The role of inflammation, oxidation and Cystatin-C in the pathophysiology of polycystic ovary syndrome.

Objective: The relationship between Cystatin-C levels and inflammatory, oxidant, and antioxidant markers in polycystic ovary syndrome (PCOS) was investigated. Materials and Methods: A total of 96 participants were included in the study as PCOS (n=58) and control (n=38) groups. Tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1B), interleukin 6 (IL-6), malondialdehyde (MDA), superoxide dismutase (SOD), and Cystatin-C were evaluated by ELISA method. Relationships metabolic and endocrine parameters seen in PCOS were examined. Univariate and multivariate logistic regression analyzes were performed to identify risk factors that may affect the PCOS group. Bivariate correlations were investigated by the Spearman's correlation analysis. Results: While Cystatin-c, TNF-α, IL-1B, IL-6, MDA were found to be higher in patients with PCOS compared with the control group, SOD was found to be lower than the control group (p<0.05). In the correlation analysis, increased Cystatin-C levels were found to be associated with high IL-6 (r=0.214, p=0.037) and low SOD levels (r=-0.280, p=0.006). Conclusion: In our study, it was found that the increase in Cystatin-C levels was associated with an increase in IL-6 and a decrease in SOD. These results may bring up different treatment options to reduce cardiovascular risks for treating PCOS.

The Detection of Preoperative Parathyroid Lesions: The Success of Ultrasonography, Technetium-99m Methoxyisobutylisonitrile Parathyroid Scintigraphy, and Single-Photon Emission Computed Tomography-Computed Tomography.

OBJECTIVE: We aimed to find and compare the efficacy of ultrasonography (US), technetium-99m methoxyisobutylisonitrile parathyroid scintigraphy (MIBI-S), and single-photon emission computed tomography-computed tomography (SPECT-CT) in detecting the localization of parathyroid adenomas in patients with primary hyperparathyroidism. METHODS: In total, 348 patients were included in this study. Preoperative parathyroid imaging with US, MIBI-S, and SPECT-CT was evaluated and compared with operative findings. The results of the imaging methods were compared with pathology and operation reports. RESULTS: In 318 patients (91.3%), one of the imaging methods was able to localize the lesion correctly. US detected the localization of the parathyroid lesions correctly in 268 patients (77%), whereas SPECT-CT and MIBI-S were correct in 254 (73%) and 209 (60%) patients, respectively. There was a statistically significant relationship between the parathyroid hormone (PTH) level and 3 imaging methods' success rates (P < .05). The PTH cut-off value, which best determined the correct localization, was 152.5 pg/mL for US, 143 pg/mL for MIBI-S, and 143 pg/mL for SPECT-CT. It was observed that the correct localization rate for parathyroid lesions increased with higher PTH levels. CONCLUSION: In our study population, US was more successful, in most cases, than other imaging methods in localizing parathyroid lesions but SPECT-CT was more accurate in localizing mediastinal lesions. In addition, it was found that preoperative PTH levels affect the accuracy of imaging methods.

Malignancy outcomes and the impact of repeat fine needle aspiration of thyroid nodules with Bethesda category III cytology: A multicenter experience.

BACKGROUND: The clinical management of Bethesda III category thyroid nodules has some undefined points and differs among centers and conflicting malignancy rates are present in the literature. The aim of this study was to investigate the Bethesda category III thyroid nodule outcomes in our centers, to determine malignancy rates and also to evaluate clinical and sonographic features which may help to predict malignancy. METHODS: This retrospective study included 333 patients with thyroid nodules who had Bethesda category III on fine needle aspiration (FNA) in three tertiary medical centers of Turkey. RESULTS: Among 333 patients, 302 had appropriate follow up. Eighteen patients received thyroidectomy after the first FNA, with a malignancy rate of 38.89% (7/18) and 284 patients received a second FNA. After the second FNA, thyroidectomy was performed in 80 patients and 41 patients needed the third FNA. Thirteen thyroidectomies were performed after the third FNA. Totally 111 patients received thyroidectomy with a malignancy rate of 48.65% (54/111) among patients with surgery and the lower bound was detected as 17.88% (54/302). Of these patients the malignancy rates of patients receiving thyroidectomy with two and three FNAs were 47.50% (38/80) and 69.23% (9/13), respectively. Hypoechogenicity, microcalcification, and irregular margin were found as good predictors for malignancy. CONCLUSION: We demonstrated that the malignancy rate was 48.65% in patients receiving thyroidectomy. We showed a higher malignancy rate than the traditionally rate of 5%-15%. This study showed that repeat FNAs decrease the rate of unnecessary surgery performed for benign lesions by increasing the rate of malignancy detection.

