The effect of COVID-19 pandemic restrictions on the management of differentiated thyroid cancer in Turkey: a single tertiary centre experience.

PURPOSE: Many countries have implemented unprecedented health measures since the World Health Organisation declared the novel coronavirus disease 2019 (COVID-19) a global pandemic. These measures have resulted in delays in the diagnosis of differentiated thyroid cancer (DTC). However, there is limited data on the impact of restrictions imposed during the pandemic on DTC management. Thus, the aim of this study is to analyse the clinicopathological and follow-up data of DTC patients diagnosed before and during the COVID-19 outbreak. METHODS: This retrospective study included 191 DTC patients that were diagnosed between December 2018 and June 2021. The patients were divided into two groups: patients diagnosed before (December 2018 to February 2020) and during (March 2020 to June 2021) the COVID-19 pandemic. The clinicopathological and follow-up data between the two groups were compared. RESULTS: Similar preoperative cytology results were obtained from the two groups. No difference with regard to tumour size, lymphovascular invasion and extrathyroidal invasion was observed between the two groups. While the American Thyroid Association risk stratification was similar between the two groups, radioactive iodine (RAI) therapy was applied less during the COVID-19 period. Although RAI therapy was administered at a lower rate during the COVID-19 period, the recurrence rates among patients after two years of follow-up were similar to those during the pre-COVID-19 period. CONCLUSION: Although the COVID-19 pandemic restrictions during the pandemic period caused difficulties in the management of DTC patients, this did not negatively affect their prognosis. These findings can confirm the applicability of active surveillance in DTC patients and may help change the real-life treatment practices in selected low-risk DTC patients.

Impact of Bolus/Basal Insulin Ratio on HbA1c and Lipid Profile in Adult Patients with Type 1 Diabetes Mellitus.

OBJECTIVE: To evaluate the existence of any relationship between the bolus/basal (B/b) insulin ratio and HbA1c and lipid profile in patients with Type 1 Diabetes mellitus (T1DM) on a basal-bolus treatment regimen. STUDY DESIGN: Retrospective observational study. Place and Duration of the Study: University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey, from January 2015 to March 2020. METHODOLOGY: This retrospective-observational study included 181 adult patients with T1DM. They were divided into two groups with <1.5 and ≥1.5 B/b insulin ratios, and the parameters were compared. RESULTS: The subjects comprised 94 females and 87 males with a mean age of 30.1 ± 9.2 years. Microvascular complications and dyslipidaemia were found in 30.9% and 68.5% of the patients, respectively. B/b insulin ratio of ≥1.5 was observed in 65.1% of the patients. The HbA1c level was <58 mmol/mol in 11.6% of the patients. A positive correlation was found between the B/b insulin ratio and HbA1c level. Fasting Plasma Glucose (FPG) and HbA1c levels were higher in those with ≥1.5 B/b insulin ratio. The rate of patients who reached the optimal HbA1c level was 3.57-fold lower in those with ≥1.5 B/b ratio. CONCLUSION: A higher B/b insulin ratio was associated with higher HbA1c levels in patients with T1DM treated with intensive insulin therapy. Prospective studies are needed to define a causal relationship between the B/b insulin ratio, glycaemic parameters, and lipid profile. KEY WORDS: Bolus/basal insulin ratio, Type 1 Diabetes mellitus, HbA1c, Low-density lipoprotein, Lipid profile.

Effect of thyroid nodule size on cytology reliability and incidence of malignancy: A large cohort of 1205 patients from a single center.

OBJECTIVE: There is controversy about whether the rates of malignancy and of false-negative malignancy are greater in large nodules. The aim of this study was to determine the reliability of cytology in ≥4cm nodules and to compare malignancy rates between ≥4cm and<4cm nodules. METHODS: The study included 1205 patients who underwent biopsy and subsequent thyroidectomy with the diagnosis of nodular thyroid disease between 2014 and 2019. The patients were separated into two groups, ≥4cm and<4cm, according to the size of the index nodule on ultrasonography. RESULTS: Two hundred and eleven index nodules (17.5%) were ≥4cm. Malignancy rate on definitive pathology was 51% in<4cm nodules and 30% in ≥4cm nodules. Malignancy risk was significantly lower in ≥4cm nodules than <4cm nodules (P<0.001). When<1cm nodules were excluded and 1-4cm and ≥4cm nodules were compared, malignancy risk was also significantly lower in ≥4cm nodules (P=0.001). On definitive pathology, there were 45 false-negative results among cytologically benign nodules. There was no difference in false-negative cytology rate between<4cm and ≥4cm nodules (P=0.209). CONCLUSION: The present study found no decrease in the reliability of cytology in ≥4cm nodules, and there may not be a linear relationship between nodule size and malignancy risk. Therefore, in asymptomatic cytologically benign ≥4cm nodules, surgery may not be recommended based on nodule size alone.

Prevalence and associated risk factors of simple renal cysts in primary hyperparathyroidism.

PURPOSE: Previous studies have pointed to the role of parathormone (PTH) in the development of simple renal cysts. However, there is insufficient evidence related to simple renal cysts in primary hyperparathyroidism (PHPT). Therefore, this study aimed to evaluate the prevalence and risk factors associated with renal cysts in PHPT patients. METHODS: In this retrospective study, we included 235 patients treated surgically for PHPT and 147 control subjects. The clinical and physical examination findings, laboratory test results, and neck and urinary system ultrasonography examination findings were evaluated. Postoperative parathyroid adenoma volume and weight were also recorded. RESULTS: Simple renal cysts were found in 53 PHPT patients (22.6%) and in 15 control subjects (10.2%) (p = 0.002). Kidney stones were found in 33 PHPT patients (14%) and in only seven control subjects (4.8%) (p = 0.004). The presence of PHPT and high PTH levels independently supported the development of a simple renal cyst. Advanced age was determined as a risk factor for the development of simple renal cysts, and the presence of kidney stones was an independent predictor of simple renal cysts in PHPT patients. There was no relationship between the presence of simple renal cysts and the volume and weight of parathyroid adenoma. CONCLUSION: A diagnosis of PHPT, high PTH levels, advanced age, and kidney stones are independent risk factors for simple renal cysts in PHPT patients. These patients should be evaluated regularly for complications of renal cysts and nephrolithiasis.

