Filiz Eksi Haydardedeoglu

Subclinical Hypothyroidism Is Characterized by Increased QT Interval Dispersion among Women

Objective: Increased QT interval dispersion (QTd) is an electrocardiographic parameter shown to be associated with malignant ventricular arrhythmias and sudden death, and QT dispersion corrected for heart rate (QTc) has emerged as a potentially important predictor of cardiac death. Increased QTd has been detected to be directly related to thyroid-stimulating hormone (TSH) levels in overt hypothyroidism, however not much is known about subclinical hypothyroidism (SH). This study was conducted to investigate the QTc in SH and determine the changes following normalization of TSH levels with L-thyroxine. Subjects and Methods: Fifty-eight women with naive SH due to Hashimoto’s thyroiditis, mean age 39.37 ± 10.43 years, and 54 age-, sex- and weight-matched controls with normal TSH were included after exclusion of any factor that might interfere with cardiac conductibility. Electrocardiographic measurements were performed with a magnifier and Bazett’s formula was used to calculate QTc. The patients were separated into two groups regarding basal TSH levels (subgroup A: 5 > TSH > 10 mIU/l, n = 36; subgroup B: TSH > 10 mIU/l, n = 22). L-Thyroxine 1–2 µg/kg/day was administered to subgroup B. Results: Mean QTc interval of the study group was significantly longer than that of the control group (100 ± 30 vs. 76 ± 30 ms, p = 0.000). It was also longer in subgroup A (5 > TSH > 10 mIU/l, n = 36) and subgroup B (p = 0.001, p = 0.000, respectively). In subgroup B, following normalization of serum TSH, mean post-treatment QTc measurement was similar to that of the control group (75 ± 40 vs. 76 ± 30 ms, p > 0.05). Conclusion: We detected prolonged QTc among SH cases. Prolongation remained significant for the whole group as well as the two subgroups. The differences in QTc were corrected when TSH levels of >10 mIU/l returned to normal.

Newly diagnosed hyperglycemia and stress hyperglycemia in a coronary intensive care unit

AIMS To determine prevalence of newly diagnosed hyperglycemia (NDH) among patients with acute coronary disease, inquire relationship of stress hyperglycemia (SH) with functional outcomes. METHODS Admission (APG) and first morning fasting plasma glucose (FPG) measurements were obtained, capillary glucose measurements (CGM) every 6-h within first day were performed-Group 1: Normoglycemics. Group 2: NDH cases: No known diabetes, APG>200mg/dl and/or FPG>126 and/or any of CGM>200. Group 2a: unrecognized glycemic disorder, HbA1c>6.0%. Group 2b: stress hyperglycemia, HbA1c<6.0%. Group 3: Recognized diabetes. Duration of ICU stays, APACHE-II scores were recorded. Logistic regression analysis was performed using ICU stay as dependent variable and age, groups, co-morbidities, problems in hospital, APACHE-II scores, CGMs were used as independent risk factors. RESULTS There were 255 (51.6%) in Group 1, 82 (16.6%) in Group 2; 37 (7.5%) cases in Group 2a, 45 (9.1%) in Group 2b and 157 (31.8%) in Group 3. Group 2b spent longer time in ICU, had higher APACHE-II scores (p=0.0001, p=0.0001). Regression analysis demonstrated SH as an independent risk factor for duration of ICU stay (OR: 2.8, 95% CI: 1.3-6.2). CONCLUSIONS Hyperglycemia was present in 48.4%; 16.6% had NDH, 9.1% had SH. Poor functional conditions of SH cases pointed that they need to be considered carefully.

Rhabdomyolysis and acute myoglobinuric renal failure in a patient with bilateral pheochromocytoma following open pyelolithotomy.

Rhabdomyolysis is an unusual manifestation of pheochromocytoma. Early diagnosis and prompt management are crucial, as it may have life-threatening consequences. This is the case of a 19-year-old man with bilateral pheochromocytoma complicated with rhabdomyolysis and acute myoglobinuric renal failure after surgery for nephrolithiasis. A massive catecholamine release during the procedure manifested itself as a hypertensive crisis, producing severe vasoconstriction and thereby provoking ischemia of the patients muscle tissue. This insult resulted in rhabdomyolysis and acute myoglobinuric renal failure. After making sure that all necessary medical precautions were performed, including blood pressure stabilization with alpha receptor blockade and adequate fluid replacement, the patient successfully underwent a bilateral cortex-sparing medullar adrenalectomy. The operation specimen was reported as pheochromocytoma.

