Postpartum thyroiditis and hypothalamo-hypophysial insufficiency in the same woman with successive pregnancies: a case report

Objective. Although the incidence of postpartum autoimmune disorders of endocrine glands are not rare, the presence of two different entities in the same patient with two different pregnancies is uncommon. Methods. We present a 35-year-old woman whose story starts with her first pregnancy when she was 29 years old, she had the diagnosis of postpartum thyroiditis with hypothyroidism. We followed up the patient when she had her second pregnancy. Results. When she was being followed up with levothyroxine replacement, 5 years later she had her second delivery after which she had complaints of polydipsia, polyuria, weight loss and had the diagnosis of central diabetes insipitus and she has started desmopressin treatment and 17 months later the delivery she again applied with amenorrhea, continuation of lactation later she noticed oligomenorrhea, and her gonadotropin levels were found to be low as well as her TSH levels, although the L-thyroxine treatment dose was not changed. Dynamic tests of hypophysis revealed hypophyseal insufficiency and repeated hypophyseal MRI was in concordance with lymphocytic hypophysitis which explains the pattern of endocrinological abnormalities after the second delivery. Conclusion. This case signals role of autoimmune mechanisms underlying the endocrinopathies seen after successive pregnancies of the same patient

Impact of physical activity on inflammation: Effects on cardiovascular disease risk and other inflammatory conditions

Since the 19th century, many studies have enlightened the role of inflammation in atherosclerosis, changing our perception of “vessel plaque due to oxidized lipoproteins”, similar to a “rusted pipe”, towards a disease with involvement of many cell types and cytokines with more complex mechanisms. Although “physical activity” and “physical exercise” are two terms with some differences in meaning, compared to sedentary lifestyle, active people have lower cardiovascular risk and lower inflammatory markers. Activities of skeletal muscle reveal “myokines” which have roles in both the immune system and adipose tissue metabolism. In vitro and ex-vivo studies have shown beneficial effects of exercise on inflammation markers. Meanwhile in clinical studies, some conflicting results suggested that type of activity, exercise duration, body composition, gender, race and age may modulate anti-inflammatory effects of physical exercise. Medical data on patients with inflammatory diseases have shown beneficial effects of exercise on disease activity scores, patient well-being and inflammatory markers. Although the most beneficial type of activity and the most relevant patient group for anti-inflammatory benefits are still not clear, studies in elderly and adult people generally support anti-inflammatory effects of physical activity and moderate exercise could be advised to patients with cardiovascular risk such as patients with metabolic syndrome

Impact of physical activity on inflammation: Effects on cardiovascular disease risk and other inflammatory conditions

Since the 19th century, many studies have enlightened the role of inflammation in atherosclerosis, changing our perception of “vessel plaque due to oxidized lipoproteins”, similar to a “rusted pipe”, towards a disease with involvement of many cell types and cytokines with more complex mechanisms. Although “physical activity” and “physical exercise” are two terms with some differences in meaning, compared to sedentary lifestyle, active people have lower cardiovascular risk and lower inflammatory markers. Activities of skeletal muscle reveal “myokines” which have roles in both the immune system and adipose tissue metabolism. In vitro and ex-vivo studies have shown beneficial effects of exercise on inflammation markers. Meanwhile in clinical studies, some conflicting results suggested that type of activity, exercise duration, body composition, gender, race and age may modulate anti-inflammatory effects of physical exercise. Medical data on patients with inflammatory diseases have shown beneficial effects of exercise on disease activity scores, patient well-being and inflammatory markers. Although the most beneficial type of activity and the most relevant patient group for anti-inflammatory benefits are still not clear, studies in elderly and adult people generally support anti-inflammatory effects of physical activity and moderate exercise could be advised to patients with cardiovascular risk such as patients with metabolic syndrome

Preclinical and clinical evidence of nephro- and cardiovascular protective effects of glycosaminoglycans

