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Background/aim The known pathogenesis of diabetes mellitus (DM) in acromegaly is mainly based on growth hormone (GH) and insulin-like growth factor-1 (IGF-1) excess. Fatty acid-binding protein 4 (FABP-4), a novel adipokine, is found to induce insulin resistance and type 2 DM. We aimed to investigate the possible effect of FABP-4 on glucose metabolism in patients with acromegaly. Materials and methods This case-control study included 28 patients newly diagnosed with acromegaly and 57 healthy volunteers. The patients with acromegaly were classified according to their glycemic status as with DM, prediabetes, and normal glucose tolerance. Anthropometric measurements, laboratory test results, and FABP-4 levels of the subjects were evaluated. Results Although no difference was observed in FABP-4 levels between acromegaly and control groups, the FABP-4 level was higher in the patients with acromegaly having DM compared to the patients with acromegaly having prediabetes and NGT, and the control group (p = 0.004, p = 0.001, p = 0.004, respectively). Logistic regression analysis suggested that the FABP-4 is an independent predictor of DM in acromegaly (β = 7.382, OR = 38.96, 95% CI: 1.52-5.76, p = 0.018). Conclusion The FABP-4 may be a helpful predictor of acromegaly-associated DM.

OBJECTIVE The purpose of the present study was to determine the effects of exenatide treatment on platelet function in type 2 diabetes mellitus (DM) patients. STUDY DESIGN Case-control observational study. PLACE AND DURATION OF STUDY University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara from October 2016 to October 2018. METHODOLOGY This study included 50 patients with type 2 DM, who had started exenatide therapy; and age-gender matched 54 control subjects. The biochemical data and BMI of the patients were analysed at the time of admission and after six months of exenatide treatment. RESULTS PDW (platelet distribution width) and MPV (mean platelet volume) were higher in the diabetic patient group than in the control group (p

Objective To determine the frequency of pyramidal lobe remnants after total thyroidectomy (TT) and the effect on stimulated thyroglobulin (Tg). Methods The study included 1740 differentiated thyroid cancer (DTC) patients who were followed up by our center. The department database was searched to identify DTC patients with residual pyramidal lobe after TT. All postoperative technetium-99m pertechnetate thyroid scintigraphy images were re-evaluated for pyramidal lobe residue. Serum stimulated Tg and thyroid stimulating hormone (TSH) levels measured within the first 6 months after TT were retrieved from the database. Results Pyramidal lobe residue was detected in 10.4% of the patients who underwent TT. Evidence of the pyramidal lobe was present on preoperative ultrasonography in 1.6% of the patients with residual pyramidal lobe. Stimulated Tg in patients with pyramidal lobe residue was significantly higher than that in patients without residue (P = .01). Endogenous stimulated TSH in patients with residual pyramidal lobe was significantly lower than that in patients without residue (P = .036). In 5.7% of patients with pyramidal lobe residue, a TSH level of >30 mIU/L was not achieved, which was a significantly higher rate than that in patients without pyramidal lobe residue (P = .034) and is the level required for maximum radioiodine uptake. Conclusion Pyramidal lobe residue was found in almost 10% of DTC patients. The pyramidal lobe is often missed on preoperative ultrasonography. Residual pyramidal lobe increased stimulated Tg and decreased endogenous stimulated TSH. Residual pyramidal lobe may complicate the follow-up of DTC patients.

Objective: Subacute thyroiditis (SAT) is an inflammatory thyroid disease that manifests with severe pain. The presence of the vitamin D receptor in immune system cells shows that vitamin D deficiency can trigger inflammatory diseases. The aim of the present study was to determine the prevalence of vitamin D deficiency in SAT patients, and the relationship between vitamin D level and permanent hypothyroidism and recurrence rate. Methods: In this retrospective study, 25-hydroxyvitamin D [25(OH)D] levels of 170 SAT patients and 86 control subjects were compared. Results: The 25(OH)D levels were significantly lower in the SAT patients, and there was no seasonal difference. A negative correlation was determined between ESR and 25(0H)D, but no significant relationship was found between vitamin D level and prognosis. Conclusions: As a result of this study, it was shown that vitamin D levels in subacute thyroiditis patients were significantly lower than in the healthy control group. Although there is no relationship between vitamin D level and disease prognosis, vitamin D deficiency may increase the rate of respiratory tract infections (especially, influenza, coxsackievirus, measles, adenovirus, retroviruses) and eventually SAT development. An Evaluation of Vitamin D Levels in Subacute Thyroiditis Patients and the Effect of Vitamin D on Disease Prognosis.

Subacute thyroiditis (SAT) is an acute inflammatory disease of the thyroid. Mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) values determined from peripheral blood, are accepted as available and practical indicators of systemic inflammation. The purpose of this study was to evaluate the value of hematological parameters in the diagnosis and prognosis of subacute thyroiditis patients. This retrospective study included 306 SAT patients and 102 healthy control subjects. Retrospective analyses were made of age, gender, complete blood counts, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), thyroid function tests, NLR, PLR, and thyroid volume of the patients and the results were compared with the control group. The mean follow-up time of patients was 29.5 ± 14 months. The ESR, CRP, white blood cell (WBC) count, neutrophil count, hemoglobin, platelet counts, NLR, and PLR were significantly higher in the SAT patients. MPV and lymphocyte count were significantly lower in the SAT patients. The rates of recurrence and permanent hypothyroidism were 15.4% and 9.8%, respectively. The values of ESR, CRP, NLR, PLR, and MPV at the time of diagnosis were not determined to have any effect on recurrence or the development of permanent hypothyroidism. The results of this study showed higher PLR and NLR values in SAT patients compared with healthy control subjects, and a lower MPV value. These findings demonstrate that the assessment of hematological parameters in conjunction with radiological and clinical findings will assist in establishing an accurate diagnosis, especially in complicated SAT cases.

