Fatma Saglam

Anti-Müllerian hormone as a marker of premature ovarian aging in autoimmune thyroid disease

Abstract There is an increased incidence of autoimmune thyroid disease (AITD) in women with infertility. We hypothesized that serum anti-Müllerian hormone (AMH) levels will be lower in premenopausal women with AITD than controls. We evaluated ovarian reserve in women with AITD (n = 85) and healthy controls (n = 80), all <40 years old. Detailed data on reproductive history were obtained. Gonadotrophins, steroids, AMH, and inhibin B levels were measured during the follicular phase. The number of pregnancies as well as live births was lower in women with AITD (p < 0.01). No difference was observed in terms of FSH, estradiol, and inhibin B. AMH levels were lower in AITD women than in controls (1.16 + 0.17 versus 1.28 + 0.25 ng/ml, mean + SD, p = 0.001). According to the multiple regression analysis, even after age adjustment, AITD was significantly and independently affected AMH levels (t = 2.674, p = 0.008). Women with AITD seem to have a diminished ovarian follicular reserve and measurement of serum AMH level has the potential to be used to predict this comorbidity.

Thyroid autoimmunity in patients with hyperprolactinemia: an observational study

OBJECTIVE To establish whether there is a relationship between hyperprolactinemia and primary thyroid disorders, focusing on patients with autoimmune features. MATERIALS AND METHODS The medical records of 100 patients with hyperprolactinemia (HPRL) were retrospectively examined. Records of thyroid ultrasonography (USG), basal serum levels of thyroid stimulating hormone, circulating free thyroxine, free triiodothyronine, antithyroglobulin (anti-Tg), and antithyroperoxidase (anti-TPO) antibodies were analyzed. In 100 control subjects, matched by age and gender with HPRL patients, thyroid USG, thyroid function tests (TFTs), and autoantibody panel were obtained. RESULTS The median PRL in patients was 93 ng/mL (range: 37-470). Twenty-five patients (25%) and 22 controls (22%) had positive anti-Tg and/or anti-TPO titers (P = 0.739). The median serum PRL was 98 (37-470) ng/mL in patients with positive thyroid autoantibodies, and 92 (40-470) ng/mL in patients who were negative (P = 0.975). Among the individuals with autoantibody positivity TFTs abnormalities were more frequent in HPRL patients (60%, out of 25 patients, 14 with subclinical hypothyroidism and one with hyperthyroidism) than in controls (9.1%, out of 22 patients, 2 with subclinical hyperthyroidism) (P < 0.001). Twenty-seven patients with HPRL and 31 controls had goiter (27 vs. 31%, P = 0.437). Forty-six patients (46%) and 50 (50%) controls had one or more of the features of thyroid disorder, which were goiter, positive thyroid autoantibody, and thyroid function abnormality (P = 0.888). CONCLUSION HPRL may be associated with more severe thyroid dysfunction in patients with thyroid autoimmunity.

False-positive iodine-131 whole body scan due to a benign dermal lesion; intradermal nevus ( 131 I uptake in a benign nevus)

Whole body radioiodine scanning (WBS), along with plasma thyroglobulin level, remains a reference method for detecting residual or metastatic differentiated thyroid cancer, however, false-positive WBS is not uncommon. External contaminations by body secretions or excretions, inflammation, and cystic structures mimicking metastases in WBS have been reported. Various benign and malignant tumors having different histopathological natures accumulate radioiodine, but intradermal melanocytic nevus was not previously described in the literature, as far as we know. This report describes an unusual cause of false-positive WBS after radioablation therapy due to an intradermal nevus, and the possible mechanisms are discussed.

