In the presence of HT, the ultrasonography (US) appearance of the thyroid gland might vary greatly, making it more difficult to differentiate between benign and malignant nodules. The aim of this study was to determine if there is an association between TC and HT and to determine if the US and histopathologic characteristics of malignant nodules in patients with and without HT are similar.
 
Methods: Six hundred thirteen patients who underwent total thyroidectomy between 2005 and 2008 for nodular goiter were included in this study. The preoperative US characteristics and postoperative histopathologic features in patients with and without HT were compared. The diagnosis of HT was based on histopathologic features.
 
Results: Ninety-two patients had HT. The prevalence of TC in the HT patients was 45.7%. In contrast, it was 29% in patients without HT (p = 0.001). The prevalence of HT in the patients with TC was 21.8% and in patients without TC was 11.9% (p = 0.001). The rate of incidental TC, defined as TC identified during surgery or following histopathologic examination of permanent sections despite preoperative benign cytology results, was higher in patients with HT (33.3%) than in those without (13.0%) HT (p = 0.004). The US characteristics of papillary thyroid carcinoma, which included number of nodules, echogenity, echoic texture, microcalcifications, macrocalcifications, halo sign, and regularity of margins, were similar in the group with HT compared with the group without HT. When the histopathologic characteristics of papillary thyroid carcinoma in patients with and without HT were compared, again there was no significant difference.
 
Conclusions: We suggest that there is an association between HT and TC, and HT may predispose to the development of TC. This indicates the need for close observation of neoplastic changes in patients with HT. Nevertheless, the presence of HT seems to have no effect on the US and histopathologic characteristics of malignant nodules in TC patients. This finding may indicate that evaluation of nodules and initial treatment of TC in these patients does not require different management.
 

22. Preoperative and postoperative evaluation of thyroid pathologies in patients undergoing surgical treatment of primary hyperparathyroidism 2010

Gul., K, D. Ozdemir, B. Korukluoglu, P.E. Ersoy, R. Aydin, S.N Ugras, R. Ersoy ve B. Cakir
Uluslararası Yayınlar Endocrine Practice, 16:1, 7-13, 2010
ABSTRACT
Objective: To evaluate the occurrence of thyroid disease in patients undergoing parathyroidectomy for primary hyperparathyroidism.
 
Methods: In this case series, records of all patients with a diagnosis of primary hyperparathyroidism who underwent parathyroidectomy between January 2005 and December 2008 in our clinic were analyzed retrospectively. Preoperatively, all patients were evaluated with ultrasonography and parathyroid scintigraphy; when needed, thyroid scintigraphy and ultrasound-guided fine-needle aspiration biopsy (FNAB) were used. All patients underwent standard neck exploration. Postoperative histopathologic findings of thyroid tissue were classified as nodular/multinodular hyperplasia, Hashimoto thyroiditis, papillary thyroid carcinoma, or normal.
 
Results: Fifty-one women and 9 men were included. In the 60 patients, preoperative ultrasonography revealed thyroiditis (without nodules) in 13 (22%), a solitary nodule in 9 (15%) (coexistent with thyroiditis in 7 patients), multinodular goiter in 24 (40%) (coexistent with thyroiditis in 5 patients), and normal findings in 14 (23%). Rates of thyroiditis and nodular goiter were 42% and 55%, respectively. Collectively, prevalence of thyroid disease was 77%. Total thyroidectomy was performed in 27 patients, and hemithyroidectomy was performed in 15 patients. Indications for total thyroidectomy were nondiagnostic or suspicious FNAB results in 5 patients, hyperthyroidism in 4 patients, ultrasonography findings in 11 patients, and intraoperatively recognized suspicious nodularity in 7 patients. Postoperatively, thyroid carcinoma was diagnosed in 9 patients (15%).
 
Conclusions: Thyroid disease, particularly thyroid carcinoma, is common in patients with primary hyperparathyroidism. This association should be considered when selecting the surgical procedure. Intraoperative evaluation of the thyroid is as important as preoperative evaluation with ultrasonography and FNAB in patients with thyroid disease and primary hyperparathyroidism.
 

21. The relationship between aortic stiffness and left ventricular function in patients with Cushing’s disease 2010

Bayram N.A., R. Ersoy, D.O Sen, S.S Inancli, T. Durmaz, T. Keles, E. Bozkurt ve B. Cakir
Uluslararası Yayınlar Endocrine, 37: 280-285, 2010
ABSTRACT

