SUMMARY

Malignant mesenchymal thyroid tumors are one of the rarest types of thyroid cancer. Clinically, these tumors present as a rapidly growing thyroid mass. Due to their rarity and nonspecific findings, they are not the first conditions that come to mind during differential diagnosis. We report herein the case of an 87-year-old woman presenting with a rapidly growing thyroid mass in whom the differential diagnosis of anaplastic cancer was challenging. Following work up, the patient was diagnosed with primary fibrosarcoma of the thyroid, a rare type of malignant mesenchymal thyroid tumor. Because she declined surgery and her clinical condition was unsuitable for chemotherapy, she was treated with palliative radiotherapy. Primary thyroid fibrosarcoma is a rare cause of thyroid cancer and should be considered in the differential diagnosis of rapidly growing thyroid masses.

Abstract

Purpose: To determine whether early repeat fine needle aspiration biopsy (FNA) has an effect on adequate or atypia of undetermined significance (AUS) cytology rates in thyroid nodules with inadequate or AUS result in the first FNA.

Methods: Nodules of patients who underwent repeat biopsy due to insufficient or AUS cytology between 2019-2022 were included. Data of the patients and ultrasonographic, cytological and histopathological results of the nodules were recorded. Additionally, the time between the two biopsies was noted. The first was called "initial" and the second was called "rebiopsy". Five different paired groups were formed according to the time between two consecutive biopsies; before and after 1 month, 45 days, 2 months, 3 months, and 6 months. The groups were compared in terms of adequate and AUS cytological results.

Results: We evaluated 1129 patients with 2187 nodules undergoing FNAB. After excluding nodules with one FNA result and/or missing data, 966 nodules of 628 patients who underwent FNA at least twice were included. Initial cytology was nondiagnostic (ND) in 665 (30.4%) and AUS in 301 (13.8%) nodules. The mean age of the patients was 52.0 ± 11.9 years, and the female sex ratio was 78.8% (n = 495). There were no differences in adequate or AUS rebiopsy results according to the different time interval groups (p > 0.05 for all). AUS result was statistically insignificantly more frequent in nodules with initially AUS nodules when rebiopsy was performed before 1 month in comparison to after 1 month (53.8%, 27.1%; p = 0.054). Accuracy of rebiopsy was also similar in the time intervals groups (p > 0.05 for all).

Conclusion: In patients with inadequate or AUS initial biopsy, the rate of adequate or AUS cytology results at rebiopsy did not vary with the timing of repeat biopsy indicating that there may be no need to wait 1 month for a repeat biopsy. In patients with suspicious nodules, biopsy might be repeated before 1 month.

Abstract

Background and study aims: Nonalcoholic fatty liver disease is the most prevalent chronic liver disease globally and is linked to augmented susceptibility to type 2 diabetes mellitus (DM), cardiovascular disease, and microvascular complications inherent to DM, such as nephropathy, neuropathy, and retinopathy. The fibrosis-4 (FIB-4) scoring system, a noninvasive tool, is useful for predicting the extent of liver fibrosis across diverse pathologies. This study aimed to assess the potential predictive role of FIB-4 scores in microvascular complications associated with diabetes.

Patients and methods: The medical records of patients with type 2 DM admitted to our endocrinology clinic between February 2019 and December 2020 were retrospectively evaluated. Parameters including demographic attributes, fasting blood glucose, glycated hemoglobin, aspartate aminotransferase, alanine aminotransferase, thrombocyte levels, and microvascular complications were recorded. The FIB-4 score was computed, and patients were categorized based on these scores (<1.3 and ≥ 1.3).

Results: The analysis included 312 patients with a median age of 60 (50-68 years); 39.7 % were men. The median duration of diabetes was 10 years (5-20 years), and the median FIB-4 score was 0.93 (0.63-1.34). Neuropathy, nephropathy, and retinopathy were observed in 50.6 %, 31.4 %, and 34 % of the patients, respectively. Although the FIB-4 score did not differ significantly between patients with and without neuropathy or retinopathy, patients with nephropathy exhibited higher FIB-4 scores. Notably, patients with FIB-4 scores ≥ 1.3 demonstrated a significantly higher prevalence of nephropathy. Logistic regression analysis demonstrated that higher FIB-4 scores were significantly associated with an increased risk of nephropathy.

Conclusion: The FIB-4 score is a cost-effective and straightforward tool with potential applicability in predicting nephropathy in individuals with type 2 DM.

Abstract

Introduction: High-resolution ultrasonography devices have led to the increased detection of thyroid nodules and the need for fine-needle aspiration biopsy (FNAB). However, FNAB is an invasive procedure that can cause discomfort and pain. Music therapy has been used for centuries to alleviate pain, and our clinical trial was conducted to investigate its impact on pain scores during thyroid FNAB.

Materials and methods: We conducted a randomized, controlled clinical trial, including adult patients undergoing thyroid FNAB. We evaluated the nonpharmacological intervention of listening to music before and during thyroid FNAB. We used a slow, nonlyrical, flowing melody with a tempo of 60 to 80 beats per minute as a therapeutic intervention for managing anxiety and pain. It had low tones, minimal percussion, and a volume of around 60 dB. The Beck Anxiety Inventory and Visual Pain Scale were used.

Results: The study included 529 patients assigned to either the music group (n = 258, 48.7%) or the control group (n = 271, 51.2%). The patients were categorized into subgroups based on either a single nodule (73.63%) or multiple nodules (24.18%). When all patients or single nodule and multiple data are examined separately, the intervention group showed statistically significantly lower pain scores than the control group.

Conclusion: Our study is among the first on this topic and the largest in the available literature to demonstrate that listening to music during FNAB significantly reduces pain and anxiety. Music therapy is an effective, safe, and noninvasive intervention that can improve patient care and reduce distress and pain.

Abstract

Background: To determine whether multiple fine-needle passes to the same thyroid nodule in the fine-needle aspiration (FNA) biopsy session affect sufficient and/or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) cytological result.

Methods: Ultrasonography(US) and cyto-histopathology results of the nodules of patients were retrospectively analyzed. The nodules were divided into 2 groups according to the number of needle passes performed in the same FNA session as those with 1 pass (1-pass group) and those with 2 or 3 passes (multiple-pass group).

Results: Totally, 1409 (93.9%) nodules were performed 1 pass, and 91 (6.1%) were performed multiple pass(n=91).The rates of cystic/mixed nodule, macrocalcification, and Thyroid Imaging Reporting and Data System 3 score were higher in the multiple-pass group (P=.001, P=.039, P=.006, respectively). Adequacy and AUS/FLUS rates were similar between the 2 groups. When nodules with macrocalcifications and cystic/ mixed structures were evaluated as 2 separate subgroups, the rates of the adequacy and AUS/FLUS were similar between 1-pass and multiplepass groups within each subgroup.The number of passes showed no univariate or multivariate significant effect on sufficient and/or AUS/FLUS cytology results (P > .05).

Conclusion: Although more passes are performed in cystic/mixed and macrocalcified nodules estimating that the material would be insufficient with macroscopic on-site evaluation, needle insertion of 2 or 3 times does not affect obtaining sufficient and/or AUS/FLUS cytology compared to 1 pass.

Abstract

There are quite a lot of studies investigating preoperative factors that might be used to predict postoperative hypocalcemia (PH) in thyroidectomized patients; however, there are less studies in parathyroidectomized patients, especially in patients who underwent single parathyroid adenoma excision by using the focused surgical approach. In this study, our aim was to determine whether any preoperative clinical, laboratory, or ultrasonographical feature anticipates PH in parathyroidectomized patients due to primary hyperparathyroidism (PHPT). All patients who operated for PHPT between 2019 and 2021 were retrospectively evaluated. Patients undergoing single parathyroidectomy by using the focused surgical approach were included in the study. Demographic, clinical, ultrasonography, and histopathology results were noted and compared in patients with and without early PH within 4 days after surgery. Of 181 parathyroidectomized patients, 98 underwent focused parathyroidectomy for single parathyroid adenoma. PH was observed in 36 (36.7%) patients. Patients with PH were younger compared to without PH (p = 0.018). Gender distribution and the presence of osteoporosis were comparable. Nephrolithiasis was less prevalent in the hypocalcemia group (p = 0.034). Preoperative levels of calcium, phosphorus, magnesium, parathyroid hormone, alkaline phosphatase, and 25 OH vitamin D were similar in the two groups. Fractional excretion of calcium (FECa) was lower in the PH group (p = 0.045, p = 0.001). Ultrasonographic and histopathologic diameters and volumes of parathyroid lesions were not different in both groups (p > 0.05 for all). In the multivariate analysis, only being 50.5 years old or younger and without nephrolithiasis were found to be associated with PH (p = 0.016, p = 0.026). Patients younger than 50.5 age and without nephrolithiasis might require closer follow-up for the development of early PH.

 

Abstract

Purpose: In the follow-up of patients with thyroid cancer, recurrences are often detected, posing challenges in locating and removing these lesions in a reoperative setting. This study aimed to assess the effectiveness of preoperative ultrasound (US)-guided injection of patent blue (PB) dye into the recurrences to aid in their safe and efficient removal.

Methods: In this retrospective analysis, we reviewed the records of the patients in a tertiary care centre between February 2019 and March 2023 who underwent US-guided PB injection in the endocrinology outpatient clinic before reoperative neck surgery. The duration between the injection of PB and the initiation of surgery was recorded. The complications and effectiveness of the procedure were evaluated using ultrasonographic, laboratory, surgical, and pathologic records.

Results: We reached 23 consecutive patients with 28 lesions. The recurrences averaged 8.8 mm (4.1-15.6) in size and were successfully stained in all cases. The median time between the PB injection and the incision was 90 (35-210) min. There were no complications related to the dye injection. The blue recurrences were conveniently identified and removed in all cases.

Conclusions: A preoperative US-guided injection of PB is a safe, readily available and highly effective technique for localising recurrent tumours, even in small lesions within scarred reoperative neck surgeries.

 

Abstract

Purpose: In previous studies, magnesium (Mg) was found to be lower in cases with more severe primary hyperparathyroidism (PHPT) and higher calcium (Ca) levels. This study evaluated the relationship between serum Mg and serum Ca and phosphorus (P) levels in PHPT and their utility in determining the presence of osteoporosis and nephrolithiasis.

Methods: Patients who were followed up with PHPT between March 2019 and March 2023 were analyzed retrospectively. Biochemical data, renal ultrasonography results, dual-energy x-ray absorptiometry (DEXA) reports, and technetium 99 m sestamibi parathyroid scintigraphy reports were obtained. MgxP, Mg/P, Ca/P, and corrected Ca (cCa)/P values were calculated. The relationships between biochemical parameters and clinical outcomes were evaluated statistically.

Results: A total of 543 patients were included in the study. Patients with nephrolithiasis had higher cCa/Mg or Ca/Mg than those without nephrolithiasis. Additionally, ROC analysis revealed that cCa/Mg greater than 5.24 could identify the presence of nephrolithiasis with a sensitivity of 73.3% and a specificity of 73%. No statistically significant correlation existed between the results of the Mg/P, MgxP, cCa/Mg, Ca/Mg values, and DEXA-bone mineral densitometry(BMD).

Conclusion: Ca/Mg and cCa/Mg ratios in particular seem more valuable in determining the presence of nephrolithiasis than the currently used 24-h urine Ca measurement. Compared to urinary Ca measurements, they are cheaper, more practical, and more accessible.

 

Abstract

 

Objective: This study aims to evaluate the presence of multiple endocrine neoplasia-1 mutations in patients with primary hyperparathyroidism detected on clinical and sonographical suspicion.

Methods: We scanned the medical records of 361 patients with primary hyperparathyroidism between January 2010 and December 2017.

Results: Fourteen of 361 patients (i.e., 2 males and 12 females) with primary hyperparathyroidism were evaluated genetically upon clinical and sonographical suspicion. Menin gene mutations were found in 3 of 14 patients (21.4%) patients. The frequency of multiple endocrine neoplasia-1 (n=3) was estimated to be 0.83% in all patients with primary hyperparathyroidism (n=361). Data of 4 patients with menin mutation analyses were as follows: case 1: A 37-year-old man presented with a 14-year history of recurring nephrolithiasis. He was diagnosed with primary hyperparathyroidism. Genetic analysis was reported as multiple endocrine neoplasia-1: c.643_646delACAG (p.Thr215Serfs*13) heterozygote; case 2: A 35-year-old man with primary hyperparathyroidism and prolactinoma was diagnosed. Genetic analysis was reported as multiple endocrine neoplasia-1: c.654+1G>A heterozygote; case 3: A 26-year-old woman with hyperammonemia, partial empty sella, and hyperprolactinemia was evaluated. Genetic testing revealed heterozygote genomic changes in c984c>a in the multiple endocrine neoplasia-1 gene on the seventh exon; case 4: A 27-year-old man was diagnosed with nephrolithiasis when he was 19 years old. He had both primary hyperparathyroidism and prolactinoma. Multiple endocrine neoplasia-1 and CDKN1B genetic mutation analyses were negative. Because mutation-negative syndromes could not be ruled out, a neck exploration was performed, and a parathyroid adenoma was excised.

