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INTRODUCTION: High-resolution ultrasonography devices have led to the increased detection of thyroid nodules and the need for fine-needle aspiration biopsy (FNAB). However, FNAB is an invasive procedure that can cause discomfort and pain. Music therapy has been used for centuries to alleviate pain, and our clinical trial was conducted to investigate its impact on pain scores during thyroid FNAB. MATERIALS AND METHODS: We conducted a randomized, controlled clinical trial, including adult patients undergoing thyroid FNAB. We evaluated the nonpharmacological intervention of listening to music before and during thyroid FNAB. We used a slow, nonlyrical, flowing melody with a tempo of 60 to 80 beats per minute as a therapeutic intervention for managing anxiety and pain. It had low tones, minimal percussion, and a volume of around 60 dB. The Beck Anxiety Inventory and Visual Pain Scale were used. RESULTS: The study included 529 patients assigned to either the music group (n = 258, 48.7%) or the control group (n = 271, 51.2%). The patients were categorized into subgroups based on either a single nodule (73.63%) or multiple nodules (24.18%). When all patients or single nodule and multiple data are examined separately, the intervention group showed statistically significantly lower pain scores than the control group. CONCLUSION: Our study is among the first on this topic and the largest in the available literature to demonstrate that listening to music during FNAB significantly reduces pain and anxiety. Music therapy is an effective, safe, and noninvasive intervention that can improve patient care and reduce distress and pain.
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Musicoterapia , Nódulo da Glândula Tireoide , Humanos , Musicoterapia/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Biópsia por Agulha Fina/métodos , Nódulo da Glândula Tireoide/terapia , Nódulo da Glândula Tireoide/patologia , Manejo da Dor/métodos , Ansiedade/terapia , Glândula Tireoide/patologia , Dor/etiologia , Idoso , Medição da DorRESUMO
OBJECTIVE: The present article analyses pre-operative demographic, biochemical, sonographic and histopathological characteristics of low-risk thyroid neoplasms (LRTNs), with a focus on four subgroups, "well-differentiated carcinoma-not otherwise specified" (WDC-NOS), "non-invasive follicular thyroid neoplasm with papillary like nuclear features" (NIFTP), "well-differentiated tumours of uncertain malignant potential" (WDT-UMP) and "follicular tumour of uncertain malignant potential" (FT-UMP). METHODS: The study retrospectively analyzed the histopathology of 2453 malignant thyroids and the final analyses included 99 cases diagnosed with LRTNs. The demographic and clinical features, pre-operative thyroid function, ultrasonography results, cytopathology results, histopathology results and prognostic classifications were assessed. RESULTS: The groups were similar demographic characteristics and the majority of clinical data, including comorbidities, thyroid function tests, thyroid cancer/neck radiotherapy history. NIFTPs represented 69.7% of all LRTNs. All (100%) WDT-UMPs had solitary nodules. Index nodule volume differed among the groups (p = .036), it was the lowest in WDC-NOS [0.68 (0.63-0.72 cc)] and highest in FT-UMP [12.6 (0.5-64 cc)]. Echogenicity findings were similar. Index nodule TIRADS demonstrated a significant difference (p = .021) but index nodule halo sign and BETHESDA scores were similar in all groups. The diameter, localisation and multicentric structure of LRTNs were again similar for all groups. Finally, prognostic scores suggested similar outcomes in all groups. CONCLUSION: The majority of LRTNs were NIFTPs in our population and all WDT-UMPs were solitary lesions. Index nodule volume was the most essential discriminating sonographic finding but further research must be performed before discriminatory potential can be described.
