ACTA ENDOCRINOLOGICA (BUC)

Aim: to evaluate the epidemiology of thyroid cancer (including their different forms)\r\nin two representative medical centers of Mure? County during 1984-2007 under the impact of\r\npossible regional risk factors: ionized radiation from Chernobyl, mild/ moderate iodine\r\ndeficiency (before 2003) and universal iodization of alimentary salt (from 2004).\r\nMethods: In our retrospective study we analysed the data of 288 patients diagnosed\r\nwith thyroid cancer in Endocrinology Clinic and Institute of Pathology T?rgu Mure? in this\r\nperiod. During 1984-1991 the incidence of thyroid cancer did not change practically, it began\r\nto increase progressively from 1992. This first significant elevation between 1992-1999 was\r\nassigned mainly to the newly appeared papillary thyroid carcinomas. Between 2000-2007 a\r\nsecond ascending wave in thyroid cancer incidence was recorded, with a progressively\r\nincreasing tendency.\r\nResults: The incidence was significantly higher compared to 1992-1999 (p<0.0001,\r\nRR=2.05, 95% CI=1.59 - 2.64). This second increase may be assigned, besides the radiation\r\nexposure, to the extension of diagnostic methods (thyroid ultrasonography from 1998 and\r\nfine-needle aspiration cytology from 2000). While before 1991 there were not found thyroid\r\ncancers in children in our county, during 1991-2006 there were registered 10 cases (most in\r\nthe first period): 7 papillary, 2 follicular and one papillary form associated with insular\r\ncarcinoma.\r\nConclusion: the universal iodine prophylaxis (applied from 2004) might influence the\r\ntype of thyroid cancers, increasing the papillary/follicular carcinoma ratio.

Background. Previous work has shown that the in vitro released prolactin (PRL) from the anterior pituitary (AP) of\r\nlactating rats, contains PRL variants i.e., from 7-14 to 70-97 kDa that when incubated with AP lactotrophs of male rats, and of rats in other conditions, they promoted the selective stimulation and/or inhibition of the in vitro release of PRL variants from APs of male rats and of rats in other conditions.\r\nMethods. In the present experiments, we sought to determine whether PRL variants, released in vitro from lactotrophs of\r\nlactating rats, non-suckled (NS) for 6h or suckled (S) for 15 min after NS, were electroeluted from SDS-PAGE, and then\r\nwere divided into 6 fractions, would influence the in vitro release of PRL variants from lactotrophs of NS and S rat APs.\r\nResults. The results obtained showed that, under non-reducing conditions, the fractions contained PRL variants of 7-23 to 97 kDa, and between 1 and more than 20 ng/&#956;l of PRL protein. Thus similar amounts of total PRL (about 60 ng/&#956;l), were released from each AP region of NS and S rats, except for the higher amount of PRL (80 ng/&#956;l) released from the central AP region of NS rats. The effects of PRL variants\r\nreleased from lactotrophs of NS and S rat APs i.e., of stimulatory and/or inhibitory type were exerted upon the release of PRL variants, and of total PRL.\r\nConclusions. These results indicate that in addition to hypothalamic influence, the release of PRL variants from the\r\nlactating rat AP is regulated also by autocrine influences exerted upon the gland by the previously released PRL variants.

Background. Lipoprotein-associated phospholipase A2 is a novel inflammation marker that generates pro-inflammatory\r\nmolecules from oxidized LDL.\r\nAim. We aimed to investigate its role in individuals with insulin resistance and metabolic syndrome which is representative of early stages of atherosclerosis.\r\nMethods. We evaluated 114 subjects with metabolic syndrome in a cross-sectional pattern. Waist circumference was measured. Fasting plasma glucose, total cholesterol,\r\ntriglycerides, high-density lipoprotein cholesterol (HDL-C), LDL-cholesterol (LDLC), fasting insulin were measured by standard assays. Oral glucose tolerance test was applied\r\nto patients with fasting blood glucose < 126 mg/dL. Patients were classified to tertiles according to their insulin resistance states. Lp-PLA2 mass levels were measured.\r\nResults. There was a correlation between hypertension and HOMA tertiles; HDL-C, hypertriglyceridemia, hyperglycemia\r\nwere not correlated with HOMA tertiles (p = 0.024, p=0.66, p=0.66, p = 0.18, respectively). We cannot find any association between HOMA tertiles and Lp-PLA2 levels. Triglyceride was negatively correlated with Lp-PLA2.\r\nConclusion. Lp-PLA2 is not correlated with insulin resistance in subjects with metabolic syndrome.