Conclusions: Patients with primary hyperparathyroidism should be evaluated for multiple endocrine neoplasia-1 mutations upon clinical and sonographical suspicion. It should be noted that an individual with the multiple endocrine neoplasia-1 gene mutation has a 100% penetrance up to the age of 40-50 years. Additionally, 2 novel multiple endocrine neoplasia-1 mutations were identified.

 

Abstract

Introduction: Computerized thoracic tomography (CT) imaging was extensively employed, especially in the early months of the COVID-19 pandemic. An incidental thyroid nodule (ITN) is defined as a nodule not previously detected or suspected clinically but identified via an imaging study. The present study aimed to determine the incidence of thyroid nodules incidentally detected in thoracic CTs for the suspicion of COVID-19 pneumonia.

Materials and methods: Adult patients who underwent thoracic CT in our hospital for COVID-19 management were retrospectively identified between March 2020 and September 2020. Medical information registered in the hospital and national health system was reviewed. The prevalence of incidental thyroid nodules at CT, thyroid function test results of patients with incidental lesions, correlation of CT findings with ultrasonography (US) findings, and fine-needle aspiration biopsy (FNAB) results were evaluated.

Results: We analyzed 35,113 patients who had COVID-19-indicated CT scans. There was information about the thyroid gland in CT reports of 3049 patients. The prevalence of ITN was 3.82% (1343/35,113 patients) and thyroid heterogeneity was 1.11% (388/35,113 patients). While it was explicitly stated that no pathology was found in the patient's thyroid gland in 3.75% of patients (1318/35,113), no information was given about the thyroid gland in 91.32% of the patients (32064/35,113). Thus, the number of patients informed about their thyroid was 3049 (8.68%) and the number of patients with thyroid pathology was 1731 (4.93%). It was observed that 308 of 1731 patients (17.80%) had follow-up thyroid US. An FNAB was indicated in 238 patients (87.50%). Of the 238 patients with indication for biopsy, only 115 (48.31%) underwent a thyroid FNAB. The cytological diagnosis was benign in 59 (51.30%), non-diagnostic in 30 (26.08%), atypia of uncertain significance in 22 (19.13%), and suspected follicular neoplasia/follicular neoplasia in four patients (3.46%). Thyroidectomy was performed in six more patients due to large nodules and the final diagnosis was benign in two and papillary thyroid cancer in three patients.

Conclusion: Increased use of thoracic CT during the COVID-19 pandemic probably enabled improved detection of ITNs. In this large-scale study, the prevalence of thyroid nodules reported with thoracic CT was 3.82%, while thyroid cancer was detected in 1.30% of patients evaluated with US. We recommend against using thoracic CT scans as a direct means of assessing thyroid disease owing to the low number of detected cancer cases in our cohort of 35,113 patients. However, thoracic CT scans obtained for various reasons might provide the opportunity for early diagnosis and treatment of thyroid disease, including cancers.

Abstract

Background and objective: Artificial intelligence (AI) applications such as Chat Generative Pre-Trained Transformer (ChatGPT) created by OpenAI, which represent the revolutionary aspects of today's technology, have benefitted professionals in many fields and society at large. In this study, we aimed to assess how effective is ChatGPT in helping both the patient and the physician manage thyroid nodules, a very common pathology.

Methods: Fifty-five questions frequently asked by patients were identified and asked to ChatGPT. Subsequently, three cases of thyroid nodules were progressively presented to ChatGPT. The answers to patient questions were scored for correctness and reliability by two endocrinologists. As for the cases, diagnostic and therapeutic approaches provided by ChatGPT were analyzed and scored by two endocrinologists for correctness, safety, and usability. The responses were evaluated by using 7-point Likert-type scales designed by us.

Results: The answers to patient questions were found to be mostly correct and reliable by both raters (Rater #1: 6.47 ± 0.50 and 6.27 ± 0.52; Rater #2: 6.18 ± 0.92 and 6.09 ± 0.96). Regarding the management of cases, ChatGPT's approach was found to be largely correct, safe, and usable by Rater #1, while Rater #2 evaluated the approaches as partially or mostly correct, safe, and usable. Conclusion: Based on our findings, ChatGPT can be used as an informative and reliable resource for managing patients with thyroid nodules. While it is not suitable to be used as a primary resource for physicians, it has the potential to be a helpful and supportive tool.

Abstract

Background: The sensitivity of cytological (CY) evaluation after fine-needle aspiration (FNA) for detecting medullary thyroid carcinoma (MTC) is a subject of controversy. The routine use of serum calcitonin (CT) in patients with thyroid nodules is not universally adopted. The authors conducted CT screening of FNA washout fluid (FNA-CT) to address the diagnostic challenges. The objective was to assess the contributions of serum CT, FNA cytology (FNA-CY), and FNA-CT to the diagnosis.

Methods: Between February 2019 and June 2022 (group 1), the authors prospectively screened the CT of patients with thyroid nodules. Both FNA-CY and FNA-CT were performed for patients with persistently elevated CT values. The sensitivity of FNA-CY, serum CT, and FNA-CT for accurate diagnosis was evaluated. Additionally, the authors retrospectively examined data from patients with thyroid nodules before CT screening (2008-2019) (group 2). They compared the characteristics of MTC patients in groups 1 and 2.

Results: MTC was identified in 30 patients (0.25%) in group 1 and 19 (0.07%) in group 2. A FNA-CT cutoff value of 4085.5 pg/mL detected MTC with a sensitivity of 96.8%, and a serum CT cutoff value of 28.3 pg/mL detected MTC with a sensitivity of 86.7%. In contrast, FNA-CY detected MTC with a sensitivity of 42.4%. In group 1, 18 patients (60%) with MTC were diagnosed with microcarcinoma, whereas only two patients (10.5%) in group 2 had microcarcinoma.

Conclusions: This study detected MTC earlier by routinely measuring serum CT in all patients with nodular thyroid disease and performing FNA-CT in those with elevated values. FNA-CT and serum CT sensitivities were significantly higher than those of FNA-CY. This study revealed different FNA-CT cutoff values compared to other studies, emphasizing the need for determining clinic-specific cutoff values.

Abstract

Objective: This study aims to investigate the frequency of fibromyalgia and its predictors in women with polycystic ovary syndrome (PCOS) and its relationship with insulin resistance, and to assess the effect of fibromyalgia on the anxiety and depressive symptoms in PCOS patients, and how the quality of life was affected by this combination.

Measurements: The study was conducted with 74 women with PCOS according to the Rotterdam criteria, which applied to our tertiary care clinic between January 2021 and January 2022, and 51 controls. Endocrinologic and rheumatologic examinations, biochemical and hormonal analyses, and radiologic imaging are made. Hospital anxiety and depression scale (HADs) and Short Form 36 (SF-36) quality of life scale were applied.

Results: There was no statistical difference between patients (n = 74 (23%)) and controls (n = 51 (13.7%)) in terms of fibromyalgia frequency. This frequency was 41.4% in PCOS patients with insulin resistance. The presence of insulin resistance was significantly higher in patients with PCOS and fibromyalgia (70.4%, 12 of 17 patients with fibromyalgia for the PCOS group; 8.3%, 1 of 7 patients with fibromyalgia for the control group) (χ2 = 9.130, p=0.003). Higher HOMA-IR levels (B = 1.278, p = 0.034) and age (B = 1.134, p = 0.022) were significant predictors of fibromyalgia in PCOS patients. Physical functioning (U = 1.960, P = 0.050), bodily pain subscales (U = 2.765, p = 0.006), and physical health summary measure (U = 2.296, p = 0.022) were significantly lower, VAS pain (U = 5.145, p < 0.0001) and fatigue (U = 5.997, p < 0.0001) scale scores were higher in PCOS patients with fibromyalgia.

Conclusions: Our results show that fibromyalgia is frequent in PCOS patients with insulin resistance.

Abstract

Objective: The present article analyses pre-operative demographic, biochemical, sonographic and histopathological characteristics of low-risk thyroid neoplasms (LRTNs), with a focus on four subgroups, "well-differentiated carcinoma-not otherwise specified" (WDC-NOS), "non-invasive follicular thyroid neoplasm with papillary like nuclear features" (NIFTP), "well-differentiated tumours of uncertain malignant potential" (WDT-UMP) and "follicular tumour of uncertain malignant potential" (FT-UMP).

Methods: The study retrospectively analyzed the histopathology of 2453 malignant thyroids and the final analyses included 99 cases diagnosed with LRTNs. The demographic and clinical features, pre-operative thyroid function, ultrasonography results, cytopathology results, histopathology results and prognostic classifications were assessed.

Results: The groups were similar demographic characteristics and the majority of clinical data, including comorbidities, thyroid function tests, thyroid cancer/neck radiotherapy history. NIFTPs represented 69.7% of all LRTNs. All (100%) WDT-UMPs had solitary nodules. Index nodule volume differed among the groups (p = .036), it was the lowest in WDC-NOS [0.68 (0.63-0.72 cc)] and highest in FT-UMP [12.6 (0.5-64 cc)]. Echogenicity findings were similar. Index nodule TIRADS demonstrated a significant difference (p = .021) but index nodule halo sign and BETHESDA scores were similar in all groups. The diameter, localisation and multicentric structure of LRTNs were again similar for all groups. Finally, prognostic scores suggested similar outcomes in all groups.

Conclusion: The majority of LRTNs were NIFTPs in our population and all WDT-UMPs were solitary lesions. Index nodule volume was the most essential discriminating sonographic finding but further research must be performed before discriminatory potential can be described.

Abstract

Purpose: Thyroid-stimulating hormone (TSH) has a pulsatile and circadian rhythm in healthy individuals. We aimed to evaluate the diurnal changes of free thyroid hormones and serum TSH levels in patients with end-stage renal failure (ESRF) whose thyroidal functions are at normal ranges.

Methods: Thirty hemodialysis patients with chronic renal failure and without a known thyroidal disease who are over 18 and 35 healthy individuals were included. The serum TSH, free T3, and free T4 levels were examined among the patient and control group which were taken at 8:00 a.m., 4:00 p.m., and 0:00 a.m.

Results: Twenty-two (73.3%) patients were male, and the mean age of the patient group was 64 (sd = 14.45 years). Seventeen (48.6%) of the control group were female, and the mean age was 31.9 (sd = 6.4 years). Serum free T3 levels, measured at three different time points (8:00 a.m., 4:00 p.m., and 0:00 a.m.), were significantly lower in the patient group than in the control group and serum free T4 levels were measured at three different time points (8:00 am, 4:00 p.m., and 0:00 a.m.) were significantly higher in the patient group than in the control group. Serum TSH levels were higher in the patient group than in the control group at 08:00, and were lower at 24:00 (p < 0.001). The nocturnal increase of serum TSH level under 0.525 suggested diurnal rhythm disruption with 83% sensitivity and 87% specificity.

Conclusion: The nocturnal serum TSH increase is not seen in ESRF patients who did not have a thyroid disease. We think that not observing a nocturnal TSH increase could be an early indication of the sick euthyroid syndrome.

Abstract

Background/aim: The aims of the study are to compare characteristics of subacute thyroiditis (SAT) related to different aetiologies, and to identify predictors of recurrence of SAT and incident hypothyroidism.

Methods: This nationwide multicenter retrospective cohort study included 53 endocrinology centers in Turkey. The study participants were divided into either coronavirus disease-2019 (COVID-19)-related SAT (Cov-SAT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine-related SAT (Vac-SAT), or control SAT (Cont-SAT).

Results: Of the 811 patients, 258 (31·8%) were included in the Vac-SAT group, 98 (12·1%) in the Cov-SAT group, and 455 (56·1%) in the Cont-SAT group. No difference was found between the groups with regard to laboratory and imaging findings. The aetiology of SAT was not an independent predictor of recurrence or hypothyroidism. In the entire cohort, steroid therapy requirement and younger age were statistically significant predictors for SAT recurrence. C-reactive protein (CRP) measured during SAT onset, female gender, absence of anti-thyroid peroxidase (TPO) positivity, and absence of steroid therapy were statistically significant predictors of incident (early) hypothyroidism, irrespective of SAT aetiology. On the other hand, probable predictors of established hypothyroidism differed from that of incident hypothyroidism.

