Do Histologically Aggressive Subtypes of Papillary Thyroid Microcarcinoma have Worse Clinical Outcome than Non-Aggressive Papillary Thyroid Microcarcinoma Subtypes? A Multicenter Cohort Study.

Histologically aggressive micropapillary thyroid carcinomas (PTMC) subtypes are thought to be associated with an aggressive clinical course. However, evidence for unfavorable clinical outcomes in patients with aggressive PTMC subtypes is not clear. In this study, we intended to determine the difference in clinical outcomes between patients with aggressive and non-aggressive PTMC subtypes. In this multicenter cohort study, the computer-recorded clinical and histopathological data of patients who underwent thyroid surgery between January 2000 - January 2021 in 9 referral centers and were diagnosed as PTMC were analyzed. A total of 1585 patients [female 1340 (84.5%), male 245 (15.5%), mean age 47.9±11.63 years), with a mean follow-up time of 66.55±37.16 months], were included in the study. Ninety-eight cases were diagnosed as aggressive and 1487 as non-aggressive subtypes. Persistent/recurrent disease was observed in 33 (33.7% )and 41 (2.8%) patients with aggressive and non-aggressive subtypes (p<0.001). Diseases-free survival rates were markedly lower in patients with aggressive than in those with non-aggressive PTMC subtypes (66.3 vs. 94.8%, log-rank p<0.001). Moreover, in multivariate analysis, aggressive histology was an independent predictor of persistent/recurrent disease, after controlling for other contributing factors (HR 5.78, 95% CI 3.32-10, p<0.001). Patients with aggressive PTMC subtypes had higher rates of incomplete biochemical and structural response than patients with non-aggressive subtypes as well (p<0.001). Aggressive PTMC subtypes share many characteristics with histologically identical tumors>1 cm in size. Therefore, the histopathological subtype of PTMC should be taken into consideration to tailor a personalized management plan.

The reference intervals of thyroid stimulating hormone in healthy individuals with normal levels of serum free thyroxine and without sonographic pathologies.

INTRODUCTION: The aim of the present study was to investigate the reference intervals for thyroid stimulating hormone (TSH) in healthy individuals with normal levels of serum free thyroxine (fT4) and without sonographic pathologies, and determine the effects of age, gender, and residence on the TSH reference intervals. SUBJECTS AND METHODS: This research was a population-based study conducted in 70 regions. The random sampling method was used to select the 1095 subjects of the study among inhabitants aged 18 and above. Patients who had a previous history of thyroid disease and had been taking medication were excluded from the study as this may have affected their fT4 or TSH levels. In addition, subjects who had serum fT4 without a reference range and abnormal ultrasonography findings were also excluded. A total of 408 subjects were used for establishing the reference intervals for TSH. RESULTS: The data for TSH in the study group were not normally distributed according to the Kolmogorov-Smirnov index. The geometric mean was 1.62 mIU/L, the median was 1.40 mIU/L, and the 95% reference intervals were 0.38-4.22 mIU/L. The median TSH level was higher in females compared to males (p < 0.05). In the female subjects 2.5th percentile of TSH was lower and 97.5th percentile was higher than those of males. The reference intervals of TSH were of lower values in subjects over 50 years old (p < 0.001). DISCUSSION: Studies suggest that determination of the TSH reference intervals may differ due to environmental influences or due to age, gender, and race. It is suggested that the lower limit of normal TSH for the adult Turkish population would be 0.38 mIU/L and the upper limit similar to the traditional value of 4.2 mIU/L. If each clinician uses their population-specific reference interval for TSH, thyroid function abnormalities can be accurately estimated.

The frequency of antibodies against cyclic citrullinated peptides and rheumatoid factor in healthy population: a field study of rheumatoid arthritis from northern Turkey.

