Changes in levothyroxine pharmacokinetics following bariatric surgery in obese hypothyroid patients

Aim: Levothyroxine (L-T4) requirements in obese hypothyroid patients receiving L-T4 therapy decrease following bariatric surgery. L-T4 absorption is also thought to decrease after surgery. The purpose of this study was to evaluate L-T4 requirements in hypothyroidism cases before and after weight loss through bariatric surgery. Methods: Seventy-six cases of hypothyroidism receiving L-T4 replacement therapy and with a body mass index over 40 kg/m2 were included in the study. Patients losing at least 10% of basal body weight following bariatric surgery were assessed in terms of thyroid hormone levels and L-T4 requirements over follow-up of at least one year. The L-T4 requirements of patients in whom euthyroidism was achieved were compared in terms of bariatric surgery procedures and hypothyroidism etiology. Results: Seventy-six patients (56 women, 20 men) with a mean age of 38 years (18-51) were included in the study. Mean weight before bariatric surgery was 121.6 ± 6.8 kg, and mean body mass index was 49.5 ± 1.6 kg/m2. Euthyroidism was confirmed at pre- and post-bariatric surgery evaluation. No statistically significant postoperative changes were determined in thyroid-stimulating hormone or free thyroxine-3 and -4 (p > 0.05). A statistically insignificant decrease was observed in L-T4 dosages after surgery in cases of Hashimoto’s thyroiditis (p = 0.064). A statistically significant decrease was determined in L-T4 dosages in cases of non-Hashimoto hypothyroidism (p = 0.001). L-T4 requirements decreased in both surgical procedures (p = 0.001) Conclusion: Postoperative L-T4 requirements decrease with weight loss. In addition, no decrease appeared to occur in L-T4 absorption following the surgical procedures in this study

Clinical Evaluation on Non-Functional Invasive Hypophysis Adenomas

Background There are ongoing studies to predetermine non-functional invasive pituitary adenomas which may show aggressive behavior. Our aim is to discuss whether there is a relationship between the immunohistochemical presence of GH, FSH, LH, PRL, ACTH, TSH and their aggressive clinical course in non-functional pituitary adenomas. Materials and Methods In this study, we evaluated retrospectively the files of the patients who were diagnosed with thesellar or parasellar tumor in our endocrinology clinic between the years of 2004-2014.The patients were divided into two groups as non-invasive pituitary adenomas and non-functional invasive pituitary adenomas. The immunohistochemical staining characteristics were compared between the two groups. Results In this study, we scanned the data of 70 patients who were followed for non-functional sellar or parasellar mass. 47.1% of the patients were female and 52.9% of the patients were male.39 patients had a non-functional pituitary adenoma.The rate of non-functional invasive adenoma was found to be 20.5%. There was a significant relationship between the immunohistochemical positivity of GH, FSH, LH andaggressive behavior of non-functional invasive adenomas. There was no a significant relationship between the immunohistochemicalpositivityof PRL, ACTH, TSH and aggressive behavior of non-functional invasive adenomas. Conclusion We found silent GH and gonadotropin adenomas as non-functional aggressive pituitary adenoma. More aggressive treatment and close clinical monitoring should be performed because atypical pituitary adenomas are characterized by invasive growth and aggressive clinical course

Histopathological distribution of thyroid cancers: A retrospective analysis of 570 patients

