Dilek Tuzun

Frequency of isolated maternal hypothyroxinemia in women with gestational diabetes mellitus in a moderately iodine-deficient area

Abstract Aim: To investigate frequency of isolated maternal hypothyroxinemia (IMH) in women with gestational diabetes mellitus (GDM) using both the method specific trimester range (MSTR) and the standard reference range (SRR). Methods: Our study included 50 GDM patients (case group) and 60 non-GDM pregnant (control group). Glucose, insulin, HOMA-IR, fT4 and TSH values were measured when pregnancy was confirmed in all participants. Thyroid function tests were measured in each trimester using the SRR and the MSTR. Results: In the second and third trimesters, mean fT4 levels were significantly lower in the case group compared to the control group, based on the SRR (p < 0.001). Mean fT4 levels were within the normal reference range in both groups, based on the MSTR; however, the levels were significantly lower in the case group (p < 0.001). Using the SRR, IMH frequencies in the second and third trimesters, in the case group were 56 and 86%, respectively, and were 13.3 and 46.7%, respectively, in the control group (p < 0.001). Using the MSTR, the IMH frequencies in the second and third trimesters were 8 and 14%, respectively; there were no instances of IMH in the control group. Conclusion: This study shows that changes in glucose metabolism may affect the thyroid hormone levels (fT4). Additionally, evaluating thyroid function tests in GDM patients using the MSTR can give more accurate results.

Cytomorphologic features and ultrasonographic characteristics of thyroid nodules with Hurthle cells

This study was designed to evaluate the ultrasonographic and histopathologic features of nodules composed predominantly of Hurthle cells detected during cytological examination. Fifty-seven patients with thyroid nodules composed predominantly of Hurthle cells on fine needle aspiration cytology were retrospectively analyzed. Patients were evaluated by thyroid ultrasonography (US), and biopsy samples taken by US-guided fine needle aspiration cytology were assessed histopathologically. There were 57 patients and 57 nodules with Hurthle cells in cytological examination; 49 (86%) were classified as Bethesda 1, and 8 (14%) were classified as Bethesda 3. Histopathologically, 45 (78.9%) nodules were benign and 12 (21.1%) were malignant. Nuclear groove, transgressing blood vessel, and absence of colloid were observed with a higher frequency in malignant nodules compared to benign nodules (P < .05). There were no specific morphological features (nodule echogenity, presence of microcalsification, presence of cystic areas, absence of halo, margin irregularity, and increased blood flow) predicting malignancy in the US evaluation of nodules including Hurthle cells. Nuclear groove, transgressing blood vessel, and absence of colloid on cytomorphological evaluation are indicative of malignancy in nodules containing Hurthle cells.

Does insulin resistance increase thyroid volume in patients with polycystic ovary syndrome

Objective To investigate the effect of gonadotropin, sex hormone levels and insulin resistance (IR) on thyroid functions and thyroid volume (TV) in polycystic ovary syndrome (PCOS). Subjects and methods 69 new diagnosed PCOS patients (age 24.82 ± 6.17) and 56 healthy control female (age 26.69 ± 5.25) were involved to the study. Fasting plasma glucose, lipid profile, insulin, thyroid stimulating hormone (TSH), free thyroxine (fT4), estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone levels and urine iodine were measured in all participants. Thyroid and pelvic ultrasound were performed in all participants. Results Insulin, HOMA-IR, LH, E2 and TV were higher in PCOS group (p < 0.05). TV was significantly higher in PCOS patients with IR compared to non-IR PCOS patients (p < 0.001), while TSH, fT4, and urine iodine levels were similar between these groups (p > 0.05). There was a negative correlation between E2 and TSH (p < 0.05) and a positive correlation between TSH and TV (p < 0.05). There was a significant positive correlation between TV and LH, insulin, HOMA-IR (p < 0.05). Conclusion This study showed that TV was increased in patients with insulin resistance but differences in TSH and LH levels may affect TV changes as well.