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Adenocarcinoma Folicular , Neoplasias da Glândula Tireoide , Humanos , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/patologia , Ultrassonografia , Demografia , Adenocarcinoma Folicular/diagnóstico por imagem , Adenocarcinoma Folicular/patologiaRESUMO
BACKGROUND: Patients with differentiated thyroid cancer (DTC) are exposed to subclinical exogenous hyperthyroidism for the suppression of thyroid-stimulating hormone (TSH). In this study, we aimed to evaluate the adrenal reserve in DTC patients receiving suppression therapy. MATERIALS AND METHODS: The study included 55 DTC patients on suppression therapy and 32 healthy volunteers. Basal serum cortisol of all participants and adrenocorticotropic hormone (ACTH) of the patient group were measured. A standard-dose ACTH test (0.25 mg) was performed in patients with a basal cortisol <14.5 mcg/dL. RESULTS: In the patient group, TSH was lower, free thyroxine (fT4) was higher, and free triiodothyronine (fT3) was similar to those of the control group (p < .01, p < .01, p = .140, respectively). The serum cortisol of the patient group was significantly lower than the control group (12.14 ± 5.12 mcg/dL vs 18.00 ± 5.56 mcg/dL, p < .001). A total of 34 (61.8%) patients with DTC had a basal cortisol <14.5 mcg/dL. Prolonged TSH suppression (≥5 years vs <5 years) was associated with lower basal cortisol (7.46 ± 2.63 mcg/dL vs 9.48 ± 2.65 mcg/dL, p = .022). The ACTH stimulation test showed that 2 (5.8%) patients had a cortisol response <18 mcg/dL. The rate of adrenal insufficiency was 3.6% in DTC patients. A moderate negative correlation was found between ACTH and fT3 of patients with low basal cortisol (r = -0.358, p = .038). CONCLUSION: Patients with DTC receiving TSH suppression therapy are at risk for adrenal insufficiency. The duration and severity of suppression might increase this possibility. Dynamic testing with synthetic ACTH can be used to reveal insufficient cortisol response in case of clinical suspicion.
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Adenocarcinoma , Insuficiência Adrenal , Neoplasias da Glândula Tireoide , Humanos , Hidrocortisona/uso terapêutico , Neoplasias da Glândula Tireoide/tratamento farmacológico , Tireotropina , Hormônio Adrenocorticotrópico/uso terapêutico , Estudos de Casos e ControlesRESUMO
BACKGROUND: Ultrasonography and fine-needle aspiration biopsy are frequently used to diagnose thyroid cancer. However, supportive data might be required in case of diagnostic difficulty. This study investigated whether there is a relationship between thiol/ disulphide homeostasis and cytological and histopathological diagnosis of thyroid nodules. METHODS: The patient group consisted of 81 individuals with euthyroid nodular (single/multiple) goiter scheduled for thyroidectomy, and the control group consisted of 28 age- and sex-matched healthy volunteers who had no thyroid nodule on ultrasonographic evaluation. All participants were selected among the admissions to the study clinic between June 2017 and June 2018, and venous blood samples were collected. The samples of the patients were taken before surgery. Thiol and disulphide levels were analysed with the automated spectrophotometric method. RESULTS: The mean age of the patient group was 45.66 ± 10.45 years, and the mean age of the control group was 43.53 ± 11.49 years (p = 0.365). The increasing Bethesda categories were positively correlated with the disulphide level (r = 0.281, p = 0.011), disulphide/native thiol ratio (r = 0.241, p = 0.030) and disulphide/total thiol ratio (r = 0.250, p = 0.024). Disulphide/native thiol ratio and disulphide/ total thiol ratio were significantly higher in the histopathologically malignant (euthyroid nodular goiter but final pathology reported malignant) compared to histopathologically benign (euthyroid nodular goiter but final pathology reported benign) (p = 0.012; p = 0.007, respectively) and control groups (p = 0.006; p = 0.004, respectively), but no significant difference was found in these ratios between benign and control group (p = 0.711; p = 0.749, respectively). DISCUSSION: Oxidative stress parameters were significantly higher in thyroid cancer. A positive correlation was detected between Bethesda categories with increased risk of malignancy and the disulphide/native thiol ratio and the disulphide/total thiol ratio.
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Bócio Nodular , Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Humanos , Adulto , Pessoa de Meia-Idade , Dissulfetos , Compostos de Sulfidrila , Nódulo da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Homeostase , Estresse OxidativoRESUMO
The aim of this study was to determine the clinicopathological features of papillary thyroid carcinomas (PTC) without extrathyroidal extension (ETE) and with lymph node metastasis (LNM). PTC > 1 cm increased the risk of LNM by 2.161 times compared to papillary thyroid microcarcinoma. The risk increased by 3.774 times in males and 1.553 times in the presence of multifocality. Presence of vascular invasion (VI) increased the risk of LNM by 3.093 times in patients without capsular invasion (CI). Clinicians should be careful about possible LNM in patients with large primary tumor diameter, multifocal tumors, CI and VI.