We aimed to investigate the aortic function and to evaluate the relationship between aortic stiffness and systolic and diastolic functions of the left ventricle in patients with Cushing’s disease (CD). Fourteen women and one man with newly diagnosed CD, and 17 control cases were enrolled in this study. All subjects underwent echocardiography and systolic and diastolic aortic measurements were noted from M-mode aortic root. Aortic elastic parameters, aortic strain, and distensibility were calculated. Left ventricle functions were measured using echocardiography including, two-dimensional, M-mode, conventional Doppler, and tissue Doppler imaging. Aortic strain (7.4 ± 1.9 vs. 12.3 ± 2.4%; P < 0.001), and aortic distensibility (3.2 ± 1.1 × 10−6 vs. 5.6 ± 1.4 × 10−6 cm2 dyn−1;P < 0.001) were significantly decreased in patient group compared with control group. Mitral E velocity and the ratio of E/A were significantly lower and deceleration time of E was significantly prolonged in patients with CD. We also observed that patients with CD had markedly lower early diastolic myocardial peak velocity (Em) and Em/Am ratio and higher Tei index than in control group. Aortic elastic parameters are deranged in patients with CD and there is a significant correlation between left ventricular parameters determined by tissue Doppler echocardiography and aortic elastic parameters in these patients. We think that patients with CD should also be evaluated with aortic stiffness known to be an early marker for atherosclerosis.

20. Thyroid carcinoma risk in patients with hyperthyroidism and role of preoperative cytology in diagnosis 2009

Gul K, A. Dirikoc, Kıyak G, Ersoy PE, Ugras NS, Özdemir D, Ersoy R ve Cakir B
Uluslararası Yayınlar Minerva Endocrinology, 34(4):281-288, 2009
ABSTRACT
AIM: The aim of this study was to determine the frequency of thyroid carcinoma in patients with hyperthyroidism and evaluate the role of preoperative ultrasonography (US) guided thyroid fine needle aspiration biopsy (FNAB) in diagnosis of thyroid carcinoma in these patients. METHODS: Three hundred twenty-five hyperthyroid patients--119 with toxic multinodular goiter (TMNG), 47 with autonomous functioning toxic nodule (AFTN) and 159 with Graves Disease (GD)--were included in this study. All patients were evaluated with US and in all patients with nodules, US guided FNAB was carried out.
RESULTS: Among 159 patients with GD, 62 were without nodules. Totally, 583 nodules in 263 patients were sampled by FNAB. Cytologic results of nodules were as follows: 87.7% benign, 6.2% inadequate, 4.3% suspicious and 1.9% malignant. Postoperatively, 42 (12.9%) patients were diagnosed as thyroid carcinoma histopathologically. Thyroid carcinoma was detected postoperatively in all patients with malignant cytology, in 47.8% of patients with suspicious cytology and in 44.4% of patients with inadequate cytology. Moreover, in 13 patients with benign cytology and in 3 Graves patients without any nodule ultrasonographically, incidental thyroid carcinoma was found (5.7%). Consequently, thyroid malignancy rates were 16% in TMNG, 6.4% in AFTN and 12.6% in GD. CONCLUSION: Thyroid carcinoma is common in hyperthyroidism and FNAB is a reliable method in diagnosis of thyroid malignancy in these patients. Additionally, incidental thyroid carcinomaprevalence is also high in patients with hyperthyroidism. We suggest that it is reasonable to evaluate nodules with FNAB in hyperthyroid patients prior to radioactive iodine treatment or surgical intervention.
 

19. Ultrasonographic evaluation of thyroid nodules: Comparison of ultrasonographic, cytological and histopathological findings 2009

Gul., K, R. Ersoy, A. Dirikoc, B. Korukluoglu, P.E Ersoy, R. Aydin, S.N Ugras, O.K. Belenli ve B. Cakir
Uluslararası Yayınlar Endocrine, 36:3, 464-472, 2009
ABSTRACT

Thyroid ultrasonography (US) and fine needle aspiration biopsy (FNAB) are the most important tools in evaluating thyroid nodules. A total of 3,404 nodules in 2,082 cases referred to our clinic between 2005 and 2008 were analyzed retrospectively. Considering US features of nodules, risk factors predicting malignancy were: margin irregularity as the most important predictor, hypoechoic pattern and microcalcification (Odds ratios: 63.2, 13.3, 7.03, respectively). Cytologic results of the patients were as follows: 1,718 (82.5%) benign, 196 (9.4%) suspicious, 68 (3.3%) nondiagnostic, and 100 (4.8%) malignant. In histopathologic examination, we determined a malignancy rate of 7.59% (158/2082). We calculated the sensitivity of FNAB as 89.16%, specificity as 98.77%, positive predictive value as 96.10%, negative predictive value as 96.39%, and accuracy as 96.32%. In cytologic examination, the malignancy rate of subcentimetric (≤1 cm) nodules was higher than supracentimetric (>1 cm) nodules (5.1% vs. 1.5%, P = 0.001). In postoperative histopathologic examination, although the malignancy rate of subcentimetric nodules was higher than that of supracentimetric nodules, the difference was statistically insignificant (5.5%, 4.4%, respectively;P > 0.05). Cytologically diagnosed malignancy was detected in 4.5% of patients with multiple nodules, while it was present in 6% of patients with solitary nodule indicating no significant difference. However, postoperative histopathologic examination revealed a significantly higher malignancy rate in patients with solitary nodule compared to in patients with multiple nodules (11.7%, 6.5%; respectively, P < 0.001). The malignancy rate of patients operated for suspicious cytology was found to be 46.15%; for nondiagnostic cytology, it was 64.29%. In conclusion, ultrasonographically, hypoechoic pattern, microcalcification and margin irregularity of thyroid nodules are important features in determining the malignancy risk. The nodule size alone still remains inadequate to exclude malignancy risk.