Mean platelet volume in patients with polycystic ovary disease

Polycystic ovary syndrome (PCOS) is a frequently encountered clinical condition characterized by chronic anovulation and hyperandrogenism. There are many reports pointing to the causal links between PCOS and cardiovascular disease (CVD). Although the level of risk for CVD remains uncertain in PCOS, there is substantial evidence that insulin resistance, obesity, dyslipidemia, hypertension, hypercoagulable state, and markers of abnormal vascular function possibly contribute to increased CVD risk [1, 2]. Platelets play a crucial role in the pathogenesis of thrombotic diseases. Circulating platelets are heterogeneous in size, density, and reactivity. The mean platelet volume (MPV), the accurate measure of platelet size, is considered a marker and determinant of platelet function since larger platelets are hemostatically more reactive than platelets of normal size, increasing the propensity to thrombosis [3]. Elevated MPV levels have been shown to be an independent risk factor for CVD [4, 5]. We investigated MPV in patients with PCOS alongside a comparable group of healthy control subjects. Eighty-five newly diagnosed PCOS patients who have no propensity to thrombotic or bleeding disorder and 81 ageand BMI (body mass index)matched regularly menstruating healthy non-hirsute women as the controls participated in this study. Demographic details of subjects are presented in Table I. All MPV measurements were performed on automated blood counter Cell-Dyn 4000 (Abbott Diagnostics, Santa Clara, CA, USA). The other parameters measured in fasting blood sample were glucose, insulin, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride, free testosterone and total testosterone, and estrogen. Glucose values obtained at 0, 30, 60, 90, and 120 minutes after a 75 g oral glucose tolerance test was also measured. Each subject’s level of insulin resistance was estimated based on the homeostasis model assessment insulin resistance (HOMA-IR) index. Clinical and laboratory features of patients with PCOS and control subjects are depicted in Table I. The MPV was significantly higher in patients with PCOS (8.5 1.4 fl) than control subjects (7.8 0.9 fl) (p1⁄4 0.002). There was no statistically significant difference regarding platelet absolute count in patients with PCOS (264 51 10/L) and control subjects (257 48 10/L). HOMA-IR index was significantly higher in patients with PCOS than control subjects (3.0 3.1 vs. 2.0 0.8, p1⁄4 0.02). We did not observe any significant correlation between MPV and age, BMI, HOMAIR, lipid parameters, and levels of estrogen, free and total testosterone in patients with PCOS. There was also no correlation between MPV and glucose values obtained at 0, 30, 60, 90, and 120 minutes after a 75 g oral glucose tolerance test. Although direct evidence for increased thrombotic risk is still lacking in patients with PCOS, increased propensity to thrombosis is suggested

Serum Immunoglobulin G4 levels are elevated in patients with Graves’ ophthalmopathy

Recent studies have shown close association between serum Immunoglobulin G4 (IgG4) levels and forms of autoimmune thyroiditis. However, there are limited data about the relationship between IgG4 and Graves’ ophthalmopathy (GO). In the present study, we aimed to determine the possible association between IgG4 and GO.

Serum betatrophin levels are reduced in patients with full-blown polycystic ovary syndrome

Abstract Betatrophin is defined as a new marker in glucose homeostasis and lipid metabolism. We aimed to investigate the role of serum betatrophin in full-blown polycystic ovary syndrome (PCOS) patients and 47-aged healthy women, 51 full-blown PCOS patients were included in this cross-sectional study. Betatrophin concentrations were significantly lower in PCOS group and displayed a positive correlation only with serum tryglyceride in control group (p < .05). A cutoff level (464.5 ng/L) was determined for betatrophin according to Receiver Operating Characteristic curve. Using this value, 64.7% of PCOS patients were classified as below the cutoff and in this group betatrophin was found to correlate negatively with fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (p = .038, p = .020, and p = .014, respectively), and positively with total testosterone (p = .041). In the rest of PCOS cases (35.3%) who had betatrophin higher than cutoff, positive correlation was found with low-density lipoprotein cholesterol (p = .009). In conclusion, betatrophin levels are reduced in full-blown PCOS patients who had worse metabolic phenotype.

Mean platelet volume in Graves’ disease: A sign of hypermetabolism rather than autoimmunity?

Objective: To evaluate the impact of mean platelet volume (MPV) on predicting disease course among patients with Graves’ disease (GD). Methods: This retrospective study was performed between 2013-2016 at the Outpatient Endocrinology Clinic of Baskent University Faculty of Medicine, Adana hospital on 65 patients with GD. Among participants, 30 cases experienced thyrotoxicosis again during the first six months after discontinuing anti-thyroid drug (ATD) sessions that had been carried out for at least 12 months prior to stopping (Relapse group). We also observed 35 patients who exhibited normal thyroid functions within six months following ATD withdrawal (Remission group). MPV levels and thyroid function tests were recorded and total duration of ATD therapy was calculated for all participants. Results: The mean MPV level that was measured at the time of drug withdrawal did not differ between groups, being 8.0±1.2 fL in the Relapse group vs. 8.0±1.0 fL in the Remission group (p=0.81). However, we found that the relapse MPV was higher than the withdrawal MPV in the Relapse group (9.2±1.3 fL) than it was in the Remission group (8.0±1.2 fL, p=0.00). Conclusions: Higher relapse MPV in Relapse group but similar MPV levels in both groups at ATD withdrawal may be attributed to hypermetabolism or hyperthyroidism rather than autoimmunity of GD. Abbreviations: BMI: Body mass index GD: Graves’ disease MPV: Mean platelet volume TSH: Thyroid-stimulating hormone TRAbs: Thyrotropin receptor antibodies ATD: Anti-thyroid drug fT4: Free thyroxine fT3: Free triiodothyronine CBC: Complete blood count PTC: Papillary thyroid carcinoma

High plasma viscosity may be a predictor of cardiovascular risk in women with polycystic ovary syndrome

Background: We aimed to evaluate plasma viscosity in subjects with polycystic ovary syndrome (PCOS) and detect its relationship with cardiovascular risk factors. Materials and Methods: A total of 96 newly diagnosed women with PCOS aged between 17 and 30 years, along with 67 age, sex, and body mass index matched healthy control subjects were recruited in the study. The diagnosis of PCOS was based on revised 2003 Rotterdam consensus criteria. Plasma viscosity, hormonal and metabolic parameters were measured. Plasma viscosity was measured using a Brookfield DV-II Pro viscometer at 37°C. Results: Total testosterone, luteinizing hormone, plasma viscosity, and fibrinogen levels were significantly higher in women with PCOS ( P 0 P r = 0.223, P Conclusions: Plasma viscosity is an important hemorheologic variable and directly determines the blood flow at the microcirculatory level. High plasma viscosity indicates increased resistance to blood flow at the tissue level. Because of direct contact of endothelial cells to plasma, high plasma viscosity seems to associate with endothelial dysfunction. In this study, we clearly demonstrated that plasma viscosity was elevated in patients with PCOS, probably indicating that they had higher cardiovascular risk.