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Metástase Linfática/fisiopatologia , Câncer Papilífero da Tireoide/complicações , Feminino , Humanos , Incidência , Masculino , Metástase Neoplásica , Câncer Papilífero da Tireoide/patologiaRESUMO
AIM: We aimed to investigate the presence of thyroid, celiac disease (CD) and anti-parietal cell antibodies (APCA) in adult type 1 diabetes (T1DM) patients. METHODS: Data of 287 T1DM patients >16 years old were reviewed retrospectively. Thyroid disease related, CD related antibodies and APCA were evaluated. Patients were divided into early onset (<30 years old) and late-onset (≥30 years old) TIDM, and ≤10 years, 11-20 years and >20 years according to disease duration. RESULTS: There were 142 (49.5%) female and 145 (50.5%) male patients. The median age at diagnosis and disease duration were 21 (2-53) and 6.91 (0-50.8) years, respectively. Antibody positivity rates were anti-glutamic acid decarboxylase (anti-GAD) 72.8%, anti-insulin 9.1%, anti-islet cell 25.7%, antithyroid peroxidase (anti-TPO) 34.8%, anti-thyroglobulin 19.9%, anti-endomysial IgA (EMA-IgA) 7.6%, anti-gliadin IgA (AGA-IgA), 12.2%, AGA-IgG 13.0%, tissue transglutaminase IgA 7.1% and APCA 14.4%. One hundred twenty-eight (44.6%) patients had at least one non-diabetes autoantibody. Thyroid autoantibodies and dysfunction were significantly higher in women than men. Anti-TPO positivity was higher in the late-onset group (P = .044). Anti-GAD level was correlated with thyroid related antibody positivity in male patients with positive anti-GAD (r: .340, P: .006). The positivity of EMA-IgA and AGA-IgA was higher in patients with disease duration >20 years (P = .017 and .039, respectively). CONCLUSION: Almost half of the adult T1DM patients were positive for at least one non-diabetic antibody. It is important to investigate thyroid autoimmunity in patients diagnosed with T1DM at any age, including advanced age. CD associated antibody positivity increases with disease duration, suggesting that they should be re-evaluated at clinical suspicion, even if prior tests were negative.
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Diabetes Mellitus Tipo 1 , Adolescente , Adulto , Autoimunidade , Feminino , Glutamato Descarboxilase , Humanos , Masculino , Proteína 2 Glutamina gama-Glutamiltransferase , Estudos RetrospectivosRESUMO
BACKGROUND: It is known that serum thyroglobulin (TG) can increase after fine-needle biopsy of thyroid nodules. We aimed to determine whether TG is increased after ultrasonography (US)-guided fine needle capillary biopsy (FNC) of suspicious cervical lymph nodes (LNs) in thyroidectomised patients and investigate the possible association between change in TG and cytology results. MATERIAL AND METHODS: Data of 188 patients who underwent FNC of suspicious cervical LNs were retrospectively evaluated. Demographical, laboratory and ultrasonography features of LNs were noted. TG levels before FNC (TGb-FNC ), after FNC (TGa-FNC ), TGa-FNC /TGb-FNC ratio and the number of patients with increased TG were determined. Patients were grouped as benign, nondiagnostic, suspicious for malignancy and malignant according to the cytological results. RESULTS: TGa-FNC , TGb-FNC /TGa-FNC and rate of patients with increased TG were significantly higher in malignant cytology group than other groups (P < .001). The optimal cut-off level of TG increase that was predictive for malignancy was 7.6% with a sensitivity of 73.7% and specificity of 85.2%. TG increase was not associated with age, sex, Thyroid-stimulating hormone (TSH) level, anti-TG positivity and US features of LNs while significantly lower in patients who received radioactive iodine (RAI) treatment. Among 31 patients with positive anti-TG, TGb-FNC /TGa-FNC , and rate of patients with increased TG were higher in malignant compared to benign and nondiagnostic cytology groups. CONCLUSIONS: Serum TG increment and rate of patients with increased TG after FNC of suspicious cervical LNs were higher in patients with malignant cytology than with all other cytology results both in all study group and in sub-group of anti-TG positive patients. Increase in TG after FNC might be an additional tool for determining LN metastasis.