18. Assessment of left ventricular functions by tissue doppler echocardiography in patients with Cushing’s disease 2009

Bayram N.A., R. Ersoy, C. Aydin, K. Gul, T. Keles, O. Topaloglu, T. Durmaz, E. Bozkurt ve B. Cakir
Uluslararası Yayınlar Journal of Endocrinological Investigation, 32:248-252, 2009
ABSTRACT

Objective: To verify whether tissue Doppler imaging (TDI) could contribute to a better understanding of the natural history of cardiomyopathy in active Cushing’s disease (CD), through its enhanced sensitivity to diastolic dysfunction, and identifying preliminary regional signs of systolic dysfunction before the appearance of clinical symptoms of cardiac pathologies. Methods: Eleven women with newly diagnosed CD and 32 control cases, purposely matched for gender, age, body mass index and co-incidental diseases were enrolled in this study. Echocardiographic examinations were assessed by conventional echocardiography and tissue Doppler imaging. The peak systolic velocity (S’m), early diastolic myocardial peak velocity (E’m), late diastolic myocardial peak velocity (A’m), isovolumic acceleration (IVA), myocardial pre-contraction time (PCT’m), myocardial contraction time (CT’m) and myocardial relaxation time (RT’m) were measured at septal and lateral mitral anulus.Results: In TDI, E’m and, E’m/A’m ratio were significantly lower, and PCT’m/CT’m ratio was higher, S’m, A’m, peak early diastole/E’m ratio, PCT’m, and isovolumetric myocardial relaxation time values were similar at lateral and septal anulus in patients with CD than controls (p>0.05). Lateral and septal anulus IVA were significantly lower in patients with CD than the control group (p<0.05). Correlation analysis showed that IVA time at lateral anulus correlated positively with S’m at lateral anulus (r=0.58; p=0.002) and IVA time at septal anulus correlated positively with S’m at septal anulus (r=0.51; p=0.008). Conclusion: Our study confirms that patients with CD have impaired diastolic function. More importantly, we also demonstrated an impairment of myocardial systolic function in patients with CD by TDI. We recommend using TDI in addition to conventional echocardiography parameters for the cardiovascular risk assessment of patients with Cushing’ syndrome.

17. Initial report of the results of percutaneous laser ablation of benign cold thyroid nodules: Evaluation of histopathological changes after 2 years 2009

Cakir, B., N.S Ugras, K. Gul, R. Ersoy ve B. Korukluoglu
Uluslararası Yayınlar Endocrine Pathology, 20:170-176, 2009
ABSTRACT

Percutaneous laser ablation (PLA) is a new method to be used for reducing the volume of symptomatic cold benign thyroid nodules. We aimed to introduce the long-term histopathological effects of PLA procedure in thyroid nodules. A 42-year-old male patient with 18.7-mL nodule volume was transferred a total of 720 J of energy with 3-W power. A 50-year-old female patient with 14.1-mL volume nodule was transferred a total of 3,300 J with 5-W power. A 61-year-old female patient with 49.7-mL volume nodule was transferred a total of 4,200 J with 5-W power. The thyroidectomy materials were examined histopathologically 2 years later. In histopathologic examination, it was observed that the periphery of ablated area was organized with hyalinized connective tissue and the center was organized with necrosis and carbon particles. Concurrently, in the center, we detected calcifications and colloid and foreign-body giant cells against colloid in one patient. We did not encounter any pathologic findings in the tissue adjacent to ablated area. In the cold benign thyroid nodules taken out by thyroidectomy 2 years after PLA procedure, necrosis and hyalinization were detected histopathologically. PLA procedure in cold benign thyroid nodules seems to be safe according to long-term histopathological findings.