Subacute thyroiditis (SAT) is an inflammatory thyroid disease. The main purpose of the treatment is to relieve pain and control the inflammatory process. The aim of the present study was to evaluate the therapeutic effects of steroid and non-steroidal anti-inflammatory drugs (NSAIDs) in SAT. Initial laboratory data, treatment response, and long-term results of 295 SAT patients treated with ibuprofen or methylprednisolone were evaluated. After the exclusion of 78 patients, evaluation was made of 126 patients treated with 1800 mg ibuprofen and 91 patients treated with 48 mg methylprednisolone. In 59.5% of 126 patients treated with ibuprofen, there was no adequate clinical response at the first control visit. In 54% of patients, the treatment was changed to steroids in mean 9.5 days. Symptomatic remission was achieved within two weeks in all patients treated with methylprednisolone. The total recurrence rate was 19.8%, and recurrences were observed more frequently in patients receiving only steroid therapy than in patients treated with NSAID only (23% vs. 10.5% p:0.04). Persistent hypothyroidism developed in 22.8% of patients treated only with ibuprofen and in 6.6% of patients treated with methylprednisolone only. Treatment with only ibuprofen (p:0.039) and positive thyroid peroxidase antibody (anti-TPO) (p:0.029) were determined as the main risk factors for permanent hypothyroidism. NSAID treatment is not as effective as steroid treatment in early clinical remission. Steroid treatment was detected as a protective factor against permanent hypothyroidism. Therefore, steroid therapy may be considered especially in anti-TPO positive SAT patients and patients with high-level acute phase reactants.

Routine calcitonin measurement in patients with nodular thyroid disease is rather controversial. The aim of this study was to evaluate the contribution of serum calcitonin measurement in the diagnostic evaluation of thyroid nodules with insufficient, indeterminate, or suspicious cytology. Out of 1668 patients who underwent thyroidectomy with the diagnosis of nodular thyroid disease and were screened, 873 patients with insufficient, indeterminate, or suspicious fine needle aspiration biopsy results were included in the study. From the total number of patients in this study, 10 (1.1%) were diagnosed as medullary thyroid cancer (MTC) using histopathology. The calcitonin level was detected to be above the assay-specific cut-off in 23 (2.6%) patients ranging between 6.5 - 4450 pg/mL. While hypercalcitoninemia was detected in all 10 MTC patients, a false positive elevation of serum calcitonin was detected in 13 patients (1.5%). Of the MTC group, 7 patients had cytology results that were suspicious for malignancy (Bethesda V), one patient’s cytology showed atypia of undetermined significance (Bethesda III) and two patient’s cytology results were suspicious for follicular neoplasm (Bethesda IV). Among the cases with non-diagnostic cytology (Bethesda I), none of the patients were diagnosed with MTC. In conclusion, routine serum calcitonin measurement can be performed in selected cases rather than in all nodular thyroid patients. While it is reasonable to perform routine calcitonin measurement in patients with Bethesda IV and Bethesda V, this measurement was not useful in Bethesda I patients. In Bethesda III patients, patient-based decisions can be made according to their calcitonin measurement. Read more in PDF.

Type 1 diabetes mellitus (T1DM) is a chronic metabolic disease that develops due to damage to beta cells in the pancreas and is characterized by insulin deficiency. Nephropathy, retinopathy, and neuropathy are known microvascular complications of diabetes. There are few studies evaluating serum uric acid (SUA) levels in T1DM patients, and the relationship of SUA level with microvascular complications is controversial. In the current study, we aimed to evaluate the SUA level in T1DM patients and investigate the relationship between SUA and microvascular complications. The present study was conducted by retrospectively evaluating the files of 160 patients and 85 healthy controls who followed up with a diagnosis of T1DM over the age of 18. The SUA level was lower in T1DM patients than in the control group (p: 0.035), and a negative correlation was found between the SUA level and HbA1c (r:-0.172, p: 0.03). There was a positive correlation between SUA and creatinine level (r: 0.269, p: 0.001). The SUA level was found to be higher in patients with nephropathy regardless of the duration of diabetes (r2: 0.185, p: 0.027). Elevated SUA level was not found as an independent risk factor in patients with neuropathy and retinopathy. In conclusion, although there was a lower SUA level in T1DM patients than in the control group, SUA level was elevated in patients with diabetic nephropathy. Further prospective studies are required to determine whether elevated SUA level is a risk factor for the development of diabetic nephropathy., Tip 1 diabetes mellitus (T1DM) pankreasta bulunan beta hücrelerinin hasarı sonucu gelişen ve insülin eksikliği ile karakterize kronik metabolik bir hastalıktır. Nefropati, retinopati ve nöropati diyabetin bilinen mikrovasküler komplikasyonlarıdır. T1DM hastalarında serum ürik asit (SÜA) düzeyini değerlendiren az sayıda çalışma mevcuttur ve SÜA düzeyinin mikrovasküler komplikasyonlar ile ilişkisi tartışmalıdır. Bu çalışmada T1DM hastalarında SÜA düzeyini değerlendirmeyi ve SÜA düzeyinin mikrovasküler komplikasyonlar ile ilişkisini incelemeyi amaçladık. Bu çalışma 18 yaşından büyük T1DM tanısı ile takipli 160 hastanın ve 85 sağlıklı kontrolün dosyalarının retrospektif değerlendirilmesi ile yapıldı. T1DM hastalarında kontrol grubuna göre SÜA düzeyi düşük bulundu (p:0.035) ve SÜA düzeyi ile HbA1c arasında negatif kolerasyon saptandı (r:-0.172, p:0.03). SÜA ile kreatinin düzeyi arasında pozitif kolerasyon saptandı (r:0.269, p:0.001). Nefropati gelişen hastalarda SÜA düzeyi diyabet süresinden bağımsız olarak yüksek saptanırken (r2:0.185, p:0.027) nöropati ve retinopatisi mevcut olan hastalarda SÜA yüksekliği bağımsız bir risk faktörü olarak saptanmadı. Sonuç olarak T1DM hastalarında kontrol grubuna göre daha düşük SÜA düzeyi bulunmasına rağmen diyabetik nefropati gelişen hastalarda SÜA düzeyinin yüksek olduğu saptandı. Yüksek SÜA düzeyinin diyabetik nefropati gelişiminde risk faktörü olup olmadığını belirlemek için daha ileri prospektif çalışmalar gereklidir.