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Carcinoma Papilar , Neoplasias da Glândula Tireoide , Biópsia por Agulha Fina , Humanos , Radioisótopos do Iodo , Linfonodos/diagnóstico por imagem , Metástase Linfática , Estudos Retrospectivos , Sensibilidade e Especificidade , Tireoglobulina , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/diagnóstico por imagem , UltrassonografiaRESUMO
PURPOSE: We aimed to determine clinicopathological features that can predict lymph node metastasis (LNM) in papillary thyroid microcarcinomas (PTMC). METHODS: Medical records of 872 patients with papillary thyroid cancer >1 cm (PTC > 1 cm) and 1184 patients with papillary thyroid microcancer (PTMC) (≤1 cm) were reviewed retrospectively. Demographical, clinical and histopathological features of (PTC > 1 cm) and PTMC were compared. Association between clinicopathological features and LNM in PTMC was investigated. RESULTS: The median age of patients with PTMC was significantly higher than patients with PTC > 1 cm (49 vs 46 years old, p < 0.001). Multifocality, capsular invasion, vascular invasion, extrathyroidal extension (ETE) and LNM were more frequent in patients with PTC > 1 cm compared to patients with PMTC (p < 0.001 for each). In PTMC group, those with LNM had significantly higher proportion of multifocality, capsular invasion, vascular invasion and ETE compared to those without LNM (p = 0.007, <0.001, p = 0.011 and p < 0.001, respectively). Multifocality and ETE were significant factors for LNM with logistic regression analysis. Multifocality increased the risk of LNM by 1.737 times (95% CI: 1.079-2.979) and ETE increased the risk by 3.528 times (95%: 1.914-6.503). Primary tumor diameter ≥ 5.75 mm was predictive for LNM with a sensitivity of 0.782 and a specificity of 0.517 in PTMC. CONCLUSIONS: LNM should be investigated more carefully in patients with PTMC in the presence of tumor diameter ≥ 5.75 mm, multifocality or ETE.
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Carcinoma Papilar/patologia , Metástase Linfática/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Feminino , Humanos , Modelos Logísticos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estudos Retrospectivos , RiscoRESUMO
PURPOSE: In this study, echogenicity and histopathological projections of parathyroid neoplasia in grey mode ultrasonography were compared with whole side imaging (WSI). The utility of the data obtained for clinical assessment was evaluated. METHODS: In 57 patients operated for hyperparathyroidism, the parathyroid gland was sampled in the sagittal plane. The lesion slides were scanned. The WSI was rendered digital. The histopathological slide images scanned with USG images were matched. With the Image J program, the areas of cell types and morphological changes were measured. RESULTS: In parathyroid neoplasms, hypoechoic areas were found to be matched with 21% [55.3%] chief cell, 2 [5.0%] oncocytic cell and 8%[20.0%] cystic morphology. Of the 57 patients, 26 [45.61%] had a cystic area. It was seen that hyperechogenic areas match more connective tissue areas than chef cell [p < 0.05]. There was less clear cell in hyperechogenic areas than iso-hyperechogenic areas [p < 0.05]. The ratio of fat tissue echogenicity was lower in hypoechoic areas than hyperechoic [p < 0.05]. There was a positive correlation between PTH and the entire tissue area [r = 0.377, p = 0.004]. A positive directional moderate linear relationship was found between blood calcium level and parathyroid adenoma [rho = 0.530, p = 0.009] and percentage [rho = 0.416, p = 0.048]. When atypical adenomas and adenoma cases were compared, no significant difference was found between the cystic and chief cell areas [p > 0.05]. CONCLUSION: The hypoechogenicity seen in USG was observed to be compatible with chief cell, hyperechogenic areas in USG were compatible with connective tissue and fat tissue. As the cystic area increased, blood calcium levels were higher in adenomas. We think that the results of this study will be guiding to evaluate the reflections of the detailed morphometric studies.