Introduction. The present study aimed to introduce a new formula for classification of nodules in TI-RADS and describe ultrasonography features of benign and malignant thyroid nodules. Methods. This study was conducted on thyroid mass in 1033 patients. The incidence of malignancy for thyroid nodules was determined by selecting malignancy coefficients. Then the patients were first classified using conventional TI-RADS classification criteria and once again according to a new proposed formula. Results. Among ultrasonography features of thyroid nodules, the irregular shape (46.7%), unclear margin (47.3%), extension to the capsule (irregular and infiltrative margin) (85%), the marked hypo-echoic nodules (63.8%), micro-calcification (49%), and to have vertical axis (74.0%) were associated with high incidence of malignancy. Conclusion. According to the proposed new formula for TI-RADS, there are four coefficients of 7, 3, 1 and 0 for incidence of malignancy of each one of ultrasound findings that help to standardization and unifying of TIRADS classification. The incidence of malignancy in TIRADS classification according to the new proposed formula was achieved as follows: group 2: 0.0%, group 3: 0.7%, groups 4a, 4b, 4c: 16.7%, 43.4%, 68.5%, and group 5: 95.2%, respectively.

Objective. We aimed to determine the risk of hypercalcemia in a geriatric population with very high dose levels of 25-hydroxy-vitamin D (25(OH)D). Patients and Method. This study was designed as a retrospective, cross-sectional two-center study for examining the elderly patients with very high 25(OH)D levels (>88ng/mL) between January 2014 and December 2019. After recruitment, subgroup analyses of the patients were performed based on their calcium and vitamin D levels. Results. A total of 81.101 elderly patients, who had been evaluated for their vitamin D levels, were screened. Of the 458 (0.6%) elderly patients with 25(OH)D>88 ng/ mL according to our criteria, 217 patients with complete data were accepted into our study. The median 25(OH)D level was 103.7ng/mL (min-max:88.2-275.9). Most of the elderly patients (86.6%) with very high 25(OH)D levels were normocalcemic. When patients with hypercalcemia were compared with normocalcemic group, no difference was observed in the levels of 25(OH)D, intact parathormone (iPTH), phosphorus, alkaline phosphatase (ALP), and their age. However, the PTH suppression rate was significantly higher in hypercalcemic group (p=0.005). Conclusion. The elderly patients with very high 25(OH)D levels would appear to be mostly normocalcemic whereas life-threatening hypercalcemia would also occur. Treatment and follow-up planning should be done according to the clinical guideline recommendations.

Context. Congenital hypothyroidism (CH) is one of the most common preventable causes of intellectual disability, and can be diagnosed in the early period through neonatal screening programs. Objective. The purpose of this study was to determine the prevalence of CH and recall rates in the province of Adıyaman. Design. This retrospective study evaluated the data of newborn screening program in Adıyaman province between January 2015 and December 2020. Subjects and Methods. The thyroid-stimulating hormone (TSH) cut-off value in the screening program is 5.5 mIU/L and TSH values lower than 5.5 mIU/L are regarded as normal. Babies with TSH levels exceeding 5.5 mIU/L were defined as ‘recalled’. TSH measurements and clinical diagnoses of the recalled babies were evaluated. Results. TSH was <5.5 mIU/L in 62270 (90.08%) of the newborns, 5.5-20 mIU/L in 6114 (8.84%), and >20 mIU/L in 742 (1.07%). Venous T4-TSH values were normal in 673 of the 742 babies with TSH levels exceeding 20 mIU/L, while 63 babies were diagnosed with CH. Heel blood results were normal in 5880 of the 6114 babies with TSH levels of 5.5-20 mIU/L and for whom repeat heel blood was requested. TSH levels in repeat heel blood were >5.5 mIU/L in 184 babies and 93 of them were diagnosed with hypothyroidism. The recall rate among babies undergoing heel blood TSH measurement in the province of Adıyaman was 9.9%. 156 babies were started on thyroid replacement therapy with diagnoses of CH. The incidence of babies diagnosed with hypothyroidism was 1/443. Conclusion. According to the CH screening results, the recall rate and incidence of CH in the province of Adıyaman were higher than the global general figures. Both the low TSH threshold value employed in neonatal hypothyroidism screening and the province falling within the iodine deficiency region may account for this.

Background. This study aimed to assess fractal dimension (FD) and the radiomorphometric indexes on the digital panoramic radiography (DPR) of patient with primary hypothyroidism receiving levothyroxine sodium replacement therapy. Methods. A total of 115 subjects were included in this cross sectional retrospective study. According to the results of the thyroid function tests, the subjects were divided into two groups as primary hypothyroidism (levothyroxine sodium replacement therapy given), (n = 57) and the healthy control group (n = 58). The fractal dimension (FD), panoramic mandibular index (PMI), mandibular cortical width (MCW), gonial index (GI) and mandibular cortical index (MCI) values of all patients were calculated on DPRs. The statistical analysis of all data was performed with SPSS version 22. Results. The distributions of age and gender in the primary hypothroidism group were similar to control group (p = 0.19 and p = 0.62, respectively). The two groups did not differ statistically significantly in terms of FD, PMI, MCW, GI, and MCI. Conclusion. We determined that mandibular cortical and trabecular bone structure did not significantly differ between healthy individuals and patients receiving drug replacement theraphy due to hypothyroidism, but our results should be further supported with the investigation of clinical parameters.