16. Subcapsular hematoma complication during percutaneous laser ablation to a hypoactive benign solitary thyroid nodule 2008

Cakir, B., Gul K, Ersoy R, Topaloglu O, Korukluoglu B.
Uluslararası Yayınlar Thyroid, 18(8): 917-918 (2008)

15. Percutaneous laser ablation of an autonomous thyroid nodule: Effects on nodule size and histopathology of the nodule 2 years after the procedure 2008

Cakir, B., Gul K, Ugras S, Ersoy R, Topaloglu O, Agac T, Aydin C, Dirikoc A, Gumus M, Korukluoglu B, Kusdemir A.
Uluslararası Yayınlar Thyroid, 18(7): 803-805 (2008)

14. Ultrasound-guided percutaneous laser ablation treatment in inoperable aggressive course anaplastic thyroid carcinoma: The introduction of a novel alternative palliative therapy-second experience in the literature 2007

Cakir, B., O. Topaloglu, K. Gul, T. Agac, C. Aydin, A. Dirikoc, R.U. Ersoy, M. Gumus, K. Yazicioglu, B. Yalcin, A. Demirkazik, F. İcli ve K. Ceyhan
Uluslararası Yayınlar Journal of Endocrinological Investigation, 30:7,624-625 (2007)

13. Pituitary metastasis of breast cancer confirmed by fluorine-18 fluorodeoxyglucose positron emission tomography: a case report 2007

Ersoy, R., O. Topaloglu, C. Aydin, A. Dirikoc ve B. Cakir
Uluslararası Yayınlar Journal of Endocrinological Investigation, 30:6 532-533 (2007)

12. The relationship between diurnal variation of TSH and thyroid blood flow with Doppler ultrasonography in healthy adults 2007

Ersoy, R., K. Gül, M. Gümüş, A. İpek, O. Topaloglu, C. Aydin, A. Dirikoc ve B.Çakır
Uluslararası Yayınlar Biological Rhythm Research 39(1): 85-91, (2007)
ABSTRACT
Aim. To determine the presence of a correlation between the Doppler parameters of thyroid blood flow and diurnal variation of TSH.
Method. Thirty healthy adults were included. FT3, FT4, and TSH measurements were made at 08.00, 16.00, and 24.00. Thyroid volumes were calculated followed by peak systolic velocity (PSV) and resistance index (RI) from the inferior thyroid artery by Doppler ultrasonography.
 
Results. The difference between diurnal measurements of TSH was found to be significant (1.29 ± 0.55 vs 3.09 ± 1.52; p < 0.001). PSV was detected to be higher at 24.00 compared to values measured at 08.00 and 16.00 (27.75 ± 9.54 vs 24.9 ± 8.51; p < 0.01 and 27.75 ± 9.54 vs 25.88 ± 9.82; p < 0.05). Mean RI values were lower at 24.00 compared to those at 08.00 and 16.00 (0.53 ± 0.07 vs 0.57 ± 0.07; p < 0.001 and 0.53 ± 0.08 vs 0.56 ± 0.05; p < 0.05).
 
Conclusion. Thyroid blood flow should be evaluated diurnally by Doppler ultrasonography in thyroid pathologies.
 

11. Effects of percutaneous laser ablation treatment in benign solitary thyroid nodules on nodule volume, thyroglobulin and antithyroglobulin levels, and cytopathology of nodule in 1 year follow-up 2006

Cakir, B., O. Topaloglu, K. Gul, T. Agac, C. Aydin, A. Dirikoc, M. Gumus, K. Yazicioglu, R. U. Ersoy ve S. Ugras
Uluslararası Yayınlar Journal of Endocrinological Investigation, 29: 876-884 2006
ABSTRACT

Objective: To investigate the effects of ultrasound (US)-guided percutaneous laser ablation (PLA) in the treatment of benign solid hypoactive thyroid nodules on nodule volume, thyroid functions, nodule cytology and patients’ complaints. Material and method: Criteria for enrollment in the study were as follows: patients with euthyroid, benign, hypofunctional nodule who had compressive symptoms or cosmetic complaints, but considered inoperable, or who rejected surgical treatment. PLA procedure at 3–5 watts (W) was applied to 15 thyroid nodules of 12 patients (4 male and 8 female; age range 20–78 yr, mean age 47.42±17.05 yr), and patients were followed up for 12 months. Thyroid functions and nodule volumes (ultrasonographically) were evaluated. US-guided fine needle aspiration biopsy (FNAB) was performed before and after the procedure, and biopsy specimens were cytologically evaluated. Results: The mean nodule volume before the procedure was 11.97 ml (min-max 0.95–26.30 ml). However, 12 months after the procedure the mean nodule volume was 2.21±2.32 ml (min–max 0.10–7.65 ml). The mean reduction in nodule volumes was 82%. Thyroglobulin levels reached peak values at 1 month after the procedure, and anti-thyroglobulin levels at 3 months after the procedure. FNAB performed at 12th month showed neutrophil polymorphs, macrophages, abundant cell debris, colloid, multinucleated giant cells, and small fragments of fibrous stroma which indicated that PLA procedure led to degenerative changes in nodules. Conclusion: US-guided PLA is a new, successful treatment method which is reliable in the long term in benign solid thyroid nodules for selected patients who are inoperable or do not prefer surgery.