Rheumatoid arthritis (RA) is a chronic, systemic and an autoimmune disease characterized by inflammation of the synovial membrane that affects approximately 1 % of the total world population. Rheumatoid factor (RF) is a widely used auto antibody in diagnosis of the RA and found positive in 50-80 % of the patients but with a lower specificity. On the other hand, anti-cyclic citrullinated peptide (anti-CCP) is the latest serological marker with a specificity around 98 %. This field survey was conducted in different regions to investigate the frequency of RF and anti-CCP and also frequency of RA in a northern province of Turkey. This study was conducted in 70 local areas (12 urban and 58 rural) in the province of Tokat, which is located in northern Turkey. The population of Tokat was reported to be 828,000 at the last census and about 530,000 individuals aged > 18 years old. The study population of 941 subjects (462 male and 479 female; urban 501 and rural 440) was selected by random sampling method among 530,000 individuals. Of the 941 healthy controls assigned to the study, 479 of them were female (51 %) and 462 of them were males (49 %), and median age of all participants was 41 ± 17. Twenty-six subjects were RF positive (2.8 %), and 9 patients were anti-CCP positive (1 %). The presence of both RF and anti-CCP antibodies has also been shown in two patients (0.2 %). In conclusion, we demonstrated that the frequency of RA was 0.53 %, RF presence was 2.8 %, and anti-CCP presence was 1 % in total 941 healthy subjects enrolled into study.

Insulin resistance and cardiovascular risk factors in women with PCOS who have normal glucose tolerance test.

INTRODUCTION: We aimed to determine the insulin resistance in women with PCOS patients who have normal oral glucose tolerance test (OGTT) and to evaluate cardiovascular risk by measuring C-reactive protein (CRP) and carotid intimae-media thickness (CIMT). METHODS: A total of 34 patients and age and body mass matched 20 healthy control subjects were included to this prospective study. Both of patients and control groups were consisted of normal oral glucose tolerance test. Insulin resistance (IR) was estimated using HOMA-IR method. CRP, lipid and hormone levels were measured. CIMT was measured by Carotid Artery B-Mode ultrasonography. RESULTS: There was no significant difference between patients and controls in BMI, and waist circumference, lipid, TSH, LH, FSH, estradiol, and prolactin levels. Serum insulin, testosterone, DHEAS, ferritin levels and HOMA values were significantly higher in patient group. We found that 64.7% (n = 22/34) patients with PCOS had insulin resistance. Both of CIMT and CRP levels were significantly higher in the PCOS patients had BMI over 25 kg/m². CRP levels was significantly higher in the PCOS patients had waist circumference greater than 80 cm. CONCLUSION: We found insulin resistance in the women with PCOS even if OGTT was normal. Our data were similar to literature, the women with PCOS have increased risk of premature atherosclerosis and metabolic syndrome.

The effects of circulating MIR22-3p and MIR16-1-3p levels in different stages of subacute thyroiditis.

Subacute thyroiditis (SAT) is an inflammatory thyroid disease with a frequency is 5% among all thyroid diseases. miRNAs are endogenous, non-coding RNAs ranging in length from 19 to 25 nucleotides. They play an important role in the posttranscriptional regulation of gene expression. In this study, we aimed to investigate whether the expression levels of two circulating miRNAs, MIR22 and MIR16-1, can be used as a parameter in the diagnosis and follow-up of SAT disease. Fifty patients diagnosed with SAT and 41 healthy controls were included in this study. Expression levels of miRNAs were determined by real time-PCR method. Expression data of miRNAs were calculated by fold change (2-ΔΔCt) method. The statistical significance of miRNA expression was evaluated by t-test. The expression levels of MIR22-3p and MIR16-1-3p were not found to be statistically different between SAT patients and controls and also between the patients in different stages (hyperthyroid, euthyroid, and hypothyroid) of the disease. According to correlation analyses, we observed a positive strong correlation between erythrocyte sedimentation rate (ESR) and the expression levels of MIR22-3p and MIR16-1-3p (r = 0.960, p = 0.000 and r = 0.865, p = 0.006, respectively), and a positive strong correlation between fT4 and the expression levels of MIR22-3p in SAT patients in euthyroid stage (r = 0.712, p = 0.047). In this study, we showed that the expression levels of MIR22-3p and MIR16-1-3p have correlation with clinical characteristics of SAT disease. Our results suggest that MIR22 and MIR16-1 may be effective in the pathogenesis of SAT.

Shear wave elastography in early diabetic kidney disease.

