Evaluation of hematologic inflammatory markers in Graves’ disease

Introduction: The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and the systemic immune-inflammation index (SII) have been used as new inflammatory markers in certain autoimmune diseases to assess the severity of inflammation. The current study aimed to evaluate the changes in neutrophil and lymphocyte series in hyperthyroid patients and to investigate whether NLR, PLR, and SII may be markers of inflammation. Methods: This cross-sectional study was conducted with 207 Graves’ patients and 120 healthy controls between 2018-2022 years. Hematologic parameters, thyroid function tests, age and gender were recorded. The NLR, PLR and SII values of all subjects were calculated. Firstly, groups were composed as Graves' group and participants without thyroid disorder as control group. Secondly, Graves' patients composed as two groups before treatment and after antithyroid treatment. These groups were compared with each other in terms of descriptive data and hematological parameters. Results: The patient and control groups were similar in terms of gender (p=0.522) and age (p=0.051). Graves’ patients had a significantly lower NLR than the control group (p=0.004). There was no significant difference between the groups in terms of PLR (p=0.120) and SII (p=0.577). Patients’ baseline TSH-receptor antibodies (TRAb) levels had a significant positive correlation with fT3 (r:0.283, p lt;0.001), fT4 (r:0.252, p lt;0.001) and Thyroid stimulating immunoglobulin (TSI) (r:0.673, p lt;0.001). There was no significant correlation between TRAb and TSI levels, inflammatory markers, and hematological parameters. Conclusions: Graves’ patients had lower NLR compared to the control group. The patient and control groups did not have a significant difference with regard to PLR and SII. Thyroid autoantibody levels and inflammatory markers did not have a significant correlation. Keywords: Hyperthyroidism, inflammation, neutrophils, lymphocyte

Clinical characteristics of incidental adrenal masses and relationship with hematological indices as indicators of inflammation

Adrenal incidentaloma (AI) is being diagnosed more frequently due to the increase in use of imaging modalities. Inflammatory processes can play a role in the development and prognosis of numerous diseases. We aimed to investigate the clinical and endocrinological characteristics of adrenal adenoma and its relationship with inflammatory markers. The present study retrospectively analysed 111 patients with adrenal incidentaloma who underwent radiological and clinical examinations between January 2018 and January 2022. Patients diagnosed with Cushing's syndrome, pheochromocytoma or primary aldosteronism were classified as functional. Inflammation was assessed using neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), glucose lymphocyte ratio (GLR), systemic immune-inflammation index (SII) and prognostic nutritional index (PNI). Of the 111 patients included, 76.6% (n=85) had nonfunctional adenomas and 23.4% (n=26) had functional adenomas. Of the patients with functional adenomas, 50% (n=13) had Cushing's syndrome, 26.9% (n=7) had pheochromocytoma and 23% (n=6) had primary aldosteronism. The median duration of follow-up was 22.0 (2.0–60.0) months. During the follow-up, two (2.4%) of the 85 patients with non-functional adenomas gained functionality and were diagnosed with Cushing's disease. Functionality was not significantly associated with NLR, PLR, GLR, SII and PNI levels. There was a negative correlation between cortisol level after the overnight 1 mg dexamethasone suppression test and PNI (r:-0.207, p=0.030). Inflammatory hemogram parameters levels were not significantly different between patients with functional and non-functional adenomas. There was a significant negative correlation between the PNI level and cortisol secretion. PNI, which can be easily calculated by serum albumin level and absolute lymphocyte count, can be a useful guide for clinicians in the follow-up for the prognosis of functional adenoma. [Med-Science 2023; 12(3.000): 961-8

Nadir Bir Acil Hemodiyaliz Endikasyonu; Ciddi Metabolik Alkaloz

ÖzAkut böbrek yetersizliğinde acil hemodiyaliz (HD) endikasyonları arasında hiperkalemi, hipervolemi, metabolik asidoz, üremik, hiperkalsemi, hiperürisemi, hiperfosfatemi, metabolik alkaloz, hiponatremi ve zehirlenmeler sayılabilir. Metabolik alkalozda plazma HCO3- düzeyindeki yükselme genellikle gastrointestinal sistem veya idrarla hidrojen kaybı nedeniyle ortaya çıkmaktadır. Bu yazıda ciddi metabolik alkalozun HD ile tedavi edildiği bir olgu sunulmuştur. 40 yaşında kadın halsizlik nedeniyle acil servise başvurdu. Hastanın ağır metabolik alkalozu mevcuttu. Hastaya öncelikle izotonik infüzyonu 120 cc/saatten başlandı.Ekokardiyografi ve idrar bulguları ile hastada klorür tedavisine dirençli (volüm açığı olmayan) metabolik alkaloz düşünüldü. Hasta asetozolamid tedavisiyle birlikte HD’e alındı. Takibinde hastanın kan gazı kısmen düzeldi. Sonuç olarak; Metabolik alkaloz tedavisinin temelini altta yatan hastalığın tedavisi ile sıvı elektrolit dengesinin sağlanması oluşturur. Konservatif önlemler ile metabolik alkaloz kontrol altına alınamazsa hemodiyaliz etkin bir tedavi yöntemi olarak kullanılabilir

Levels of obestatin in euthyroid patients receiving levothyroxine replacement therapy

To investigate the relationship between obestatin and TSH levels in patients who received thyroid hormone replacement and were in the euthyroid state. Included 30 patients who were followed up in the endocrinology outpatient clinic in 2020, who received L-thyroxine replacement, and 30 healthy individuals without any chronic disease who did not receive thyroid hormone replacement. Blood samples were taken from both groups for obestatin, thyroid-stimulating hormone (TSH) and free T4 hormone (fT4) levels. There is significant difference in TSH levels (p = 0.007) was found between the two groups. The obestatin levels of the L-thyroxine replacement group were lower than those of the control group (p = 0.001). No correlation was observed between the TSH and obestatin levels in the control and L-thyroxine replacement groups. In this study, obestatin levels were significantly lower in patients who received L-thyroxine replacement therapy and were in euthyroid status than those in the control group. No correlation was found between obestatin and TSH levels in the control and patient groups. As a result of this study, the thyroid gland may play a more important role in the synthesis or regulation of obestatin synthesis beyond our current knowledge. [Med-Science 2022; 11(1.000): 131-4