Normalisation of serum TSH doesn't represent true euthyroidism for patients on levothyroxine treatment.

OBJECTIVE: To evaluate whether normalisation of serum thyroid-stimulating hormonelevels with levothyroxine is related with metabolic parameters and psychologic wellbeing. METHODS: The observational, case-control study was conducted from to May to July 2019 in the outpatient thyroid clinics of Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey, and comprised of hypothyroid patients in the euthyroid state with levothyroxine treatment and euthyroid controls. Psychological wellbeing was assessed using the General Health Questionnaire-12, and metabolic parameters with lipid levels and body composition were analysed for both the groups. Data was analysed using SPSS 25. RESULTS: Of the 159 subjects, 110(69%) were cases with a mean age of 50.1±11.7 years, and 49(31%) were controls with a mean age of 47.3±15.2 years. There was no significant difference related to thyroid-stimulating hormone levels between the groups (p=0.191). Free throxine levels were significantly higher in the cases, while free triiodothyroinine levels were higher in the controls (p<0.001). Total cholesterol and triglycerides levels were significantly higher in the cases than the controls (p<0.05). The cases had lower basal metabolic rate and fat free mass than the controls, but the difference was not significant (p>0.05). The cases scored higher in terms of wellbeing than the controls, but the difference was not significant (p>0.05). CONCLUSIONS: Thyroid hormone replacement needs to be adjusted to provide a satisfactory treatment for hypothyroid patients with normal thyroid-stimulating hormone levels who remain clinically and biochemically asymptomatic. In symptomatic patients, peripheral parameters of hypothyroidism, such as lipid levels, physiological symptoms and quality of life, might be useful in determining the levothyroxine dose and bringing the thyroid-stimulating hormone level within the normal range.

Rhinitis in patients with acquired hypothyroidism.

OBJECTIVES: Our aim was to evaluate the rhinological changes during hypothyroid and euthyroid periods in patients with acquired hypothyroidism. MATERIALS AND METHODS: The newly diagnosed 40 adult patients with hypothyroidism who presented to the Endocrinology clinic at a tertiary hospital were enrolled in the study. Patients having blood thyroid-stimulating hormone levels greater than 4.95 IU/dl were consulted to the ENT clinic. Nasal Obstruction Symptom Evaluation scores, Peak Nasal Inspiratory Flow rates and nasal mucociliary clearance time of patients were noted before and 4 months after the oral levothyroxine sodium tablet treatment. RESULTS: Of the patients included in the study, 34 (85%) were females and 6 (15%) were males. The mean thyroid-stimulating hormone values before the treatment was 10.01 ± 3.31 IU/dl and 4.03 ± 2.45 IU/dl at the end of the treatment. The difference in values was statistically significant (p < 0.001). The mean mucociliary clearance time before treatment was 8.03 ± 3.29 min and 7.35 ± 2.87 min at the end of treatment. The decrease in mucociliary clearance time was statistically significant (p = 0.001). We did not detect any significant difference between pre- and posttreatment values of nasal obstruction symptom evaluation scores and peak nasal inspiratory flow rates. CONCLUSION: The patients with hypothyroidism have prolonged mucociliary clearance time in hypothyroid period of the disease. Regarding to this data, we may recommend clinicians to follow-up these patients more closely for respiratory tract diseases and sinonasal infections.

The correlation of inflammatory markers and plasma vaspin levels in patients with diabetic nephropathy.

Vaspin, a recently identified adipokine, is a visceral adipose tissue-derived serine protease inhibitor that may have insulin sensitizing effect on adipose tissue. Herein, we measured vaspin level in patients with different stages of diabetic nephropathy (DNP), and investigated the correlation of the vaspin level with other inflammatory parameters. 106 adult type 2 diabetic patients with no known chronic inflammatory disease were included and grouped according to the stage of DNP: Albuminuria <30 mg/day and estimated glomerular filtration rate (eGFR) > 60 mL/min/1.73m(2) (Group-1); albuminuria 30-300 mg/day and eGFR >60 mL/min/1.73m(2) (Group-2); albuminuria >300 mL/min and eGFR <60 mL/min/1.73m(2) (Group-3). Demographic, clinical and laboratory data were recorded as well as vaspin, high sensitivity C-reactive protein (hsCRP), interleukin (IL)-1 and tumor necrosis factor (TNF)-α levels. There were 38, 35 and 33 patients in Group 1, 2 and 3, respectively. Groups were similar regarding age and gender. Vaspin level did not differ between groups. When all the groups were considered, vaspin was positively correlated with IL-6 level (r = 0.215, p = 0.041). No correlation of vaspin was found with IL-1, TNF-α and hsCRP levels (p = 0.580, r = 0.054; p = 0.463, r = 0.072; p = 0.812, r = 0.025, respectively). Vaspin levels of the patients with GFR ≥60 mL/min/1.73m(2) was less than that of patients with GFR <60 mL/min/1.73m(2) (p = 0.03). Age and IL-6 were found to be the major determinants of vaspin level with linear regression analysis. In patients with DNP, vaspin level does not change within the early stages of DNP; while it is higher in patients with decreased GFR, which may be related with increasing inflammation regardless of the stage of the kidney disease.