Conclusion:Since there is no difference in terms of follow-up parameters and outcomes, COVID-19- and SARS-CoV-2- vaccine related SATs can be treated and followed up like classical SATs. The recurrence was determined by the younger age and steroid therapy requirement. Steroid therapy independently predict incident hypothyroidism that may sometimes be transient in overall SATs and is also associated with lower risk of established hypothyroidism.

Abstract

We aimed to determine whether any biochemical feature or ultrasonographical diameter can help to predict histopathological diagnosis in patients with primary hyperparathyroidism (PHPT). Data of 398 patients operated for PHPT were evaluated. Patients were grouped as parathyroid hyperplasia (PH), parathyroid adenoma (PA), parathyroid carcinoma (PC) + atypical, and parathyroid adenoma (APA) histopathologically. Three-way ROC analysis was used to evaluate the performance of variables to determine the three groups. The volume under surface (VUS) > 0.17 was giving information beyond chance. Cut-off levels and correct classification rates were calculated when the VUS value was significantly > 0.17. There were 20 patients with PH, 343 with PA, and 35 with PC + APA (30 APA, 5 PC). Serum calcium, phosphorus, alkaline phosphatase, and parathyroid hormone were significantly different between groups (p = 0.007, p = 0.003, p = 0.035, and p < 0.001, respectively). Ultrasonographically, there were significant differences in the anteroposterior, transverse, and longitudinal diameters of lesions (p = 0.001, p = 0.001, and p = 0.002, respectively). The VUS values of serum calcium and anteroposterior and longitudinal diameters of lesions were statistically significantly higher than 0.17. Serum calcium lower than 10.73 mg/dL, 10.73-11.45 mg/dL, and > 11.45 mg/dL were predictive for PH, PA, and PC + APA, respectively. Ultrasonographically, anteroposterior diameter < 6.0 mm and longitudinal diameter < 14.0 mm were predictive for PH, and anteroposterior diameter of > 12.9 mm and longitudinal diameter of > 22.2 mm were predictive for PC + APA. Values in between were predictive for PA. In this study, we found that serum calcium levels and anteroposterior and longitudinal diameters of lesion in ultrasonography can predict the histopathological diagnosis in patients with PHPT.

Abstract

Background: Patients with differentiated thyroid cancer (DTC) are exposed to subclinical exogenous hyperthyroidism for the suppression of thyroid-stimulating hormone (TSH). In this study, we aimed to evaluate the adrenal reserve in DTC patients receiving suppression therapy.

Materials and methods: The study included 55 DTC patients on suppression therapy and 32 healthy volunteers. Basal serum cortisol of all participants and adrenocorticotropic hormone (ACTH) of the patient group were measured. A standard-dose ACTH test (0.25 mg) was performed in patients with a basal cortisol <14.5 mcg/dL.

Results: In the patient group, TSH was lower, free thyroxine (fT4) was higher, and free triiodothyronine (fT3) was similar to those of the control group (p < .01, p < .01, p = .140, respectively). The serum cortisol of the patient group was significantly lower than the control group (12.14 ± 5.12 mcg/dL vs 18.00 ± 5.56 mcg/dL, p < .001). A total of 34 (61.8%) patients with DTC had a basal cortisol <14.5 mcg/dL. Prolonged TSH suppression (≥5 years vs <5 years) was associated with lower basal cortisol (7.46 ± 2.63 mcg/dL vs 9.48 ± 2.65 mcg/dL, p = .022). The ACTH stimulation test showed that 2 (5.8%) patients had a cortisol response <18 mcg/dL. The rate of adrenal insufficiency was 3.6% in DTC patients. A moderate negative correlation was found between ACTH and fT3 of patients with low basal cortisol (r = -0.358, p = .038).

Conclusion: Patients with DTC receiving TSH suppression therapy are at risk for adrenal insufficiency. The duration and severity of suppression might increase this possibility. Dynamic testing with synthetic ACTH can be used to reveal insufficient cortisol response in case of clinical suspicion.

Abstract

Objective:Primary hyperparathyroidism is a common endocrine disease and most cases are asymptomatic. Currently, in a hypercalcemic patient, the first laboratory investigation is serum primary hyperparathyroidism measurement. However, the primary hyperparathyroidism level cannot be measured in many primary healthcare centers in our country. In addition, serum calcium levels are normal in normocalcemic primary hyperparathyroidism patients, even if most centers have serum calcium levels measured. Therefore, a simple and inexpensive laboratory biochemical marker is required for the diagnosis of primary hyperparathyroidism. Recently, the calcium/phosphorus ratio has been proposed as a suitable tool for diagnosing primary hyperparathyroidism. This study aimed to investigate the diagnostic value of serum calcium/phosphorus ratio in primary hyperparathyroidism screening.

Methods: A total of 462 patients followed in our clinic with a diagnosis of primary hyperparathyroidism were reviewed in this retrospective study. Out of these patients, 148 with normal levels of serum parathyroid hormone, calcium, and phosphorus were selected as the control group. Serum calcium, corrected calcium, phosphorus, albumin, parathyroid hormone, 25-hydroxyvitamin D, and creatinine were evaluated. The diagnostic accuracy of the calcium/phosphorus ratio was investigated using receiver operating characteristic curve analysis.

Results: There were 404 (87.4%) females and 58 (12.6%) males in the primary hyperparathyroidism group. Calcium, parathyroid hormone, and calcium/phosphorus ratio were significantly higher in primary hyperparathyroidism than in controls (p<0.001 for each). Receiver operating characteristic curve analyses identified a cutoff value of 2.59 (3.35 if calcium and phosphorus are measured in mg/dL) for the calcium/phosphorus ratio, with a sensitivity of 90.5% and specificity of 93.2% (p<0.001).

Conclusion: The calcium/phosphorus ratio is a simple and inexpensive method for primary hyperparathyroidism screening when a cutoff value of 2.59 is used.

Abstract

Objective: The effect of thyrotropin receptor antibody positivity on the cytology and histopathology of nodules developing on the basis of Graves’ disease is unknown. The objective of this study was to evaluate the relationship between thyrotropin receptor antibody positivity and cytological and histopathological results in Graves’ disease patients.

Methods: A total of 598 patients who underwent thyroidectomy due to Graves’ disease and had preoperative thyrotropin receptor antibody levels were evaluated retrospectively. The study population was divided into 2 groups as thyrotropin receptor antibody-positive and -negative. Thyroid nodule cytology, histopathology results, and tumor characteristics in cases with thyroid cancer were compared between the groups.

Results: Thyrotropin receptor antibody was found as negative in 239 (40%) patients and positive in 359 (60%) patients. Cytological results were available in 363 nodules in the thyrotropin receptor antibody-negative and 185 nodules in the thyrotropin receptor antibody-positive group, and there was no significant difference between the groups in terms of cytology results (P > .05, all). Malignancy was detected in 13.4% of patients in the thyrotropin receptor antibody-positive group and in 13.8% patients in the thyrotropin receptor antibody-negative group (P=.878). There was no difference between the groups in terms of the incidence of papillary thyroid carcinoma (P=.299). The incidences of incidental carcinoma and microcarcinoma were similar in the groups (P=.521 and P=.613). There was no case with lymph node metastasis in both groups. Capsular invasion, vascular invasion, and extrathyroidal extension rates were similar between the groups (P > .05, all).

Conclusion: Contrary to the literature, we found that thyrotropin receptor antibody positivity did not increase the incidence of malignancy and did not affect cytology and histopathology results in Graves’ disease patients.

Abstract

Background/aim: Ultrasonography and fine-needle aspiration biopsy are frequently used to diagnose thyroid cancer. However, supportive data might be required in case of diagnostic difficulty. This study investigated whether there is a relationship between thiol/ disulphide homeostasis and cytological and histopathological diagnosis of thyroid nodules.

Materials and methods: The patient group consisted of 81 individuals with euthyroid nodular (single/multiple) goiter scheduled for thyroidectomy, and the control group consisted of 28 age- and sex-matched healthy volunteers who had no thyroid nodule on ultrasonographic evaluation. All participants were selected among the admissions to the study clinic between June 2017 and June 2018, and venous blood samples were collected. The samples of the patients were taken before surgery. Thiol and disulphide levels were analysed with the automated spectrophotometric method.

Results: The mean age of the patient group was 45.66 ± 10.45 years, and the mean age of the control group was 43.53 ± 11.49 years (p = 0.365). The increasing Bethesda categories were positively correlated with the disulphide level (r = 0.281, p = 0.011), disulphide/native thiol ratio (r = 0.241, p = 0.030) and disulphide/total thiol ratio (r = 0.250, p = 0.024). Disulphide/native thiol ratio and disulphide/ total thiol ratio were significantly higher in the histopathologically malignant (euthyroid nodular goiter but final pathology reported malignant) compared to histopathologically benign (euthyroid nodular goiter but final pathology reported benign) (p = 0.012; p = 0.007, respectively) and control groups (p = 0.006; p = 0.004, respectively), but no significant difference was found in these ratios between benign and control group (p = 0.711; p = 0.749, respectively). Conclusion: Oxidative stress parameters were significantly higher in thyroid cancer. A positive correlation was detected between Bethesda categories with increased risk of malignancy and the disulphide/native thiol ratio and the disulphide/total thiol ratio.

Abstract

Objective: SARS-CoV-2 might present with multisystem involvement due to its entry into many cells with ACE2 receptors on their surfaces, such as heart, endothelial, and lung alveoli cells. Studies have indicated that COVID-19 infection causes a severe clinical presentation in diabetic patients due to dysregulation of the metabolic and immune systems. The hematological effects of COVID-19 and the relationship of lymphopenia with the severity of the disease have been reported previously. The parameter of percentage of large unstained cells (LUCs) reflects active lymphocytes and peroxidase-negative cells. The neutrophil-to-lymphocyte ratio (NLR) is another reliable marker of inflammation in cases of cardiac diseases, solid tumors, and sepsis. The present study aimed to evaluate whether the parameters of LUCs and NLR differed between diabetic and nondiabetic individuals with COVID-19. Associations with disease severity were also sought.

Materials and methods: In our retrospective study, the data of 1,053 patients [230 diabetic patients (21.83%) and 823 nondiabetic patients (78.15%)] were reviewed. The white blood cell (WBC) count, neutrophil count, neutrophil%, lymphocyte count, lymphocyte%, LUC count, %LUCs, NLR, platelet count, hemoglobin level, HbA1c, history of diabetes, surveillance during hospitalization, and pulmonary infiltration status within the first 24 hours after admission to the hospital were analyzed from the records.

Results: When diabetic patients were compared with nondiabetics, the age [65 (20-90) vs. 42 (18-94) years], WBC count [6.72 (2.6-24.04) vs. 5.91 (1.35-52.68)], neutrophil count [4.29 (1.28-65) vs. 3.68 (0.02-50.47)], neutrophil% [67.53±12.3 vs. 64.08±13.28], NLR [3.35 (0.83-38.11) vs. 2.48 (0.01-68.58)], and LUC count [0.11 (0.03-0.98) vs. 0.1 (0.02-3.06)] of the diabetic group were found to be higher and these differences were statistically significant (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, and p=0.015, respectively).

Conclusions: We determined that LUC counts and NLR values in COVID-19-positive patients with diabetes were statistically significantly higher compared to nondiabetic patients.

Abstract

Background: COVID-19 has caused a pandemic and is associated with significant mortality. The pathophysiology of COVID-19, affecting many organs and systems, is still being investigated. The hypothalamus, pituitary gland, and possibly adrenal glands are the targets of SARS-CoV-2 because of its angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) receptors expression. Hypocortisolemia can be seen in the postinfection period. COVID-19 infection tends to be severe in diabetic patients due to immune dysfunction. In this study, our aim was to investigate the relationship between basal cortisol levels and the course of COVID-19 infection in diabetic and non-diabetic patients.

Methods: Our retrospective study included 311 PCR-positive COVID-19 patients over the age of 18 who were hospitalized in Ankara City Hospital Infectious Diseases Department or Intensive Care Unit (ICU) between 15 March 2020 and 15 May 2020. Serum basal cortisol, fasting plasma glucose (FPG), HbA1c values, and diabetes history were recorded within the first 24 h of hospitalization. The presence of pulmonary involvement was noted from the patients’ imaging records. Pregnant and breastfeeding women, patients with chronic liver disease or chronic kidney disease, and patients who were already using steroids or had started COVID-19 infection treatment within the 72 h before blood collection were excluded from the study.