Levothyroxine suppression therapy (LST) can cause some unfavorable effects on the cardiovascular system in patients with differentiated thyroid cancer (DTC). The aim of this study was to evaluate ventricular arrhythmia predictors based on electrocardiography (ECG) in patients with DTC with LST. The ECG parameters including QT, corrected QT (QTc), Tp-e intervals, Tp-e/QT, and Tp-e/QTC ratios of 265 patients with DTC who met the inclusion criteria were compared with 100 controls. No difference was observed in the number of patients with DTC and controls with prolonged and borderline QTc interval ( P = .273). Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were significantly higher in patients ( P = .002, P = .02, P = .003; respectively). Linear regression analysis suggested that male gender was a predictor of higher Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios (β = 4.322, R 2 = 0.024, P = .042; β = 0.016, R 2 = 0.048, P = .005; β = 0.015, R 2 = 0.044, P = .006, respectively). A higher serum fT4 level was found to be associated with a higher Tp-e/QT ratio (β = 0.018, R 2 = 0.089, P = .007). Ventricular arrhythmia indicators were found to be higher in patients with DTC with LST. Defining ventricular arrhythmia predictors through ECG, an easily accessible cardiac diagnostic tool, can be potentially useful in raising awareness of the possible cardiac harm of LST.

Objective To determine whether tumor volume and tumor size are related to disease severity in parathyroid cancer (PC). Methods Patients treated for PC at our institution were retrospectively identified. Data were collected about clinical and pathologic characteristics, laboratory parameters, tumor volume, recurrence, metastasis, and mortality. Correlation analysis was applied to laboratory parameters, tumor volume, and tumor size in PC patients. Results The study included 20 patients diagnosed with PC at our center. The median follow-up was 33 months. Serum calcium (median, 12.5 mg/dL), serum parathormone (PTH) (median, 743 pg/mL), and serum alkaline phosphatase (ALP) (median, 298 U/L) levels were found to be increased, and 25-hydroxyvitamin D (25[0H)D) (median, 12.3 ng/mL) and serum phosphorus (median, 2.1 mg/dL) levels were decreased. Magnesium level was within normal limits (median, 1.9 mg/dL). The median tumor volume was 5.7 mL and median tumor size was 2.5 cm. Significant positive correlations were found between tumor volume and calcium, ALP, and PTH levels. A significant negative correlation was found between tumor volume and 25(OH)D level. There were no significant correlations between tumor size and calcium, ALP, PTH, and 25(OH)D. Conclusion These results found that the tumor volume affected PTH, calcium, ALP, and 25(OH)D levels. The morbidity and mortality associated with PC were usually associated with PTH secretion and hypercalcemia. Therefore, tumor volume may be a more effective parameter than tumor size when evaluating the severity of disease.

Objective The optimal steroid regimen in the treatment of subacute thyroiditis (SAT) is controversial. This study aims to compare low- and high-dose steroid regimens in the treatment of SAT. Methods A single-center, retrospective observational cohort study with up to 1 year of follow-up was conducted. A total of 44 patients in the 16-mg methylprednisolone (MPS) group and 47 patients in the 48-mg MPS group were enrolled. Clinical and laboratory findings from the time of diagnosis to 1-year of the follow-up were assessed. Treatment response, recurrence, and hypothyroidism (HPT) rates were evaluated. Results Clinical symptoms, sedimentation rates, C-reactive protein, and thyroid hormone levels of the patients were similar in the 2 groups. Recovery was achieved in all patients at the end of the treatments; however, treatment duration needed to be extended for 6 (13.6%) and 1 (2.1%) of the patients in the 16-mg and 48-mg MPS groups, respectively. The 48-mg MPS group had a higher SAT recurrence rate than the 16-mg MPS group (P = .04). Logistic regression analysis suggested that a lower thyroid-stimulating hormone level at the end of the treatment was a predictor of recurrence (β = –0.544, P = .014, 95% CI: 0.376-0.895). While the transient HPT rate was 10 (21.3%) and 10 (22.7%) in the 48-mg and 16-mg MPS groups, respectively, a permanent HPT developed in 5 (10.6%) of patients in the 48-mg MPS and 3 (6.8%) in the 16-mg MPS group. The permanent and transient HPT rates were determined to be similar in the low- and high-dose groups (P > .05). Conclusion Low-dose steroid therapy may be sufficient to achieve a complete recovery and better outcomes in SAT.

