ACTA ENDOCRINOLOGICA (BUC)

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Background. Scintigraphy using 99mTcpertechnetate (TS) is the diagnostic test to differentiate thyroiditis following Graves’ disease (GD) from painless thyroiditis (PT). However, TS may be contraindicated or unavailable. Objective. We compared the diagnostic effectiveness of two TSH receptor antibody (TRAb) immunoassays in untreated PT, already confirmed by qualitative and quantitative(99m) Tc-pertechnetate thyroid uptake (TCTU). Method. TRAb assay and TS were performed in suspected PT patients. All 67 subjects (27 males) with confirmed diagnosis of PT based on qualitative (subjective) low uptake and quantitative uptake below 0.4% (Normal TcTU: 0.4-4%) . During the period of study, we used two 2nd generation TRAb assays. Result. Mean age, TSH, free T4 and TcTU were 40.5± 12.7 years, 0.066±0.089 mIU/L, 2.46±2.18 ng/mL and 0.188±0.0503% respectively. Fifteen (22.39%) of our PT patients were TRAb positive. Sensitivity, specificity, accuracy, PPV and NPV of TRAb in predicting thyroiditis were 81%, 75%, 78.2%, 83.6% and 74.4% in Assay 1. The same parameters were 74%, 64%, 71.2%, 76.8% and 62.7% respectively in TRAb Assay 2. However, ROC curve did not reveal any difference between the two assays. Conclusion. Negative TRAb value does not reliably distinguish PT from mild GD, in situations where TS is contraindicated or unavailable.

Context. Minimally invasive parathyroidectomy (MIP) procedure has become a widely accepted alternative to the standard four-gland exploration nowadays. Objective. The aim of this study was to evaluate patients with primary hyperparathyroidism (PHPT), who had been treated with thyroidectomy and bilateral neck exploration (BNE), rather than MIP alone, due to coexisting thyroid nodules and to determine the benefits of simultaneous thyroidectomy and the possible negative outcomes of not performing this additional procedure. Design. There were 185 patients who were operated for PHPT at our clinic from January 2014 to November 2016. Subjects and Methods. 50 patients meet inclusion criteria: have thyroidectomy at the same time of parathyroid surgery, have concordant findings of parathyroid adenoma localization at preoperative MIBI-SPECT and the cervical US and have not had malignancy on fine needle aspiration biopsy (FNAB). Results. The mean age of the patients was 55.3±10.4, and female to male ratio was 7:1. All patients had parathyroidectomy with BNE and thyroidectomy: 11 (22%) patients had micropapillary thyroid cancer (mPTC), 2 (4%) had papillary thyroid cancer (PTC). Conclusion. The results were inconclusive in clearly demonstrating which patients presenting with coexisted thyroid nodules should undergo thyroidectomy, rather than MIP, and which should be monitored for thyroid nodules after MIP. However, we consider that in cases who are not clearly indicated for thyroidectomy, MIP followed by monitoring of thyroid nodules can be the treatment approach.

Introduction. Subacute thyroiditis (SAT) is a self-limiting thyroid disease associated with a triphasic clinical direction of hyperthyroidism, hypothyroidism and back to normal thyroid function. Precise etiology of this clinical condition is unknown. Generally diagnosis is based on clinical-laboratory parameters. Considerable cases of SAT develop after several types of viral infections. We herein describe two cases that developed SAT after dental extraction. Cases. Two-female patients in the forties ages experienced fever and neck pain after dental extraction. The patients presented elevated sedimentation rates and SAT symptoms. After clinical diagnosis and therapy administration, symptoms resolved after one week. Conclusion. We have presented two cases experiencing SAT after dental extraction. The management and possible association with current literature were discussed.

COVID-19 is a viral disease that is recognized now as a pandemic by the World Health Organization. It is known that some viral infections may trigger autoimmune diseases. It has been revealed that COVID-19 may also lead to the pathogenesis of some autoimmune diseases, including Type 1 DM (T1DM) and autoimmune thyroid diseases. Here, we aimed to present a young female patient with COVID-19, who we followed up in our clinic, who presented with diabetic ketoacidosis (DKA), and developed Hashimoto’s disease during the treatment process. In order to emphasize that COVID-19 may trigger the emergence of T1DM, that it may mask nonspecific DKA symptoms like nausea and vomiting, that it may cause delay in diagnosis of DKA, and also to emphasize the importance of evaluating other autoimmune diseases accompanying COVID-19, we found it appropriate to present this case.

Background. Peroxisome proliferator– activated receptors (PPAR) α and γ are ligand-activated transcription factors and members of the nuclear hormone receptor superfamily that regulate the metabolism of glucose and lipids. Aim. This study investigated the effects of PPARα deficiency on body weight in wild type and PPAR-αnull mice. Materials and methods. The study was performed on male wild type (WT) mice and homozygous PPAR-αnull (PPARα-knockout) mice of C57BL/6J genetic background. The mRNA expression was quantitatively analyzed by the real time of polymerase chain reaction (RTPCR). Liver TG content was measured by using a commercially available kit. Serum triglyceride (TG) content was measured using enzymatic methods. Serum insulin was determined using an ELISA kit. Serum glucose was determined by the glucose oxidase method using a glucose analyser. Results. Compared with WT, PPAR-αnull mice had high relative adipose tissue weight. These mice exhibited high adiposity state. PPAR-αnull mice also expressed high adiponectin and leptin mRNA levels compared to wild type animals. The PPAR-αnull mice had significantly higher body weight than WT. Hepatic TG and FFA were higher in PPAR- αnull mice as compared to WT animals. PPAR-αnull mice had a high accumulation of TG and FFA in the plasma. Serum insulin concentrations and its pancreatic mRNA transcripts were downregulated in PPAR-αnull mice, suggesting that PPARα gene deletion contributes to low insulin gene transcription. We have reported that PPARα deficiency leads to hypoglycaemia in mice. Conclusion. It is suggested a role of PPARα in obesity-diabetes in mice by studying PPARα-knockout mice.

Psychosis following steroid replacement in Sheehan's syndrome is rarely encountered. We present the clinical course of two patients who developed severe psychosis after starting them on low dose prednisolone. Psychosis subsided after either stopping or decreasing the dose together with use of antipsychotic medications. Glucocorticoids restarted a week later in low doses were well tolerated. Both the patients were reviewed after three months and were psychosis free.

Background. Managing pheochromocytoma during pregnancy presents significant challenges due to the absence of well-established guidelines. Early detection during prenatal care, together with timely medical and surgical interventions, is crucial for achieving favorable maternal and fetal outcomes. Case presentation. This report presents the case of a 35-year-old nulliparous woman with bilateral pheochromocytoma who became pregnant between the first and second stages of adrenalectomy. Preoperative management included α-adrenergic blockade and hydration, which was successfully implemented despite the patient being normotensive. The patient underwent a corticalsparing tumor resection during the second trimester without complications and subsequently delivered a healthy fullterm infant through normal labor. Conclusion. This case demonstrates that preoperative α-adrenergic blockade remains the recommended approach for managing pheochromocytoma during pregnancy, even in normotensive patients. Additionally, laparoscopic cortical-sparing adrenalectomy appears to be an effective surgical option for minimizing the risk of long-term adrenal insufficiency in cases of bilateral lesions.