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Citodiagnóstico/métodos , Interpretação de Imagem Assistida por Computador/métodos , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/patologia , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico por Imagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Atypia of undetermined significance (AUS) is an indeterminate category in the Bethesda system for reporting thyroid cytopathology. Cytological features described as atypia are not always observed in every case, and it is difficult to determine how the small population of cells with enlarged nuclei, a few grooves, and rare elongated nuclei should be classified. Therefore, there is inter-intra observer variability considering these cell types, even though the cytological criteria are well defined. Therefore, this study aimed to establish a nuclear scoring system to help in the differential diagnosis of AUS. METHODS: Fine needle aspiration (FNA) samples that showed AUS and had surgical follow-up were included in this study. The aspirate was scored for the presence of intanuclear cytoplasmic inclusions, nuclear grooves, overlapping, enlargement, and elongation individually. The total nuclear score for each case was calculated. Statistical analysis of the association between each nuclear feature and the presence of papillary thyroid cancer (PTC) in the surgical specimens was performed. Cut-off points from the total score of these nuclear features were also calculated. RESULTS: Nuclear grooves and overlapping were more common in malignant cases (pâ¯<â¯0.001 and pâ¯=â¯0.048, respectively). A cut-off point of ≥5.5 for the total score was sensitive and specific for defining malignancy. CONCLUSION: The risk of PTC was higher in nodules with more prominent nuclear overlapping or nuclear groove in their FNA samples. In order to achieve a more confident AUS diagnosis, our scoring system can be helpful for thyroid FNA samples.
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Câncer Papilífero da Tireoide/diagnóstico , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Biópsia por Agulha Fina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Background/aim: We aimed to evaluate the utility of thyroid imaging reporting and data system (TI-RADS) in prediction of malignancy in thyroid nodules with persistent nondiagnostic (ND) cytology. Materials and methods: A total of 246 thyroid nodules which were surgically removed and had at least two fine-needle aspirations (FNAs) with ND cytology were included in this study. Ultrasonography features and TI-RADS scores were recorded. Results: Of 246 nodules, 218 (88.6%) had benign and 28 (11.4%) had malignant final histopathology. Frequencies of taller than wide shape, solidity, hypoechogenicity, microcalcifications, and presence of irregular borders were similar between benign and malignant nodules (P > 0.05). The number of nodules categorized as TI-RADS 3, 4a, 4b, and 4c were 12 (4.9%), 53 (21.5%), 104 (42.3%), and 77 (31.3%), respectively. There was not any nodule in TI-RADS 5 category. Malignancy rates of categories 3, 4a, 4b, and 4c were 0%, 13.2%, 9.6%, 14.3%, respectively. No significant differences were detected in TI-RADS categories between benign and malignant nodules (P > 0.05). Conclusion: In this study, we did not demonstrate any suspicious ultrasound (US) finding predictive for malignancy in thyroid nodules with persistent ND cytology and did not determine any difference between malignant and benign nodules regarding TI-RADS scores. Whereas, we found that thyroid nodules in 4a, 4b, and 4c TI-RADS categories had higher malignancy rates than those previously reported in ND cytology. We think that TI-RADS categories in thyroid nodules with persistent ND cytology can be helpful in treatment decision.
