Umut Mousa

Should neck pain in a patient with Hashimoto's thyroiditis be underestimated? A case and review of the literature

Hashimotos Thyroiditis (HT) is an autoimmune disease and the most frequent cause of hypothyroidism. Subacute thyroiditis (SAT) overlapping HT is a rare entity. A 69-year-old female patient with HT and multinodular goiter has been followed on levothyroxine replacement therapy for 7 years. She presented with neck pain radiating to the right ear persisting for 2 months. She was prescribed analgesics and antibiotics by other physicians during that period, which did not work. Her vital signs were stable with no tachycardia or fever. The right lobe of the thyroid gland was tender on palpation. Her TSH level was 3.94 mIU/ml, ESR 23 mm/h, CRP 3.2 mg/l, WBC 4900/μl at presentation. Thyroid ultrasonography revealed a hypoechoic area over the tender lobe. Power Doppler imaging revealed almost no blood flow in that area. She was started on methylprednisolone 32 mg/day. At day 10 of therapy, her symptoms had completely resolved. Ultrasonography repeated showed that the hypoechoic area had disappeared. Glucocorticoid dosage was tapered and stopped. Emergence of subacute thyroiditis in a case with preexisting Hashimotos thyroiditis is a quite rare condition, but should be kept in mind along with a painful attack of HT in the differential diagnosis.

Performance of abdominal bioelectrical impedance analysis and comparison with other known parameters in predicting the metabolic syndrome.

Although obesity is a powerful risk factor for metabolic syndrome (MetS) it is not present in all obese individuals. Increased visceral adipose tissue is the hallmark of this syndrome. In this cross sectional survey we aimed to use abdominal bioelectrical impedance analysis to measure the visceral adipose tissue (VAT) and trunk fat percentages (TF%) in the study population, correlate these findings with traditional anthropometric measures and biochemical parameters of metabolic syndrome and estimate a cut-off value of visceral fat for development of MetS. A total of 285 subjects were enrolled. VAT and TF% were measured by the AB-140 device via abdominal bioelectrical impedance analysis. Fat% was measured by a body composition analyzer (TBF-300). VAT was significantly positively correlated with body mass index, waist circumference, TF%, HOMA IR, fat percentage, fasting plasma glucose and triglycerides. Strongest correlations were between VAT and TF%, VAT and device measured waist circumference and between VAT and manual waist circumference (r=0.95, r=0.93, r=0.92 respectively). Correlations of VAT and TF% with metabolic parameters were significant but weak. The mean VAT and TF% in MetS (+) groups were significantly higher than patients in MetS (-) groups in both sexes. The areas under the ROC curves were 0.730 (95% CI: 0.661-0.791) for female VAT and 0.702 (95% CI: 0.654-0.749) for male VAT in predicting MetS which were similar to the areas under ROC curves calculated for device and manually measured waist circumference, HOMA IR and TF% in predicting MetS (p>0.05 for all comparisons). The accuracy of VAT and TF% for predicting MetS was not sufficient. From our results we can deduce that the performance of abdominal BIA in predicting MetS is weak but could be used in the follow-up of patients with obesity and/or MetS. This has to be confirmed in future studies.

Association of the renal resistive index with microvascular complications in type 2 diabetic subjects.

Chronic complications are the leading causes of morbidity and mortality in the diabetic population. The intrarenal resistive index (RI) has been reported to be increased in hypertensive subjects with microalbuminuria and limited data is present for diabetic subjects. 101 subjects with Type 2 Diabetes Mellitus were included in the study. We grouped the study population according to the urinary albumin excretion (UAE). Group 1: UAE<30 mg/day (n=36); Group 2: UAE 30-300 mg/day (n: 37); Group 3: UAE>300 mg/day (n: 28). We also grouped the study population according to the intrarenal RI value. Group I consisted of subjects with RI≥0.70 and group II<0.70. The mean intrarenal RI values of patients in group 3 were higher than those of group 1 and group 2 (0.72 vs. 0.69 p=0.048; 0.72 vs. 0.69; p=0.048 respectively). The duration of diabetes, hip circumference, and hs-CRP levels were statistically significantly higher in subjects with intrarenal RI≥0.70 compared to those with intrarenal RI<0.70 (p:<0.001, 0.048 and 0.0148 respectively). Presence of retinopathy and neuropathy was statistically significantly higher in subjects with intrarenal RI≥0.70 compared to those with intrarenal RI<0.70. RI may predict the development of microvascular complications in diabetic subjects.

Work Patterns of Mothers Influence the Weights of Their Children

D O I: 10 .2 51 79 /t je m .2 01 759 38 5 Objective: Recent studies have reported a positive association between paid work hours of mothers and obesity in their children. Like most of other hospitals, nurses at our center work either on irregular shifts or on a regular basis. The aim of this study was to analyze factors affecting the weights of the children of female nurses. Material and Methods: We evaluated 100 children of female nurses on duty at our hospital. We prepared a questionnaire including details such as the gender of the child, birth-weight, education level and working status of both parents, duration of breastfeeding, age at which supplementary food was first introduced, exercise habits, snacking habits, and identity of caretakers while the mothers were at work. We calculated the body mass index percentiles using standard growth charts. Results: According to the standard body mass index percentiles, 13 children were underweight, 53 had normal weight, 14 were overweight, and 20 were obese. The weight patterns of children were positively associated with regular maternal workstyle (p=0.016), frequency of snacking habits (p=0.003), and caesarian birth (p=0.04). Children of nurses working on shifts were more likely to be underweight compared to those working on fixed schedules. There was no association between the weight patterns of children and education levels of parents, working status of fathers, duration of lactation, birth-weight, gender, order of birth, and supplementary food consumption patterns. Conclusion: Irregular working hours of mothers can cause irregular and insufficient nutrition for their children. The mother is generally unable to supervise the child during feeding hours. These findings need to be confirmed through more studies on a large scale.

