Ötiroid tiroid patolojilerinde metabolik parametreler ve vücut yağ dağılımı

Tiroid fonksiyonları ile obezite ve metabolik sendrom arasındaki ilişki literatürde çok araştırılan ve hergün yeni bilgilerin öğrenildiği bir konudur. Tiroid fonksiyonlarının obezite ile olan ilişkisini hipotiroksineminin etkisinden çok insülin direncine ve vücut yağ yüzdesine bağlayan yayınlar da bulunmaktadır. Bu çalışmanın amaçları 1) TSH düzeyi ile beden kütle indeksi, bel çevresi, boyun çevresi, kalça çevresi, bel-kalça oranı, visseral yağ düzeyi, karın yağı yüzdesi, yağ yüzdesi, trigliserid düzeyi, HDL düzeyi, insulin düzeyi, HOMA IR ve açlık kan şekeri arasında korelasyon analizi yapmak; 2) Hashimoto tiroiditi, benign noduler guatr ve sosyodemografik özelliklere göre eşleştirilmiş tiroid patolojisi saptanmayan bir kontrol grubunda bu antropometrik ölçümleri ve metabolik sendrom komponentlerini karşılaştırmak ayrıca her üç grupta metabolik sendrom prevelanslarını karşılaştırmak; 3)Nodüllü ve nodülsüz hashimoto tiroiditi vakalarını, levotiroksin kullanan ve kullanmayan Hashimoto tiroiditi vakalarını ayrıca tek nodüllü ve çok nodüllü benign noduler guatr vakalarını bu parametreler açısından karşılaştırmaktır. Çalışmaya Başkent Üniversitesi Ankara Hastanesi ve Ümitköy semt polikliniklerine başvuran 110 tiroid patolojisi saptanmayan, 99 Hashimoto tiroiditi olan ve 92 benign noduler guatr olan toplam 301 gönüllü dahil edildi. Üç grupta metabolik sendrom prevelansları, antropometrik ve metabolik parametreler benzer saptandı. TSH ile insulin düzeyi, AKŞ, HOMA IR ve BKİ arasında pozitif korelasyon saptandı (r=0,28: p<0,001; r=0,27; p<0,05: r=0,32; p<0,001: r=0,13; p<0,05 sırası ile) Hashimoto tiroiditi olgularında TSH düzeyi 3-5 μIU/ml arası olanların insulin düzeyleri, HOMA IR, visseral yağlanma düzeyleri, ve trigliserid düzeyleri, TSH düzeyi <3 μIU/ml olanlara göre anlamlı şekilde yüksek saptanıp HDL düzeyleri daha düşük saptandı (p<0,05 tüm parametreler için). Tiroid otoimmunitesi olmayan ve TSH düzeyi 3-5 μIU/ml olan olgularda da metabolik sendrom prevelansı TSH düzeyi <3 μIU/ml olan olgulara göre daha yüksek saptandı. Hashimoto tiroiditi olgularında TSH düzeyinin hangi aralıkta tutulması gerektiği de bir tartışma konusudur. Bu çalışmada metabolik riskin TSH 3 μIU/ml üzerinde olan olgularda daha fazla olmasından dolayı sınır bu düzeylerde kabul edilebilir. Ancak bu bulgu başka çalışmalarda da doğrulanmalıdır. Bu olgularda TSH düzeyinin düşmesiyle metabolik riskin düzelip düzelmeyeceği prospektif çalışmalarla doğrulanması gerekmektedir

Amyloid Accumulation in the Toxic Nodule of the Thyroid Gland in a Patient with End Stage Renal Failure

Amyloidosis is characterized by accumulation of amorphous, proteinaceous material in various organs and tissues of the body. Amyloid may accumulate in the thyroid gland in cases of medullary thyroid carcinoma and systemic amyloidosis. Amyloid accumulates extracellularly in the thyroid parenchyma and disrupts the normal follicular patterns. Most of the cases reported up to now were clinically euthyroid, but many presentation forms and overlaps have been reported. Herein we present a patient with toxic nodular goiter with amyloid deposition in the toxic nodule as well as the remaining thyroid tissue

Should neck pain in a patient with Hashimoto's thyroiditis be underestimated? A case and review of the literature

Hashimoto's Thyroiditis (HT) is an autoimmune disease and the most frequent cause of hypothyroidism. Subacute thyroiditis (SAT) overlapping HT is a rare entity. A 69-year-old female patient with HT and multinodular goiter has been followed on levothyroxine replacement therapy for 7 years. She presented with neck pain radiating to the right ear persisting for 2 months. She was prescribed analgesics and antibiotics by other physicians during that period, which did not work. Her vital signs were stable with no tachycardia or fever. The right lobe of the thyroid gland was tender on palpation. Her TSH level was 3.94 mIU/ml, ESR 23 mm/h, CRP 3.2 mg/l, WBC 4900/μl at presentation. Thyroid ultrasonography revealed a hypoechoic area over the tender lobe. Power Doppler imaging revealed almost no blood flow in that area. She was started on methylprednisolone 32 mg/day. At day 10 of therapy, her symptoms had completely resolved. Ultrasonography repeated showed that the hypoechoic area had disappeared. Glucocorticoid dosage was tapered and stopped. Emergence of subacute thyroiditis in a case with preexisting Hashimoto's thyroiditis is a quite rare condition, but should be kept in mind along with a painful attack of HT in the differential diagnosis

Is manubrium limited mini-sternotomy an alternative for traditional full sternotomy in cases with massive mediastinal (retrosternal) goiter? A case report