Results: Of the 311 patients, 100 had Type 2 Diabetes Mellitus (T2D), while 211 did not. The age, serum basal cortisol, and glucose levels of the patients with T2D (64.51 ± 12.29, 19.5 ± 13.12, and 143.5 (77-345)) were higher than those of the patients without T2D (46.67 ± 16.38, 15.26 ± 8.75, and 96 (65-202)), and the differences were statistically significant (p = 0.004, p = 0.004, and p < 0.001, respectively). The basal cortisol values of the ICU patients (27.89 (13.91-75)) were significantly higher than those of the ward patients (13.68 (1.48-51.93)) and patients who were transferred to the ICU from the ward due to worsening conditions (19.28 (7.74-55.21)) (p < 0.001 and p = 0.007, respectively). The factors affecting ICU admission were determined to be age, T2D history, basal cortisol, and elevation in FPG using univariate logistic regression analysis. In the multiple logistic regression analysis, age, basal cortisol level, and infiltrative involvement in thorax CT were determined to be the risk factors affecting intensive care admission.

Conclusion: High basal cortisol levels in patients with T2D may predict the severity of COVID-19 infection or mortality. Although high basal cortisol levels are among the risk factors affecting ICU admission, patients with COVID-19 should also be evaluated in terms of clinical and laboratory findings and relative adrenal insufficiency.

Abstract

Background: Acromegaly is an acquired disorder related to excessive production of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). Empty sella (ES) is an anatomical condition of sella turcica that is partially or completely filled with cerebrospinal fluid mainly due to intrasellar herniation of subarachnoid space. Here, we describe a patient who presented with clinical and biochemical features of acromegaly and who had an ES on pituitary magnetic resonance imaging (MRI).

Case report: A 73-year-old male patient was consulted in our clinic because of the acromegalic phenotype while planning for colorectal adenocarcinoma surgery. The patient noticed gradual enlarging of his hands, feet and nose for 30 years, but never consulted to any clinician for this reason. Serum GH was 20.6 ng/mL (normal <3 ng/mL) and IGF-1 was 531 ng/mL (normal, 69-200 ng/ml). An oral glucose tolerance test showed no suppression of GH values. T1-weighted MRI revealed an ES. 18F-FDG PET/CT and Ga-DOTATADE PET/CT did not show any finding consistent with ectopic GH secretion. Growth hormone releasing hormone (GHRH) was within the normal range (<100mg/dL). He was treated with long-acting octreotide 20 mg per 28 days. At the 6^th month of treatment, serum GH and IGF-1 levels were decreased to 5.45 ng/mL and 274 ng/mL, respectively.

Conclusion: The mechanism underlying the association of acromegaly and ES remains unclear. Apoplexy on existing pituitary adenoma and then formation of necrosis can proceed to ES. Since our patient did not have a history of pituitary apoplexy and we could not find any reason for secondary ES, we considered primary ES.

Abstract

Eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome) is a rare multisystem necrotizing vasculitis that involves small- to medium-sized blood vessels. We report a rare case of syndrome of the inappropriate antidiuretic hormone (ADH) secretion (SIADH) secondary to EGPA. A 53-year-old man applied with complaints of pain in the large joints and morning stiffness in knee for 2 months. The patient had the history of impaired fasting glucose, asthma, nasal polyps, and urticaria. Physical examination revealed intrinsic muscle atrophy and weakness in the right hand. Peripheral eosinophil count was 9.78 �- 109/L (0.02-0.5), erythrocyte sedimentation rate 39 mm/h (0-20), and C-reactive protein 5.77 mg/dL (0-0.5). Migratory ground-glass pulmonary opacities had been reported in previous chest computed tomography scans. Echocardiography revealed findings compatible with eosinophilic involvement. Electroneuromyographic evaluation showed acute distal axonal neuropathy of right ulnar nerve. EGPA was considered. Oral methylprednisolone treatment was initiated. Intravenous immunoglobulin (IVIG) and cyclophosphamide treatment and gradual tapering of oral steroids were planned. In 24-h urine analysis, sodium was 387 mEq, creatinine was 1156 mg, and volume was 3000 mL. When his medical records were investigated, it was observed that hyponatremia was present for nearly 2 years. While serum osmolality was 270, urine osmolality was 604 mOsm/kg H2O. So, SIADH diagnosis was made. Fluid intake was restricted. Although the patient's sodium level did not return to normal, it rose up to 130 mEq/L. After second cycle of EGPA treatment (cyclophosphamide and IVIG), serum sodium was normal. There is only four other documented cases of SIADH associated with EGPA. We hypothesized that blood supply to the hypothalamus and/or posterior hypophysis might be affected from EGPA vasculitis. Here, in this case, with effective treatment of EGPA, SIADH was resolved which implies a causality between two conditions.

ABSTRACT

Objective: We aimed to evaluate the awareness and perspectives of acromegaly patients in the diagnosis and treatment processes and to evaluate basic clinical and demographic features.

Methods: This cross-sectional study was conducted at the Endocrinology Department of Yildirim Beyazit University between March 2019 and April 2020. A total of 58 acromegalic patients were enrolled. All patients were identified from our database and called for a clinical visit and filling the questionnaire forms.

Results: A total of 58 patients were included in this study (41.4% female). The mean age of the patients was 52±10.8 years. Median year from symptom to diagnosis (min-max) was 2 (1-12). Notably, 55.2% of the patients did not graduate from high school. Of the 58 patients, 30 (51.7%) patients had knowledge about the etiology of their disease. While 12 (20.7%) patients identified their initial symptoms themselves, 75% of the patients reported their symptoms during the clinical history taken by a health care professional. The majority of patients were diagnosed by an endocrinologist (69%). Acromegaly did not affect social life but affected work life and caused early retirement. Transsphenoidal surgery was performed as primary treatment in 96.6% of the patients (n=56). In all, 46 (79.3%) patients received medical treatment with somatostatin receptor ligands (e.g., octreotide or lanreotide long-acting release [LAR]) with or without cabergoline. Overall disease control was achieved in 38 (65.5%) patients.

Conclusions: Acromegaly is usually detected incidentally by clinicians. The diagnosis of acromegaly is delayed in most patients and disease-related complications have already developed at the time of diagnosis. Therefore, increasing the awareness of the society and health care professionals will reduce both disease-related comorbidities and the economic burden on the health system.

ABSTRACT

Purpose: Graves' orbitopathy (GO) is an inflammatory process that may involve the ocular surface, orbital fat, extraocular muscles, and optic nerves in patients with Graves' disease (GD). We aimed to compare thicknesses of retinal layers in patients with GD with and without GO.

Methods: One hundred seven patients with GD [23 with GO (Group 1), 84 without GO (Group 2)] and eighteen volunteers (Group 3) were enrolled. The spectral-domain optical coherence tomography (SD-OCT) was used for ophthalmologic evaluation. Seven retinal layers including retinal nerve fibre layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE) were assessed. The thicknesses of layers were compared in groups.

Results: The median GCL thickness values in groups 1, 2, and 3 were 14 µm, 15 µm, and 17.5 µm, respectively (p = 0.02). The median IPL thickness was 20 µm in group 1, 21 µm in group 2, and 22 µm in group 3 (p = 0.038). The median RPE thickness values in groups 1, 2, and 3 were 16 µm, 17 µm, and 18.5 µm, respectively (p = 0.001). GCL in group 1 was thinner than in group 3 (p = 0.02), while similar in groups 2 and 3 (p = 0.06). IPL in group 1 was thinner than in group 3 (p = 0.035), while similar in groups 2 and 3 (p = 0.13). RPE in groups 1 and 2 was thinner than in group 3 (p = 0.009, p = 0.001, respectively), while it was similar in groups 1 and 2 (p = 0.93). RNLF, INL, OPL, ONL were similar in all three (p > 0.05 for each).

Conclusion: Ganglion cell layer and IPL were thinner in patients with GO than in healthy controls, while both were similar in patients without GO and healthy controls. RPE was thinner in all Graves patients than in healthy controls. Early detection of changes in retinal layers of GD may guide the physician to prevent significant vision problems.

ABSTRACT

In this study, we found that patients with hypoparathyroidism had a problem with calcium medication compliance, and this problem increased with the duration of the disease. We also showed that patients are concerned about the possible side effects of drugs.

Introduction: In this study, we aimed to evaluate adherence to active vitamin D and calcium replacement in patients with post-surgical hypoparathyroidism.

Methods: To elucidate the medication adherence, we performed a questionnaire survey using the six-item "Medication adherence questionnaire"(MAQ). The first, second, and sixth questions reflect the motivation status of the patients whereas the third, fourth, and fifth questions reflect the knowledge about the medication that is received. The responses are scored and patients are classified regarding their motivation to and knowledge about the particular drug.

Results: Totally, 64 patients (male: 12/female: 52; mean age 48.6±11.6 years) who had post-operative hypoparathyroidism were included in our study. Median disease durance was 60 months (min-max: 12-295 months). We found that motivation score of calcium usage was significantly lower compared to vitamin D usage (p<0.001). The calcium motivation score was reversely correlated with disease duration (r= -0.256 and p=0.046). The most common worry about calcium usage was nephrotoxicity, and the most common worries about calcitriol treatment were kidney damage and polyuria. One-third of the patients were taking oral calcium and calcitriol less than the recommended dose.

Conclusion: One-third of patients lack motivation to use calcium whereas half of the patients experiences anxiety about drug-related side effects. This is a preliminary study showing that vital calcium and active vitamin D intake may be interrupted due to side effect anxiety.

ABSTRACT

The first pump developed by Dr. Kadish and his team in 1963 aimed to "continue subcutaneous insulin infusion". The number of patients using insulin pumps has increased since the 1980s. This historical perspective has labeled pump therapy in endocrinology and metabolism synonymous with insulin pumps. However, certain other hormonal disorders might also benefit from this kind of treatment. Pump therapy is currently the best approach to achieve physiological mimicry. Furthermore, it may help in overcoming pharmacokinetic issues or allergies. Until now, hormone replacement via pumps has been a salvage method for complex cases at the expense of increased costs. However, it is believed that applications of pump treatment will widen in the future owing to the rapidly evolving technology. In this mini review, data on pump use for patients with adrenal insufficiency, hypogonadism, hypoparathyroidism, congenital adrenal hyperplasia, and congenital hyperinsulinism have been briefly summarized. The study has aimed at covering all the relevant clinical studies and important case reports/series. METHODS: A systematic literature search has been conducted on PubMed database seeking articles published until May 2021 using a combination of the following Medical Subject Headings terms and keywords: pump "OR" continue infusion "AND" (adrenal insufficiency "OR" Addison "OR" hydrocortisone "OR" hypoparathyroidism "OR teriparatide" "OR" somatostatin "OR" hypogonadism "OR" hypoglycemia "OR" endocrinology "OR" hormone replacement). In addition, the reference publications in the identified articles have also been reviewed.

ABSTRACT

Objective: Familial papillary thyroid cancer (FPTC) is an uncommon and not well-defined clinical entity. Although some studies report more aggressive characteristics in FPTC, others do not favor these findings. This study aimed to analyze the ultrasonographic and cyto-histopathological features of patients with FPTC and sporadic papillary thyroid cancer (SPTC).

Methods: The data of 292 patients diagnosed with PTC histopathologically between 2007 and 2018 were retrospectively reviewed; and their thyroid function tests, ultrasonographic properties, and cyto-histopathological results were compared.

Results: We analyzed 132 tumor foci in 69 patients with FPTC and 322 foci in 223 patients with SPTC. Sex distribution, rate of thyroid autoantibody positivity, and median nodule number were similar in the 2 groups. In preoperative ultrasonographic (US) examination of malignant nodules, the mean nodule diameter was smaller, microcalcification was lower, and isoechogenity were higher in patients with FPTC than in those with SPTC (p=0.001, p=0.005, p=0.0.025, respectively). Cytological results were distributed similarly (p=0.100). Multifocality was higher in patients with FPTC (47.8% vs 30.9%, p=0.009). The median tumor diameters, rate of microcarcinoma, distribution of PTC variants, extracapsular extension, and vascular invasion were comparable. Capsular invasion and regional nodal metastasis were significantly increased in the SPTC group (17.4% vs 9.1%, p=0.024 and 13.0% vs 2.9%, p=0.018; respectively). Although stimulated thyroglobulin levels at the 6th month were higher in the sporadic group, the conventional and dynamic responses were similar in both groups.