Thyroid FNAC containing hürthle cells and hürthle-like cells: A study of 128 cases

Aim: It is a diagnostic challenge to differentiate benign and malignant cytology in the presence of Hürthle cells. In our previous study, it was determined that in fine needle aspirations (FNA), the malignancy outcome of the Hürthle cells containing group tend to be papillary thyroid carcinoma (PTC) in a higher percentage. The most common misinterpretation is caused by PTC cells with large cytoplasm-like Hürthle cells. The aim of this study is to predict histologic outcome of the nodules, which have Hürthle cells in FNA according to cytological, clinical features, and BRAF V600Emutation status. Materials and Methods: Detailed cytological features of 128 cases were compared with histopathological diagnosis. The analysis of BRAF V600Emutation of the PTC cases were performed by real-time polymerase chain reaction. Results: The neoplastic outcome was increased statistically significantly with younger age (P = 0.020), increase in cellular dyshesion (P = 0.016), presence of nuclear budding (P = 0.046), and granular chromatin (P = 0.003). Nuclear budding (P = 0.014), granular chromatin (P = 0.012), and hypoechoic nodules in ultrasonography (P = 0.011) were significant independent factors for the increase in the malignancy risk. Increased lymphocytes (P= 0.015) and colloid were related to non-neoplastic outcome. According to the surgical outcome, more than half of the malign cases were PTC (74%). BRAF V600Emutation was detected in 27.8% of the PTC cases. Conclusion: PTC cases containing Hürthle cell-like cells may lead to diagnostic errors. Nuclear budding and granular chromatin of Hürthle cells are significant, remarkable findings to predict the outcome of neoplasm and malignancy.

Importance of ectopic thyroid tissue detected in the midline of the neck: single center experience

OBJECTIVE Ectopic thyroid tissue (ETT) is a rare abnormality of the thyroid gland and the true prevalence and importance is not known. The aim of this study was to evaluate ultrasonography (US) guided fine needle aspiration biposy (FNAB) results, sonographic features, and frequency of ETT detected in the midline of the neck. SUBJECTS AND METHODS Five thousand five hundred and twenty outpatients who were referred to our thyroid clinic between September 2010 and April 2012 and underwent thyroid US, were retrospectively analyzed. Patients with ETT, detected in the midline of the neck in US were included in the study. Thyroid functions, sonographic features, and US guided FNAB results were evaluated. RESULTS There were 81 (81.8%) female and 18 (18.2%) male patients with a mean age of 50.9 ± 11.7. The ETT in the midline was present in 1.79% (99/5,520) of the patients. In the majority of the patients, benign sonographic features (isoechoic, regular margin, type 1 vascularization) were detected. There were 92 (92.9%) patients with a previous history of thyroidectomy and all were histopathologically benign. In 7 (7.1%) patients, there was no history of thyroid operation. FNAB results of ETT were benign. CONCLUSION This study evaluated the importance of ETT detected incidentally in the midline of the neck. Especially in patients with a history of thyroidectomy, the thyroid masses in the midline of the neck can be found as incidental with imaging methods. Our results suggests that the incidence of malignancy in this group is much lower than orthotopic thyroid nodules and they are often benign.

Primary Adrenal Failure due to Antiphospholipid Syndrome

Background. Antiphospholipid syndrome (APS) characterized by thrombosis and abortus may rarely cause primary adrenal failure. Case Presentations. A 34-year-old male presented with hypotension, hypoglycemia, hyperpigmentation on his skin and oral mucosa, scars on both legs, and loss of consciousness. In laboratory examinations, hyponatremia (135 mmol/L), hyperpotassemia (6 mmol/L), and thrombocytopenia (83 K/µL) were determined. Cortisol (1.91 µg/dL) and adrenocorticotropic (550 pg/mL) hormone levels were also evaluated. The patient was hospitalized with a diagnosis of acute adrenal crisis due to primary adrenal insufficiency. A Doppler ultrasound revealed venous thrombosis. The patient was diagnosed with antiphospholipid syndrome after the detection of venous thrombosis, thrombocytopenia, elevated aPTT, and anticardiolipin antibody levels. Anticoagulation treatment was started for antiphospholipid syndrome. The patient is now following up with hydrocortisone, fludrocortisone, and warfarin sodium. Conclusion. Antiphospholipid syndrome is a rare reason for adrenal failure. Antiphospholipid syndrome should be suspected if patients have morbidity secondary to venous-arterial thrombosis.

