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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

Purpose: Graves’ ophthalmopathy (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 (Group1), 84 without GO (Group2)) and eighteen volunteers (Group3) were enrolled. The spectral-domain optical coherence tomography (SD-OCT) is used for ophthalmologic evaluation. Seven retinal layers including retinal nerve fiber 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 are 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. The median GCL, IPL, RPE were different in the groups, while RNLF, INL, OPL, ONL were similar (p>0.05 for each). Conclusion: The median GCL, IPL and RPE were thinner in patients with GO than healthy controls.

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.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.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).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.

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.

Purpose: Endocrine and metabolic changes, which may affect the prognosis and outcome, can occur in critically ill patients. In this prospective study, we aimed to evaluate the changes in the pituitary-adrenal-gonadal-thyroid axis in patients admitted to the adult intensive care unit on admission and 15 days later and also to evaluate whether these hormonal changes contribute to prognosis and mortality as well as to investigate the association between these hormonal changes and Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores, length of hospitalization, and mortality. Material and Method: One hundred and fifty seven patients were enrolled in this study. Severity of illness was assessed by APACHE II and SOFA scores. Blood samples were collected within the first 4 hours of intensive care unit admission and 15 days later for hormonal evaluation. Results: Eighty-five patients were in survival (S), 72 were in the non-survival (NS) group. The median age, and baseline APACHE II, median APACHE II mortality and SOFA scores in NS group were significantly higher than in S group. According the baseline endocrine parameters, the predictive factors on mortality were age, baseline SOFA score and hospitalization length and also, 15 days after the admission, age and Δ TSH were found be the predictive factors in mortality. Discussion: Our study revealed that none of the endocrine parameters contribute to mortality except Δ TSH. We assume that Δ TSH can be used together with APACHE II or SOFA scores in the prediction of prognosis in a tertiary mixed type intensive care unit.

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

Objectives: The main determinants of surgerydecision for thyroid nodules are cytology and ultrasonography. It is stilldebated in the literature if the giant nodules should be routinely operateddespite benign cytology reports. This study aimed to determine the malignancyrate in operated giant nodules and calculate the false negativity of cytologyin that group.Materials and Methods We enrolled 675 patients with giantnodules who were followed in our clinics between the dates of June 2015 andApril 2019. We evaluated the malignancy rates and other hormonal anddemographic parameters of 226 patients who underwent an operation and hadhistopathology result, retrospectivelyResults: According to thehistopathology results; 37 (14.40%) of the giant nodules were malignant whereas220 (85.60%) were benign. There was no statistically significant differencebetween malign and benign groups regarding preoperative ultrasonographicfeatures, nodule size and demographic properties. TSH was higher in themalignant group. False negativity of the cytology was calculated as 11.65%.Conclusion: Decision of surgeryshould be based on ultrasonography findings and FNAC in giant thyroid nodules.Routine surgery is not recommended. Repeated biopsies and sampling thedifferent parts of the nodule during a biopsy can decrease the false negativeresults., Amaç: Tiroid nodüllerinde operasyonkararının en önemli belirleyicisi ultrason özellikleri ile birlikte altınstandart olarak kabul edilen sitolojidir. Dev nodüller sitoloji benignse takipmi edilmeli yoksa sitoloji sonucundan bağımsız olarak opere mi edilmeli henüznetleştirilmemiştir. Bu çalışmanın amacı opere olmuş dev nodüllerde maligniteve İİAB'ın yanlış negatiflik oranlarını belirlemektir.Materyal ve Metot: Bu çalışmayaHaziran 2015- Nisan 2019 tarihleri arasında ≥ 4 cm çaplı nodülü olan 675 hastadahil edilmiştir. Bu hastaların 226 'sı opere edilmiş ve verileri retrospektifolarak incelenmiştir. Bulgular: Histopatolojik incelemedebu nodüllerin 37'si (14.40%) malign, 220’si (85.60%) benigndi. Benign ve malignnodüllerin ultrasonografik özellikleri ve nodül çapları arasında anlamlıfarklılık saptanmadı. İki grup demografik özellikler açısından benzerbulunurken, TSH düzeyi malign nodüllerde daha yüksekti. Sitolojinin yanlışnegatiflik oranı dev nodüller için %11.65’di.Sonuç: Sonuç olarak dev nodüllerdecerrahi kararı verirken sitoloji ve ultrason özellikleri ve bası semptomuvarlığı veya kozmetik problem varlığı göz önünde bulundurulmalıdır. Sitolojideyanlış negatiflik oranı küçük nodüllerden yüksek olabilir bu nedenle takipteultrason ve gerektiğinde tekrarlayan biyopsi yapmak gerekir. Bu bulgular rutincerrahi önermek için yeterli değildir.