Hypocalcemia is a common problem after parathyroidectomy and/or thyroidectomy. The complication may be transient or permanent. Most cases occur as a result of removal of the parathyroid glands or damage to the glands during neck surgery. The purpose of this study was to evaluate the effect of preoperative vitamin D deficiency in predicting transient hypocalcemia and hypoparathyroidism after parathyroidectomy.Retrospective evaluation was made of 180 patients with primary hyperparathyroidism in respect of serum 25(OH)D, calcium and parathyroid hormone before and after parathyroidectomy. Transient hypocalcemia was defined as corrected calcium ≤ 8.4 mg/dL, and these cases were then evaluated for preoperative 25(OH)D values. Transient hypoparathyroidism has been described as low PTH level immediately after surgery before beginning any supplementation. Permanent hypoparathyroidism is accepted as the need for medical treatment is necessary over 12 months.Both transient hypocalcemia and hypoparathyroidism developed at statistically significantly higher rates in patients with preoperative vitamin D deficiency and vitamin D insufficiency.Vitamin D deficiency is an independent contributor to transient hypocalcemia and hypoparathyroidism following parathyroidectomy.

This study aims to evaluate factors affecting the quality of life (QOL) of hypoparathyroidism. While QOL is reduced in post-surgical and non-surgical groups, mental health seems to be less affected in non-surgical patients. Having an additional disease affects QOL negatively but having thyroid cancer may not change the QOL results. Hypoparathyroidism (HypoPT) is an orphan disease, which causes physical, emotional, and cognitive problems. We aimed to estimate the factors affecting the quality of life (QOL) of HypoPT patients. Basal characteristics, treatments, and laboratory results of the participants were recorded. QOL of the patients and controls were evaluated via the Short Form-36 (SF-36) survey. One hundred sixty HypoPT patients were compared with 148 controls. Patients had lower scores in all SF-36 domains than controls. Non-surgical patients had better scores in vitality and mental health compared with post-surgical ones. Males had higher scores in mental and physical health domains than females. Non-surgical patients had higher scores in mental health compared with post-surgical ones when calcium levels were between 8 and 8.9 mg/dL. When we compared the patients with the pathological results, QOL scores of post-surgical patients with thyroid cancer were not different from the patients with thyroid nodular hyperplasia. HypoPT patients having an additional disease presented lower scores in physical functions and general health. Disease duration was found out positively correlated with vitality in non-surgical patients. While QOL is reduced in both post-surgical and non-surgical HypoPT groups, mental health seems to be less affected in non-surgical patients. Non-surgical patients might be tolerating hypocalcemia symptoms, lower calcium levels, and longer disease duration better than post-surgical ones. Having an additional disease affects the QOL negatively but having thyroid cancer may not change the QOL results of post-surgical patients.

Objective Ultrasound assessment plays an important role in the diagnosis, and monitoring of subacute thyroiditis (SAT). However, the relationship between ultrasonographic findings and severity or prognosis of the disease is not known. The aim of the present study was to evaluate the relationship between bilateral and unilateral disease involvement and severity and prognosis of the disease. Subjects and methods The initial laboratory values, ultrasonographic findings and long-term outcomes of 247 SAT patients were evaluated retrospectively. Results In the ultrasonographic evaluation, bilateral involvement was detected in 154 patients, and unilateral involvement in 93 patients at the time of diagnosis. No significant difference was found between patients with bilateral or unilateral disease at the time of diagnosis in respect of the initial acute phase reactants. FT4 was significantly higher and TSH was significantly lower in the group with bilateral disease. Bilobar or unilobar disease on ultrasound at the time of diagnosis was not found to be a risk factor for permanent hypothyroidism or recurrence. The mean thyroid volume was determined to be 22.5 ± 10 cm3 at the beginning of treatment, and 11.2 ± 8 cm3 at the end of treatment. The initial thyroid volume and the thyroid volume at the end of treatment were significantly lower in patients who developed hypothyroidism. Conclusion There was no relationship between initial acute phase reactants and bilateral or unilateral involvement of the disease. FT4 levels were found to be associated with the extension of the disease. The risk of recurrence and permanent hypothyroidism are not associated with the initial ultrasonographic aspect. Arch Endocrinol Metab. 2020;64(3):306-11

Proton pump inhibitors (PPIs) are extensively prescribed drugs usually used for a long period. Recent reports linked PPI use with development of hypomagnesemia. However, there is still uncertainty regarding risk of hypomagnesemia in outpatients who were on long-term PPI use. Thus, we aimed to evaluate frequency of hypomagnesemia among a well-defined outpatient patient cohort with no other possible risk factors affecting serum magnesium levels. This was a case-control study carried out at the outpatient gastroenterology clinic of a University hospital. Patients who were on PPI therapy for at least 6 months without diuretic use and chronic kidney disease were included. Patients who were subjected to the same inclusion and exclusion criteria and not using PPI were included as control subjects. One hundred fifty-four patients and 84 control subjects were included. The mean duration of PPI use was 27.5 ± 2.5 months. Mean serum magnesium levels of PPI users and nonusers were 2.17 ± 0.20 mg/dL and 2.19 ± 0.15 mg/dL, respectively. None of the patient had a serum magnesium level below laboratory lower range of 1.7 mg/dL. Our results showed that for typical gastroenterology outpatient clinic patients with no other risk factors affecting serum magnesium levels, long-term PPI use did not affect serum magnesium levels.