OBJECTIVE: This study aimed to analyze the kidneys among the subjects with early stages of type 2 diabetic kidney disease by shear wave elastography quantitatively. METHODS: A total of 108 patients with type 2 diabetic kidney disease and 17 control subjects were enrolled. According to the estimated glomerular filtration rate and urinary albumin-to-urinary creatinine ratio, patients were classified into stages 1 to 3 diabetic kidney disease. Grayscale ultrasound andshear wave elastography were performed. The sizes, depths, and shear wave elastography values were recorded. These parameters were compared between the diabetic kidney disease and the control subjects. RESULTS: The mean shear wave elastography values were significantly higher in the diabetic kidney disease group (10.156±1.75 kPa vs. 8.241±1.4 kPa; p<0.001). We obtained statistically significantly higher shear wave elastography values in stages 2 and 3 diabetic kidney disease subjects than control subjects and in patients with stage 3 diabetic kidney disease compared to those with stage 1 diabetic kidney disease (p<0.05 for all). We obtained a cutoff value of 9.23 kPa for predicting diabetic kidney disease in early stages, with a sensitivity of 67% and a specificity of 82%. CONCLUSION: Shear wave elastography may be used as a noninvasive, simple, and quantitative method to provide diagnostic information as a part of routine management of patients with type 2 diabetes mellitus, especially in the early stages of diabetic kidney disease.

Quantitative Color Doppler Ultrasonography Measurement of Thyroid Blood Flow in Patients with Graves' Disease.

BACKGROUND: Graves' Disease is an autoimmune disorder characterized by increased levels of thyroid hormones correlated with increased thyroid blood flow. Thyroid scintigraphy is an important and conventional method. However, it has limited accessibility, has ionizing radiation, and is expensive. OBJECTIVES: To investigate the thyroid blood flow in patients with Graves' Disease by color Doppler Ultrasonography and a newly developed software Color Quantification. METHODS: Forty-one consecutive subjects with GD and 41 healthy controls were enrolled. Color Doppler ultrasonography parameters of the thyroid arteries and Color Quantification values of the gland were measured by a radiologist. The correlations between thyroid blood flow parameters, levels of 99mTechnetium pertechnetate uptake, thyrotropin, and free thyroxine were evaluated. The diagnostic performances of these parameters were investigated. RESULTS: The peak systolic-end diastolic velocities of thyroid arteries and Color Quantification values were increased in the study group (p < 0.05 for all). We observed negative correlations between thyrotropin levels and peak-systolic and end-diastolic velocities of superior thyroid arteries and Color Quantification values. There were positive correlations between 99mTechnetium uptake levels and thyroid blood flow parameters (p < 0.05 for all). In the diagnostic performance of thyroid blood flow parameters, we observed utilities significantly in peak-systolic and end-diastolic velocities of thyroid arteries and Color Quantification values (p < 0.05 for all). CONCLUSION: The increased peak-systolic and end-diastolic velocities of thyroid arteries, and increased Color Quantification values might be helpful in the diagnosis of Graves' Disease.

Prevalence of Nonalcoholic Fatty Liver Disease in Familial Mediterranean Fever.

INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome (MetS), insulin resistance (IR) and chronic inflammation. Although familial Mediterranean fever (FMF) patients have no symptoms in the periods between attacks, their subclinical inflammation continues. The aim of the present study was to determine the NAFLD frequency in FMF patients and to evaluate their MetS, IR and lipid profiles. METHODS: The study included 54 FMF patients and 54 control subjects. The clinical and demographic characteristics of the subjects were recorded, and the patients' Pras disease severity score was calculated. IR was determined using the homeostasis model assessment (HOMA) index. MetS was diagnosed using the revised National Cholesterol Education Program Adult Treatment Panel III criteria (NCEP ATP III). Hepatic ultrasonography was used to diagnose NAFLD. RESULTS: NAFLD was observed in 15 FMF patients (27.8%) and 14 controls (25.9%). The difference between the groups was not significant (p=0.828). Similarly, no significant difference was found between the two groups for MetS frequency and HOMA index levels. Fasting plasma glucose was significantly higher in FMF patients, whereas differences between the two groups were not significant for lipid levels and other parameters. When FMF patients with and without NAFLD were compared, no significant difference was found in Pras disease severity score, duration of the disease and daily colchicine dose. CONCLUSION: The present study showed that NAFLD frequency was not increased in FMF patients, and that patients' MetS frequency, IR and lipid profiles were not different from control subjects.

Prevalence of insulin resistance and identifying HOMA1-IR and HOMA2-IR indexes in the Middle Black Sea region of Turkey.