Background We aimed to compare nonaspiration (NAS) and aspiration (AS) techniques in the evaluation of fine-needle cytology of lymph node (FNC-LN) in terms of diagnostic adequacy of cytologic material. Methods One hundred and twenty-three superficial cervical LNs in 75 patients who underwent NAS and AS-FNC-LN in the same visit were evaluated. Cytological results were categorized as diagnostic and nondiagnostic. Results The rates of malignancy were 13.8% in AS versus 16.3% in NAS technique, whereas nondiagnostic cytology was detected in 43.1% and 25.2%, respectively (P = .549 and P

Considering the diameter of the largest tumor while determining T stage in multifocal papillary thyroid microcarcinomas (PTMCs) might cause underestimation of tumoral stage. We aimed to investigate the effect of total tumor diameter (TTD) on tumor node metastasis (TNM) classification in multifocal T1a PTMCs.T1 tumors were grouped as T1a or T1b according to 7th TNM edition. For patients with multifocal T1a, TTD (the sum of the maximal diameter of each focus) was calculated, and these patients were further subgrouped as TTD ≤1 cm or TTD 1 to 2 cm.There were 724 patients with T1 tumors. Multifocality was observed in 150 (28.5%) of 527 patients with T1a and 84 (42.6%) of 197 patients with T1b tumors (P.001). Lymph node metastasis (LNM), thyroid capsule invasion, and lymphovascular invasion were significantly higher in T1b compared to T1a (P.001, P.001, and P = .015, respectively). There were 8 (1.5%) patients with persistence but not any with recurrence in the T1a group. Persistence and recurrence were observed in 3 (1.5%) and 5 (2.5%) patients in the T1b group, respectively. Among 150 T1a patients with multifocal tumors, TTD was ≤1 cm in 89 (59.3%) and 1 to 2 cm in 61 (40.7%) patients. Number of tumor foci, LNM, and thyroid capsule invasion were significantly higher in multifocal T1a patients with TTD 1 to 2 cm compared to with TTD ≤1 cm (P.001, P = .032, P = .014, respectively).TTD might be used as a parameter to determine patients at higher risk for persistence, and T1a multifocal PTMCs with TTD 1 to 2 cm can be reclassified as T1b.ETE = extrathyroidal extension LNM = lymph node metastasis PTC = papillary thyroid carcinoma PTMC = papillary thyroid microcarcinoma RAI = radioactive iodine TNM = tumor, node, metastasis TTD = total tumor diameter.

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.

Purpose. In the present study, we aimed to investigate postural change of PTH in normal individuals and in patients with primary hyperparathyroidism (PHPT).Methods. Twenty-two patients with PHPT and nine healthy controls were enrolled. Following 12 h of fast, patients stayed in recumbent position for an hour and PTH and total Ca measurements were performed at the 45th and 60th minutes of resting. Afterwards, the patients resumed an upright posture for an hour and again blood samples were taken at the 45th and 60th minutes of standing.Results. In the PHPT group, mean PTH was calculated as 153.9 pg/mL in the recumbent position while it was 206.3 during upright position (Δ change was 47.7) (P<0.001). In the control group mean serum PTH was measured as 41.2 pg/mL in the recumbent position while it was 44.8 pg/mL in the upright position (Δ change was 1.7) (P=0.11). In both groups, serum Ca was higher in the upright position compared to the recumbent position (P<0.001).Conclusion. Postural change of serum PTH is significant only in PHPT group. Postural PTH test may give a clue to the clinician when the diagnosis of PHPT is equivocal.