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Sistemas de Dados , Diagnóstico por Computador , Glândula Tireoide , Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Adulto , Biópsia por Agulha Fina , Citodiagnóstico , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Testes de Função Tireóidea , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologiaRESUMO
OBJECTIVE: Thyroid Imaging Reporting and Data System (TIRADS) is a simple and reliable reporting system for the prediction of malignancy. We aimed to determine the role of TIRADS in the prediction of malignancy in subcategories of Bethesda Category III, atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS). DESIGN & PATIENTS: A total of 461 nodules with AUS cytology in 450 patients and 179 nodules with FLUS cytology in 168 patients were included. Ultrasonography (US) features and postoperative histopathology results were documented. Every suspicious US feature was scored as 1 and 0 according to the presence or not, respectively. TIRADS category of each nodule was determined. RESULTS: In AUS subcategory, histopathologically malignant nodules had significantly different TIRADS categories compared to benign nodules (P = 0·001), but this was not the case in FLUS subcategory (P = 0·121). In AUS group, malignant nodules had significantly higher prevalance of microcalcification, hypoechogenicity and anteroposterior/transverse ratio than benign ones (P < 0·001, P < 0·001 and P = 0·003, respectively) and TIRADS categories of 4c and 5 were more frequent in malignant nodules (P < 0·05). Microcalcification, hypoechogenicity and TIRADS were found to be associated with malignancy in multivariate logistic regression analysis in this subcategory. TIRADS category ≥4c was associated with malignancy (AUC ± SE: 0·584 ± 0·028). In FLUS subcategory, there was no significant difference between histopathologically malignant and benign nodules with respect to suspicious US features (P > 0·05, all). CONCLUSION: TIRADS seems to be useful in predicting malignancy and planning further management in the AUS subcategory, but not quite so in the FLUS subcategory.
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Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia , Adenocarcinoma Folicular/diagnóstico por imagem , Adulto , Citodiagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Neoplasias da Glândula Tireoide/classificação , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/classificação , Nódulo da Glândula Tireoide/diagnóstico por imagem , UltrassonografiaRESUMO
OBJECTIVE: The aim of this study to was to evaluate the effect of fibroblast growth factor-23 (FGF-23), osteoprotegerin (OPG), receptor activator nuclear κB ligand (RANKL), and vitamin D hormones on bone loss in patients with hyperprolactinemia due to pituitary prolactinoma. METHODS: We recruited 46 premenopausal female patients with prolactinoma and age and sex-matched healthy controls (Group 3, n = 20) for this cross-sectional study. Prolactinoma patients were divided into 2 groups as patients newly diagnosed (Group 1, n = 26) and those under cabergoline treatment (Group 2, n = 20). Anthropometric and metabolic variables; hormonal profiles; and osteocalcin, deoxypyridinoline (DOP), and bone mineral density measurements were performed for all participants. FGF-23, OPG, and RANKL levels were analyzed in all groups. RESULTS: FGF-23, OPG, calcium, phosphorus, and parathormone levels were similar between all groups despite significantly higher levels in the control group in terms of vitamin D and RANKL levels than in patients. Bone loss was found more in Group 2, particularly observed in Z scores of femur and spinal bone (P<.05). Correlation analysis revealed a negative correlation between FGF-23 and femur neck T score (r = -0.0433, P = .05) in patients with active prolactinoma. A positive correlation was also observed between parameters of DOP and OPG (r = 0.673, P = .02). In patients with remission there were a negative correlation between prolactin and luteinizing hormone (r = -600, P = .08). Additionally, a negative correlation was found between osteocalcin and osteoprotegerin in patients in remission (r = -0.73, P = .01). CONCLUSION: Our data indicated that FGF-23 and OPG levels do not play a critical role on the development of bone decrease in patients with hyperprolactinemia. However, further prospective studies in larger numbers of participants should be designed to clarify this issue. ABBREVIATIONS: BFP = body fat percentage BMD = bone mineral density BMI = body mass index CV = coefficient of variation DOP = deoxypyridinoline ELISA = enzyme-linked immunosorbent assay FGF-23 = fibroblast growth factor-23 HOMA-IR = homeostatic model assessment of insulin resistance OPG = osteoprotegerin RANKL = receptor activator nuclear κB ligand.