BACKGROUND: Insulin resistance (IR) is one of the most important etiological risk factors in the development of diabetes. However, there is no clear data regarding the prevalence of IR in the country. OBJECTIVE: This study evaluates the prevalence of IR and identifies the optimal threshold values for the HOMA indexes in Turkey. METHODS: This cross-sectional, population-based survey includes 2013 participants aged 20-84 years. The values of the anthropometric measurements and laboratory analysis were recorded. The 90th percentile in the non-obese and non-diabetic population was accepted as cut-off values for IR. RESULTS: The optimal threshold values for IR were 2.46 in HOMA1-IR and 1.40 in HOMA2-IR. Using the HOMA2-IR method, the overall prevalence of IR was 33.2%. The IR prevalence was higher in women (35.6%) compared to men (30.1%) [p=0.008]. There was a higher IR prevalence in men living in urban areas (p=0.001), not in women. The multivariate logistic regression analysis showed that gender, serum glucose level, serum levels of triglycerides and high-density lipoprotein cholesterol, bodymass index and income status were associated with insulin resistance. CONCLUSION: The cut-off values of HOMA1-IR and HOMA2-IR were determined in this study and we believe that these findings will be helpful to clinicians in the fight against health problems such as diabetes.

Comparison of Mean Platelet Volume, Platelet Count, Neutrophil/ Lymphocyte Ratio and Platelet/Lymphocyte Ratio in the Euthyroid, Overt Hypothyroid and Subclinical Hyperthyroid Phases of Papillary Thyroid Carcinoma.

INTRODUCTION: Thyroid hormones are essential for the normal development, differentiation, metabolic balance and physiological function of all tissues. Mean platelet volume (MPV) indicates mean platelet size and reflects platelet production rate and stimulation. Increased platelet size has been observed in association with known cardiovascular risk factors. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are known markers of the systemic inflammatory response. This study aimed to investigate the effect of thyroid hormone changes by comparing platelet count, MPV values, NLR and PLR in thyroid papillary carcinoma. METHODS: Forty-nine females and nine males comprising a total of 58 patients were included in the study. Clinical and laboratory parameters of patients were recorded in the following three phases of the disease: euthyroid phase (before thyroid surgery), overt hypothyroid (OH) phase (before radioactive iodine [RAI] treatment) and subclinical hyperthyroid (SCH) phase (six months after RAI treatment). RESULTS: The mean thyroid-stimulating hormone (TSH) values of the patients in the euthyroid, OH and SCH phases were 1.62±1.17, 76.4±37.5 and 0.09±0.07 µIU/mL, respectively. The mean MPV values of the patients in the euthyroid, OH and SCH phases were 9.45±1.33, 9.81±1.35 and 9.96±1.21 fL, respectively. MPV was significantly higher in the SCH phase than in the euthyroid phase (p=0.013). Platelet count, NLR and PLR were not statistically different between the euthyroid, OH and SCH phases. CONCLUSION: The results of this study demonstrated that the levels of MPV increased significantly in the SCH phase in patients with papillary thyroid carcinoma (PTC), and increased MPV values contributed to increased risk of cardiovascular complications. These findings suggest that MPV can be a valuable, practical parameter for monitoring the haemostatic condition in thyroid disorders. No significant difference was observed in platelet count, NLR and PLR in all stages of PTC.

Association of Acromegaly and Central Sleep Apnea Syndrome.

Acromegaly is usually characterized by the excessive secretion of growth hormone (GH) after the closure of epiphyseal plaques, resulting from functional pituitary adenomas. The most common manifestations of acromegaly are acral and soft tissue overgrowth, diabetes mellitus, hypertension, and heart and respiratory failure. In patients, obstruction of the upper airway may develop due to enlargement of the tongue and thickening of the tissues of the larynx; consequently, obstructive sleep apnea syndrome (OSAS) occurs commonly in acromegaly. Previous studies have shown an association between acromegaly and central sleep apnea syndrome (CSAS). Some of these described patients described showed that an elevation in the GH level may cause a defect in the respiratory drive. Most systemic diseases seen in acromegaly require effective treatment. We believe that it is necessary to perform effective treatments by examining respiratory disorders in sleep.

Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study).

BACKGROUND: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro- and microvascular complications of patients are not apparent. OBJECTIVES: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. METHODS: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. RESULTS: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. CONCLUSION: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity.

Effect of Laparoscopic Sleeve Gastrectomy on Thyroid Hormones in Euthyroid Obese Patients.