Conclusion: Whether FPTC is more aggressive than SPTC is debatable. We found a higher rate of multifocality, but a lower rate of lymph node metastasis in FPTC. The prognosis was similar in patients with FPTC and SPTC. Early detection might lead to an early diagnosis in the familial form of the disease.

Abstract

Aim: We aimed to investigate the presence of thyroid, celiac disease (CD) and anti-parietal cell antibodies (APCA) in adult type 1 diabetes (T1DM) patients.

Methods: Data of 287 T1DM patients >16 years old were reviewed retrospectively. Thyroid disease related, CD related antibodies and APCA were evaluated. Patients were divided into early onset (<30 years old) and late-onset (≥30 years old) TIDM, and ≤10 years, 11-20 years and >20 years according to disease duration.

Results: There were 142 (49.5%) female and 145 (50.5%) male patients. The median age at diagnosis and disease duration were 21 (2-53) and 6.91 (0-50.8) years, respectively. Antibody positivity rates were anti-glutamic acid decarboxylase (anti-GAD) 72.8%, anti-insulin 9.1%, anti-islet cell 25.7%, antithyroid peroxidase (anti-TPO) 34.8%, anti-thyroglobulin 19.9%, anti-endomysial IgA (EMA-IgA) 7.6%, anti-gliadin IgA (AGA-IgA), 12.2%, AGA-IgG 13.0%, tissue transglutaminase IgA 7.1% and APCA 14.4%. One hundred twenty-eight (44.6%) patients had at least one non-diabetes autoantibody. Thyroid autoantibodies and dysfunction were significantly higher in women than men. Anti-TPO positivity was higher in the late-onset group (P = .044). Anti-GAD level was correlated with thyroid related antibody positivity in male patients with positive anti-GAD (r: .340, P: .006). The positivity of EMA-IgA and AGA-IgA was higher in patients with disease duration >20 years (P = .017 and .039, respectively).

Conclusion: Almost half of the adult T1DM patients were positive for at least one non-diabetic antibody. It is important to investigate thyroid autoimmunity in patients diagnosed with T1DM at any age, including advanced age. CD associated antibody positivity increases with disease duration, suggesting that they should be re-evaluated at clinical suspicion, even if prior tests were negative.

ABSTRACT

Objective: Thyroid hormone suppression treatment (THST) is an essential modality in treating differentiated thyroid cancer (DTC). This study aimed to evaluate thiol/disulfide homeostasis with a new method in patients on THST, which causes a state of subclinical hyperthyroidism.

Material and Methods: Serum thyrotrophin (TSH), free triiodothyronine (fT3), free thyroxine (fT4), duration of disease, levothyroxine dose, and radioactive iodine (RAI) dose were evaluated along with native and total thiol and disulfide levels.

Results: Data of 50 patients with DTC and 41 healthy subjects were analyzed. Though native thiol and total thiol were lower in patients with DTC, the difference was not statistically significant. Disulfide was found to be 18.25 μmol/L in DTC patients and 15.23 μmol/L in the control group. The ratios of native thiol to total thiol (N/T), disulfide to native thiol (D/N), and disulfide to total thiol (D/T) were similar in the 2 groups. Disulfide, D/N, and D/T were significantly higher, and N/T was lower in patients with overt thyrotoxicosis than patients with subclinical thyrotoxicosis and the control group. Disulfide, D/N, and D/T were both positively, and N/T was negatively correlated with fT4/fT3.

Conclusion: Although the thiol/disulfide balance was maintained in patients with subclinical thyrotoxicosis, there was a shift of redox status toward disulfide in patients with overt thyrotoxicosis on THST. This suggests that the potency of oxidative stress is associated with the degree of thyrotoxicosis. Considering the potentially harmful effects of oxidative stress, overt thyrotoxicosis must be avoided in patients on THST.

ÖZET

Amaç: Diferansiye tiroid kanserinin (DTK) tedavisinde, tiroid hormon süpresyon tedavisi (THST) önemli bir modalitedir. Bu çalışmada, bir subklinik hipertiroidi durumuna yol açan THST alan hastalarda, thiol/disülfid homeostazını yeni bir metot ile değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Nativ ve total tiol ve disülfid seviyelerinin yanı sıra serum tirotropin (TSH), serbest triiyodotironin (sT3), serbest tiroksin (sT4), hastalık süresi, levotiroksin dozu ve radyoaktif iyot (RAI) dozu değerlendirildi.

Bulgular: DTK’li 50 hasta ve 41 sağlıklı birey analiz edildi. Nativ tiol ve total tiol, DTK’li hastalarda daha düşüktü fakat farklılık istatistiksel olarak anlamlı değildi. Disülfid, DTK’li hastalarda 18,25 μmol/L ve kontrol grubunda 15,23 μmol/L’ydi. Nativ tiolün, total tiole (N/T); disülfidin, nativ tiole (D/N) ve disülfidin, total tiole (D/T) oranı her 2 grupta da benzerdi. Aşikâr tirotoksikozlu hastalarda, subklinik tirotoksikoz ve kontrol grubuna göre disülfid, D/N ve D/T anlamlı olarak daha yüksek ve N/T daha düşüktü. sT4/sT3 oranı disülfid, D/N ve D/T ile pozitif ve N/T ile negatif olarak koreleydi.

Sonuç: THST alan ve subklinik tirotoksikozu olanlarda, her ne kadar tiol/disülfid dengesi korunmuş olsa da aşikâr tirotoksikozu olan hastalarda, redoks durumunda disülfid yönünde kayma vardı. Bu oksidatif stres potensinin, tirotoksikozun derecesiyle ilişkili olduğunu göstermektedir. Oksidatif stresin zararlı etkileri düşünüldüğünde, THST alan hastalarda aşikâr tirotoksikozdan kaçınılmalıdır.

Abstract

The aim of this study was to determine the clinicopathological features of papillary thyroid carcinomas (PTC) without extrathyroidal extension (ETE) and with lymph node metastasis (LNM). PTC > 1 cm increased the risk of LNM by 2.161 times compared to papillary thyroid microcarcinoma. The risk increased by 3.774 times in males and 1.553 times in the presence of multifocality. Presence of vascular invasion (VI) increased the risk of LNM by 3.093 times in patients without capsular invasion (CI). Clinicians should be careful about possible LNM in patients with large primary tumor diameter, multifocal tumors, CI and VI.

Abstract

Background: It is known that serum thyroglobulin (TG) can increase after fine-needle biopsy of thyroid nodules. We aimed to determine whether TG is increased after ultrasonography (US)-guided fine needle capillary biopsy (FNC) of suspicious cervical lymph nodes (LNs) in thyroidectomised patients and investigate the possible association between change in TG and cytology results.

Material and methods: Data of 188 patients who underwent FNC of suspicious cervical LNs were retrospectively evaluated. Demographical, laboratory and ultrasonography features of LNs were noted. TG levels before FNC (TGb-FNC ), after FNC (TGa-FNC ), TGa-FNC /TGb-FNC ratio and the number of patients with increased TG were determined. Patients were grouped as benign, nondiagnostic, suspicious for malignancy and malignant according to the cytological results.

Results: TGa-FNC , TGb-FNC /TGa-FNC and rate of patients with increased TG were significantly higher in malignant cytology group than other groups (P < .001). The optimal cut-off level of TG increase that was predictive for malignancy was 7.6% with a sensitivity of 73.7% and specificity of 85.2%. TG increase was not associated with age, sex, Thyroid-stimulating hormone (TSH) level, anti-TG positivity and US features of LNs while significantly lower in patients who received radioactive iodine (RAI) treatment. Among 31 patients with positive anti-TG, TGb-FNC /TGa-FNC , and rate of patients with increased TG were higher in malignant compared to benign and nondiagnostic cytology groups.

Conclusions: Serum TG increment and rate of patients with increased TG after FNC of suspicious cervical LNs were higher in patients with malignant cytology than with all other cytology results both in all study group and in sub-group of anti-TG positive patients. Increase in TG after FNC might be an additional tool for determining LN metastasis.

Abstract

Introduction: Bilateral inferior petrosal sinus sampling (BIPSS) is an important procedure in the diagnostic work-up of Cushing's syndrome (CS). In this study, we investigated the diagnostic performance of BIPSS in detecting the source of adrenocorticotropic hormone (ACTH) secretion in Cushing's disease (CD) without radiological evidence.

Methods: Thirty-five consecutive patients who underwent BIPSS due to ACTH-dependent CS between 2010 and 2019 in our clinic and subsequently underwent transsphenoidal surgery were included. The indication for BIPSS was biochemically proven ACTH-dependent CS but normal or ≤6 mm pituitary lesion in pituitary magnetic resonance imaging (MRI). Corticotropin releasing hormone (CRH) stimulation was applied to all patients during the BIPSS procedure. BIPSS data, MRI results, pathological findings, and follow-up results were analyzed. The diagnostic performance of BIPSS was calculated.

Results: A total of 35 patients, 6 (17%) males and 29 (83%) females, were included in the study. Pituitary MRI was normal in 12 (34.3%) and revealed lesions ≤ 6 mm in 23 (65.7%) patients. BIPSS lateralized the right side in 13 (37.1%) and left side in 18 (51.4%) patients, while no lateralization was observed in the remaining 4 (11.5%) patients. BIPSS showed lateralization in the same direction with pituitary adenoma in 21 (60%) patients before CRH injection and in 29 (83%) patients after CRH injection (p = 0.034). The sensitivity of the BIPSS procedure was 88%. Accurate localization of the pituitary lesion was more frequent when based on BIPSS results than on MRI (83% vs. 51%, P = 0.005).

Conclusion: BIPSS appears to be a valuable and safe diagnostic tool in patients who are diagnosed with CD biochemically but do not have clear radiological evidence of ACTH-producing lesion.

Abstract

Objective: Thyroid nodules located in isthmus were found less prevalent, although papillary thyroid cancer in this location was reported to be more aggressive behaviour in some studies. Our aim was to evaluate hormonal, ultrasonographic, and cytopathologic features of nodules located in isthmus (isthmic nodules).

Methods: Patients who underwent thyroidectomy between 2006-2014 reviewed retrospectively. Hormonal, ultrasonographic, and cytopathologic features compared between patients with isthmic (Group-1) and with lober (non-isthmic, Group-2) nodules.

Results: Group-1 and Group-2 consisted of 251 and 2076 patients, respectively. 260 isthmic (5.5%) and 4433 non-isthmic (94.5%) nodules were compared. However, most ultrasonographical features such as presence of microcalcification and halo, diameters, echogenicity, texture, margin, and vascularity were similar between groups, macrocalcification rate was lower in isthmic nodules (18.8%, 25.9%; p = 0.012). Cytologic results were also similar. Although malignancy rate was lower in isthmic nodules (6.2%, 12.5%; p = 0.002), type of thyroid cancer was similar in isthmic and non-isthmic nodules. When malignant isthmic (n = 16,2.8%) and malignant non-isthmic nodules (n = 553, 97.2%) were compared, diameter and type of tumor, lymphovascular and capsular invasions, extrathyroidal extension and multifocality rates were not statistically significant. Malignant isthmic nodules (n = 16, 6.2%) had smaller size [10.1 (7.5-34.5) mm, 19.95 (8.4-74.1) mm; p = 0.002], and higher hypoechogenicity rate (31.3%, 5.7%, p = 0.003) compared to benign isthmic nodules (n = 244, 93.8%). Negative predictive value was higher and positive predictive value was lower in isthmic nodules compared to non-isthmic nodules (p = 0.033, p = 0.047, respectively).

Conclusion: Isthmic nodules appear to be indolent because of having lower malignancy rate. FNAB might be required in isthmic nodules even if it has relatively small size. The surgery with limited extent or follow-up might seem to be reliable in the management of patients having isthmic nodules especially with indeterminate cytology.

Abstract

Purpose: We aimed to determine clinicopathological features that can predict lymph node metastasis (LNM) in papillary thyroid microcarcinomas (PTMC).

Methods: Medical records of 872 patients with papillary thyroid cancer >1 cm (PTC > 1 cm) and 1184 patients with papillary thyroid microcancer (PTMC) (≤1 cm) were reviewed retrospectively. Demographical, clinical and histopathological features of (PTC > 1 cm) and PTMC were compared. Association between clinicopathological features and LNM in PTMC was investigated.