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Fatores de Crescimento de Fibroblastos/sangue , Osteoprotegerina/sangue , Neoplasias Hipofisárias/sangue , Prolactinoma/sangue , Receptor Ativador de Fator Nuclear kappa-B/sangue , Adulto , Aminoácidos/sangue , Antineoplásicos/uso terapêutico , Biomarcadores Tumorais/sangue , Densidade Óssea , Cabergolina , Estudos Transversais , Ergolinas/uso terapêutico , Feminino , Fator de Crescimento de Fibroblastos 23 , Humanos , Pessoa de Meia-Idade , Osteocalcina/sangue , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Estudos Prospectivos , Ligante RANK/sangue , Vitamina D/sangueRESUMO
OBJECTIVE: The aim of this study was to determine whether there is an association between cagA [cytotoxin-associated gene A] positivity and thyroid autoimmunity and thyroid volume. METHODS: This prospective study included 78 Helicobacter pylori-positive (H. pylori) dyspeptic patients in the study group, and 50 age-, gender-, and body mass index-matched H. pylori-negative dyspeptic patients in the control group. All the controls were evaluated via upper gastrointestinal endoscopic biopsy or breath test, and were found as H. pylori negative. Gastric biopsy specimens were obtained via endoscopy and histological examination was performed for documentation of H. pylori. RESULTS: In all, 55.1% (n = 43) of the H. pylori-positive patients were cagA positive. There was no significant difference in metabolic syndrome parameters or thyroid function test results between the study and control groups. The frequency of anti-TPO and Hashimoto's thyroiditis positivity was significantly higher in the study group than in the control group. Thyroid volume was higher and severe parenchymal heterogeneity was more common in the H. pylori-positive patients. CONCLUSIONS: H. pylori infection might be a risk factor for autoimmune thyroid disease and high thyroid volume in patients diagnosed with histological evaluation. However, cagA positivity has no additional effect on these parameters.
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Antígenos de Bactérias/sangue , Proteínas de Bactérias/sangue , Dispepsia/sangue , Doença de Hashimoto/sangue , Infecções por Helicobacter/sangue , Helicobacter pylori/patogenicidade , Glândula Tireoide/diagnóstico por imagem , Adulto , Feminino , Doença de Hashimoto/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Testes de Função Tireóidea , UltrassonografiaRESUMO
AIM: This study aimed to compare thyroid functions, thyroid autoantibodies, and the existence of nonthyroidal illness syndrome (NTIS) according to vitamin D level. MATERIALS AND METHODS: The study included age- and BMI-matched healthy volunteers with and without vitamin D deficiency. In addition, the nonthyroidal illness syndrome status was evaluated. RESULTS: Anti-TPO positivity was significantly more common in those with severe and moderate vitamin D deficiency, as compared to those with a normal 25(OH)D level. Furthermore, TSH levels were significantly lower in those with severe and moderate vitamin D deficiency than in those with a normal 25(OH)D level. In addition, there was a significant weak inverse correlation between anti-TPO positivity and the 25(OH)D level and a positive correlation between the TSH level and 25(OH)D level. Only 1 thyroid function test result was compatible with NTIS among the participants with moderate vitamin D deficiency; therefore the difference was not significant. CONCLUSIONS: The prevalence of thyroid autoantibody positivity was higher in those with severe and moderate vitamin D deficiency than in those with a normal 25(OH)D level. Additional large-scale studies must be conducted to determine if vitamin D deficiency plays a causal role in the pathogenesis of Hashimoto's thyroiditis and NTIS.