Serum testosterone does not affect bone mineral density in postmenopausal women

OBJECTIVE The purpose of the present study was to investigate the correlation between serum testosterone levels and bone mineral density (BMD) in postmenopausal women. MATERIALS AND METHODS The study group was made up of postmenopausal women admitted to our tertiary center. Serum calcium, phosphorus, albumin, parathyroid hormone (PTH), thyrotropin (TSH), 25-OH vitamin D, and total testosterone concentrations were measured. Subjects were categorized into three groups regarding bone mineral density (BMD) values: normal (n = 22), osteopenia (n = 21), and osteoporosis (n = 21). Subjects were also categorized into three groups according to serum testosterone levels: low testosterone (n = 10), normal testosterone (n = 42), and high testosterone (n = 12). RESULTS No significant difference was found for serum testosterone, TSH, calcium, phosphorus, albumin, PTH, and 25-hydroxyvitamin D levels among patients with normal BMD, osteopenia, and osteoporosis (p > 0.05). Lumbar spine, total femur, femoral neck, trochanteric, intertrochanteric, and Wards triangle BMD values were similar for the different testosterone levels (p > 0.05). CONCLUSION There was no correlation between serum testosterone levels and patient age, body-mass index, or any measured BMD values. Given the findings in our study, which failed to demonstrate a statistically significant relationship between testosterone and BMD, adjustment of other risk factors for osteoporosis might have a more distinctive effect in this setting.

Primary Thyroid Disorders in Patients with Endogenous Hypercortisolism: An Observational Study

Cushings syndrome (CS) may alter the performance of the hypothalamic-hypophyseal-thyroid axis. We searched for a relationship between hypercortisolism and primary thyroid disorders. The medical records of 40 patients with CS were retrospectively examined. Thyroid ultrasonography (USG), basal thyroid function test results (TFT), and antithyroglobulin and antithyroperoxidase antibodies were analyzed. In 80 control subjects, matched by age and gender with CS patients, thyroid USG, TFTs, and autoantibody panel were obtained. Among the CS patients, 17 had nodular goiter, versus 24 controls (42.5% versus 30%, P > 0.05). Among the twenty-five patients with an available TFT and autoantibody panel—before and after surgical curative treatment—autoantibody positivity was detected in 2 (8%) patients before and 3 (12%) after surgery (P = 0.48). Regarding TFT results, 1 (2.5%) patient had subclinical hyperthyroidism and 1 (2.5%) had subclinical hypothyroidism, whereas 1 (2.5%) control had hyperthyroidism. In total, 21 (52.5%) patients and 32 (40%) controls had ≥1 of the features of thyroid disorder, including goiter, positive thyroid autoantibody, and thyroid function abnormality; the difference was not significant (P > 0.05). The prevalence of primary thyroid disorders is not significantly increased in patients with CS.

Does testosteron have an effect on bone mineral density in postmenopausal women

Background: Osteoporosis is a common problem in postmenopausal women. There is limited data about the physiological importance of endogenous testosterone (T) on bone mineral density (BMD) in older women is poorly understood. Aim: The aim of this study was to evaluate association of endogeneous T with BMD and body mass index( BMI ). Materials-methods: This cross-sectional study included 64 patients (45-85 year) postmenopausal women; their demographic features, BMD and serum total testosteron levels and relationship between T and BMD were evaluated. When the patients divided into three cathegories according to BMD; Group 1A: normal; Group 1B:osteopenic; Group 1C:osteoporotic (Table 1) Results: Serum total testosterone levels were found not to be correlated with BMD. We didn’t find any differences in serum testosterone levels between three BMD groups. Conclusion: This study suggests that endogenous androgens are influential on bone density in postmenopausal women. However, we didn’t find any relationship. Effects of endogenous testosterone level on BMD is controversial. Table 1. Demographic parameters and laboratory results of three groups. Group 1A (n=22) Group 1B (n=21) Group 1C (n=21) P-value Age (years) 54±6.3 56±7.9 58±1.0 0.058 Menopausal age 46±4.0 44±5.4 43±6.6 0.131 Height (cm) 158±6.2 1.58±4.9 155±6,1 0.304 Weight (kg) 75±13.4 71±15.0 68±12.5 0.383 BMI (kg/m2 ) 30.5±5.1 28±5.3 27.6±4.3 0.450 Calcium (mg/dl) 9.45±0.56 9.40±0.42 9.40±0.57 0.984 Phosphorus (mg/dl) 3.7±0.79 3.6±0.59 3.5±0.48 0.684 Albumin (g/dL) 4.4±0.31 4.3±0.40 3.5±0.48 0.933 PTH (pg/mL) 55.1±2.98 60±3.5 43.6±1.37 0.045 25-OH D vit (μ/L) 21.5±16.3 24.8±13.8 23.7±14.2 0.986 Testosterone (ng/dL) 38.6±20.2 27.1±14.7 28.6±19.2 0.712