Results: The median age of patients with PTMC was significantly higher than patients with PTC > 1 cm (49 vs 46 years old, p < 0.001). Multifocality, capsular invasion, vascular invasion, extrathyroidal extension (ETE) and LNM were more frequent in patients with PTC > 1 cm compared to patients with PMTC (p < 0.001 for each). In PTMC group, those with LNM had significantly higher proportion of multifocality, capsular invasion, vascular invasion and ETE compared to those without LNM (p = 0.007, <0.001, p = 0.011 and p < 0.001, respectively). Multifocality and ETE were significant factors for LNM with logistic regression analysis. Multifocality increased the risk of LNM by 1.737 times (95% CI: 1.079-2.979) and ETE increased the risk by 3.528 times (95%: 1.914-6.503). Primary tumor diameter ≥ 5.75 mm was predictive for LNM with a sensitivity of 0.782 and a specificity of 0.517 in PTMC.

Conclusions: LNM should be investigated more carefully in patients with PTMC in the presence of tumor diameter ≥ 5.75 mm, multifocality or ETE.

Abstract

Purpose: Prolactinoma is a type of pituitary tumour that produces an excessive amount of the hormone prolactin. It is the most common type of hormonally-active pituitary tumour. These tumours can cause ocular complications such as vision loss and visual fields (VF) defect. In this study, we aimed to evaluate the thickness of chorioretinal layers in patients with prolactinoma.

Methods: We enrolled 63 eyes of 32 prolactinoma patients and 36 eyes of 18 age and gender-matched healthy controls. All participants underwent complete hormonal and ophthalmological examination, including spectral-domain optical coherence tomography (SD-OCT) and VF test.The complete biochemical response was defined as serum PRL concentration ≤ 20 ng/mL at the time of evaluation.The seven layers were retinal nerve fibre layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), and retinal pigment epithelium (RPE). The results of prolactinoma patients were compared with the control group.

Results: The mean RNFL, GCL, IPL, INL, ONL, and RPE were thinner in prolactinoma patients than the control group (p < 0.05) while OPL was similar between groups (p > 0.05).None of the patients had VF defect.The thickness of retinal layers was similar in patients with and without complete biochemical response (p > 0.05).

Conclusion: To our knowledge, this is the first study that evaluates the thickness of chorioretinal layers in patients with prolactinoma.Most of the layers were thinner than the control group.Therefore, detailed eye assessment should be a routine component of the follow-up visits of prolactinoma patients and further studies related to this condition are required.

Abstract

Background: The present survey aimed to find out the demographical and clinical characteristics of patients with hypertension in a population with type 2 diabetes mellitus (T2DM) in Turkey.

Methods: Patients with T2DM who were followed-up in tertiary endocrine units for at least last one year were recruited. Demographic, clinical and biochemical data of the patients were collected. Hypertension was defined as taking anti-hypertensive medications or having office arterial blood pressure (ABP) ≥140/90 mmHg or home ABP ≥ 130/80 mmHg.

Results: A total of 4756 (58.9% women) diabetic patients were evaluated. The percentage of patients with hypertension was 67.5% (n = 3212). Although 87.4% (n = 2808) of hypertensive patients were under treatment, blood pressure was on target in 52.7% (n = 1479) of patients. Hypertension proportions were higher in woman (p = 0.001), older, more obese, and those who had longer diabetes duration, lower education levels, higher frequency of hypoglycemic events (all p < 0.001) and higher triglyceride levels (p = 0.003). LDL cholesterol level and the percentage of smokers were lower in hypertensive group than in non-hypertensive group (both p < 0.001). The percentage of macro and microvascular complications was higher in the hypertensive group than in the normotensive one (both p < 0.001). In multivariate logistic regression analysis, being a woman (OR: 1.26, 95% CI: 1.04-1.51, p = 0.016), smoking (OR: 1.38, 95% CI: 1.05-1.80, p = 0.020), regular physical activity (OR: 1.24, 95% CI: 1.01-1.53, p = 0.039) and the presence of macrovascular complications (OR: 1.38 95% CI: 1.15-1.65, p = 0.001) were the significant predictors of good ABP regulation. The ratios of masked and white coat hypertension were 41.2% and 5.7%, respectively.

Conclusion: Our findings indicate that two-thirds (67.5%) of adult patients with T2DM have hypertension. Co-existence of hypertension increases the frequency of macro and microvascular diabetic complications in these patients. Despite the critical role of hypertension in morbidity and mortality, only half of the patients have favorable ABP levels. Masked hypertension seems to be another important issue in this population.

ABSTRACT

Objective: The aim of the present study was to investigate the possible association between obesity and thyroid functions and thyroid morphology.

Material and Methods: A total of 674 subjects-121 obese and 553 nonobese-were included in the study. Body mass index, serum thyrotrophic, free triiodothyronine (fT3), free thyroxine (fT4), antithyroid peroxidase antibody, and antithyroglobulin antibody (antiTg) were evaluated in each subject. The subjects with thyroid nodules in ultrasonography (USG) were excluded. The thyroid volume of each subject was calculated and analyzed.

Results: Obesity was significantly associated with increased age and low fT4 in univariate analysis (p<0.05). With multivariate analysis, the odds of obesity was found to increase by 21.8% (95% CI: 12.4-31.9%) for each 5-year increase in age anddecrease by 53.1% (95% CI: 0.4-77.9%) for each 1 ng/dL increase in fT4. The odds of obesity in patients with positive antiTg was 1.603 (95% 1.047-2.454) times higher than the odds of obesity in patients with negative antiTg. The median total thyroid volume was significantly higher in obese as compared to nonobese subjects (12.11 mL vs. 10.77 mL, p<0.001). Heterogeneous gland with negative thyroid antibodies was observed in 17 (14%) obese and 40 (7.2%) nonobese subjects (p=0.024).

Conclusion: Obesity was positively associated with antiTg and age, whereas negatively associated with fT4. Approximately, in every seven obese subjects, one showed heterogeneity in US despite negative thyroid autoantibodies. This suggests that the value of US in the diagnosis of autoimmune thyroiditis might decrease in obese patients.

ÖZET

Amaç: Obezite ile tiroid fonksiyonları ve tiroid morfolojisi arasındaki muhtemel ilişkiyi araştırmaktır.

Gereç ve Yöntemler: Çalışmaya toplam 121’i obez 553’ü nonobez olmak üzere 674 birey alındı. Her bireyde beden kitle indeksi, serum tirotiropin, serbest triodotironin (sT3), serbest tiroksin (sT4), antitiroid peroksidaz antikoru ve antitiroglobulin antikoru (antiTg) değerlendirildi. Ultrasonografi (USG) de tiroid nodülü olanlar çalışma dışında bırakıldı. Her bireyde tiroid volümü hesaplandı ve analiz edildi.

Bulgular: Univariate analizde obezite anlamlı olarak artan yaş ve düşük sT4 ile ilişkiliydi (p<0,05). Multivariate analizde obezite riski yaşta artan her 5 yıl için %21,8 (%95 güven aralığı (GA): %12,4-31,9) ve sT4’teki her bir ng/dL azalışta %53,1 (%95 GA: %0,4-77,9) artmaktaydı. AntiTg negatif hastalara göre antiTg pozitif olan hastalarda obezite riski 1,603 (%95 1,047-2,454) kat daha fazlaydı. Obezlerde nonobezlere göre median total tiroid volümü anlamlı olarak daha fazlaydı (12,11 mL’ye karşı 10,77 mL, p<0,001). Heterojen glandıyla birlikte tiroid antikorlarının negatifliği 17 (%14) obez ve 40 (%7,2) nonobez bireyde tespit edildi (p=0,024).

Sonuç: Obezite antiTg ve yaş ile pozitif ve sT4 ile negatif olarak ilişkiliydi. Obezitesi olan yaklaşık olarak her 7 bireyin birinde tiroid antikorları negatif olmasına rağmen USG’de heterojenite vardı. Bu bize, obez hastalarda otoimmün tiroidit tanısında USG'nin değerinin azalabileceğini göstermektedir.

Abstract

Background: Attaining acceptable levels of LDL Cholesterol (LDL-C) significantly improves cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus (T2DM). The LDL-C target attainment and the characteristics of patients attaining these targets were investigated in this study. Furthermore, the reasons for not choosing statins and the physicians' attitudes on the treatment of diabetic dyslipidemia were also examined.

Methods: A nationwide, cross-sectional survey was conducted in tertiary centers for diabetes management. Adult patients with T2DM, who were under follow-up for at least a year in outpatient clinics, were consecutively enrolled for the study. LDL-C goals were defined as below 70 mg/dL for patients with macrovascular complications or diabetic nephropathy, and below 100 mg/dL for other patients. Data about lipid-lowering medications were self-reported.

Results: A total of 4504 patients (female: 58.6%) were enrolled for the study. The mean HbA1c and diabetes duration was 7.73 ± 1.74% and 10.9 ± 7.5 years, respectively. The need for statin treatment was 94.9% (n = 4262); however, only 42.4% (n = 1807) of these patients were under treatment, and only 24.8% (n = 448) of these patients achieved LDL-C targets. The main reason for statin discontinuation was negative media coverage (87.5%), while only a minority of patients (12.5%) mentioned side effects. Physicians initiated lipid-lowering therapy in only 20.3% of patients with high LDL-C levels. It was observed that the female gender was a significant independent predictor of not attaining LDL-C goals (OR: 0.70, 95% CI: 0.59-0.83).

Conclusions: Less than 50 % of patients with T2DM who need statins were under treatment, and only a quarter of them attained their LDL-C targets. There exists a significant gap between the guideline recommendations and the real-world evidence in the treatment of dyslipidemia in T2DM.

Abstract

Purpose: Familial hypercholesterolemia (FH) is a genetic disease characterized by increased levels of low-density lipoprotein cholesterol (LDL-C). It is underdiagnosed and undertreated despite relatively high prevalance and significant association with increased mortality. We aimed to determine treatment status and compliance in patients with LDL-C ≥ 250 mg/dL and FH.

Design: Patients older than 18 years old and have a serum LDL-C ≥ 250 mg/dL between January 2010 to December 2016 were identified from the hospital database. A phone survey was performed. Demographic features, smoking status, alcohol use, exercise, cardiovascular disease (CVD), use of medication for dyslipidemia, and CVD and high cholesterol levels in the family were questioned. Dutch Lipid Clinical Network Criteria was used to classify patients. The study was registered to Clinicaltrials.gov in July 2020 (NCT04494464).

Results: 1365 patients with a LDL-C ≥ 250 mg/dL were identified. Patients that could not be reached and who refused to interview were excluded and the data of 367 patients were analyzed. There were 248 (67.6%) female and 119 (32.4%) male patients and mean age was 50.52 ± 11.66. LDL-C was ≥330 mg/dL in 50 (13.6%) and 250-329 mg/dL in 317 (86.4%) patients. Forty (10.9%) patients were classified as definite, 181 (49.3%) as probable and 146 (39.8%) as possible FH. 213 (58.0%) patients were not receiving lipid-lowering treatment, and 162 (76.1%) stated that medication was never recommended previously, 30 (14.1%) had stopped medication him/herself and 21 (9.8%) had stopped medication with the advice of the physician. Among patients with definite/probable FH, 84 (38.0%) had CVD and the rate of lipid-lowering drug use in these patients was 58.3%.

Conclusion: A significant proportion of patients with LDL-C ≥ 250 mg/dL were not taking lipid-lowering drugs. Similar with many other studies, diagnosis, and treatment rates of FH patients were very low in our study. Further national studies are required to increase awareness of the disease in both physicians and patients.

Abstract

Objective: In this study, we aimed to determine the frequency of and the clinical and metabolic features of patients with latent autoimmune diabetes in adults (LADA) at a single center in Turkey.

Subjects and methods: Patients over 30 years of age diagnosed with type 2 diabetes who did not require insulin for a minimum of 6 months following diagnosis were included. Data from 324 patients (163 women; 161 men), with a mean age of 54.97 ± 7.53 years, were analyzed in the study. Levels of antibodies to glutamate decarboxylase (anti-GAD) were measured in all patients, and LADA was diagnosed in patients testing positive for anti-GAD antibodies.

Results: Anti-GAD positivity was identified in 5 patients (1.5%). Family history of diabetes, body mass index (BMI), age, sex distribution, insulin resistance, serum triglycerides, high-density lipoprotein, and low-density lipoprotein were similar in the LADA and type 2 diabetes patients. Median HbA1c was significantly higher (10.8% vs. 7.38%, p = 0.002) and fasting C-peptide was lower (0.75 ng/mL vs. 2.82 ng/mL, p = 0.009) in patients with LADA compared to in those with type 2 diabetes. Among the 5 patients with LADA, 4 were positive for antithyroid peroxidase antibodies. The median disease duration was relatively shorter among patients with LADA (4 years vs. 7 years, p = 0.105).