Do Statins Affect Thyroid Volume and Nodule Size in Patients with Hyperlipidemia in a Region with Mild-to-Moderate Iodine Deficiency? A Prospective Study

Objective: The objective of this study was to assess the antiproliferative pleiotropic effects of statins on thyroid function, volume, and nodularity. Subjects and Methods: One hundred and six hyperlipidemic patients were included in this prospective study. The 69 patients in the statin groups received atorvastatin (16 received 10 mg and 18 received 20 mg) or rosuvastatin (20 received 10 mg and 15 received 20 mg). The 37 patients in the control group, assessed as not requiring drugs, made only lifestyle changes. Upon admission and after 6 months, all patients were evaluated by ultrasonography as well as for lipid variables (total cholesterol, high- and low-density lipoprotein cholesterol, and triglycerides) and thyroid function and structure. Results: After 6 months, no differences in thyroid function, thyroid volume, the number of thyroid nodules, or nodule size were observed in the statin and control groups. In a subgroup analysis, total thyroid volume had decreased more in patients receiving 20 mg of rosuvastatin than that in the control group (p < 0.05). Maximum nodule size had decreased more in those receiving 10 mg of rosuvastatin (p < 0.05). Conclusions: Our results suggest an association between rosuvastatin treatment and smaller thyroid volume and maximum nodule diameter; this could be attributable to the antiproliferative effects of statin therapy on the thyroid.

Iodine status of pregnant women residing in Northern Cyprus

Iodine requirements increase in pregnancy (1). The World Health Organization and U.S. Institute of Medicine suggest a daily intake of 250 μg/d (2) and 220 μg/d, respectively, for pregnant women (3). A median urinary iodine concentration below 150 μg/L reflects insufficient iodine intake in a pregnant population (2). Before the introduction of iodized salt to our country in 1999, we performed a study in 625 school-age children and found that the median (minimum-maximum) urinary iodine concentration was 120 (11-900) μg/L (4). In 2003, we conducted a monitoring study in 450 school-age children. The median (minimum-maximum) urinary iodine concentration increased to 139.5 (16-770) μg/L (unpublished data). Thus, our region was considered to be iodine-replete. We have no data regarding pregnant subjects. The aim of this study was to analyze the urinary iodine concentration in a cohort of pregnant women residing in Northern Cyprus. The study was approved by “B. Nalbantoglu Ethical Committee, Nicosia, Cyprus” in which 258 pregnant inhabitants in all trimesters were included between January and June 2016. We administered a questionnaire and obtained morning iodine samples from the study population until laboratory analysis performed in Ankara University, Medical School, Endocrinology Laboratory, which is a part of the Ensuring the Quality of Urinary Iodine Procedures program conducted by the Centers for Disease Control and Prevention (USA). Subjects using iodine supplements or iodine-containing multivitamins were not eligible for this study. According to the World Health Organization criteria for iodine nutrition during pregnancy, participants were divided into five groups: adequate iodine (urinary iodine concentration: 150-249 μg/L), mild deficiency (urinary iodine concentration: 100-150 μg/L), moderate deficiency (urinary iodine concentration <100 μg/L), severe deficiency (urinary iodine concentration <50 μg/L), and more than adequate or excessive (urinary iodine concentration ≥250 μg/L) groups. General characteristics of the study group are presented in Table 1. The mean age of the study group was 28.62±5.8 years (17-46). The median (minimum-maximum) urinary iodine concentration was 110 (8-450) μg/L. The median urinary iodine concentration were similar in all three trimesters (1st trimester 108 μg/L, 2nd trimester 112 μg/L, 3rd trimester 116 μg/L; p=0.392) The median urinary iodine concentration was 113 μg/L among subjects using iodized salt and 77 μg/L in subjects using noniodized salt (p=0.330). The median urinary iodine concentration was 114 μg/L among subjects who restricted their salt intake and 106 μg/L among those who did not restrict their salt intake (p=0.273). The

Amyloid Accumulation in the Toxic Nodule of the Thyroid Gland in a Patient with End Stage Renal Failure

Amyloidosis is characterized by accumulation of amorphous, proteinaceous material in various organs and tissues of the body. Amyloid may accumulate in the thyroid gland in cases of medullary thyroid carcinoma and systemic amyloidosis. Amyloid accumulates extracellularly in the thyroid parenchyma and disrupts the normal follicular patterns. Most of the cases reported up to now were clinically euthyroid, but many presentation forms and overlaps have been reported. Herein we present a patient with toxic nodular goiter with amyloid deposition in the toxic nodule as well as the remaining thyroid tissue.