Although most mediastinal goiters (MG) are operable by a cervical approach, some cases require sternotomy. Manubrium limited mini-sternotomy (MLMS) is an alternative method for traditional full sternotomy in subjects with MG. We present the case of a 45-year-old male subject who was operated for a total MG. The nodular mass was conical in shape and extended beyond the aortic arch and tracheal bifurcation. Sternotomy was decided because excision via cervical Kocher incision was not safe. The nodular mass was extracted from the mediastinum easily via MLMS. The postoperative period was uneventful, without any complication, and the patient was discharged from the hospital after two days. He returned to his normal life within one month. This case shows that MLMS is a convenient and easy alternative for traditional full sternotomy in subjects with MG

Association of the Renal Resistive Index with Microvascular Complications in type 2 Diabetic Subjects

MOUSA, UMUT/0000-0002-8078-9376WOS: 000350789400007PubMed: 25343266Chronic complications are the leading causes of morbidity and mortality in the diabetic population. The intrarenal resistive index ( RI) has been reported to be increased in hypertensive subjects with microalbuminuria and limited data is present for diabetic subjects. 101 subjects with Type 2 Diabetes Mellitus were included in the study. We grouped the study population according to the urinary albumin excretion ( UAE). Group 1: UAE 300 mg/ day ( n: 28). We also grouped the study population according to the intrarenal RI value. Group consisted of subjects with RI = 0.70 and group II < 0.70. The mean intrarenal RI values of patients in group 3 were higher than those of group 1 and group 2 ( 0.72 vs. 0.69 p = 0.048; 0.72 vs. 0.69; p = 0.048 respectively). The duration of diabetes, hip circumference, and hs- CRP levels were statistically significantly higher in subjects with intrarenal RI = 0.70 compared to those with intrarenal RI < 0.70 ( p: < 0.001, 0.048 and 0.0148 respectively). Presence of retinopathy and neuropathy was statistically significantly higher in subjects with intrarenal RI = 0.70 compared to those with intrarenal RI < 0.70. RI may predict the development of microvascularcomplications in diabetic subjects

Do Statins Affect Thyroid Volume and Nodule Size in Patients with Hyperlipidemia in a Region with Mild-to-Moderate Iodine Deficiency? A Prospective Study

Objective: The objective of this study was to assess the anti-proliferative pleiotropic effects of statins on thyroid function, volume, and nodularity. Subjects and Methods: One hundred and six hyperlipidemic patients were included in this prospective study. The 69 patients in the statin groups received atorvastatin (16 received 10 mg and 18 received 20 mg) or rosuvastatin (20 received 10 mg and 15 received 20 mg). The 37 patients in the control group, assessed as not requiring drugs, made only lifestyle changes. Upon admission and after 6 months, all patients were evaluated by ultrasonography as well as for lipid variables (total cholesterol, high-and low-density lipoprotein cholesterol, and triglycerides) and thyroid function and structure. Results: After 6 months, no differences in thyroid function, thyroid volume, the number of thyroid nodules, or nodule size were observed in the statin and control groups. In a subgroup analysis, total thyroid volume had decreased more in patients receiving 20 mg of rosuvastatin than that in the control group (p < 0.05). Maximum nodule size had decreased more in those receiving 10 mg of rosuvastatin (p < 0.05). Conclusions: Our results suggest an association between rosuvastatin treatment and smaller thyroid volume and maximum nodule diameter; this could be attributable to the antiproliferative effects of statin therapy on the thyroid. (C) 2018 The Author(s) Published by S. Karger AG, Base

Thyroid Nodules Are More Prevalent in Subjects with Colon Polyps, Independent of Insulin Resistance

Objective: Colorectal polyps and thyroid nodules are common disorders linked to hyperinsulinemia and metabolic syndrome (Mets). The direct association between these two diseases is not clear. We aimed to analyze the prevalence of thyroid nodules in subjects with and without colorectal polyps. The secondary aim was to establish the prevalence of Mets and its parameters in both disorders and to determine if insulin resistance and hyperinsulinemia are common underlying pathophysiological mechanisms. Subjects and Methods: One hundred and five subjects with colorectal polyps (71 males, 34 females) and 68 controls (28 males, 40 females) were enrolled. The parameters of Mets together with TSH, insulin, low-density lipoprotein cholesterol, and homeostasis model for assessment of insulin resistance levels were calculated. We performed thyroid ultrasonography in all participants. Results: The prevalence of Mets was similar in the colorectal polyp and control groups (37.1 vs. 37.3%, p = 0.982). The prevalence of Mets was nonsignificantly higher in subjects with a documented thyroid nodule compared to subjects without a thyroid nodule (43.0 vs. 32.6%, p = 0.205). The prevalence of thyroid nodules in subjects with colorectal polyps was significantly higher than in subjects without polyps (52.9 vs. 35.3%, p = 0.017). Compared to subjects with no colorectal polyps, we established a significant increase in the odds of having thyroid nodules (OR 2.05; 95% CI: 1.097-3.860, p = 0.017). The presence of colorectal polyps and age in the adjusted model were established to be independent risk factors for having thyroid nodules (p = 0.025 and p = 0.007, respectively). Conclusion: These results may support the presence of other common mechanisms in the development of these two pathologies other than insulin resistance and hyperinsulinemia. (C) 2019 The Author(s) Published by S. Karger AG, Base

Cranial imaging findings in neurobrucellosis: results of Istanbul-3 study

Objective Neuroimaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The purpose of this study was to evaluate the prevalence of imaging abnormalities in neurobrucellosis and to identify factors associated with leptomeningeal and basal enhancement, which frequently results in unfavorable outcomes