Conclusion: We observed a LADA frequency of 1.5% among Turkish patients followed for type 2 diabetes. The presence of obesity and metabolic syndrome did not exclude LADA, and patients with LADA had worse glycemic control than patients with type 2 diabetes did.

Abstract

Objective: We aimed to evaluate the patients diagnosed with papillary thyroid carcinoma (PTC) and papillary thyroid microcarcinoma (PTMC) in terms of clinical, ultrasonographical (US) and histopathological features and their relationships with tumor size.

Subjects and methods: We retrospectively evaluated 881 patients who underwent thyroid surgery in our clinic and diagnosed with PTC histopathologically were enrolled the study. Demographic characteristics, US findings and histopathological features were evaluated.

Results: In total, 1264 nodules were identified in the 881 patients. The incidentality rates were higher in the PTMC group and also in the ≤ 5 mm group. In total multifocality rate was 32.9%, and was significantly higher in PTMC group than the PTC group. PTC and > 5 mm PTMC groups compared to PTMC and ≤ 5 mm groups respectively, were more aggresive histopathological features.

Conclusions: Since the incidentality rates were found significantly more common in our patients with PTMC and those with ≤ 5 mm, ultrasonographic features of the nodules should be evaluated carefully and for cases which are suspicious with US, US-guided fine needle aspiration biopsy (FNAB) should be considered in order to make the correct treatment strategy. Also our study revealed that PTC and > 5 mm PTMC groups compared to PTMC and ≤ 5 mm groups respectively, have more aggresive histopathological features.

Abstract

Purpose: In this study, echogenicity and histopathological projections of parathyroid neoplasia in grey mode ultrasonography were compared with whole side imaging (WSI). The utility of the data obtained for clinical assessment was evaluated.

Methods: In 57 patients operated for hyperparathyroidism, the parathyroid gland was sampled in the sagittal plane. The lesion slides were scanned. The WSI was rendered digital. The histopathological slide images scanned with USG images were matched. With the İmage J program, the areas of cell types and morphological changes were measured.

Results: In parathyroid neoplasms, hypoechoic areas were found to be matched with 21% [55.3%] chief cell, 2 [5.0%] oncocytic cell and 8%[20.0%] cystic morphology. Of the 57 patients, 26 [45.61%] had a cystic area. It was seen that hyperechogenic areas match more connective tissue areas than chef cell [p < 0.05]. There was less clear cell in hyperechogenic areas than iso-hyperechogenic areas [p < 0.05]. The ratio of fat tissue echogenicity was lower in hypoechoic areas than hyperechoic [p < 0.05]. There was a positive correlation between PTH and the entire tissue area [r = 0.377, p = 0.004]. A positive directional moderate linear relationship was found between blood calcium level and parathyroid adenoma [rho = 0.530, p = 0.009] and percentage [rho = 0.416, p = 0.048]. When atypical adenomas and adenoma cases were compared, no significant difference was found between the cystic and chief cell areas [p > 0.05].

Conclusion: The hypoechogenicity seen in USG was observed to be compatible with chief cell, hyperechogenic areas in USG were compatible with connective tissue and fat tissue. As the cystic area increased, blood calcium levels were higher in adenomas. We think that the results of this study will be guiding to evaluate the reflections of the detailed morphometric studies.

Abstract

Objective: To evaluate the changes in thyroid functions in Ramadan, and compare late evening and pre-seheri use of levothyroxine in patients with hypothyroidism.

Study design: Cross-sectional study.

Place and duration of study: Department of Endocrinology, Ankara Ataturk Education and Research Hospital and Ankara Yildirim Beyazit University, Turkey, from May to June 2018.

Methodology: Patients who were on levothyroxine treatment and having normal thyroid functions were recruited for the study in the last one week before Ramadan. Patients were offered to take levothyroxine at 22.30-23.00 pm before sleep or between 01:30-03:00 am at least 30 min pre-seheri.

Results: There were 53 (85.5%) female and 9 (14.5%) male patients. Basal thyrotrophin (TSH) was 2.02 μIU/mL (0.27-4.14) and insignificantly increased at the end of Ramadan [2.18 μIU/mL (0.04-19.69), p=0.167]. Free-triiodothyronine (fT3) decreased while free-thyroxine (fT4) increased (p<0.001 for both). Eighteen patients preferred to take levothyroxine in late evening and 44 preferred to take at pre-seheri. There were insignificant increases in TSH in both groups (p=0.401 and p=0.276, respectively). At the end of Ramadan, TSH increased in 39 (63.9%), decreased in 22 (36.1%), and did not change in one patient.

Conclusion: Increase in TSH was not significant after Ramadan. While there was an insignificant increase in median TSH, about one-third of patients had lower TSH, indicating for the need to evaluate every patient individually and follow closely during Ramadan. Clinical studies with larger sample sizes will be helpful to determine the optimal time for levothyroxine use during Ramadan.

Abstract

Introduction: Targeting better glycated hemoglobin (HbA1c) and blood pressure (BP) goals may endanger older adults with type 2 diabetes mellitus (T2DM). Overtreatment of T2DM and hypertension is a trending issue, although undertreatment is still common. We investigated the rates and predictors of overtreatment and undertreatment of glycemia and BP in older adults with T2DM and physicians' attitudes to deintensify or intensify treatment.

Methods: Data from older adults (≥ 65 years) enrolled in a large nationwide T2DM survey in 2017 across Turkey were analyzed. Overtreatment of glycemia was defined as HbA1c < 6.5% plus the use of ≥ 2 oral antihyperglycemics or insulin, and BP overtreatment was defined as systolic BP (SBP) < 120 mmHg or diastolic BP (DBP) < 65 mmHg plus the use of ≥ 2 drugs. Undertreatment of glycemia was defined as HbA1c > 9%, and BP undertreatment was defined as SBP > 150 mmHg or DBP > 90 mmHg. Deintensification or intensification rates were calculated according to treatment modification initiated by the treating physician(s).

Results: The rate of overtreatment in the glycemia group (n = 1264) was 9.8% (n = 124) and that in the BP group (n = 1052) was 7.3% (n = 77), whereas the rate of undertreatment was 14.2% (n = 180) and 15.2% (n = 160), respectively. In the adjusted model, use of oral secretagogues (sulfonylureas or glinides) (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.2-3.1) and follow-up at a private clinic (OR 1.81, 95% CI 1.0-3.3) were predictors of glycemia overtreatment. BP overtreatment was independently associated with the use insulin-based diabetes therapies (OR 1.86, 95% CI 1.14-3.04). There was no independent association of BP undertreatment to the study confounders. The deintensification and intensification rates were 25 and 75.6%, respectively, for glycemia and 10.9 and 9.2%, respectively, for BP.

Conclusions: The results show that one in ten older adults with T2DM are overtreated while one in four require modification of their current antihyperglycemic and antihypertensive treatments. Physicians are eager to intensify medications while they largely ignore deintensification in diabetes management. These results warrant enforced measures to improve the care of older adults with T2DM. 

ABSTRACT

Abstract

Aim:The levels of several hormones including melatonin, leptin, and ghrelin are regulated by circadian rhythm. Deregulated hormone levels due to disruption of circadian rhythm may result in medical conditions like metabolic syndrome (MetS). The aim of this cross-sectional study was to investigate the associations among circadian rhythm, melatonin, leptin, ghrelin and metabolic syndrome by determining melatonin levels of healthy nurses who were working on night-shift for at least 3 months and of those on day-shift for at least 3 months. Methods: Venous bloods following 8-hour fasting of 50 nurses, who were aged at 20-40 age range and whose Body Mass Index (BMI) were >25, were collected. Those working on night-shift were named as night group and the control group of the study was named as day group. From the bloods collected; melatonin, leptin and ghrelin levels were evaluated by ELISA method, insulin was evaluated by immunochemically, whereas fasting blood glucose, cholesterol, triglyceride, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were evaluated spectrophotometrically. Results: Melatonin level was significantly lower in the night-shift group compared to the day-shift group (p=0.003). Leptin level was slightly but not significantly lower in the night-shift group (p=0.097). In contrast, ghrelin level and other biochemical parameters including triglyceride, fasting blood sugar (FBS), insulin, insulin resistance index (HOMA-IR) and cholesterol were increased in the night-shift group but these increments were not statistically significant. Conclusion: Our results suggest that night-shift work might exhibit tendency towards MetS by disrupting circadian rhythm.

Keywords:Night shift, Metabolic syndrome, Melatonin, Leptin, Ghrelin

Özet

Amaç:Melatonin, leptin ve grelin dahil olmak üzere birçok hormonun seviyeleri sirkadiyen ritim tarafından düzenlenir. Sirkadiyen ritim bozulmasına bağlı düzensiz hormon düzeyleri metabolik sendrom (MetS) gibi sorunlara neden olabilir. Bu kesitsel çalışmada, en az 3 aydır gece ve en az 3 aydır gündüz vardiyasında çalışan sağlıklı hemşirelerin melatonin düzeylerini belirleyerek, melatonin, sirkadien ritim, leptin, grelin ve metabolik sendrom ilişkisinin araştırılması amaçlanmıştır. Yöntemler: 20-40 yaş aralığında, Vücut Kitle İndeksi (BMI) > 25 olan 50 hemşirenin sabah 8 saatlik açlıkla venöz kanları alınmıştır. Gece nöbet tutan grup gece grubu olarak, gündüz çalışan kontrol grubu ise gündüz grubu olarak adlandırılmıştır. Alınan kanlarda melatonin, leptin ve grelin düzeyleri ELISA metodu ile, metabolik sendrom kriterlerinden olan insülin immünokimyasal olarak, açlık kan şekeri, kolesterol, trigliserid, yüksek yoğunluklu lipoprotein (HDL) ve düşük yoğunluklu lipoprotein (LDL) düzeyleri ise spektrofotometrik olarak incelenmiştir. Bulgular: Melatonin düzeyleri gece grubunda, gündüz grubuna göre anlamlı derecede düşük bulunmuştur (p=0,003). Leptin düzeyleri gece grubunda düşük bulunmuştur ancak istatistiksel olarak anlamlı değildir (p=0,097). Aksine grelin düzeyleri ve diğer biyokimyasal parametreler olan trigliserit, açlık kan şekeri, insülin, insülin direnci ve kolesterol gece grubunda artmıştır, ancak bu artışlar istatistiksel olarak anlamlı değildir. Sonuç: Bulgularımız gece vardiyasında çalışmanın sırkadiyen ritmin bozularak, MetS eğiliminin artabileceğini göstermektedir.

Anahtar kelimeler:Gece vardiyası, Metabolik sendrom, Melatonin, Leptin, Grelin

ABSTRACT

BACKGROUND:

In this study, we aimed to evaluate ultrasonographical and cytological features of thyroid nodules in

patients who were treated with radioactive iodine (RAI) for hyperthyroidism years ago.

METHODS:

Patients who had a history of RAI treatment for hyperthyroidism and had thyroid nodules that were

evaluated with fine-needle aspiration biopsy (FNAB) were included in the study.

RESULTS:

There were 27 patients (22 female and 5 male) with a mean age of 59.3 ± 13.5. The indication for

RAI treatment was Graves in 5 (18.6%), toxic nodular or multinodular goiter in 16 (69.2%), and

unknown in 6 (22.2%) patients. A total of 48 thyroid nodules were evaluated with FNAB and

cytological diagnosis were benign in 24 (50.0%), nondiagnostic in 15 (31.2%), atypia of

undetermined significance in 5 (10.4%), suspicous for malignancy in 2 (4.2%), and malignant in 2

(4.2%) nodules. Thyroidectomy was performed in 10 patients, 5 were benign (50.0%), and 5

(50.0%) were malignant histopathologically. Ultrasonography features of 31

cytologically/histopathologically benign and five cytologically/histopathologically malignant

nodules were compared. Prevalence of isoechoic nodules was higher in benign nodules (P = .025).

Macrocalcification was observed in 4 (80.0%) of malignant and 10 (32.3%) of benign nodules (P

= .042).

CONCLUSION:

In patients with a history of RAI treatment for hyperthyroidism, thyroid nodules with suspicious

ultrasonography features, particulary hypoechoic appearence and macrocalcification, should be

evaluated with FNAB irrespective of the time elapsed after RAI treatment.

ABSTRACT

BACKGROUND:

Despite significant improvement in imaging quality and advanced scientific knowledge, it may still

sometimes be difficult to distinguish different parathyroid lesions. The aims of this prospective

study were to evaluate parathyroid lesions with ultrasound elastography and to determine whether

strain index can help to differentiate parathyroid lesions.