The aim of the present study was to evaluate the predictive value of 25-hydroxyvitamin D, calcium and parathormone level, co-existence of thyroid nodule, thyroidectomy history and adenoma volume on the success of neck ultrasound (US) and technetium-99m sestamibi (MIBI) scan in primary hyperparathyroidism (PHP) patients. This study included 256 patients with PHP who underwent parathyroidectomy. 169 (%66) patients had vitamin D deficiency and 56 (%22) of patients had insufficiency. The sensitivity of US and MIBI studies showed no difference between vitamin D deficiency, insufficiency and replete groups (%80.5, %82 and %71 (p > 0.05) and %81, %84 and %71 respectively (p > 0.05)). Vitamin D level was not found to be an independent predictor of localization on either US or MIBI scan after adjusting for different variables (p > 0.05). Calcium level was found to be an independent predictor for US sensitivity (r2:0,033, p:0,032) and parathormone level for MIBI sensitivity (r2:0,05, p:0,025). The co-existence of nodular thyroid disease and history of thyroidectomy significantly decreased the sensitivity of US (%76 and %43). MIBI sensitivity was not impaired by nodular disease but the history of thyroidectomy also impaired the sensitivity of MIBI (%43). As a result vitamin D level does not affect the sensitivity of preoperative localization tests.

Obesity, a remarkably increased healthcare problem, accompanies with morbidities including type 2 diabetes mellitus (DM), hypertension, and cardiovascular diseases. Hypothalamic-pituitary-adrenal (HPA) axis alteration is thought to be effective on the background of obesity, even concomitant with DM and hypertension. We aimed to evaluate the negative feedback mechanism of the HPA axis via overnight 1 mg dexamethasone suppression test (DST) and the association of post-1 mg DST cortisol level with DM and hypertension presence in obesity.This study consisted of 402 obese patients who provide suppression after DST. Post-1 mg DST cortisol level and its association with other variables including anthropometric measurements, laboratory test results, hypertension, prediabetes, and DM presence were evaluated. Predictivity of post-1 mg DST for hypertension and DM was investigated.We established a significant difference in post-1 mg DST cortisol level when compared patients with and without DM, patients without DM and with prediabetes, patients with prediabetes and DM (p 0.001 vs. p = 0.003 vs. p = 0.022 respectively). Post-1 mg DST cortisol level was significantly higher in hypertensive patients (p 0.001). Post-1 mg DST cortisol level had positive correlation with age (r = 0.319, p 0.001), fasting plasma glucose (r = 0.168, p = 0.001), and HbA1c (r = 0.278, p 0.001) levels. Logistic regression analyses demonstrated that post-1 mg DST cortisol level is an independent predictor of DM and hypertension presence.Cortisol negative feedback mechanism may be altered in obese patients who are complicated with hypertension and DM. Therefore, post-1 mg DST cortisol level can be predictive for hypertension and DM presence in obesity.

OBJECTIVE: Glucagon-like peptide-1 (GLP-1) analogues are now widely used for the treatment of type 2 diabetes mellitus (DM). Many binding sites for GLP-1 have been demonstrated in the specific tissue compartments of organs in­cluding the brain and thyroid. The aim of this study was to investigate the effect of exenatide treatment on thyroid-stimulating hormone (TSH) and thyroid volume in diabetic patients without thyroid disease. MATERIAL AND METHODS: The study included 46 diabetic patients without thyroid disease who were receiving exenatide treatment. Comparisons were made of total thyroid volume and serum concentrations of TSH at baseline and after 6 months of follow-up. RESULTS: Of the 46 patients, 13 were excluded from the study, as they were unable to complete the treatment or left the follow-up process. After 6 months of exenatide treatment, the serum TSH concentration decreased significantly (from 2.3 [0.7–5.4] to 1.8 mIU/L [0.3–4.2], p = 0.007). There were no significant differences in thyroid volume (11.6 ± 9.0 vs. 12.1 ± 8.8 cm3, p = 0.19), free thyroxine (fT4), free tri-iodothyronine (fT3), and calcitonin levels before and after treatment. Thyroid volume was not affected by decreased TSH level (p:= 0.141) or a reduction in body mass index (BMI) (p > 0.05), and no correlation was detected between variation in TSH level and change in BMI (p > 0.05). CONCLUSIONS: Exenatide treatment for 6 months significantly decreased serum TSH concentration but did not affect thyroid volume in diabetic patients without thyroid disease.