Aim: Thyroid cancers are the most commonly encountered endocrine system malignancies.  The incidence continues to rise worldwide. Our aim in this study is to investigate the frequency and histopathological subtypes of thyroid cancer in our clinic. Methods: The present study was conducted with 3614 patients who were followed up in our endocrinology and general surgery clinic and operated with the diagnosis of multinodular and/or nodular goiter between 2015 and 2021. The histopathological types and information of patients diagnosed with thyroid cancer were obtained retrospectively from the pathology reports. Among the patients included in the study, a total of 570 people who were reported to have thyroid cancer due to histopathology were included in the study. Results: The data of a total of 3614 biopsy reports were examined for the study. Among these patients, 570 (421 females, 149 males) were operated and whose pathology reports were accessed were included in the study. The mean age of the patients was 49.12±10.4 years. As a result of the operations, malign postoperative tissue histopathology was 98.9% (n=564), and uncertain malignancy potential was reported to be 1.0% (n=6). In our study, the histopathological distribution of thyroid cancers was as follows; thyroid papillary cancer 89.4% (n=510), follicular cancer 7.3% (n=42), medullary cancer 2.1% (n=12), and malignancy potential uncertain 1.0% (n=6). Conclusion: The results of our study suggest that thyroid cancers are more common in women in our country, in parallel with the similar rates reported in the literature, with the increase worldwide

The relationship between Vitamin D deficiency and polycystic ovary syndrome

Background: Vitamin D deficiency is frequently seen in patients with polycystic ovary syndrome (PCOS) and has been shown to exhibit multiple effects on the disease process. The purpose of this study was to investigate the role of vitamin D deficiency in complex PCOS pathophysiological pathways. Methods: Two hundred sixty-seven patients with PCOS were divided into two groups Group 1 with 25(OH)D3 deficiency, and Group 2 with normal 25(OH)D3. Biochemical and hormonal parameters (androgen hormones, gonadotropins, and thyroid function tests) were compared between the two groups. Results: Eighty-six percent of the patients (n=231) were in Group 1 and 14% (n=36) in Group 2. Statistically significantly higher concentrations of serum testosterone, dehydroepiandrosterone-sulfate and LH were determined in Group 1 (p<0.05). 25(OH)D3 concentrations were negatively correlated with body mass index (r= 120.459), serum testosterone (r = 120.374) and dehydroepiandrosterone-sulfate levels (r= 120.418); (all; p< 0.05). Conclusion: The study findings show that low 25(OH)D3 levels are associated with high androgen levels in women with PCOS. Vitamin D deficiency should be considered as an additional risk factor in the development of PCOS. We think that providing vitamin D supplementation for women from identified deficiency areas can reduce the risk of PCOS development

The prevalence of obesity and the factors affecting obesity in the students of secondary education

Background: Childhood obesity has reached alarming dimensions all around the world. In this study, our objective is to determine the prevalence of childhood obesity in the secondary education as well as genetic, cultural and environmental factors giving rise to obesity, nutritional habits, family history and activity status.Methods: The research was performed on 750 students aged between 14-18. Body Mass Index (BMI= weight/height2 (kg/m²)) and Relative Body Mass Index (Rel BMI)  values of each child were calculated by making use of their height and weight measurements. An evaluation was made through the use of a questionnaire form consisting of 46 questions that questioned the family history, nutritional habits and activity status of the children at issue.Results: About 41.7% of 750 children incorporated into the study were female, whereas 58.2% of them were male. The age distribution was between the age range, 14-18. According to BMI values, 12.3% of the children were overweight, while 4% of them were obese. According to Relative BMI values, on the other hand, 10.4% of the children were overweight, whereas 12.9% of them were obese. When the children’s nutritional habits, activity status and family history were evaluated, we ascertained that doing physical exercises irregularly, consuming pastry foods at home and the presence of obesity history within the family had all led to the development of obesity as well as being overweight (p <0.05).Conclusions: In these research subjects comprising children of secondary education, we showed that the nutritional habits, cultural nutritional differences and the insufficiency in physical activities as well as the genetic susceptibility in children could be the determinants in obesity development

Influence of Flexible Insulin Dosing with Carbohydrate Counting Method on Metabolic and Clinical Parameters in Type 1 Diabetes Patients

