ACTA ENDOCRINOLOGICA (BUC)

Context. Therapeutic plasma exchange (TPE) provides time for thyroidectomy in thyrotoxic patients. Objective. TPE is indicated in cases where antithyroid medications cannot be used due to the side effects or attain no adequate hormonal suppression response at the highest dosage and in cases of rapid onset of clinical symptoms. This study presents the treatment results of patients who underwent TPE and were subsequently operated for thyrotoxicosis. Design. The patients who underwent thyroidectomy and TPE between January 1999 and February 2019 were retrospectively analyzed. Subjects and Methods. The files of 27 patients with thyrotoxicosis who performed TPE prior to surgery were analyzed in relation to the demographic and clinical features. Results. We included 15 (55.6%) females, 12 (44.4%) males with a mean age of 44 (23-82) years. The pre-TPE mean free thyroxine (fT4) level was 12 (5-46) pmol/L while free tri-iodothyronine (fT3) level was 34 (17- 141) pmol/L. The post-TPE fT4 level was 6 (3-10) pmol/L while the fT3 level was 21 (12-41). There was one case of an allergic reaction during the procedure. In the postoperative follow-up, there was transient hypocalcemia in 8 (29%) patients, permanent hypocalcemia in 1 (3.7%) patient, and surgical site infection in 1 (3.7%) patient. Conclusion. Preoperative TPE is an alternative treatment option for thyrotoxic patients. This is an especially effective treatment for patients with inadequate response or adverse reaction to antithyroid drugs or patients who need urgent surgery for thyroid storm.

Context. The dominant type of adipose tissue accumulation in the body is associated with the peculiarities of using key substrates in energy metabolism and their hormonal regulation. Hormonal and metabolic parameters were investigated in women with android and gynoid obesity before and after the short-term food deprivation test. Results. At baseline, at gynoid obesity as compared to android obesity, the women’s blood contained lower glucose and insulin levels and higher FFA levels. The reaction to food deprivation manifested by a decrease in glucose level and an increase in FFA level in the blood is less pronounced in women with gynoid obesity than in those with android obesity. At the same time, a similar (though varying in expression) decrease in insulin level and elevated levels of glucagon, growth hormone and thyroxine were revealed in women’s blood in both groups. Blood cortisol level increased in women with gynoid obesity and remained unchanged in those with android obesity. Conclusions. More pronounced activation of hormonal mechanisms for maintaining blood glucose levels at gynoid obesity as compared to android one suggests that glucose is the preferable substrate for energy metabolism at gynoid obesity in women.

Context. Radioactivity has been known to be a causative factor for thyroid cancer. Objective. To answer whether the Chernobyl nuclear accident had any harmful effect on the rate of thyroid cancers after a wait-and-see period. Background. The Chernobyl accident in 1986 was chosen as a milestone because of its close proximity to the geographical area studied. Design. The time periods chosen were: I. 1990-1996 (latent period), II. 1997-2003 (sensitive period), III. 2004-2015 (control period). Subject and Methods. A retrospective study was conducted in a teaching and reference state hospital. The statistical analysis of the data of 4251 patients was made by chi-square and Fisher exact tests. Results. A total of 4251 patients were operated on because of thyroid diseases between 1990-2015. The number of patients in regard to the three time periods were 817, 1141 and 2293, respectively. Statistically significant rise of thyroid cancer and significant geographic vulnerability among different parts of the country were detected between the first two periods, but not between the second and third. The rising rates of malignancy were 1.71% (14/817), 6.83% (78/1141) and 8.59%(197/2293). The mean ages of malignant cases were 51.07 years, 46.2 years and 41.8 years although the mean ages of benign cases were 47.91,60.2, and 61.3 years according to groups, respectively. Conclusion. The Chernobyl nuclear accident seemed to have harmful effect on the rate of thyroid cancer or at least contributed to its increase.