Context. Adiponectin is an abundant adipokine, which has antiinflammatory, anti-atherosclerotic and vasoprotective actions, and potential antiresorptive effects on bone metabolism. It seems to be directly involved in the improvement and control of energy homeostasis, protecting bone health and predicting osteoporotic fracture risk. Objective. To examine the relationship between adiponectin level and bone mineral density (BMD) in postmenopausal women with metabolic syndrome (MetS) and low BMD, and to estimate the prognostic significance of adiponectin in osteoporosis. Design. Clinical-laboratory cross-sectional study including 120 middle-aged and elder women (average 69.18±7.56 years). Subjects and Methods. The anthropometric parameters were measured for all examinees. Lumbar spine and hip BMD, as well as body fat percentage, were measured using a Hologic DEXA scanner. In all subjects serum adiponectin concentration was measured by ELISA method. Results. The level of adiponectin was significantly positively correlated with BMD-total, BMD of the lumbar spine and BMD of the femoral neck (r=0.618, r=0.521, r=0.567; p<0.01). Levels of adiponectin and BMD are significantly lower in post-menopausal women with MetS and osteoporosis compared to patients with osteopenia (856.87±453.43 vs. 1287.32±405.21 pg/mL, p<0.01; BMD, p<0.05), and the highest values in healthy examinees. A cutoff value of adiponectin level for osteoporosis/osteopenia was 1076.22/1392.74 pg/mL. Conclusions. Post-menopausal women with MetS have significantly lower adiponectin level and low BMD compared to healthy examinees. Adiponectin may be an early, significant and independent predictor of developing osteoporosis in women with MetS, especially in postmenopausal period.

Graves&#8217; disease and toxic nodular goiter both cause thyrotoxicosis by different pathophysiological mechanisms. Rare cases associates both etiologies are undertaken by the diagnosis of Marine-Lenhart syndrome. A woman aged 38, with Graves&#8217; unilateral ophthalmopathy and a solitary, echo-dense thyroid nodule, developed thyrotoxicosis within the following 3 months. The diagnosis was certified by suppressed TSH (0.002 mIU/L), high fT4 (5.6 ng/mL) associated with elevated TRAb (3.5 IU/L), moderately elevated TPOAb (63.1 IU/mL) and ATGl (248 IU/mL). The thyroid radioiodine scan revealed a solitary hot nodule in the left lobe with an elevated radioiodine uptake. Methyl prednisolone was started by oral and pulse therapy, with stabilization of ophthalmopathy within 5 months. After four months with antithyroid drug therapy followed by radioiodine (25 mCi 131I), the thyroid scan revealed diffuse radioiodine uptake. Nine months after radioiodine therapy, the patient was in clinical and biochemical hypothyroidism and substitutive therapy was instituted. A broad literature review suggested that in such rare cases, underlying autoimmune mechanisms might be involved in the development of thyroid nodules with variable function and proliferation activity.

Chronic transfusion regimen and chelating therapy has dramatically improved the life expectancy of thalassemic patients. The aim of this study was to assess the prevalence of endocrine disturbances in patients with beta-thalassemia major. Subjects were 64 patients with a mean age of 19.45 ? 6.82 years found in haematological care at the National Institute of Transfusional Haematology. All the patients were evaluated clinically and biologically. LH, FSH, estradiol, testosterone, TSH, free T4, insulin were measured by chemiluminescence; mean ferritin value was used to assess iron overload. Fifty one patients (79.68%) -27 male and 24 female in our group were at pubertal or adult age. Eleven boys (40.74%) had delayed puberty, 10 (37%) arrested puberty and 4 (14.8%) had reached complete sexual maturation. In the female group, 6 (25%) had delayed puberty, 4 (16.66%) arrested puberty and 14 (58.32%) reached full sexual development. Half of both the male and female patients with complete sexual maturation had hypogonadotropic hypogonadism at the evaluation moment. Moreover, 34 (53.12%) of our patients had pathological short stature, 11 (17.18%) primary hypothyroidism, 5 (7.8%) hypoparathyroidism, 3 (4.68%) diabetes mellitus and 6 (9.37%) insulin resistance. We found a significantly higher mean ferritin value in patients with endocrine disturbances of any type compared to subjects without endocrinopathies. In conclusion, our data showed that hypogonadism and short stature were the most frequently found endocrine disturbances. Early form of hypogonadism had a major clinical impact on sexual development and final height. These results suggest that early endocrine evaluation and treatment are necessary in order to improve the quality of life of these patients.