Evaluation of the Tpeak-Tend Interval as an Arrhythmogenicity Index in Graves' Disease

Introduction.Graves’ disease is the most common cause of hyperthyroidism. The mortality rate increases by 20% in hyperthyroid patients; cardiac problems are the leading cause of death and arrhythmia is the most common cardiac complication. Our study aimed to evaluate the corrected QT interval (QTc), the Tpeak-Tend interval (Tp-e), and the Tp-e/QTc ratio to predict arrhythmia risk in patients with Graves’ disease. Methods. The study included 64 patients with Graves’ disease and 57 euthyroid controls. The 12-lead electrocardiograms of the individuals under study were evaluated. The QTc interval, the Tp-e interval, and the Tp-e/QTc ratio of all participants were determined and statistically evaluated with thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4) values. Results. Tp-e (p < 0.001) and QTc (p < 0.05) were significantly prolonged in the group of patients with Graves’ disease as compared to the control group. Heart rate was higher in patients with Graves’ disease as well (p < 0.05). Correlation analysis in patients with hyperthyroidism demonstrated that Tp-e (r=0.372, p=0.002), QTc (r=0.291, p=0.020), and fT3 levels were significantly and positively correlated. Similarly, Tp-e (r=0.271, p=0.030), QTc (r=0.259, p=0.039), and fT4 levels were significantly and positively correlated. Conclusions. We observed a significant prolongation of the Tp-e and QTc intervals with the increase in fT3 and fT4 levels. On the other hand, our study demonstrated that the sensitivity and specificity of Tp-e in the prediction of hyperthyroidism were 70.3% and 70.1%, respectively (AUC=0.724 (CI: 0.629-0.818)), the optimal cut-off value=83.5 ms). The Tp-e interval, which has recently been used as one of the arrhythmogenicity indices, may be an indicator of arrhythmia risk in patients with Graves’ disease

Technological devices in treatment of diabetes mellitus

Technological inventions are being used recently to enable the treatment of diabetes mellitus more effective and easier to comply. Insulin pumps, after the implementation of readily available insulin pens, have made the transition to a very important stage in diabetes therapy. Insulin pumps have also enabled the transition from intermittent injection patterns to treatment modalities that provide continuous insulin infusion in diabetic subjects. Remedial studies on the next stage, the artificial pancreas, are still ongoing. Each of these treatments has its own advantages, some difficulties, and safety issues. We aimed to discuss the features of insulin pump devices in present short review.

Comparison of triglyceride-glucose index and HOMA-IR as indicators of insulin resistance in obese women with subclinical hypothyroidism

Introduction and aim. Thyroid hormones play an important role in glucose metabolism as in many metabolic events. The aim of our study is to evaluate the relationship between subclinical hypothyroidism (SCH) and insulin resistance, especially in obese women. Material and methods. Newly diagnosed SCH patients with body mass index (BMI) ≥30 who applied to our outpatient clinic between March 2021 and October 2021, and euthyroid obese women who applied for routine control were included in the study. In this study, we used homeostasis model assessment of insulin resistance (HOMA-IR) and triglyceride glucose (TyG) indexes, which are noninvasive, simple and useful methods for evaluating insulin sensitivity. Results. The study included 78 female patients between the ages of 19 and 64. A correlational analysis was performed between thyroid stimulating hormone (TSH) and HOMA-IR, TyG, and BMI. The results showed that TSH levels were positively correlated with HOMA-IR (R=0.297, p=0.008), TyG (R=0.316, p=0.005) and BMI (R=0.307, p=0.006). This relationship was stronger for TyG compared to the other variables. As another finding, BMI was positively correlated with HOMA-IR (R=0.359, p=0.001) and TyG (R=0.404, p<0.001). This relationship was stronger for TyG than HOMA-IR. Conclusion. These results show that patients with SCH are at risk of developing diseases that accompany insulin resistance, such as metabolic syndrome and cardiovascular disorders. The most important finding of our study is that the TyG index gives more significant results than HOMA-IR, especially in obese women

Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study)

Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro-and microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity. (c) 2019 The Author(s) Published by S. Karger AG, Base

Subacute THYROiditis Related to SARS-CoV-2 VAccine and Covid-19 (THYROVAC Study): A Multicenter Nationwide Study.

Context The aims of the study are to compare characteristics of subacute thyroiditis (SAT) related to different etiologies, and to identify predictors of recurrence of SAT and incident hypothyroidism. Methods This nationwide, multicenter, retrospective cohort study included 53 endocrinology centers in Turkey. The study participants were divided into either COVID-19-related SAT (Cov-SAT), SARS-CoV-2 vaccine-related SAT (Vac-SAT), or control SAT (Cont-SAT) groups. Results Of the 811 patients, 258 (31.8%) were included in the Vac-SAT group, 98 (12.1%) in the Cov-SAT group, and 455 (56.1%) in the Cont-SAT group. No difference was found between the groups with regard to laboratory and imaging findings. SAT etiology was not an independent predictor of recurrence or hypothyroidism. In the entire cohort, steroid therapy requirement and younger age were statistically significant predictors for SAT recurrence. C-reactive protein measured during SAT onset, female sex, absence of antithyroid peroxidase (TPO) positivity, and absence of steroid therapy were statistically significant predictors of incident (early) hypothyroidism, irrespective of SAT etiology. On the other hand, probable predictors of established hypothyroidism differed from that of incident hypothyroidism. Conclusion Since there is no difference in terms of follow-up parameters and outcomes, COVID-19- and SARS-CoV-2 vaccine-related SAT can be treated and followed up like classic SATs. Recurrence was determined by younger age and steroid therapy requirement. Steroid therapy independently predicts incident hypothyroidism that may sometimes be transient in overall SAT and is also associated with a lower risk of established hypothyroidism