Despite advances in pharmacological treatment, diabetic nephropathy is still the leading cause of end-stage renal disease and an important cause of morbidity and mortality in diabetics. Glycosaminoglycans are long, unbranched mucopolysaccharides that play an important role in establishing a charge-selective barrier that restricts the passage of negatively charged molecules, such as albumin and other proteins, at the level of the glomerular basal membrane. Their loss is associated with loss of selectivity and proteinuria. Extensive preclinical evidence and some clinical trials suggest that glycosaminoglycans replacement is associated with improvement of glomerular selectivity and of proteinuria. Sulodexide could also have some other effects, potentially useful to reduce the renal damage and the cardiovascular disease associated with proteinuria, such as improvement of haemorheological and blood lipid parameters, an endothelium protective effect and anti-inflammatory action. This review will discuss the evidence supporting the potential nephroprotective effects of sulodexide and other glycosaminoglycans

Hyperthyroidism and cardiovascular complications: a narrative review on the basis of pathophysiology

Cardiovascular complications are important in hyperthyroidism because of their high frequency in clinical presentation and increased mortality and morbidity risk. The cause of hyperthyroidism, factors related to the patient, and the genetic basis for complications are associated with risk and the basic underlying mechanisms are important for treatment and management of the disease. Besides cellular effects, hyperthyroidism also causes hemodynamic changes, such as increased preload and contractility and decreased systemic vascular resistance causes increased cardiac output. Besides tachyarrythmias, impaired systolic ventricular dysfunction and diastolic dysfunction may cause thyrotoxic cardiomyopathy in a small percentage of the patients, as another high mortality complication. Although the medical literature has some conflicting data about benefits of treatment of subclinical hyperthyroidism, even high-normal thyroid function may cause cardiovascular problems and it should be treated. This review summarizes the cardiovascular consequences of hyperthyroidism with underlying mechanisms

Birinci Saat Hiperglisemisi Olan Normolipidemik Hastalarda Alkole Bağlı Olmayan Yağlı Karaciğer Hastalığı İle İlişkili Faktörler

Purpose: Oral glucose tolerance tests (OGTT) use fasting and 120-minute values for the diagnosis of diabetes, impaired glucose tolerance (IGT) andimpaired fasting glucose (IFG), however, in the medical literature, various studies suggest the probable importance of one-hour hyperglycaemia.Non-alcoholic fatty liver disease (NAFLD) is also shown to be related with insulin resistance and cardiovascular risks. We aimed to evaluate thefactors related with NAFLD in patients with elevated one-hour plasma glucose levels in the absence of IGT or IFG, hyperlipidemia and hypertension.Material and Method: Among 746 subjects who underwent physical examination, evaluation of drug and alcohol use, lipid profiles, transaminases,and hepatitis markers as well as OGTT, 69 patients (21 males, 48 females) had 1-hour glucose levels higher than 155 mg/dL. The hepatic steatosisultrasound examination was conducted to grade (between 0 and 3) the presence of fat within the liver parenchyma. Ordinal regression analysis wasperformed to evaluate factors related with the degree of liver steatosis.Results: Overall, hepatosteatosis grade was significantly related with glycohemoglobin (HbA1c) levels, gender and obesity (body massindex?30kg/m2). Considering only non-obese patients, ultrasonographic grading was significantly associated with age and homeostasis modelassessment (HOMA) of insulin resistance.Discussion: Even if the diagnosis of diabetes, IGT and IFG is not established, insulin resistance can be related with hepatosteatosis and elevatedHbA1c level and, homeostasis model assessment may be predictive for NAFLD grade on ultrasonography in patients with high 60-minuteglycaemia on standard 75-g OGTT

The relationship between calcium metabolism, insulin-like growth factor-1 and pulse pressure in normotensive, normolipidaemic and non-diabetic patients