Objective: The purpose of providing and maintaining a proper metabolic control is to prevent the development of chronic complications. In this study, we aimed to determine the influence of flexible insulin dosing with carbohydrate counting method on metabolic and clinical parameters in type 1 diabetes patients. Material and Method: This study was conducted with patients following up at the Endocrinology Clinic with a diagnosis of type 1 diabetes mellitus between 2012 and 2015. Metabolic and clinical parameters before and after carbohydrate counting were compared. Results: Forty patients were included to the study. Of the patients, 40% (n=16) were female and 60% (n=24) were male, and mean age was 21.5±7 year at the time of diagnosis. Statistically significant differences were not detected when hemoglobin A1c, fasting plasma glucose, post-prandial glucose, LDL-cholesterol, and HDL-cholesterol levels were compared at standard dose insulin use and after carbohydrate counting (p<0.005). Among the parameters measured when the patients received standard dose insulin without counting carbohydrate and flexible insulin dosing by counting carbohydrate, statistically significant differences were not detected for baseline insulin dose, bolus insulin dose, triglyceride level, body mass index, or monthly hypoglycemia episodes (p>0.05). Conclusion: Flexible insulin dosing with carbohydrate counting provides significant improvements in clinical and metabolic control. We detected improvements in lipid profiles and glycemic control. Additionally, patients generally did not gain weight despite flexible nutrition, and frequency of hypoglycemia remained unchanged despite strict glycemic control. OBJECTIVE: The purpose of providing and maintaining a proper metabolic control is to prevent the development of chronic complications. In this study, we aimed to determine the influence of flexible insulin dosing with carbohydrate counting method on metabolic and clinical parameters in type 1 diabetes patients. MATERIAL AND METHODS: This study was conducted with patients following up at the Endocrinology Clinic with a diagnosis of type 1 diabetes mellitus between 2012 and 2015. Metabolic and clinical parameters before and after carbohydrate counting were compared. RESULTS: Forty patients were included in the study. Of the patients, 40% (n = 16) were female, and 60% (n = 24) were male, and mean age was 21.5 ± 7 year at the time of diagnosis. Statistically significant differences were not detected when haemoglobin A1c, fasting plasma glucose, post-prandial glucose, LDL-cholesterol, and HDL-cholesterol levels were compared at standard dose insulin use and after carbohydrate counting (P < 0.005). Among the parameters measured when the patients received standard dose of insulin without counting carbohydrate and flexible insulin dosing by counting carbohydrate, statistically, significant differences were not detected for baseline insulin dose, bolus insulin dose, triglyceride level, body mass index, or monthly hypoglycemia episodes (P > 0.05). CONCLUSION: Flexible insulin dosing with carbohydrate counting provides significant improvements in clinical and metabolic control. We detected improvements in lipid profiles and glycemic control. Additionally, patients generally did not gain weight despite flexible nutrition, and frequency of hypoglycemia remained unchanged despite strict glycemic control

The relationship between Vitamin D deficiency and polycystic ovary syndrome

Background: Vitamin D deficiency is frequently seen in patients with polycystic ovary syndrome (PCOS) and has been shown to exhibit multiple effects on the disease process. The purpose of this study was to investigate the role of vitamin D deficiency in complex PCOS pathophysiological pathways. Methods: Two hundred sixty-seven patients with PCOS were divided into two groups Group 1 with 25(OH)D3 deficiency, and Group 2 with normal 25(OH)D3. Biochemical and hormonal parameters (androgen hormones, gonadotropins, and thyroid function tests) were compared between the two groups. Results: Eighty-six percent of the patients (n=231) were in Group 1 and 14% (n=36) in Group 2. Statistically significantly higher concentrations of serum testosterone, dehydroepiandrosterone-sulfate and LH were determined in Group 1 (p<0.05). 25(OH)D3 concentrations were negatively correlated with body mass index (r=-0.459), serum testosterone (r =-0.374) and dehydroepiandrosterone-sulfate levels (r=-0.418); (all; p< 0.05). Conclusion: The study findings show that low 25(OH)D3 levels are associated with high androgen levels in women with PCOS. Vitamin D deficiency should be considered as an additional risk factor in the development of PCOS. We think that providing vitamin D supplementation for women from identified deficiency areas can reduce the risk of PCOS development.WOS:0006774662000132-s2.0-85098057003PubMed: 3439425