Context. Gender identity, psychosexual function, psychiatric adjustment and quality of life have been investigated in congenital adrenal hyperplasia(CAH) patients. Objective. We aimed to investigate gender identity problems and the psychiatric disorders and associated factors in children and adolescents with CAH patients. Subjects and methods. Forty-five children and adolescents with CAH were included in the study. Psychiatric comorbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children – Present and Lifetime Version. Gender identity problems were investigated using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Results. The mean age of the sample was 11.02 years (SD: 3.25, range: 6–18). 51.1% of the patients had at least one lifetime comorbid psychiatric disorder. The most common diagnoses were anxiety disorders, attention deficit hyperactivity disorder(ADHD), tic disorders and enuresis nocturna. Tic disorders and ADHD were higher in males but they were not statistically significant. Two female patients were diagnosed with gender dysphoria and 18.5% of females showed variably masculinized behaviors. The girls with gender identity problems expressed lower satisfaction with their sex than other girls and boys. Conclusions. Children and adolescents with CAH had many psychiatric disorders, especially neurodevelopmental disorders. ADHD and tic disorders should be kept in mind during assessment especially in male patients. Gender dysphoria and masculine behaviors seem to be common in female patients with CAH so they should be carefully investigated.

Background. Exposure to methotrexate (MTX) causes infertility in young women treated for non-neoplastic\r\ndiseases. Leucovorin an antidote to MTX is used to prevent its side effects. Reproductive tract cells are fast proliferating like cancer cells. Hence, MTX may cause deleterious effect on these cells.\r\nAim. Explore MTX effect on biochemical markers and the protective role of leucovorin in the accessory reproductive\r\norgans viz; oviduct, uterus, cervix and vagina.\r\nAnimals and Methods. Rats with regular oestrous cycle were randomly divided into five groups (n=6) as follows:\r\nControl, MTX LD (low dose), MTX HD (high dose), MTXHD+LCN (leucovorin, LCN), and MTXHD+WD (withdrawal): 20 days withdrawal. Animals were treated once per day intramuscularly (im) for 20 days. Rats were sacrificed on day 21. MTXHD treatment was withdrawn for additional 20\r\ndays and animals sacrificed on day 41. Oviducts, uterus, cervix and vagina were used for biochemical markers analysis.\r\nResults. MTX treatment decreased RNA, DNA and protein concentrations. Such similar effects were also observed in\r\nG6PD, LDH and ALP activities. Leucovorin and withdrawal of treatment partially recovered MTX effects. Uniquely, this study signifies MTX action on nucleic acids and protein levels and also G6PD, LDH and ALP activities in oviducts, uterus, cervix and vagina.

Objective. Carpal tunnel syndrome(CTS) is a neuropathy of the upper limb that is quite common in patients with active acromegaly, but the diagnosis of acromegaly is often made years after the diagnosis of CTS. But in the absence of the typical acral phenotype it is difficult to know when CTS will appear as the first symptom. Method. Here, we present a 27-year-old female patient with a history of numbness that first appeared in her right hand and 2 weeks later in her left hand. While the etiology of acute CTS was being investigated on cervical MRI, the hormonal evaluation of the incidentally detected mass in the sella turcica revealed that it was a clinically silent somatotroph adenoma. Results. Considering the patient's age, desire to have children, lack of typical acral features, the fact that these adenomas may cause phenotypic changes over time, their aggressive course and more recurrences, the decision for transsphenoidal surgery was made. The patient, who has been followed for 14 years, has two healthy children and does not have any complaints, acral phenotype or GH hormone excess. Conclusion. Awareness that acute unilateral/ bilateral CTS without any risk factors may be the first sign of clinically silent somatotrophinoma may improve the prognosis of acromegaly by preventing diagnostic delay.

Pseudoobstruction is an uncommon manifestation of hypothyroidism. However,\r\nhypotony of the bladder in myxedema is very rare, and there were only four such cases\r\nreported previously. We present a 45-year-old man with myxedema and ileus, who was\r\nstarted on thyroxine therapy and was detected to have bladder hypotony on the 5th day of\r\nadmission. There was no evidence of bladder outflow obstruction, and both bowel and\r\nurinary symptoms improved with thyroxine therapy. Bladder hypotony may be more\r\nprevalent in patients of hypothyroidism than previously reported; hence, it is important to\r\nhave a high clinical suspicion and perform early urodynamic studies to avoid back-pressure\r\ndamage to the upper tracts.

