Cemil Bilir

Hematologic Effects of Levothyroxine in Iron-Deficient Subclinical Hypothyroid Patients: A Randomized, Double-Blind, Controlled Study

CONTEXT In patients with coexisting iron-deficiency anemia and subclinical hypothyroidism, anemia does not adequately respond to oral iron therapy. OBJECTIVE We studied whether iron-deficiency anemia might indicate treatment of subclinical hypothyroidism. DESIGN PATIENTS were assigned to a control or experimental group: 240 mg/d oral iron alone (iron group) or 240 mg/d oral iron plus 75 microg/d levothyroxine (iron/levothyroxine group). Levels of hemoglobin, hematocrit, red blood cell count, serum iron levels, ferritin, total iron-binding capacity, TSH, and free T(4) were measured before and after treatment. SETTING The study was conducted at a university hospital outpatient clinic. PATIENTS Fifty-one patients with coexisting iron-deficiency anemia and subclinical hypothyroidism participated in the study. INTERVENTION PATIENTS were treated as described above in either the iron group or the iron/levothyroxine group. MAIN OUTCOME MEASURE A clinically satisfactory increase in hemoglobin was regarded as successful. RESULTS Mean hemoglobin levels increased by 0.4 g/dl in the iron group [95% confidence interval (CI) 0.2-0.7, P = 0.001], whereas it increased by a mean of 1.9 g/dl in the iron/levothyroxine group (95% CI 1.5-2.3, P < 0.0001). The increase in serum iron was greater in the iron/levothyroxine group by a mean of 47.6 microg/dl (95% CI 34.5-60.6, P < 0.0001). Increases in hemoglobin, red blood cells, hematocrit, and serum ferritin levels after treatment were statistically significantly greater in the iron/levothyroxine group (P < 0.0001). Starting hemoglobin and increase in hemoglobin were negatively correlated in the iron/levothyroxine group (r = -0.531, P = 0.006). CONCLUSIONS Subclinical hypothyroidism should be treated in iron-deficiency anemia patients when both conditions coexist. This would provide a desired therapeutic response to oral iron replacement and prevent ineffective iron therapy.

Increased Serum Asymmetric Dimethylarginine Levels in Primary Dysmenorrhea

Background: Primary dysmenorrhea is a common disorder among young women, and uterine ischemia plays an important role in pelvic pain. Asymmetric dimethylarginine (ADMA) is accepted as a strong marker of endothelial dysfunction. Objective: To investigate the role of ADMA in primary dysmenorrhea. Methods: Thirty-three patients with primary dysmenorrhea and 29 healthy controls were evaluated in a hospital outpatient clinic-based study. Secondary causes of dysmenorrhea had been ruled out in each patient. LDL cholesterol, triglycerides measured and body mass index were also calculated. Blood samples for determination of ADMA concentration were drawn on the 3rd day of menses in each woman. Groups were compared for statistically significant difference by Mann-Whitney U test. Results: Groups did not differ in age or hormone levels. ADMA level was higher in women with dysmenorrhea compared to healthy controls (Mann-Whitney U test, Z = –2.24, p = 0.025). ADMA levels showed positive correlation with age and erythrocyte sedimentation rate in the first group (Spearman’s rho = 0.360, p = 0.040, and r = 0.379, p = 0.029, respectively). Although erythrocyte sedimentation rate and C-reactive protein (CRP) were positively correlated, no significant correlations were found between high-sensitivity CRP and ADMA level in the first group (Spearman’s rho = 0.048, p = 0.749). Conclusion: ADMA concentrations are elevated in primary dysmenorrhea compared to healthy controls. This suggests that endothelial dysfunction plays a role in primary dysmenorrhea.

Anti-Saccharomyces cerevisiae Antibodies in Acute Myocardial Infarction

Background Elevated anti-Saccharomyces cerevisiae antibody (ASCA) immunoglobulin (IgG) and IgA levels were first described in the serum of Crohn disease patients and have increasingly been reported in other inflammatory diseases. The role of in situ and remote inflammation in atherosclerosis is a major area of interest. In this study, we compared ASCA IgG and IgA levels in acute myocardial infarction (AMI) and controls to investigate the possible role of ASCA in AMI. Methods Serum samples were obtained from 140 consecutive patients who presented to the emergency department with acute chest pain. AMI was diagnosed by electrocardiography and serial enzymes. Patients ruled out for acute coronary event were grouped as controls. ASCA IgA and IgG levels were determined using enzyme-linked immunosorbent assay. Groups were compared for statistically significant difference. Results ASCA IgG titers ranged between 0.1 and 31.0 RIU/mL (mean 4.92) in the AMI group and 0.1 and 6.0 (mean 0.84) in the controls. The groups were found to differ very significantly (p = .001). ASCA IgA titers ranged between 2.0 and 200.0 RIU/mL (mean 13.73) in the AMI group and 2.0 and 11.5 RIU/mL, (mean 4.25) in controls. The groups differed significantly (p = .32). AMI and controls were also analyzed for ASCA IgA and IgG positivity. Both groups differed significantly from controls (p = .013). Conclusion Elevated ASCA IgA and IgG levels as well as ASCA positivity in the AMI might suggest use of ASCA as a marker for atherosclerotic plaque instability. It might also provide a link between inflammatory processes and increased cardiovascular risk. Further studies are needed on a Saccharomyces cerevisiae-based diet, related intestinal colonization, and associated inflammation, autoimmune disorders, and cardiovascular events.

Thyroid dysfunction in hyperemesis gravidarum: a study in Turkish pregnant women.

OBJECTIVE In this study we investigate the possible relation of thyroid dysfunction and thyroid antibodies to hyperemesis gravidarum. MATERIAL AND METHODS Thirty-seven patients with hyperemesis gravidarum and 33 healthy controls have been included in this study. RESULTS Thyroid dysfunction was significantly more common than in controls (38% vs 6%, p=0.002). Thyroglobulin antibodies were also significantly more common in patients with hyperemesis gravidarum than controls (54 IU/mL vs. 14 IU/mL, p=0.03). CONCLUSION Hyperemesis gravidarum can be a risk factor for postpartum thyroid dysfunction. Thyroid antibodies must be checked in the hyperemesis population in an endemic goitre region and/or iodine replacement regions.

Isolated Renal Vein Thrombosis Associated With MTHFR-1298 and PAI-1 4G Gene Mutations

Isolated renal vein thrombosis is very rare without the presence of nephrotic syndrome. It is more common in the newborns and infants. Whereas major risk factors in adults are the procoagulant states such as protein C or S deficiency, factor V Leiden mutation, primary or secondary antiphospholipid syndrome, severe hypothyroidism, and trauma. Here, we report a case of isolated renal vein thrombosis associated with MTHFR-1298 and PAI-1 4G gene mutations. It should be noted that the presence of MTHFR-1298 and PAI-1 4G gene mutations together might be one of the examples of genetic mutation combinations that increase the likelihood of a thrombotic event.