Should human chorionic gonadotropine treatment increase thyroid volume

OBJECTIVE Our aim was to investigate the thyroid function tests and thyroid volume differences among males with isolated hypogonadotropic hypogonadism (IHH) who take androgen replacement treatment (ART). MATERIALS AND METHODS Forty-four male with IHH with a mean age 33.2 (18-54), diagnosed in Endocrinology and Metabolism Department between September 2013 and September 2014 and 40 healthy male control with a mean age 27.77 (18-55) were involved to study. Patient group was divided to testosterone-treated patients (n = 19) and human chorionic gonadotropine (hCG)-treated patients (n = 25). Patient group was compared in terms of total testosterone, thyroid function tests [thyroid stimulating hormone (TSH), free thyroxine (fT4)] and thyroid volume, before and 6 months after treatment. Patient group was compared with control group as well. RESULTS When we compared the patient group with the control group, there was no significant difference for age, Body mass index, TSH, fT4 and thyroid volume between two groups before treatment. There was no difference in terms of TSH, but fT4, testosterone levels and thyroid volume were significantly higher after treatment, when the patient group was compared before and after treatment (p < 0.05). When we compared testosterone-treated patients and hCG-treated patients; thyroid volume was higher among hCG-treated patients (p = 0.001) but there was no difference for thyroid volume before and after testosterone treatment (p > 0.05). There was no statistically significant correlation between testosterone levels with TSH, fT4 and thyroid volume (r = 0.09, p = 0.32; r = 0.14, p = 0.11; r = 0.15, p = 0.09, respectively). CONCLUSION Our study showed that ART increases the thyroid volume especially in hCG-treated patients. Therefore, we suggest that thyroid volume changes should be followed up in hCG-treated patients.

Assessment of Subclinical Cardiac Alterations and Atrial Electromechanical Delay by Tissue Doppler Echocardiography in Patients with Nonfunctioning Adrenal Incidentaloma

Background Majority of the incidentally discovered adrenal masses, called adrenal incidentaloma (AI), are nonfunctioning adrenal adenomas. The appropriate management of AI is still a matter debate, so it is necessary to investigate their associated morbidity. However, data regarding morphological and functional cardiac alterations are limited in this group. Objective In this study, we aimed to assess cardiac structural and functional characteristics and atrial conduction properties in patients with nonfunctioning AI. Methods Thirty patients with nonfunctioning AI and 46 properly matched control subjects were included in the study. After hormonal and biochemical analysis, all participants underwent transthoracic echocardiography to obtain systolic and diastolic parameters of both ventricles, in addition to atrial conduction times by tissue Doppler echocardiography. Data were analyzed with Statistical Package for the Social Sciences (SPSS, Chicago, IL, United States) statistics, version 17.0 for Windows. P < 0.05 was considered statistically significant. Results Left ventricular (LV) mass index and LV myocardial performance index were significantly increased in AI group. Among atrial conduction times, both intra- and interatrial electromechanical delays were significantly prolonged in patients with nonfunctioning AI. Other laboratory and echocardiographic findings were similar between groups. Conclusion Our study revealed that intra- and inter-atrial conduction times were prolonged, and LV mass index was increased in patients with nonfunctioning AI. These findings may be markers of subclinical cardiac involvement and tendency to cardiovascular complications. Close follow-up is necessary for individuals with nonfunctioning AI for their increased cardiovascular risk.

Insulin Edema in Newly Diagnosed Type 1 Diabetes Patient

Insulin plays an essential role in the treatment of diabetes mellitus (DM). The most frequent side effects of insulin therapy are hypoglycemia and weight gain. However, insulin edema can also develop in relation with insulin therapy, though this complication is rare. It is often observed in patients with newly diagnosed type 1 DM or poorly controlled type 2 DM following intensive insulin therapy or following a high-dose insulin therapy among underweight diabetics (1). Insulin edema is probably an underdiagnosed phenomenon; therefore, its true incidence rate is not known. It is reported most often among children and adolescents (2). Despite its self-limiting nature, it is rarely observed with pleural effusion, heart failure, or generalized edema (3). In this case report, we aimed to draw attention to the edema developing after high-dose insulin therapy and overhydration in an underweight patient with newly diagnosed type 1 DM who presented with diabetic ketosis.

Giant pubertal prolactinoma: Complete resolution following short term carbegoline treatment.

Prolactinomas are the most common pituitary tumors but rarely seen in adolescent males. There is no indication for surgery both in micro- and macro-adenomas unless an urgent treatment is necessary. First line treatment is always medical with dopamine agonists. In this report, we presented a patient with pubertal arrest and giant prolactinoma that disappeared in a short time with cabergoline treatment.