INTRODUCTION: In obese patients, the incidences of several thyroid disorders have increased in comparison to the general population. This study is aimed to investigate the effect of laparoscopic sleeve gastrectomy (LSG) on thyroid function tests in obese patients. METHODS: The patient files of 186 individuals who underwent laparoscopic sleeve gastrectomy surgery were examined retrospectively. Forty-nine females and 29 males comprising a total of 78 patients were included in the study. The routine physical examination findings and laboratory parameters recorded preoperatively were compared with their counterparts obtained in the postoperative sixth month. RESULTS: The mean preoperative body mass index (BMI) levels of the patients in the study was calculated as 46.91 kg/m2, whereas the mean BMI in the postoperative sixth month was 30.35 kg/m2 (p<0.001). Prior to the sleeve gastrectomy, the mean thyroid stimulating hormone (TSH) level of the patients was 2.53 ±2.06 µIU/mL; however, a significant reduction was observed in the mean TSH level during the postoperative sixth month, which was calculated as 1.77 ±1.12 µIU/mL (p=0.015). The mean free T4 level was 1.18±0.1 ng/dL in the preoperative period, but this increased to 1.22 ±0.24 ng/dL postoperatively, an insignificant change. The decrease in the TSH levels after the LSG was determined not to be correlated with the decrease in body weight. CONCLUSION: The results of our study demonstrate that the levels of TSH decreased significantly in patients who underwent LSG and that the decrease was independent of the changes in BMI.

Correction to: Effect of Sleeve Gastrectomy on Platelet Counts and Mean Platelet Volumes.

In the original article, in the Results section of the Abstract the text "…(10.41 ± 1.23 fL, p > 0.001)" should be changed to "…(10.41 ± 1.23 fL, p < 0.001)". The same error occurs on the next page of the article in the second paragraph of the Results section of the main text.

Effect of Sleeve Gastrectomy on Platelet Counts and Mean Platelet Volumes.

BACKGROUND: Obesity is a chronic metabolic disorder associated with cardiovascular disease, characterized by a chronic proinflammatory and prothrombotic state. The size and hemostatic potential of circulating platelets (PLTs) differ, with larger PLTs containing more granules and producing greater amounts of vasoactive and prothrombotic factors. This study aimed to investigate the effect of laparoscopic sleeve gastrectomy (LSG) on PLT count and mean platelet volume (MPV) in morbidly obese patients. METHODS: Two hundred five patients (females, n = 143; males, n = 62) who attended monitoring visits in the period prior to LSG and for 6 months after surgery were included in this study. Routine physical examination findings and laboratory parameters recorded preoperatively were compared with the same parameters in the postoperative 6th month. RESULTS: The mean age of the patients was 37.36 ± 10.93 years. The mean preoperative body mass index (BMI) of the patients was 47.65 kg/m2, whereas the mean postoperative BMI at 6 months was 31.49 kg/m2. Prior to LSG, the mean PLT count was 314.16 ± 76.40 × 109/L. At the postoperative 6th month, the mean PLT count was significantly reduced (263.17 ± 65.67 × 109/L, p < 0.001). In the preoperative period, the MPV was 10.12 ± 0.88 fL. In the postoperative period, it was significantly increased (10.41 ± 1.23 fL, p > 0.001). Both preoperatively and postoperatively, PLT counts were significantly higher in females than in males. After LSG, the MPV increased in both females and males. CONCLUSIONS: The results demonstrated that PLT counts decreased and MPV levels increased significantly after LSG and that the decrease in PLT counts was independent of changes in BMI.

Association between Vitamin K Epoxide Reductase (VKORC1) -1639G>A Polymorphism and Osteoporosis in Postmenopausal Women.