Relationship between diabetes mellitus and hemostasis: a prothrombotic condition

Background: Diabetes is very common disorder. Many studies have shown that patients with diabetes mellitus have incresing trombotic complications both arterial and venous trombosis. Bad control diabetes increases risk of trombosis. Recent reports have shown that shortened APTTs and increased fibrinogen indicate procoagulan situations. In this study we aimed to evaluate whether chronic hyperglisemia or bad control diabetes causes trombosis which is reflected by shortened APTTs and increased fibrinogen. Materials and Methods: Our study included 349 patients with type 2 diabetes mellitus. They all underwent blood sampling APTT, PT, fibrinogen, fasting plasma glucose (FPG), postprandial plasma glucose (PPG), complete blood count(CBC), serum lipids and HBA1C measurements. Among 349 patients whose APTT<22 sec and PT<10.5 sec were determined. Patients were divided into two groups based on HBA1C levels as follows: regulated diabetic group (HBA1C≤7.0%) and disregulated diabetic group (HBA1C˃7.0%). (Table 1) Results: But there was no significant difference in terms of APTT<22 sec, PT<10,5 sec and fibrinogen levels between two groups. Conclucion: APTT, PT and fibrinogen measurements are relatively inexpensive and are available. But they are not enough alone for evaluating hypercoaguable states in diabetes patients.

Screening interval for celiac disease in patients with type 1 diabetes mellitus.

We read with great interest the article by Bakker et al. [1]. They made a retrospective evaluation of 118 patients with both type 1 diabetes mellitus (T1DM) and celiac disease (CD). They collected data on sex distribution, age of onset of T1DM, age of CD diagnosis, CD complaints and duration of CD complaints before CD diagnosis. And they found that 33% of T1DM + CD patients reported CD related complaints for at least 5 years before CD diagnosis. The authors concluded that a delay of CD diagnosis is frequently found in adult T1DM patients and more frequent screening for CD in particularly adult T1DM patients is required, preferably by a 5 year interval. The article has important messages. But there are some items to be clarified. First issue of our concern is the ratio of patients (n = 24) who reported CD related complaints for at least five years before CD diagnosis. If the authors aim to provide any evidence for a screening policy they should take into consideration all of the CD patients regardless of the presence of CD related complaints. And twenty-four should be divided by the total number of patients (n = 118) but not only the number of symptomatic patients (n = 72). In this way, the percentage of patients with prolonged symptoms (N5 years) would be twenty but instead of thirty-three. This means that a five-year-interval screening would detect one in every five but not three patients. Another issue of our concern is that there are no signs or symptoms specific for CD. Gastrointestinal symptoms are already more prevalent in diabetic patients in comparison to the general population and have a negative effect on the quality of life [2,3]. Diarrhea or increased stool frequencymay occur because of pancreatic insufficiency, bacterial overgrowth, consumption of artificial sweeteners, islet cell tumors, fecal incontinence andmetformin therapy in addition to coexistent CD [4]. Iron deficiency anemia in some European countries was reported as high as 13.5% in premenopausalwomen andmenstrual bleeding is probably the main cause [5]. And hypoglycemia in T1DM is frequently caused by exogenously delivered insulin which is not subject to normal physiologic