Introduction: Recent evidence suggests an interaction between bone metabolism and blood pressure (BP) regulation. The aim of our study was to evaluate endocrinological and metabolic factors related to pulse pressure (PP) in normotensive, normolipidaemic, non-smoker subjects. Material and methods: We consecutively enrolled 156 adults (37 males, 119 females) in summer 2009. The BP and body mass index (BMI) were recorded, and serum samples were taken for 25-hydroxy vitamin D (25-OHD), insulin-like growth factor-1 (IGF-1), growth hormone (GH), parathormone (PTH), calcium, albumin, phosphorus, glucose, triglyceride and cholesterol levels. Results: In the postmenopausal group, PP was significantly associated with age and BMI, while in premenopausal patients it was inversely related to ionized calcium. In men, a reverse relationship was present between GH and IGE-1 levels and PP. Conclusions: The PP was predicted by different parameters in different genders and these predictors change even in the same gender before and after menopause. Well-known predictors of PP such as age and BMI were more pronounced in postmenopausal women, but none of the groups showed a relationship between PP and 25-OHD or PTH

The factors that affect plasma homocysteine levels, pulse wave velocity and their relationship with cardiovascular disease indicators in peritoneal dialysis patients

Objective The incidence of cardiovascular diseases (CVD) is high in end-stage renal disease (ESRD) population and hyperhomocysteinemia is an important CVD risk factor. The aims of this study are to asses the incidence of hyperhomocysteinemia and the factors that affect the homocysteine (Hcy) levels in peritoneal dialysis (PD) patients, and to analyze the relationships between Hcy levels and clinical and echocardiographic CVD, and the pulse wave velocity (PWV). Study design Sixty ESRD patients undergoing PD for at least 6 months were included in the study. Biochemical parameters, echocardiography, and PWV were analysed for every subject. Results Mean Hcy level was 27.2 ± 15.7 lmol/L and was high in 53 patients (88.3%). Fibrinogen, dialysate/plasma creatinine ratio and folic acid were found to be the independent predictors of Hcy level (P\0.001; P\0.01; P\0.05, respectively). Patients with atherosclerosis had significantly higher plasma Hcy levels (P\0.05). No significant relationship was found between plasma Hcy levels and echocardiographic findings and PWV. Conclusion Hyperhomocysteinemia incidence seems high among PD patients and despite significant relationship between fibrinogen and Hcy in our study, it is essential to evaluate the link between Hcy levels and inflammation. Folic acid replacement even in normal folic acid levels, enough elimination of volume and solutesmay be beneficial to control Hcy levels, whereas PWV was found to be related with comorbidities and and dialysate kinetics

Role of cytological characteristics of benign thyroid nodules on effectiveness of their treatment with levothyroxine

Introduction: Levothyroxine (LT4) therapy has been used for the treatment of euthyroid nodular goiter, but there are controversial results about its usefulness. We aimed to evaluate the possible role of benign nodules’ cytological characteristics in response to LT4 therapy. Material and methods: In total, 93 patients with 128 nodules were included in the study; 74 of the nodules were treated with LT4 (group 1), and 54 of them had no medication (group 2). The subgroups consisted of adenomatous nodules, colloid nodules and cystic nodules. Results: In group 1, mean thyroid volume and mean nodule volume were reduced significantly (p = 0.002 and p = 0.022, respectively) with low-normal level thyrotropin (TSH) suppression (between 0.3 mIU/ml and 1.0 mIU/ml), while there were no significant changes in group 2. When we evaluated changes of the initial and last nodule volumes in cytological subgroups, only colloid nodules in group 1 had significant reduction (p = 0.040) and the others had no significant changes. By omitting the colloid nodules, when the other nodules were revaluated, there were no significant changes in either group. Conclusions: On the basis of these results, obtained from a large sample of Anatolian patients, it is possible that LT4 therapy leads to significant reductions of both thyroid volume and nodule size in colloid nodules, but not in other kinds of benign nodules