Doppler ultrasonographic findings in cases with Hashimoto thyroiditis

Objective: To investigate the effect of thyroid-stimulating hormone (TSH) levels on hemodynamic indexes in color doppler ultrasonography in patients with Hashimoto's disease Design: Prospective observational study Setting: Departmant of Endocrinology, Medical Park Hospital, Ordu, Turkey Subjects: One hundred and twelve patients Intervention: The patients were divided into two groups: Group 1, TSH: 0.35-4.94 mIU/L; and Group 2, TSH >4.94 mIU/L. The mean peak systolic velocity (mPSV), mean end diastolic velocity (EDV) and mean resistive index (RI) of the inferior thyroid artery were measured using doppler ultrasonography at the appropriate angle (45-60 degrees C). Main outcome measure: The mPSV, EDV and RI of the inferior thyroid artery Results: A total of 48.21% of the patients (n=54) were in Group 1 and 51.78% of them (n=58) were in Group 2. In our study, we found that as the TSH levels increased, the thyroid blood flow and RI decreased in patients with Hashimoto's disease and with clinical and subclinical hypothyroidism compared with normal ones. Conclusion: The TSH level in Hashimoto's disease and the vascular RI increases as the parenchymal damage increases.WOS:0006132291000072-s2.0-8509887988

Carotid Doppler ultrasonographic findings of dapagliflozin use in type 2 diabetic patients

Aim: Sodium-glucose cotransporter 2 inhibitors have been shown to reduce the risk of cardiovascular disease in type 2 diabetes (T2DM) patients. The purpose of this study was to evaluate cardiovascular disease risk indirectly through Doppler ultrasonography (USG) of carotid artery vascular markers in T2DM patients using dapagliflozin. Methods: One hundred forty-five patients presenting to our clinic between March 2016 and June 2018 and diagnosed with T2DM were included in the study. These were divided into two groups - a dapagliflozin group of 85 patients and a 60-member non-dapagliflozin control group. Common carotid artery end-diastolic velocity (EDV), peak systolic velocity (PSV), and resistive index (RI) parameters were evaluated using Doppler USG in both groups. Results: The mean duration of follow-up was 2.2 +/- 0.4 years. Mean ages were 45 +/- 14 years in the dapagliflozin group and 42 +/- 15 in the control group. Mean HbA1c was 7.4 +/- 1.6 in the dapagliflozin group and 7.3 +/- 2.1 in the control group. Common carotid artery, PSV, and EDV parameters were higher (p = .012/p = .036), while RI was lower (p < .001), in the dapagliflozin group than in the control group. Conclusion: Vascular resistance was lower in the group using dapagliflozin for diabetes management.WOS:0005320185000012-s2.0-85084268581PubMed: 3234271

The effects of zoledronic acid treatment on depression and quality of life in women with postmenopausal osteoporosis: A clinical trial study

Background: Osteoporosis affects quality of life (QoL) and may lead to depression in women. he purpose of this study was to evaluate the effects of zoledronic acid (ZA) treatment on depression and QoL in women with postmenopausal osteoporosis (PO). Materials and Methods: A total of 88 newly diagnosed women with PO were included in this study. All patients were treated with once-yearly ZA (5 mg). A QoL questionnaire from the European Foundation for Osteoporosis and Beck Depression Inventory were given to patients at baseline and at 12 months. he results for baseline and post - 12th month were compared, and bone mineral density (BMD) levels were compared. Results: he consumption of once-yearly ZA (5 mg) treatment increases BMD at levels of lumbers 1-4 (P = 0.026), total Hip T score's P value is same as femoral neck (P: 0,033). ZA 5 mg treatment also improved QoL (P = 0.001) and reduced depression (P = 0.001). Conclusion: ZA treatment increases BMD levels and QoL while reducing depression. Once-yearly ZA (5 mg) may be considered for postmenopausal women as a first-line treatment