THYROID HORMONE REPLACEMENT IN TOTAL THYROIDECTOMIZED PATIENTS : SYMPTOMATIC AND METABOLIC EFFECTS OF LEVOTHYROXINE MONOTHERAPY

Purpose: In this study, we planned to investigate the effects of L-thyroxine monotherapy on total thyroidectomized patients. The main goal of our study is to evaluate if FT4 therapy is good enough not only to maintain euthyroidism but also to provide a good quality of life and a balance in their metabolism Methods: In this study, we retrospectively evaluated 30 total thyroidectomized patients without malignancy. We compared their thyroid hormone levels, glucose metabolism, lipid metabolism, their body mass indexes, and their symptoms of thyroid problems before surgery and after one year of treatment of L-thyroxine monotherapy. Results: the pre-op and post-op thyroid hormone levels were both in the normal range but the FT4 levels were significantly higher in the 1st year results than pre-op results (1,42 +/- 0,18 vs 1,29 +/- 0,49 respectively P=0,005*) The FT3 levels also were in the normal range in pre and 1st year post-op but post-op FT3 levels were significantly lower than pre-op levels (2,25 +/- 0,27 vs 2,92 +/- 0,49 retrospectively P<0,001*). The pre-op and postop TSH levels were euthyroid and not statistically significant. The patients tended to gain weight and it seems to be because of a tendency of being insulin resistant. (HOMA-IR pre-op and post-op were 2,2 +/- 1,1 vs 2,6 +/- 1,1 P<0,01 retrospectively; pre-op and post-op weights were 69,8 +/- 9,5 vs 71,1 +/- 10,3 P=0,006* respectively). Even all of them were euthyroid the patients tended to feel hypothyroidism symptoms. Conclusion: This study demonstrates that even though they are euthyroid with FT4 treatment total thyroidectomized patients may suffer from hypothyroidism signs and symptoms and metabolic deterioration may occur in such patients. We recommend that we should aim not only to normalize s-TSH levels but also to normalize patients' metabolic parameters and improve the quality of daily life when regulating our treatments

Thyroid Hormone Replacement in Total Thyroidectomized Patients: Symptomatic and Metabolic Effects of Levothyroxine Monotherapy

Purpose: In this study, we planned to investigate the effects of L-thyroxine monotherapy on total thyroidectomized patients. The main goal of our study is to evaluate if FT4 therapy is good enough not only to maintain euthyroidism but also to provide a good quality of life and a balance in their metabolism Methods: In this study, we retrospectively evaluated 30 total thyroidectomized patients without malignancy. We compared their thyroid hormone levels, glucose metabolism, lipid metabolism, their body mass indexes, and their symptoms of thyroid problems before surgery and after one year of treatment of L-thyroxine monotherapy. Results: the pre-op and post-op thyroid hormone levels were both in the normal range but the FT4 levels were significantly higher in the 1st year results than pre-op results (1,42 +/- 0,18 vs 1,29 +/- 0,49 respectively P=0,005*) The FT3 levels also were in the normal range in pre and 1st year post-op but post-op FT3 levels were significantly lower than pre-op levels (2,25 +/- 0,27 vs 2,92 +/- 0,49 retrospectively P<0,001*). The pre-op and postop TSH levels were euthyroid and not statistically significant. The patients tended to gain weight and it seems to be because of a tendency of being insulin resistant. (HOMA-IR pre-op and post-op were 2,2 +/- 1,1 vs 2,6 +/- 1,1 P<0,01 retrospectively; pre-op and post-op weights were 69,8 +/- 9,5 vs 71,1 +/- 10,3 P=0,006* respectively). Even all of them were euthyroid the patients tended to feel hypothyroidism symptoms. Conclusion: This study demonstrates that even though they are euthyroid with FT4 treatment total thyroidectomized patients may suffer from hypothyroidism signs and symptoms and metabolic deterioration may occur in such patients. We recommend that we should aim not only to normalize s-TSH levels but also to normalize patients' metabolic parameters and improve the quality of daily life when regulating our treatments

Prognostic value of dysnatremia in COVID-19 disease

Objective: The infection of Corona 2019 (COVID-19) had first diagnosed in December 2019 and evolved into a worldwide pandemic in March 2020. In Turkey first diagnose was announced in March 2020. Low costed and easily accessible laboratory parameters needed for predicting the prognosis of this disease as its outcome pattern vary greatly from patient to patient. There is promising data on predicting the outcomes with disnatremic results. Methods: In this study we retrospectively investigated all adults with the diagnosis of COVID-19 who attended to Turkan Ozilhan Hospital over a 3 months period. We evaluated the relation of dysnatremia (hyponatremia as 145 mmol/L) for need of intensive care unit (ICU) treatment, need of intubation for mechanic ventilatory support and inpatient mortality. Results: one thousand seventy tree patients with COVID-19 [53..9% males (793 patients) and 46.1% females (680 patients), were investigated for this study. Their median age was 53.9 years ranging betweent 19-94. The dysnatremic groups had significantly higher rates of need for ICU and intubation The need for ICU was 89 (21.5%) patients in normonatremic group but 38 (76%) patients in hypernatremic and 71 (64%) in hyponatremic patients (p<0.01 for each of them). The mortality rate was 5% in normonatremic patients but 50% in hypernatremic and 28% in hyponatremic patients (p<0.01 for each of them). Conclusion: In this study we aimed to draw attention to the importance of abnormal sodium levels as a predictive marker in COVID-19. In small town hospitals the physicians should be aware of the risks of disnatremic patients with COVID-19 and take precautions while treating them

Karydakis Procedure without a Drain for Sacrococcygeal Pilonidal Sinus Patients

Objective: This study aimed to evaluate patients with sacrococcygeal pilonidal sinus (PS) disease who underwent the Karydakis procedure without any drains. Methods: Ninety-eight patients presenting with PS at our center underwent the Karydakis procedure from September 2017 to April 2018. These patients were evaluated for fluid collection, failure of wound healing, wound infection and dehiscence on the postoperative first, third, the seventh days and the first month. Results: A total of ninety-eight patients underwent Karydakis procedure, of which 84 were males and 14 females. Of the two patients had recurrent disease. Three patients had a serious collection on the third postoperative day. One patient had a wound infection on the seventh postoperative day and drainage was performed. One patient had wound dehiscence on the 10th postoperative day due to local trauma. The remaining 93 patients had normal physical examination findings on the first, third, seventh days and the first month after surgery. Conclusion: We think that not using drains in the Karydakis procedure does not increase the complications. However, drain usage should be weighed according to its costs and benefits in every case, especially in patients with a body mass index greater than 30

Real-world data on efficacy and safety of first-line alectinib treatment in advanced-stage, ALK-positive non-small-cell lung cancer patients: A Turkish Oncology Group study

Aims: In this multicenter study, the authors aimed to determine the real-life efficacy and safety of first-line alectinib. Materials & methods: This retrospective trial included advanced-stage, ALK-positive non-small-cell lung cancer patients who were treated with first-line alectinib in terms of ALK-tyrosine kinase inhibitors, regardless of previous chemotherapy. The co-primary end points were progression-free survival both for all patients and for the treatment-naive population. The secondary end points were overall response rate, overall survival, rate of CNS progression and safety. Results & conclusion: A total of 274 patients (n = 177 for treatment-naive patients) were enrolled in the study. The median progression-free survival was 26 and 28.8 months for all patients and the treatment-naive group, respectively. The overall response rate, CNS progression rate and 1-year overall survival ratio were 77.9, 12.4 and 77%. Alectinib is a highly effective therapy with a favorable safety profile