Background: Vasculopathy is a major cause of mortality and morbidity in Behcet’s Disease (BD). Subclinical atherosclerosis can even be detected in the early stage of BD. Soluble tumor necrosis factor-like (TNF) weak inducer of apoptosis (TWEAK) is known as a good marker of the inflammation in vascular tree. The aim of this study is to examine the relationship between carotid artery intima-media thickness (cIMT) and serum TWEAK levels in patients with BD. Materials and Methods: In line with International BD Study Group criteria, 48 BD, and 30 controls were included in our study. Disease activity was evaluated according to BD current activity form (BDCAF). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lipid parameters, serum TWEAK levels, and cIMT were measured. Results: Disease activity score of BD patients was found as 2 (range 0–7). cIMT, serum TWEAK, CRP and ESR levels of BD patients were significantly higher comparing to cIMT (0.62 ± 0.13 mm vs. 0.43 ± 0.09 mm, p < 0.001), serum TWEAK (667.5 ± 130.6 vs. 603.4 ± 89.6 pg/ml, p = 0.015), CRP (3.9 ± 4.3 vs. 1.4 ± 1.0 mg/dl, p < 0.001) and ESR (10.2 ± 10.0 vs. 5.6 ± 3.7 mm/h, p = 0.005) levels of the control group. There was a positive correlation between serum TWEAK level and disease activity (r = 0.251, p = 0.030) and cIMT (r = 0.463, p < 0.001). Our study also revealed an independent correlation between cIMT and serum TWEAK levels (beta = 0.354, p < 0.001). Conclusion: Increased serum TWEAK levels can play a part in the development of atherosclerotic heart disease in BD. Due to their liability to atherosclerosis, patients with BD must followed closely.

PubMed ID: 27436495, Familial Mediterranean fever (FMF) is a disease characterized by chronic inflammation. Atherogenic index of plasma (AIP) is a logarithmic value of the triglyceride to high-density lipoprotein cholesterol ratio and it is a good marker for atherosclerotic heart disease and cardiac risk. In this study, we investigated subclinical atherosclerosis and cardiac risks in patients with FMF. Patients with FMF (78 men and 84 women) and healthy controls (74 men and 82 women) were included in this study. The AIP values of the patients were calculated and carotid intima-media thicknesses (cIMTs) were measured. The cIMT (P

cure, erkan/0000-0001-7807-135X; Cure, Medine Cumhur/0000-0001-9253-6459; Aydogan Baykara, Rabia/0000-0003-0542-266X WOS: 000399025700011 PubMed: 27431747 Behcet's disease (BD) is a systemic vasculitis characterized by cardiovascular complications. Early diagnosis of these complications can reduce morbidity and mortality. Carotid artery intima-media thickness (cIMT) and the logarithmic value of triglyceride to high density lipoprotein ratio (atherogenic index of plasma, AIP) are good markers of atherosclerosis. the purpose of this study was to investigate whether AIP is a predictive marker of subclinical atherosclerosis in BD patients. A total of 84 BD patients (60 male, 24 female) and 84 healthy control individuals (58 male, 26 female) were included in this study. cIMT measurements were made, and AIP values were calculated. cIMT (p < 0.001) and AIP (p < 0.001) values of the BD patients were higher than those of the control group. A strong independent relationship was found between the AIP value and cIMT (beta = 0.232, p = 0.018). in the subgroup analysis, the cIMT and AIP values of male BD patients were higher than those of female BD patients. Increased AIP and cIMT values can be a good marker for subclinical atherosclerosis in BD patients, especially in male BD patients.

Familial Mediterranean Fever (FMF) is a progressive disease characterized by chronic inflammation, which also has negative effects on cochlear functions and hearing levels. We investigated whether the cochlear functions and hearing levels of FMF patients were different than healthy controls and also evaluated the relationship of hearing levels with the age at diagnosis, duration without treatment, and inflammation and lipid parameters in this study. A total of 60 patients diagnosed with FMF and 48 age, gender and body mass index (BMI)-matched healthy controls were included in the study. The hemogram, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lipid parameters of the subjects were studied and they all underwent pure tone audiometry and Transient evoked otoacoustic emission tests after an otologic examination. The hearing levels of the FMF group were significantly higher than those of the control group. The TEOAE signal/noise (S/N) ratios were similar in both groups. A positive relationship was present between the audiometric test results and the age, BMI, low-density lipoprotein and triglyceride levels and a negative relationship with the high-density lipoprotein levels. A negative relationship was present between the TEOAE S/N ratios and the age of the patients, duration without treatment, lipid parameters, inflammation markers and the creatinine level. FMF patients are exposed to chronic inflammation and this can influence their hearing levels. The age at diagnosis, duration without treatment, chronic inflammation, unfavorable lipid parameters, and obesity can affect hearing tests negatively.

Cure, Medine Cumhur/0000-0001-9253-6459; cure, erkan/0000-0001-7807-135X; Balta, Sevket/0000-0002-6657-7334 WOS: 000374792900009 PubMed: 26941246 Behcet's disease (BD) is a vasculitic and inflammatory disease causing endothelial dysfunction. Irisin is a metabolic hormone related to insulin resistance and endothelial functions. in this study, we investigated the relationship between irisin and carotid intima-media thickness (cIMT), which is a marker of atherosclerosis in patients with BD. 48 patients with BD and 50 healthy individuals were enrolled in the study. Disease severity was evaluated by BD current activity form. Irisin, glucose, insulin, C reactive protein, erythrocyte sedimentation rate and lipid panel were examined in all patients. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was used to calculate insulin resistance. A simple and inexpensive cIMT test was used as indicator of atherosclerosis. cIMT was 0.62 (0.45-1.05) mm in the patients, while it was 0.38 (0.25-0.65) mm in the control group (p