Context. Despite the developments in strategies related to the iodization of salt, iodine deficiency is still a serious problem, particularly among pregnant women in certain regions of Turkey. Objective. We aimed to re-evaluate the efficiency of iodine prophylaxis in pregnant women and adults 13 years after iodized dietary salt became mandatory in Istanbul. Subjects and Methods. This study was performed with pregnant women (n = 200) and adults (n = 200, 100 nonpregnant women and 100 men). The participants were questioned about the iodization status of the salt they used. Urinary iodine concentration (UIC) was measured using the Sandell-Kolthoff method. Goiter size and UIC were determined according to Pan American Health Organization and World Health Organization recommendations, respectively. Results. Ratio of iodized table salt use was 91% in both groups. Although the median UICs were 162.5μg/L (95% CI = 162.5–186.1) in pregnant women and 167μg/L (95% CI = 153.7–172.7) in adults, 43% of pregnant women had a UIC < 150μg/L, and 23% of adults had a UIC < 100μg/L. The prevalence of goiter was significantly higher in pregnant women than that in adults (50% and 32%, respectively), but a small goiter was found in all cases. Conclusion. Iodine prophylaxis in Istanbul is sufficient and has progressed. However, iodine deficiency remains a problem for a considerable proportion of pregnant women, despite more than one decade of successful salt iodization in Istanbul Province. Iodine-containing preparations should be considered to supplement iodized salt for pregnant women.

Context. Neoangiogenesis and lymphangiogenesis are essential for the growth of tumor and progression of malignancy. Objective. The study examined the significance of VEGF-C expression in comparison to classical prognostic factors in differentiated thyroid carcinoma (DTC), as well as an independent prognostic marker in DTC. Design. The study included 81 patients with DTC allocated in two groups according to the type of cancer (follicular versus papillary) and then compared to expression of VEGF-C and clinicopathological features. Methods. Expression of VEGF-C was identified with anti-VEGF-C antibody using tris-EDTA buffer Antigen Retrieval Protocol. Each specimen was scored with a semiquantitative score system (H-score). Results. The analysis of T staging system showed a linear correlation between the size of a tumor, expression of VEGF-C and recurrence of a disease, with a statistical significance (p < 0.0001). There was a clear and significant correlation between VEGF-C expression and T stage in patients with papillary carcinoma (p = 0.0294). Analysis of invasion of a surgical margin demonstrated significant positivity in patients with papillary thyroid cancers who expressed VEGF-C (p = 0.0207) indicating the worse prognosis of a disease. Also a statistically significant correlation was between VEGF-C and extrathyroid extension, indicating the worse prognosis (p = 0.0133) in papillary cancers. The level of VEGF-C expression was statistically significant in patients with papillary thyroid cancer (p = 0.039). Conclusions. This study undoubtedly demonstrates that VEGF-C expression is an evident negative prognostic factor in patients with papillary thyroid carcinoma, along with the classic prognostic factors, such as a larger tumor size, tumor margin involvement, extrathyroid extension, i.e. local aggressiveness.

Objective. We hypothesized that vitamin D-deficient diabetic patients might demonstrate cognitive deficits and therefore investigated this association in patients with diabetes mellitus (DM). Methods. This study comprised 236 patients with type 2 DM (118 with vitamin D deficiency (less than 20 ng/ mL) and 118 without vitamin D deficiency as the control group). All patients were outpatients in the endocrinology clinics of Baskent University, Turkey from 1 October 2013 to 31 January 2014 and, chosen in a randomized manner according to their application time. The serum vitamin D levels were measured and cognitive functions were evaluated using the Mini Mental Status Examination (MMSE). Results. The mean age in the study and control group was 57.02±7.30 and 58.92±7.58 years, respectively (p=0.051). The male:female ratio in the study and control group was 1.00:1.46 and 1.00:2.11, respectively. The study group was further divided into three subgroups: patients with mild, moderate, and severe vitamin D deficiency. The study outcomes revealed no significant relationship between the vitamin D deficiency level and the total score or subscores of the MMSE (p<0.05). Conclusions. These study results do not confirm the hypothesis that vitamin D deficiency unfavorably affects cognitive functions in patients with type 2 DM.