10. Diurnal Variation in Ultrasonographic Dimensions of Thyroid Gland 2005

Gursoy G., B. Cakir, B. Ozturk, M Kacar, S Guler, K. Gul, O. Topaloğlu ve Dogan Yucel
Uluslararası Yayınlar Biological Rithym Research,36:4, 361 - 367 (2005)
ABSTRACT

Aim: To evaluate thyroid volume at the circadian nadir and peak of TSH levels. Subjects and methods: Serum TSH, fT3 and fT4 levels and thyroid volumes were measured at 08.00 am and 24.00 in 55 (20 male, 35 female) euthyroid healthy individuals. Results: Mean TSH level were significantly lower at 08.00 h than at at 24.00 h (1.95 ± 1.29 vs 2.52 ± 1.5 μIU/ml, respectively; p < 0.001). Mean thyroid volume was also significantly lower at 08.00 h than at 24.00 h (15.09 ± 4.97 vs. 17.38 ± 3.49; p < 0.001). There was no relationship between TSH level and thyroid volume at either time point. Conclusion: Although thyroid volume and TSH levels increase at midnight compared to 08.00 h, there is no relationship between these two parameters. We suggest that thyroid volume measurements should be performed in the morning hours.

9. Plasma Tumor Necrosis Factor-Alpha Levels and Insulin Resistance in Nondiabetic Hypertensive Subjects 2002

Demirbaş, B., S. Güler, B. Çakır, C. Çulha ve Y. Aral
Uluslararası Yayınlar Hormone Research, 58:283-286 (2002)
ABSTRACT

Objectives: Tumor necrosis factor-α (TNF-α) is associated with insulin resistance in certain conditions. However, whether TNF-α is related to insulin resistance in hypertensive subjects is still controversial. The aim of this study was to determine the status of TNF-α and insulin resistance in hypertension. Methods: Newly diagnosed nondiabetic 17 essentially hypertensive (6 men, 11 women) patients, and 11 control healthy subjects (5 men, 6 women) are involved in the study. Body mass index (BMI), insulin, fasting blood glucose, cholesterol, triglyceride, and TNF-α levels were measured. Insulin resistance is assessed according to homeostasis model of assessment (HOMA-IR). Results: Serum insulin (8.4 ± 2.7 vs. 6.1 ± 1.4 mIU/ml; p < 0.01), triglyceride (245.0 ± 39.9 vs. 193.0 ± 22.8 mg/dl; p < 0.01), and TNF-α (4.2 ± 0.7 vs. 3.0 ± 0.6 pg/ml; p < 0.001) levels, and HOMA-IR (2.0 ± 0.8 vs. 1.3 ± 0.3; p < 0.001) were significantly higher in the hypertensive patients compared to the normotensive control group. There were positive correlations between TNF-α levels and body mass index (r = 0.64, p < 0.01), and triglyceride (r = 0.55 p = 0.02) levels in the whole study group. However, there was no correlation of either TNF-α or HOMA-IR. Conclusions: Our data revealed that hypertensive patients have insulin resistance and higher TNF-α levels, but there is no relation between TNF-α levels and insulin resistance.

8. Plasma Soluble Intercelluler Adhesion Molecule 1 Levels are Increased in Type 2 Diabetic Patients with Nephropathy 2002

Guler, S., B. Cakir, B. Demirbaş, A. Yönem, E. Odabaşı, U. Önde, Ö. Aykut ve G. Gürsoy
Uluslararası Yayınlar Hormone Research, 58:67-70 (2002)
ABSTRACT

Background/Aim: Intercellular adhesion molecule 1 (ICAM-1) is a mediator in the recruitment of leukocytes in the glomerular cells. The role of ICAM-1 in diabetic complications is still a matter of debate. This study was performed to investigate the relation of plasma soluble ICAM-1 (sICAM-1) to nephropathy in patients with type 2 diabetes mellitus. Methods: Ninety-three patients (24 males and 69 females) with type 2 diabetes mellitus were included into the study. Fifty patients had nephropathy, and 43 were free from nephropathy. Fifty healthy subjects (14 males and 36 females) served as the control group (group 1). Twenty-five of the diabetic patients had microalbuminuria (group 2), 25 had macroalbuminuria (group 3), and 43 had neither micro- nor macroalbuminuria (group 4). The plasma sICAM-1 levels were measured in blood samples drawn after fasting. Results: The mean plasma sICAM-1 levels were not different in the 93 diabetic patients as compared with the healthy controls (392.7 ± 119.5 vs. 350.1 ± 90.2 ng/ml, p > 0.05). The mean sICAM-1 level was significantly higher in the diabetic patients with nephropathy than in those without nephropathy (430.3 ± 78.2 vs. 368.2 ± 122.5 ng/ml, p = 0.03) and in the controls (430.3 ± 78.2 vs. 350.1 ± 90.2 ng/ml, p = 0.016). The difference in sICAM-1 levels between groups 2 and 3 was not significant (p > 0.05). The plasma sICAM-1 levels were significantly higher in both groups 2 and 3 than in both groups 1 and 4 (434.5 ± 129.2 vs. 427.2 ± 113.7 ng/ml and 368.2 ± 122.5 vs. 350.1 ± 90.2 ng/ml, respectively). Conclusions: The plasma sICAM-1 levels in patients with type 2 diabetes mellitus are not significantly different from those in nondiabetic subjects. High levels of sICAM-1 suggest that sICAM-1 may play a role in the development of nephropathy in patients with type 2 diabetes mellitus.