Ankylosing spondylitis (AS) is associated with an increased risk of atherosclerotic cardiovascular disease (ACD). The atherogenic index of plasma (AIP), which is the logarithmic transformation of the plasma triglyceride (TG) level to the high-density lipoprotein level (HDL) ratio, has been suggested to be a novel marker in the identification of atherosclerosis risk. Therefore, this study aims to determine if the AIP can act as an accurate marker for the detection of subclinical atherosclerosis. Fifty-two male patients with AS and 52 age-, gender-, and body mass index (BMI)-matched healthy control subjects were included in the study. For each patient, AIP and total cholesterol (TC)/HDL values were calculated and carotid artery intima-media thickness (cIMT) was measured. The mean (SD) cIMT and median (range) AIP values for AS patients were higher than that of the healthy control subjects (0.60 ± 0.18 vs. 0.51 ± 0.10, p = 0.003 and 0.23 [− 0.32 to 0.85] vs. 0.09 [− 0.53 to 0.49], p = 0.007, respectively). A positive correlation was found between the patients’ cIMT and AIP values (r = 0.307, p = 0.002) and TC/HDL values (r = 0.241, p = 0.014). Regression analysis revealed an independent association between the subclinical atherosclerosis and AIP (beta [β] = 0.309, p = 0.002). There were no independent correlations between subclinical atherosclerosis and TC (β = 0.245, p = 0.065), TG (β = 0.185, p = 0.515), HDL (β = 0.198, p = 0.231), TC/HDL (β = 0.032, p = 0.862), and low-density lipoprotein (LDL) (β = 0.151, p = 0.246). A strong and independent correlation exists between AIP and cIMT values. Therefore, the AIP could serve as a better marker than the TC/HDL ratio for the detection of subclinical atherosclerosis in AS patients.

The constriction of vessels due to atherosclerotic lesions causes hypoxia/ischemia and oxidative changes resulting in transformation of free albumin to ischemia-modified albumin (IMA) in the circulation and increased carotid intima–media thickness (cIMT). We investigated the reliability of IMA increase in evaluating atherosclerosis in patients with familial Mediterranean fever (FMF) compared with cIMT. Patients with FMF (n = 58) diagnosed by the Tel-Hashomer criteria in attack-free period and 38 healthy people were included in the study. Patient demographics as well as the clinical and laboratory characteristics of the healthy controls and patients with FMF were noted. The IMA levels and cIMT in patients with FMF were 0.30 ± 0.09 absorbance units (ABSUs) and 1.12 ± 0.27 mm, respectively, and in the control group, IMA levels and cIMT were 0.25 ± 0.07 ABSU and 0.74 ± 0.26 mm, respectively. The IMA levels and cIMT were significantly higher in patients with FMF than in controls ( P = .020 and P < .0001, respectively). The IMA values showed positive correlation with cIMT in patients with FMF( r = .302, P = .041). Our results reveal that IMA—an oxidative stress marker—may be an indicator of atherosclerosis in patients with FMF. This finding deserves further investigation.

Amaç: Primer hiperparatiroidili hastalarda, paratiroid adenom ağırlığıveya hacminin hiperparatiroidinin biyokimyasal parametreleri ileilişkisini araştıran çalışmaların sonuçları çelişkilidir. Bu çalışmada, primer hiperparatiroidilihastalarda preoperatif adenom hacmi ile labaratuvar parametreleri ve kardiyo-metabolikrisk faktörleri arasındaki ilişkinin değerlendirilmesini amaçladık. Gereç ve Yöntemler: Çalışmaya primer hiperparatiroidisi olan 75 hasta ve 96 kontrol olgusu alındı.Demografik, antropometrik ve biyokimyasal veriler kaydedildi. Adenom hacmi ilelabaratuvar ve kardiyo-metabolik risk faktörleri arasındaki ilişki korrelasyonanalizi ile değerlendirildi. Preoperatif adenoma hacmi ellipsoid model formülüile hesaplandı. Sonuçlar: Ortalama yaş her iki gruptabenzerdi (52.69 ± 10.91 to 53.33 ± 7.70, p:0.667). Ortalama adenom hacmi 1.42 ± 2.62 cm3 idi. Paratiroid adenomhacmi, parathormon ve kalsiyum düzeyleri ile pozitif korrele iken, vitamin Ddüzeyleri ile negatif korrele idi (p0.05).Parathormon, kalsiyum,fosfor veya vitamin D düzeyleri ile kardiyo-metabolik risk faktörleri arasındailişki saptanmadı (p>0.05). Sonuç: Paratiroid adenoma hacmi ile parathormon, kalsiyum vevitamin D düzeyleri arasında korrelasyon olmasına rağmen paratiroid adenoma hacmiile kardiyo-metabolikrisk faktörleri arasında ilişki saptanmadı., Aim: Thestudies conducted to investigate the association between biochemicalmanifestations of hyperparathyroidism such as serum parathyroid hormone, serumcalcium, and serum phosphate levels, and parathyroid adenoma weight and volumehave conflicting results. We aimed to investigate whether there is an associationof preoperative size of adenoma with laboratory parameters and cardio-metabolicrisk factors in patients with primary hyperparathyroidism.Material and Method: Seventy-five patients with PHPT and 96 controlsubjects were enrolled in the study. Demographic, anthropometric andbiochemistry data were recorded. Correlation analysis was used for determiningthe relation between adenoma volume and cardio-metabolic parameters.Preoperative adenoma volume was calculated bythe ellipsoid model formula. Results: Mean agewas similar between groups (52.69 ± 10.91 to 53.33 ± 7.70, p:0.667). Mean sizeof adenoma was 1.42 ± 2.62cm3. Size of adenoma was positively correlated with calcium andparathormone levels and negatively correlated with vitamin D level (p0.05). PTH, calcium, phosphorus or vitamin D levels were also notcorrelated cardio-metabolic risk factors.Conclusions: Adenomavolume has a correlation with parathormone, calcium, phosphorus and vitamin Dlevels, however, it is not associated with cardio-metabolic risk factors.