The value of routine measurement of serum calcitonin on insufficient, indeterminate, and suspicious thyroid nodule cytology.

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.

Effect of Exenatide Therapy on Platelet Function in Type 2 Diabetes Mellitus.

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 <0.01 and p=0.036, respectively). Significant positive correlations were determined between PDW and BMI (p<0.001), FPG (p <0.001), and HbA1c (p<0.001). After six months of exenatide treatment, PDW (p = 0.015) values and platelet count (p = 0.003) were significantly decreased. CONCLUSIONS: Exenatide causes a decrease in PDW value and platelet count independent of its positive effect on lipid profile, glycemic regulation, and weight loss, which contributes to explain the effect of treatment on the cardiovascular system through a different mechanism. Key Words: Exenatide, Type 2 diabetes mellitus, Platelet count, Platelet distribution width, Mean platelet volume.

The Effects of Chronic Lymphocytic Thyroiditis on Clinicopathologic Factors in Papillary Thyroid Cancer.

OBJECTIVE: This study evaluated the impact of chronic lymphocytic thyroiditis (CLT) on clinicopathologic parameters, prognostic outcome, and initial treatment responses in patients with papillary thyroid cancer (PTC). METHODS: A retrospective review was conducted of 1409 patients with PTC, comprising 443 patients with pathology-proven PTC with CLT and 447 patients with PTC without CLT. RESULTS: The median follow-up time was 58 months (range, 8-380 months), and the median age at the time of diagnosis was 43 years. The age at diagnosis was significantly lower in patients with CLT than in those without CLT (42 years vs 45 years, respectively; P = .001). The preoperative thyroid-stimulating hormone level was found to be significantly higher in patients with CLT than in those without CLT (1.71 mIU/L vs 1.28 mIU/L, respectively; P < .001). Multifocality and capsular, lymphovascular, and perineural invasion were detected at a higher rate in the group with CLT than in the group without CLT (P = .015, P = .024, P = .004, and P = .039, respectively). No difference was found between the 2 groups in terms of tumor size, bilaterality, extrathyroidal invasion, lymph node metastasis, disease stage, or response to treatment (P > .05). CONCLUSION: The results of the present study demonstrated that the coexistence of PTC and CLT is very frequent. Patients with the coexistence of PTC and CLT were diagnosed at a younger age, and the thyroid-stimulating hormone level was higher in these patients. Contrary to previous studies, no positive effect of the CLT and PTC combination was detected on any clinicopathologic factor. In addition, lymphovascular and perineural invasions, which had negative effects on prognosis, were more common in the group with CLT.

Fatty acid-binding protein-4 as a biomarker predicting acromegaly-associated diabetes mellitus.

BACKGROUND: 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. 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 (ß = 7.382, OR = 38.96, 95% CI: 1.52-5.76, p = 0.018). DISCUSSION: The FABP-4 may be a helpful predictor of acromegaly-associated DM.

Tumor Volume Can Be Used as a Parameter Indicating the Severity of Disease in Parathyroid Cancer.

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.

The Evaluation of Low- and High-Dose Steroid Treatments in Subacute Thyroiditis: A Retrospective Observational Study.

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 (ß = -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.

Residual Pyramidal Lobe Increases Stimulated Thyroglobulin and Decreases Endogenous Thyroid Stimulating Hormone Stimulation in Differentiated Thyroid Cancer Patients.

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.

The Assessment of Ventricular Arrhythmia Indicators Based on Electrocardiography in Patients With Differentiated Thyroid Cancer Followed Up With Levothyroxine Suppression.

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 (ß = 4.322, R2 = 0.024, P = .042; ß = 0.016, R2 = 0.048, P = .005; ß = 0.015, R2 = 0.044, P = .006, respectively). A higher serum fT4 level was found to be associated with a higher Tp-e/QT ratio (ß = 0.018, R2 = 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.

The contribution of ultrasonographic findings to the prognosis of subacute thyroiditis.

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.

Preoperative Vitamin D Levels as a Predictor of Transient Hypocalcemia and Hypoparathyroidism After Parathyroidectomy.

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.

The contribution of ultrasonographic findings to the prognosis of subacute thyroiditis

ABSTRACT 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

The effects of patient and disease-related factors on the quality of life in patients with hypoparathyroidism.

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. PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Serum cortisol level after low dose dexamethasone suppression test may be predictive for diabetes mellitus and hypertension presence in obese patients: A retrospective study.

AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

The Importance of Vitamin D Level in Subacute Thyroiditis Disease and the Effect of Vitamin D on Disease Prognosis.

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 the erythrocyte sedimentation rate and 25(OH)D, but no significant relationship was found between vitamin D level and prognosis. CONCLUSION: 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.

The prognostic and diagnostic use of hematological parameters in subacute thyroiditis patients.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

An Evaluation of the Results of the Steroid and Non-steroidal Anti-inflammatory Drug Treatments in Subacute Thyroiditis in relation to Persistent Hypothyroidism and Recurrence.

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.