7. Secondary Osteoporosis in Women 2002

Çakır, B., E. Odabaşı, M. Turan, S. Güler ve M. Kutlu
Uluslararası Yayınlar Archives of Gynecology and Obstetrics, 266:214-217 (2002)
ABSTRACT

Secondary osteoporosis comprises a minority of all osteoporosis cases. In this study we summarize the causes of secondary osteoporosis we encountered in patients currently on follow-up in our osteoporosis outpatient clinic. A total of 1015 female patients are involved in the study. Recorded data of the patients are evaluated retrospectively. Patients with spine bone mineral density (BMD) 2.5 standard deviation below a reference range established using our own data obtained from a Turkish population of normal healthy women using dual energy X-ray absorptiometry (T score less than –2.5) were accepted as having osteoporosis. We detected osteoporosis in 384 (38%) of the female patients. A secondary cause for osteoporosis has been found in 33 (8.6%) of the 384 osteoporotic patients. Thyrotoxicosis (n=10), parathyroid adenoma (n=10), and glucocorticoid administration (n=7) constituted 82% of the causes of osteoporosis. The data obtained in our study indicate that appropriate search for secondary causes of osteoporosis is essential because different modalities are needed for treatment.

6. Effects of aminoguanidine and tolrestat on the development of ocular and renal structural changes in experimental diabetic rats 2002

Azal, O., A. Yonem, S. Guler, B. Cakir, A. Baydar, A. Corakcı ve M. Kutlu
Uluslararası Yayınlar Diabetes, Obesity and Metabolism ,4 (1): 75-79, (2002)
ABSTRACT

Studies that researched the role of aminoguanidine and tolestat in the prevention of diabetic retinopathy and nephropathy resulted in conflicting data. We investigated the effects of these agents in the prevention of ocular and renal changes in streptozotocin (STZ)-induced diabetic rats. Diabetes was induced by intravenous injection of STZ in 30 rats. Ten rats that were not given STZ served as non-diabetic control (Group 1). Ten STZ-diabetic rats that were not given any treatment served as diabetic control (Group 2). Groups 3 and 4 were composed of STZ-induced diabetic rats (10 each) that were given tolrestat and aminoguanidine respectively. Eyes and kidneys were examined at the 24th week under electronmicroscopy. Cataract was observed in all six of the surviving rats in Groups 2 and 4, and in one of 6 surviving rats in group 3. Cataract development was lower in Group 3 than Groups 2 and 4. All retinal samples obtained from group 2 demonstrated a number of structural abnormalities, whereas there were no significant ultrastructural changes in groups 3 and 4. Groups 2 and 3 demonstrated mesangial proliferation and expansion, diffuse glomerular basement membrane (GBM) thickening, and focal GBM thickening in the bulb form. Group 4 demonstrated a normally appearing mesangial space, minimal diffuse but no focal GBM thickening. The urinary albumin excretion (UAE) was lower in Group 4 than the other groups. In conclusion, our results suggest that aminoguanidine may be an important agent for the prevention of renal changes, whereas tolrestat may be effective for the prevention of ocular changes in diabetes mellitus.

5. Effects of Granulocyte-Colony Stimulating Factor in the Treatment of Diabetic Foot Infection 2001

Yönem, A., B. Çakır, S. Güler, Ö. Azal ve A. Çorakçı
Uluslararası Yayınlar Diabetes, Obesity & Metabolism, 3, 332-337 (2001)
ABSTRACT
Aims  Foot infections and the subsequent amputation of a lower extremity are the most common cause of hospitalization among patients with diabetes mellitus. Although there are several reasons for susceptibility to infection in diabetic patients, white blood cell dysfunction is considered to be an important cause for this tendency. Granulocyte-colony stimulating factor (G-CSF) increases the release of neutrophils from the bone marrow and improves neutrophil functions. Based on this knowledge, the aim of the present study was to investigate the effects of addition of G-CSF to the treatment of foot infections in diabetic patients.
 
Methods  Thirty diabetic patients with foot infection were included in the study. Fifteen of the patients received standard treatment consisting of local wound care and antibiotics (standard goup), and the other 15 patients received G-CSF besides standard treatment (G-CSF group). The objectives of this study were to determine the time to resolution of infection, time to hospital discharge, need for surgical intervention, and the effects of G-CSF on phagocytosis and respiratory burst of neutrophils.
 