Systemic lupus erythematosus (SLE) is characterized by chronic inflammation. Plasma atherogenic index (PAI) is a valuable marker for the cardiovascular disease and cardiac risk. The aim of this study was to evaluate the role and clinical use of PAI in atherosclerosis and the cardiac risk in SLE patients.We included 56 female SLE patients who were selected according to the American College of Rheumatology (1997) diagnosis criteria. Furthermore, we selected age-and body mass index (BMI)-matched 56 female healthy individuals. PAI was measured as a logarithmic value of triglyceride to high-density cholesterol ratio. We used carotid intima media thickness (cIMT) as an inflammatory marker because of its widespread use. The lipid and other biochemical parameters of patient and control groups were examined.The PAI and cIMT values of SLE patients were 0.04±0.23 and 0.78±0.18 mm, respectively. Besides, for the control group, the PAI value was -0.09±0.20 and cIMT value was 0.50±0.15 mm (p=0.002, p0.001; respectively). There was a strong correlation between cIMT and PAI (r=0.273, p=0.003). According to the multiple logistic regression analysis, we found that PAI value is an independent factor for cIMT in SLE patients (odds ratio: 2.6, 95 % confidence interval; 1.506-4.374; p=0.029).We determined that PAI can be used as an independent indicator for subclinical atherosclerosis in SLE patients.Sistemik lupus eritematozus (SLE), kronik inflamasyon ile karakterize bir hastalıktır. Plazma aterojenik indeks (PAI), kardiyovasküler hastalık ve kardiyak risk için değerli bir belirteçtir. Bu çalışmanın amacı PAI’in SLE hastalarında aterosklerozu ve kardiyak riski değerlendirmekteki rolü ve klinik kullanılabilirliliğini araştırmaktır.Amerikan Romatoloji Koleji (1997) tanı kriterlerine göre değerlendirilen 56 kadın SLE hastası dahil edildi. Ayrıca yaş ve vucüt kitle indeksi uyumlu 56 kadın sağlıklı kişi seçildi. PAI, trigliserit’in yüksek yoğunluklu kolesterole oranı logartimik ölçümüdür. Karotis intima medya kalınlığı (KIMK) inflamatuvar belirteç olarak yaygın olarak kullanıldığından, bu işareti bu çalışmada kullandık. Hasta ve kontrol gruplarının lipid ve diğer biyokimyasal parametreleri incelendi.Hasta grubunda PAI 0,04±0,23, KIMK 0,78±0,18 mm, kontrol grubunda PAI −0,09±0,20, KIMK 0,50±0,15 mm olduğu tespit edildi. Hasta grubunda PAI ve KIMK’ın kontrol grubuna kıyasla yüksek olduğu görüldü (sırasıyla p=0,002, p0,001). SLE hastaları içerisine KIMK ile PAI arasında pozitif korelasyon olduğu görüldü (r=0,273, p=0,003). Multipl logistik regresyon analize göre PAI, KIMK için bağımsız risk faktörü olarak değerlendirildi (Olasılık oranı: 2,6, Güven aralığı %95 1,506–4,374, p=0,029).Bu çalışma bize PAI’nın SLE hastalarında subklinik aterosklerozun değerlendirilmesinde kullanılabilecek bağımsız bir belirteç olabileceğini düşündürdü.

The thyroid gland is susceptible to nodulation. The mechanism responsible for the growth of only some follicular cells, which results in nodule formation, is not yet clear. Selenium deficiency may be a risk factor in the development of thyroid nodules. The aim of this study was to investigate the relationship between selenium levels in patients with euthyroid nodular thyroid disease. Seventy patients with a solitary euthyroid thyroid nodule, 70 patients with more than one euthyroid nodule, and 60 healthy patients without thyroid nodules were included in the study. Venous serum samples were stored at -80°C and analyzed the same day using spectrometry. The selenium levels of patients with multiple thyroid nodules, solitary nodules, and patients without nodules were 57.3 ± 14.8 μg/L; 58.8 ± 15.1 μg/L; and 57.6 ± 13.3 μg/L, respectively. The mean serum selenium level of all patients included in the study was 57.9 ± 14.4 μg/L. Although serum selenium levels were slightly higher in men, a statistically significant difference was not observed. In our study, a significant relationship between serum selenium levels and nodular thyroid disease was not seen. Our study was undertaken in an iodine sufficient region. Mean serum selenium levels were lower compared with many other studies, which may be associated with the low selenium content of the soil. Nodular thyroid disease shows multifactorial features. When our study is considered together with previous studies, serum selenium levels may considered to be effective on structural thyroid diseases if combined with additional factors such as severe iodine deficiency. Further studies are required to assess the role of selenium in thyroid nodule formation.