Safak Akin

Markers of subclinical atherosclerosis in premenopausal women with vitamin D deficiency and effect of vitamin D replacement.

BACKGROUND Recent studies have revealed a relationship between vitamin D deficiency and atherosclerosis. This study aims to investigate the impact of vitamin D deficiency and replacement on markers of subclinical atherosclerosis in young premenopausal women in whom vitamin D deficiency is prevalent. METHODS Thirty-one premenopausal vitamin D deficient women and 27 age and gender-matched control subjects were enrolled in this study. Markers of subclinical atherosclerosis including carotid intima-media thickness (cIMT), flow-mediated dilatation (FMD), endothelial progenitor cell (EPC) count and cytokine levels were determined at baseline. All measurements were repeated at 6-month follow-up in vitamin D-deficient subjects after vitamin D replacement. RESULTS Vitamin D deficient premenopausal women had lower FMD (9.9 ± 1.3 vs. 13.8 ± 1.7%, p < 0.001) and EPC counts at baseline. This population also had lower IL-10 and higher IL-17 levels. A 6-month vitamin D replacement therapy resulted in a significant increase in FMD (9.9 ± 1.3 vs. 11.4 ± 1.4%, p < 0.001) and EPC counts. Furthermore, cytokine profile shifted toward a more anti-inflammatory phenotype including elevated IL-10 and decreased IL-17 levels. cIMT was not different between patient and control groups and did not change following vitamin D replacement. Change in 25(OH)D and IL-17 levels were independent predictors of the change in FMD measurements following vitamin D replacement. CONCLUSION This study demonstrates that endothelial function is impaired in otherwise healthy vitamin D deficient young premenopausal women and improves with 6-month replacement therapy. Immune-modulatory effects of vitamin D may, at least partly, be responsible for its beneficial effects on vascular health.

The association between thyroid volume, L-thyroxine therapy and hepatocyte growth factor levels among patients with euthyroid and hypothyroid goitrous and non-goitrous Hashimoto’s thyroiditis versus healthy subjects

ABSTRACT Objective: Hashimoto’s thyroiditis (HT) is the most common etiology of hypothyroidism in regions where iodine deficiency is not a concern. To date, many clinical investigations have been conducted to elucidate its pathogenesis. Several growth factors have been shown to have a role in its development. Hepatocyte growth factor (HGF) is one of the aforementioned molecules. We aimed to demonstrate whether HGF is responsible for HT and goiter development. Also, we aimed to test the hypothesis that levo-thyroxine sodium therapy will suppress HGF levels. Materials and methods: Sixty-one premenopausal women who were admitted to our outpatient clinic between November 2010 and September 2011 were enrolled. Three groups were determined according to their thyroid function tests (TFTs) as euthyroid Hashimoto’s, control and subclinical hypothyroid Hashimoto’s groups. Basal TFTs, anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-tg), thyroid ultrasonography (USG) and HGF were studied and recorded. Subclinical hypothyroid HT patients received levo-thyroxine sodium replacement therapy, and were re-assessed for the same laboratory and radiologic features after a median 3.5 month follow-up. Results: Basal HGF levels were not different between groups. In the subclinical hypothyroidism group, HGF levels (752.75 ± 144.91 pg/ml vs. 719.37 ± 128.05 pg/ml; p = 0.496) and thyroid volumes (12.51 ± 3.67 cc vs. 12.18 ± 4.26 cc; p = 0.7) before and after treatment did not change significantly. No correlations were found between HGF and other parameters. HGF levels were similar between subjects with nodular goiter and normal thyroid structure. Conclusions: HGF was not shown to be associated with HT and goiter development. In addition, levo-thyroxine sodium replacement therapy did not alter serum HGF levels significantly.

Parathyroid hormone therapy for postoperative resistant hypocalcaemia

Case Report: A 31 year-old woman presented with hypercalcemia. Serum calcium and phosphorus levels were 10.5 mg/dl and 2.56 mg/dl, respectively. The serum PTH level was increased (1619 pg/ml). The serum 25 OH vitamin D level was decreased (3.5 ng/ml). Her past medical history revealed osteoporosis (femur T score -4.0). Parathyroid USG showed left and right parathyroid adenomas. Double adenoma excision from left and right inferior sites and total thyroidectomy was performed. On pathological examination of thyroid was benign thyroid nodules. Double parathyroid adenomas was identified. Postoperative serum calcium level was 5.5 mg/dl. She recieved daily calcium gluconate infusions. Discharge with calcitriol and CaCO3 with latest calcium level was 6 mg/dl. During follow-up, she was taken to internal medicine ward with symtomatic hypocalcemia. Serum calcium, phosphorus, PTH, and 25 OH vitamin D levels were 5.2 mg/dl, 3.2 mg/dl, <3 pg/ml, and 5 ng/ml, respectively. The doses were progressively increased up to 12 mcg/d calcitriol. Under this tretatment serum calcium level was 6.9 mg/dl. Phosphorus level was 3.8 mg/dl. Follow-up, 20 mcg teriparatide b.i.d was added to the treatment. She has used teriparatide for a period of ten months. At the end of teriparatide treatment, calcitriol reduced to 4.5 mcg/d and calcimax D3 reduced 3x1 tb. Final control visit her calcium level was 8.5 mg/dl and phosphorus level was 4.1 mg/dl while taking calcitirol dose of 3.5 mcg/d and calcimax D3 dose of 2x2 tb.

Nasopharyngeal sarcoidosis: a rare involvement

Sarcoidosis is a chronic, multisystemic, non-caseating granulomatous disease of unknown etiology. Nasopharyngeal involvement is very rare in sarcoidosis. The objective of this report was to evaluate a rare involvement of sarcoidosis. This report includes a case of nasopharyngeal sarcoidosis. A 51-year-old female with nasopharyngeal sarcoidosis was treated as sarcoidosis, and she was better. Nasopharyngeal involvement is very rare in sarcoidosis but it must be kept in mind.