Results  Treatment with G-CSF led to significantly higher neutrophil counts on the 5th and 10th days, and at the end of treatment in the G-CSF treated group compared to the standard group. Respiratory burst of neutrophils increased significantly in both the G-CSF group (from 1.6 ± 0.3 to 2.3 ± 0.5, p = 0.001) and the standard group (from 2.0 ± 0.4 to 2.3 ± 0.4, p = 0.02) with treatment. But, while phagocytosis of neutrophils increased significantly in the G-CSF group (from 70.4 ± 2.0 to 74.5 ± 1.9, p = 0.004), it did not change significantly in the standard group (from 68.1 ± 0.2 to 69.4 ± 1.9, p = 0.3) with treatment. Duration of hospitalization (26.9 ± 2.0 vs. 28.3 days, p < 0.05), duration of parenteral antibiotic administration (22.9 ± 2.0 vs. 23.3 ± 1.9 days, p < 0.05), time to resolution of infection (23.6 ± 1.8 vs. 22.3 ± 1.7 days, p < 0.05), and need for amputation (13.3% vs. 20%, p > 0.05) were similar between the G-CSF and the standard groups.
 
Conclusions  Although G-CSF improves neutrophil function as well as increasing the absolute numbers, this improvement is not associated with shortening of duration of antibiotic administration, duration of hospital stay or need for amputation in diabetic foot infection.
 

4. Insulin resistance in nonobese patients with polcystic ovary syndrome 2001

Toprak, S., A. Yonem, B. Cakir, S. Güler, Ö. Azal, M. Ozata ve A. Çorakçı
Uluslararası Yayınlar Hormone Research, 55:65-70 (2001)
ABSTRACT

Objectives: Most patients with polycystic ovary syndrome (PCOS) are obese and known to have insulin resistance. Obesity per se is a cause of insulin resistance. This study was performed to determine whether insulin resistance occurs in patients with PCOS in the absence of obesity and acanthosis nigricans. Method: For this purpose, an euglycemic hyperinsulinemic clamp study was performed in 12 nonobese patients with PCOS and in 10 healthy control subjects matched for age and weight. Results: The mean serum testosterone and luteinizing hormone (LH) levels were significantly elevated (4.09 ± 1.32 vs. 1.18 ± 0.53 pg/ml, p < 0.001, and 11.63 ± 5.37 vs. 4.98 ± 2.73 mIU/ml, p < 0.001, respectively), and the serum sex hormone binding globulin level was significantly reduced (40.96 ± 14.94 vs. 73.98 ± 30.40 nmol/l, p < 0.001) in patients with PCOS as compared with the values in control subjects. The mean serum insulin level was also elevated in patients with PCOS as compared with control subjects (32.33 ± 4.98 vs. 19.56 ± 2.21 µU/ml, p < 0.05). The insulin sensitivity was lower in patients with PCOS as compared with the control subjects (200 ± 27.8 vs. 427.8 ± 88.9 µmol kg–1min–1, p < 0.001). In patients with PCOS, the serum levels of free testosterone (r = –0.89, p < 0.001) and LH were inversely correlated with the insulin sensitivity (r = –0.63, p < 0.05). Serum follicle-stimulating hormone, prolactin, and dehydroepiandrosterone sulfate levels were similar in both groups.Conclusions: These results indicate that a significant degree of insulin resistance exists in nonobese patients with PCOS and that this insulin resistance is significantly related to serum LH and free testosterone levels. Thus, measures to decrease insulin resistance may have to be considered earlier to decrease the potential risks of developing diabetes mellitus and coronary artery disease at later ages of life in these patients.

3. Plasma Leptin Concentrations in Postmenopausal Women with Osteoporosis 2000

Odabaşı, E., M. Özata, M. Turan, N. Bingöl, A. Yönem, B. Çakır, M. Kutlu ve İ.Ç. Özdemir
Uluslararası Yayınlar European Journal of Endocrinology, 142:2, 170-173 (2000)
ABSTRACT
BACKGROUND: The obese are usually protected against osteoporosis and have increased bone mineral density and plasma leptin concentrations. A recent in vitro study demonstrated that leptin acts on human marrow stromal cells to enhance differentiation to osteoblasts, suggesting an influence of leptin on bone mass. However, little is known about the relationship between plasma leptin and bone mass in postmenopausal women with osteoporosis. OBJECTIVE: To investigate plasma leptin concentrations in postmenopausal women with osteoporosis to improve the understanding of the role of leptin in determining bone mass. METHODS: Fifty postmenopausal women with osteoporosis (ages 61.18+/-6.51 years; body mass index (BMI) 28. 91+/-3.44kg/m(2), mean+/-s.d.) and 30 age- and BMI-matched healthy postmenopausal women were included in the study. Bone mineral densities (BMD) were measured by dual energy X-ray absorptiometry. Plasma leptin concentrations were determined using an immunoradiometric assay. RESULTS: The median spine BMD value in the patient group (0.695+/-8.26g/cm(2), median+/-s.e.m.) was significantly lower than that in the control group (1.006+/-1. 29g/cm(2), median+/-s.e.m.; z=-7.454, P<0.001). The median plasma leptin concentration in the patient group (18.70+/-1.78ng/ml, median+/-s.e.m.) was not significantly different from that in the control group (22.35+/-2.20ng/ml, median+/-s.e.m.; z=-1.630, P=0. 103). Plasma leptin concentrations were correlated with BMI in both groups (r(s)=0.394, P=0.031 in controls and r(s)=0.404, P=0.004 in the patient group). There was no correlation between plasma leptin concentrations and BMD values in controls (r(s)=-0.107, P=0.575) but a weak correlation was observed in the patient group (r(s)=0.285, P=0.045). CONCLUSION: Our data suggest that circulating plasma leptin does not have a significant direct influence on bone mass in postmenopausal women.