METHODS:

Patients with biochemically confirmed hyperparathyroidism and localised parathyroid lesions in

ultrasonography were included. All patients underwent B-mode US and USE examination.

Ultrasound elastography scores and strain index of lesions were determined. Strain index was

defined as the ratio of strain of the thyroid paranchyma to the strain of the parathyroid lesion.

RESULTS:

Data of 245 lesions of 230 patients were analysed. Histopathologically, there were 202 (82.45%)

parathyroid adenomas, 26 (10.61%) atypical parathyroid adenomas, and 17 (6.94%) cases of

parathyroid hyperplasia. Median serum Ca was significantly higher in atypical parathyroid adenoma

patients than parathyroid hyperplasia patients (P = 0.019) and median PTH was significantly higher

in APA compared to PA patients (P&lt;0.001). In 221 (90.2%) of the parathyroid lesions, USE score

was 1 or 2. The median SI of atypical parathyroid adenomas was significantly higher than

parathyroid adenomas and hyperplasia lesions [1.5 (0.56-4.86), 1.01 (0.21-8.43) and 0.91 (0.26-

2.02), respectively, P = 0.003].

CONCLUSION:

Our study revealed that SI of parathyroid lesions as well as serum calcium, parathyroid hormone

levels, and B-mode US features may help to predict the atypical parathyroid adenoma. Ulrasound

elastography can be used to differentiate among parathyroid lesions and guide a surgical approach.

ABSTRACT

BACKGROUND:

Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the

highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic

control, and the macro- and microvascular complications of patients are not apparent.

OBJECTIVES:

This nationwide survey aimed to investigate the prevalence of overweight and obesity among

patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of

these patients. We also investigated the independent associates of obesity in patients with type 2

diabetes.

METHODS:

We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary

healthcare units in 37 cities. The demographic, anthropometric, and clinical data including

medications were recorded. Patients were excluded if they were pregnant, younger than 18 years,

had decompensated liver disease, psychiatric disorders interfering with cognition or compliance,

had bariatric surgery, or were undergoing renal replacement therapy.

RESULTS:

Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while

the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher

prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations

were present between high BMI levels and lower education levels, intake of insulin,

antihypertensives and statins, poor metabolic control, or the presence of microvascular

complications. Age, gender, level of education, smoking, and physical inactivity were the

independent associates of obesity in patients with type 2 diabetes.

CONCLUSION:

The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control

in patients with type 2 diabetes. These results underline the importance of prevention and

management of obesity to improve health care in patients with type 2 diabetes. Also, the results

point out the independent sociodemographic and clinical associates of obesity, which should be the

prior targets to overcome, in the national fight with obesity.

ABSTRACT

BACKGROUND:

Atypia of undetermined significance (AUS) is an indeterminate category in the Bethesda system for

reporting thyroid cytopathology. Cytological features described as atypia are not always observed in

every case, and it is difficult to determine how the small population of cells with enlarged nuclei, a

few grooves, and rare elongated nuclei should be classified. Therefore, there is inter-intra observer

variability considering these cell types, even though the cytological criteria are well defined.

Therefore, this study aimed to establish a nuclear scoring system to help in the differential diagnosis

of AUS.

METHODS:

Fine needle aspiration (FNA) samples that showed AUS and had surgical follow-up were included

in this study. The aspirate was scored for the presence of intanuclear cytoplasmic inclusions, nuclear

grooves, overlapping, enlargement, and elongation individually. The total nuclear score for each

case was calculated. Statistical analysis of the association between each nuclear feature and the

presence of papillary thyroid cancer (PTC) in the surgical specimens was performed. Cut-off points

from the total score of these nuclear features were also calculated.

RESULTS:

Nuclear grooves and overlapping were more common in malignant cases (p &lt; 0.001 and p = 0.048,

respectively). A cut-off point of ≥5.5 for the total score was sensitive and specific for defining

malignancy.

CONCLUSION:

The risk of PTC was higher in nodules with more prominent nuclear overlapping or nuclear groove

in their FNA samples. In order to achieve a more confident AUS diagnosis, our scoring system can

be helpful for thyroid FNA samples.

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Objective: Experience with atypia of undetermined significance/follicular lesions of undetermined

significance (AUS/FLUS) showed that this category exhibited a marked variability in incidence and

malignant outcome in resection specimens. We aimed to determine the utility of repeated fine-

needle aspiration biopsies (FNABs) and ultrasonography to determine the malignancy rate in

AUS/FLUS nodules.

Methods: 23,587 nodules were biopsied, and 1,288 had at least one AUS/FLUS cytology.

Ultrasonographic features including solid hypoechoic status, irregular margins, microcalcifications,

nodule taller than wider, or an extrathyroidal extension were also recorded. Nodules for which only

1 FNAB revealed AUS/FLUS cytology were termed Group 1; nodules that underwent 2, 3, and 4

FNABs were termed Groups 2, 3 and 4, respectively. We compared these groups according to

malignancy rates.

Results: 576 of nodules underwent only 1 FNAB (Group 1); 505, 174, and 33 underwent 2 (Group

2), 3 (Group 3), and 4 FNABs (Group 4), respectively. Fifty-six (30.6%), 45 (27.3%), 18 (30%),

and 5 (33.3%) of Groups 1-4 were malignant, respectively. The risk of malignancy was similar in

each group (p > 0.05). Suspicious ultrasonographic features were encountered in malignant nodules

more than benign nodules (p < 0.05, for each).

Conclusion: Repeat biopsy of AUS/FLUS nodules did not enhance the identification of

malignancy. Ultrasonographic features may be a better guide for the decision of either surveillance

or diagnostic surgery.

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Purpose: In this study, we aimed to evaluate ABO blood groups and Rh factor in patients with

thyroid cancer.

Methods: Demographical and clinical features, cytological results, ABO blood groups, and Rh

factor status of patients with benign and malignant thyroid disease were evaluated.

Histopathological features of thyroid cancer were compared in Rh positive and negative patients,

and patients with different ABO blood groups.

Results: Histopathological diagnosis was benign in 1,299 (63.5%) and malignant in 744 (36.5%)

patients. There was no significant difference between benign and malignant patients in terms of age,

sex, thyroid autoantibody positivity, and ABO blood groups (p &gt; .05 for each). A significantly

higher rate of patients with malignant disease were Rh positive compared to patients with benign

disease (91.8% vs. 88.1%, p = .046). In thyroid cancer patients, extrathyroidal extension and

advanced stage (3-4) were observed more frequently in patients with B compared to non-B blood

groups (p = .028 and 0.042, respectively). The likelihood of the extrathyroidal extension was 4.272

(95%: 1.816-10.049) times higher in B blood group compared to non-B blood groups in patients

with multifocal disease (p &lt; .001). Patients with O blood group had lower rate of capsular invasion

than patients with non-O blood groups (p = .018).

Conclusion: Patients with B blood group had higher risk of extrathyroidal extension and advanced

stage compared to patients with non-B blood group.

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BACKGROUND:

The suppressive effect of the increase in thyroid hormone in patients with toxic nodular goiter is

thought to protect the extranodular thyroid tissue from thyroid malignancy. In this study, we aimed

to evaluate the prevalence and features of thyroid cancer in patients with toxic nodular goiter who

underwent thyroidectomy.

METHODS:

Medical data of patients who had solitary toxic or nontoxic nodules and underwent total

thyroidectomy were reviewed retrospectively. We reviewed the clinical, laboratory, and

histopathologic features of patients with toxic nodular goiter and nontoxic solitary nodules.

RESULTS:

There were 73 patients with toxic nodular goiter and 366 patients with nontoxic solitary nodules.

Median age was greater in the toxic nodular goiter compared with nontoxic solitary nodules patients

(50 years; range: 18-73 vs 42 years; range: 18-83, P &lt; .001). Median nodule diameters were 40.9

mm (range: 11.0-98.0) and 23.3 mm (range: 4.9-99.0) in patients with toxic nodular goiter and

nontoxic solitary nodules, respectively (P &lt; .001). Histopathologic examination revealed thyroid

cancer in 14 patients (19%) with toxic nodular goiter and 132 (36.1%) patients with nontoxic

solitary nodules (P = .008). Median tumor diameters were 6 mm (range: 1-50) in toxic nodular

goiter and 14 mm (range: 1-80) in nontoxic solitary nodules (P = .150). The malignant nodule was

the hyperfunctioning nodule in 7 patients with toxic nodular goiter; 4 were follicular and 3 were

papillary thyroid cancer. The other 7 malignant foci were located in the suppressed contralateral

lobe, and all were papillary microcarcinomas. The incidence of thyroid cancer outside the main

nodule was similar in 2 groups (P = .934).

CONCLUSION:

Thyroid cancer in patients operated for toxic nodular goiter was 19%, which is not as rare as

previously thought. A careful histopathologic examination of both the hyperfunctioning nodule and

the extranodular thyroid tissue might help to disclose an unexpected tumor foci when

thyroidectomy is performed in patients with toxic nodular goiter.

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BACKGROUND:

We aimed to compare the cytology and histopathology results of hot, cold, and warm nodules in

patients who had thyroidectomy due to toxic multinodular goiter (TMNG).

METHODS:

Five hundred and nine thyroid nodules from 413 patients who had operation with TMNG were

included in this retrospective study. The nodules were categorized as hot, cold, and warm groups.

The cytology and histopathology results were compared.

RESULTS:

The 509 thyroid nodules were grouped as hot (n = 364 [71.5%]), cold (n = 122 [24.0%]), and warm

(n = 23 [4.5%]) according to scintigraphy. Cytological evaluations of 364 hot nodules were as

follows: 80 (22%) nondiagnostic (ND), 259 (71.2%) benign, 17 (3.6%) atypia of undetermined

significance/follicular lesion of undetermined significance (AUS/ FLUS), 2 (0.5%) follicular

neoplasm/suspicious for follicular neoplasm (FN/SFN), 2 (0.5%) suspicious for malignancy (SM),

and 4 (1.1%) malignant. The cytology of 122 cold nodules were ND in 25 (20.5%), benign in 86

(70.5%), AUS/FLUS in 8 (6.6%), FN/SFN in 1 (0.8%), and finally SM in 2 (1.6%). The 23 warm

nodules were determined as ND, benign, and FN/SFN in 7 (30.4%), 15 (65.2%) and 1 (4.3%),

respectively. There were no differences according to cytological results between groups (P = .616).

However, malignancy rate was 3.8% in hot nodules, it was found as 6.6% in cold nodules. The

malignancy was detected in 4.3% of warm nodules. There were no differences in malignancy rates

between groups (P = .459).

CONCLUSION:

We demonstrated similar malignancy rates in hot nodules when compared with cold and warm

nodules.

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BACKGROUND/AIM:

We aimed to evaluate the utility of thyroid imaging reporting and data system (TI-RADS) in prediction of malignancy in thyroid nodules with persistent nondiagnostic (ND) cytology.

MATERIALS AND METHODS:

A total of 246 thyroid nodules which were surgically removed and had at least two fine-needle aspirations (FNAs) with ND cytology were included in this study. Ultrasonography features and TI-RADS scores were recorded.

RESULTS:

Of 246 nodules, 218 (88.6%) had benign and 28 (11.4%) had malignant final histopathology. Frequencies of taller than wide shape, solidity, hypoechogenicity, microcalcifications, and presence of irregular borders were similar between benign and malignant nodules (P > 0.05). The number of nodules categorized as TI-RADS 3, 4a, 4b, and 4c were 12 (4.9%), 53 (21.5%), 104 (42.3%), and 77 (31.3%), respectively. There was not any nodule in TI-RADS 5 category. Malignancy rates of categories 3, 4a, 4b, and 4c were 0%, 13.2%, 9.6%, 14.3%, respectively. No significant differences were detected in TI-RADS categories between benign and malignant nodules (P > 0.05).

CONCLUSION:

In this study, we did not demonstrate any suspicious ultrasound (US) finding predictive for malignancy in thyroid nodules with persistent ND cytology and did not determine any difference between malignant and benign nodules regarding TI-RADS scores. Whereas, we found that thyroid nodules in 4a, 4b, and 4c TI-RADS categories had higher malignancy rates than those previously reported in ND cytology. We think that TI-RADS categories in thyroid nodules with persistent ND cytology can be helpful in treatment decision.

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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.

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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.

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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 (TSH) 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, TSH and serum sodium (Na) levels was investigated. Relation between SH and clinical status and metabolic parameters was also evaluated. The mean morning fT3, nocturnal fT3, nocturnal TSH, and TSH 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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

ABSTRACT

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.