The effects of salt consumption habits on iodine status and thyroid functions during pregnancy

Background/aim: Iodine is the basic substrate for thyroid hormone synthesis and is vital for the general population and especially pregnant women. Iodine deficiency may cause severe health problems for a foetus. This study aimed to determine the relationship, if any, between iodine level and thyroid function tests, and to determine the relationship between consumption of salt types and its effects on thyroid function tests in the first trimester of pregnancy. Materials and methods: Three hundred and six pregnant women in the first trimester of pregnancy, who had known no thyroid disease history and had not received iodine supportive therapy, were included in the study. All patients were questioned for their preferred table salt or rock salt in daily use and urine iodine concentrations (UICs) were analysed in spot urine. The results were evaluated statistically according to salt usage preferences. Results: The median age of patients in the study was 27.8 (± 5.4). In terms of salt consumption habits, 235 (76.8%) of patients reported using table salt, and 71 (23.2%) reported using rock salt. Iodine deficiency was found in 75.81% (n = 232) of all cases according to urinalysis. Median UICs of table salt group were significantly higher than rock salt group (123.7 µg/L and 70.9 µg/L respectively, P < 0.001). Conclusion: Although large-scale salt iodination began long time ago, iodine deficiency is still a serious health problem among pregnant women. According to this study, use of rock salt is associated with low urinary iodine concentration in pregnant women and TSH values within the reference limits are not a good indicator for determining the iodine level.

Exenatide improves cardiovascular risk factors in obese patients with type 2 diabetes mellitus: a prospective study

Background/aim: The aim of this study was to evaluate the effects of a 6-month treatment regimen with exenatide on the lipid profile, high-sensitivity C-reactive protein (hsCRP), carotid intima media thickness (CIMT), visceral adiposity, and nonalcoholic fatty liver disease (NAFLD), all of which are important cardiovascular risk factors. Materials and methods: This study included 45 obese patients with type 2 diabetes mellitus (T2DM). Baseline clinical findings, laboratory parameters, and ultrasonography findings were recorded. An exenatide recipe was given twice daily to the patients and, after 6 months of therapy, the same variables were compared. The compared parameters were lipid profiles, hsCRP, aspartat aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, liver craniocaudal diameter, visceral fat volume, subcutaneous fat thickness, and CIMT. Liver diameter, visceral fat volume, subcutaneous fat thickness, and CIMT were measured by ultrasonography. Results: After therapy, statistically significant improvements were achieved in lipid profile, hsCRP, liver enzymes, body mass index, and waist and hip circumferences. Also, statistically significant decreases were obtained in liver craniocaudal diameter, subcutaneous fat thickness, visceral fat volume, and CIMT. The reduction of CIMT and liver diameter were not correlated with BMI and HbA1c reduction. Conclusion: This study showed improvement in lipid profile and hsCRP levels with exenatide treatment. We also showed decrease in both visceral fat volume and subcutaneous fat thickness. We demonstrated significant decrease in liver enzymes with significant decrease in liver diameter. These findings support the use of exenatide in patients with NAFLD and T2DM. Additionally, this study showed that exenatide treatment given twice daily reduces CIMT in obese T2DM patients.

The role of therapeutic plasmapheresis in patients with hyperthyroidism.

BACKGROUND: Hyperthyroidism is characterized by excess hormone secretion from the thyroid gland. Anti-thyroid drugs (ATDs), surgery, and radioactive iodine can be used in treatment. Plasmapheresis is a rapid and effective treatment option in cases where rapid euthyroidism is needed to be obtained due to complications of thyrotoxicosis and major adverse effects of ATDs. MATERIAL AND METHOD: We present patients receiving plasmapheresis to provide immediate euthyroidism due to severe hyperthyroidism, adverse effects of ATDs, or non-thyroid surgery from January 2012 to December 2016. RESULTS: This study included 18 patients. The etiology of hyperthyroidism was TDG in seven patients, TDMNG in two, TA in two, TMNG in four, and one patient had AIT. Plasmapheresis was performed to achieve euthyroidism before surgery in two patients. The mean plasmapheresis session was 5.35. The mean number of sessions needed for patients with TDG and TDMNG was 4, whereas it was 6.5 for patients with TA and TMNG (p = 0.07). The decrease of mean free thyroxine and free triiodothyronine were 57 % and 73 %, respectively (p < 0.001). After plasmapheresis, total thyroidectomy was performed in 14 patients. Euthyroidism was achieved with RAI in one patient and with medical therapy in three patients. CONCLUSIONS: Plasmapheresis therapy is a reliable and effective treatment option for patients who cannot use ATDs because of their adverse events and those with hyperthyroidism that does not resolve with these drugs, or to achieve euthyroidism before total thyroidectomy, RAI or non-thyroid emergency surgery. However, it cannot be used widely because it is expensive and invasive.