2. Leptin Concentrations are Related to Glycaemic Control, But do not Change with Short Term Oral Antidiabetic Therapy in Female Patients with Type II Diabetes Mellitus 2000

Güler, S., B. Çakır, B. Demirbaş, G. Gürsoy, R. Serter ve Y. Aral
Uluslararası Yayınlar Diabetes, Obesity & Metabolism, 2, 313-316 (2000)
ABSTRACT

This study evaluated the relation of leptin with glycaemic control and the effect of 14 days of diet, or diet combined with gliclazide, glipizide-GITS or metformin treatment, on leptin concentration in 51 female patients with type 2 diabetes mellitus. Leptin levels were similar both at baseline and after treatment in diabetic and control groups. Diabetic patients with basal fasting plasma glucose (FPG) < 10 mmol/l or with basal postprandial plasma glucose (PPPG) < 13.9 mmol/l had significantly higher leptin levels than diabetic patients with basal FPG ≥ 10 mmol/l or with basal PPPG ≥ 13.9 mmol/l (19.6 ± 8.7 vs. 13.65 ± 5.4 μg/l, p < 0.05; and 20.2 ± 7.9 vs. 12.9 ± 5.2 μg/l, p < 0.05, respectively). Mode of treatment did not influence leptin levels. Δ leptin showed a weak correlation with basal FPG (r = 0.346; p < 0.05), basal and post-treatment PPPG (r = 0.335, p < 0.05 and r = 0.325, p < 0.05, respectively) and a moderate correlation with post-treatment FPG (r = 0.391, p < 0.01). In conclusion, leptin level is not affected by the presence of type 2 diabetes mellitus and by short-term treatment with diet or oral antidiabetic drugs but is directly related to glycaemic control in female patients with type 2 diabetes mellitus.

1. Relation of Leptin and Tumor Necrosis Factor α to Body Weight Changes in Patients with Pulmonary Tuberculosis 1999

Çakır, B., A. Yönem, S. Güler, E. Odabaşı, B. Demirbaş, G. Gürsoy, ve Y. Aral
Uluslararası Yayınlar Hormone Research, 52, 279-283 (1999)
ABSTRACT

In this study we investigated whether leptin and TNFalpha levels change with improvement in body weight with antituberculotic therapy in active tuberculosis patients. 30 patients (8 females and 22 males) with active pulmonary tuberculosis formed the patient group, and 25 sex- and age-matched healthy subjects (8 females and 17 males) served as the control group. Body weight, body mass index (BMI) and serum leptin and plasma TNFalpha levels are measured before and in the sixth month of therapy in all patients. Before the initiation of therapy, BMI of the patients was significantly lower than BMI of the controls (20.2 +/- 1.6 vs. 25.2 +/- 2.7 kg/m(2), respectively; p < 0.05). After treatment, BMI of the patients increased significantly to 21.4 +/- 1.9 kg/m(2) (p < 0.05), but was still lower than that of the controls (p < 0.05). Pretreatment serum leptin (4.5 +/- 0.9 vs. 2.1 +/- 0.2 ng/ml, respectively; p < 0.05) and plasma TNFalpha (27.9 +/- 3.4 vs. 23.9 +/- 3.0 pg/ml, respectively; p < 0.05) levels of the patients were significantly higher than those of the controls. After treatment, serum leptin levels increased to 6.7 +/- 2.2 ng/ml, but this rise was not statistically significant (p > 0.05). Treatment did not result in any significant change in TNFalpha levels, either. Delta leptin was highly related to Delta BMI in patients with tuberculosis (r = 0.68, p = 0.02). In the pretreatment period, there was a significant correlation between leptin and TNFalpha levels in the whole patient group (r = 0.78, p < 0.001), and in female (r = 0.74, p < 0.001) and male patients separately (r = 0.74, p = 0.035). In conclusion, leptin and TNFalpha may be responsible for the weight loss in pulmonary tuberculosis patients, but their levels do not change with improvement in body weight with antituberculotic treatment.