Introduction: Osteoporosis is a common disease, and several factors contribute to its development. Recently, there has been increasing evidence that vitamin K (VK) plays a critical role in maintaining bone strength. Vitamin K serves as a co-factor for the γ-carboxylation of particular proteins to convert specific glutamic acid residues to γ-carboxyglutamic acid residues. This process involves two enzymes, γ-glutamyl carboxylase and vitamin K epoxide reductase (VKORC1). The number of studies investigating the effects of VKORC1 gene mutations on bone mineral density in postmenopausal osteoporosis patients is limited. The aim of this study was to investigate the relationship between the VKORC1 -1639G>A polymorphism and osteoporosis in postmenopausal Turkish women. METHODS: The study group consisted of 176 postmenopausal women with osteoporosis and 140 healthy postmenopausal women. The selection criteria for the healthy controls included non-osteoporotic bone mineral density (BMD) and similar demographic characteristics to the osteoporosis group. The genotyping of the VKORC1 -1639G>A polymorphism was conducted using the restriction fragment-length polymorphism method. RESULTS: We found that the genotype frequencies of the GG, GA and AA genotypes were 25.6, 64.2 and 10.2% in the patients and 33.6, 55.8 and 10.7% in the controls, respectively. In the patient and control groups, the genotype distribution of the studied locus was found to be non-compatible with Hardy-Weinberg equilibrium. We found a nonsignificant association between the -1639G>A polymorphism in the VKORC1 gene and osteoporosis in postmenopausal Turkish women. CONCLUSION: We have shown that the VKORC1 -1639G>A polymorphism is not a risk factor for postmenopausal osteoporosis.

Shear wave elastography in early diabetic kidney disease

SUMMARY OBJECTIVE: This study aimed to analyze the kidneys among the subjects with early stages of type 2 diabetic kidney disease by shear wave elastography quantitatively. METHODS: A total of 108 patients with type 2 diabetic kidney disease and 17 control subjects were enrolled. According to the estimated glomerular filtration rate and urinary albumin-to-urinary creatinine ratio, patients were classified into stages 1 to 3 diabetic kidney disease. Grayscale ultrasound andshear wave elastography were performed. The sizes, depths, and shear wave elastography values were recorded. These parameters were compared between the diabetic kidney disease and the control subjects. RESULTS: The mean shear wave elastography values were significantly higher in the diabetic kidney disease group (10.156±1.75 kPa vs. 8.241±1.4 kPa; p<0.001). We obtained statistically significantly higher shear wave elastography values in stages 2 and 3 diabetic kidney disease subjects than control subjects and in patients with stage 3 diabetic kidney disease compared to those with stage 1 diabetic kidney disease (p<0.05 for all). We obtained a cutoff value of 9.23 kPa for predicting diabetic kidney disease in early stages, with a sensitivity of 67% and a specificity of 82%. CONCLUSION: Shear wave elastography may be used as a noninvasive, simple, and quantitative method to provide diagnostic information as a part of routine management of patients with type 2 diabetes mellitus, especially in the early stages of diabetic kidney disease.

A rare cause of pericardial effusion: giant cell arteritis.

Giant cell arteritis is a granulomatous vasculitis characterized by medium or large sized vessel involvement. Although extracranial branches of the carotid artery are typically involved, involvement of aorta and its major branches can also be seen. Cardiac involvement has been encountered less frequently and pericardial effusion is rarely encountered. In this paper, a case has been presented in which pericardial effusion was determined during the examination and diagnosis was giant cell arteritis.

Association of cytokine gene polymorphisms (IL6, IL10, TNF-α, TGF-ß and IFN-γ) and Graves' disease in Turkish population.

INTRODUCTION: Cytokines play a crucial role in the pathogenesis of autoimmune thyroid disease, and recent studies have demonstrated an association between cytokine gene polymorphisms and Graves' Disease (GD) in different ethnic groups. The aim of the present study was to investigate the relationship of interleukin-6 (IL-6), IL-10, tumor necrosis factor-alpha (TNF-α), transforming growth factor-beta (TGF-ß), and interferon-gamma (INF-γ) gene polymorphisms in the development of GD in Turkish population. MATERIAL AND METHODS: A total of 224 subjects were included in the study comprising of 100 patients with GD (70 female, 30 male; mean age, 43.9 ±13.8 years) and 124 healthy subjects (81 female, 43 male); mean age, 37.8 ±10.2 years) without antithyroid autoantibodies or family history of autoimmune disorders. Genotyping was conducted by using PCR and sequence-specific primers. RESULTS: Statistical analysis showed a significant association between high TNF-α -308GA and IL-6 -174CC gene polymorphisms in patients with GD compared to control subjects (p=0.016, p=0.044, respectively). However, no significant differences were observed between GD and control subjects for IL-10, TGF-ß, and INF-γ gene polymorphisms. CONCLUSION: TNF-α-308GA and IL-6 -174CC gene polymorphisms are involved in susceptibility to GD in Turkish population. The polymorphism hypothesis in pro-inflammatory cytokines might be involved in predisposition to GD.