Assuntos
Síndromes do Eutireóideo Doente/etiologia , Tireoidite Autoimune/etiologia , Deficiência de Vitamina D/complicações , Adulto , Autoanticorpos/imunologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Síndrome , Glândula Tireoide/imunologia , Hormônios Tireóideos/sangue , Tireotropina/sangue , Vitamina D/sangueRESUMO
CONTEXT: Several studies have reported increased risk of cardiovascular disease due to early development of endothelial dysfunction and structural vascular changes in patients with acromegaly. OBJECTIVE: The aim of this study was to evaluate subclinical cardiovascular disease with epicardial fat thickness (EFT), aortic stiffness and serum levels of cell adhesion molecules (CAMs) in patients with acromegaly. DESIGN: Cross-sectional study. PATIENTS: Twenty-seven patients with active acromegaly (AA), 13 patients with remission acromegaly (RA) and 37 age- and sex-matched healthy controls were studied. MEASUREMENTS: Epicardial fat thickness was evaluated by transthoracic echocardiography (TTE). Aortic stiffness (ß) index, aortic strain (AoS) and aortic distensibility (AoD) were calculated from the aortic diameters measured by TTE. Serum levels of CAMs such as intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1 and E-selectin were measured. RESULTS: Epicardial fat thickness was significantly increased in patients with RA and AA as compared to controls 9·71 ± 1·54 and 10·08 ± 1·95 mm vs 5·74 ± 0·92 mm, P < 0·001, respectively). A significant positive correlation was found between the EFT and growth hormone (GH) levels (r = 0·365, P = 0·024). ß-index was similarly higher in patients with RA and AA than controls (15·68 ± 7·27 and 11·90 ± 8·24 vs 6·85 ± 2·87, P < 0·001, respectively). AoS and AoD were significantly decreased in patients with RA and AA as compared to the control group (3·81 ± 1·94 and 3·68 ± 1·99 vs 8·19 ± 4·19%, P < 0·001, respectively; and 1·21 ± 0·66 and 1·18 ± 0·63 vs 2·58 ± 1·50, 10(-6) cm(2) /dyn, P < 0·001, respectively). Serum ICAM-1 and VCAM-1 levels were significantly higher in patients as compared to the control group (P < 0·001 vs P = 0·032, respectively). There were no significant differences in EFT, AoD, AoS, ß-index and serum CAMs between two patients groups (AA vs RA, P > 0·05). There was a significant negative correlation between E-selectin and AoD (r = -0·45, P = 0·008). In multiple linear regression analysis, EFT was found to be associated with GH levels (ß-coefficient = 0·575, P = 0·008). CONCLUSION: This study suggests that EFT and risk of subclinical cardiovascular disease are increased in patients with acromegaly. Serum GH level is an independent risk factor for EFT.
Assuntos
Acromegalia/sangue , Tecido Adiposo/patologia , Aorta/patologia , Doenças Cardiovasculares/diagnóstico , Moléculas de Adesão Celular/sangue , Pericárdio/patologia , Acromegalia/complicações , Adulto , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/complicações , Artérias Carótidas/patologia , Espessura Intima-Media Carotídea , Estudos Transversais , Selectina E/sangue , Ecocardiografia , Elasticidade , Feminino , Humanos , Molécula 1 de Adesão Intercelular/sangue , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Molécula 1 de Adesão de Célula Vascular/sangue , Rigidez VascularRESUMO
OBJECTIVE: The aim of this study was to evaluate the effect of hyperprolactinemia on body fat, insulin sensitivity, inflammatory markers, and cardiovascular risk in patients with prolactinoma. METHODS: The study included 35 untreated hyperprolactinemic patients with pituitary adenomas, and 36 age-, gender-, and body mass index (BMI)-matched healthy controls without any known disease. Serum glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR, lipid profile, high-sensitivity C-reactive protein (hs-CRP), and heart-type fatty acid binding protein (H-FABP) levels were measured. Waist and hip circumference (WC and HC) were measured in all the participants. The body fat percentage was measured, and the visceral fat and abdominal fat percentages were measured via bioelectrical impedance (BIA). In addition, carotid intima media thickness (CIMT) was measured using high-resolution B-mode ultrasound. RESULTS: The serum glucose level, HOMA-IR, triglyceride level, and SC were significantly higher in the patient group than in the control group. The hs-CRP level and CIMT were significantly higher in the hyperprolactinemic patients. Visceral and truncal fat percentages were significantly higher in the patients with prolactinoma. H-FABP levels were similar in the 2 groups, and there was a positive correlation between the prolactin (PRL) and H-FABP protein levels. CONCLUSIONS: Based on the present findings, hyperprolactinemia is associated with preclinical atherosclerosis and metabolic abnormalities. Patients with hyperprolactinemia might experience cardiovascular disease in the long term. Metabolic control should be achieved in addition to the control of hyperprolactinemia in the clinical management of patients diagnosed with prolactinoma.
Assuntos
Aterosclerose/etiologia , Prolactinoma/complicações , Adulto , Espessura Intima-Media Carotídea , Proteínas de Ligação a Ácido Graxo/sangue , Feminino , Humanos , Resistência à Insulina , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: This study aims to investigate the frequency of fibromyalgia and its predictors in women with polycystic ovary syndrome (PCOS) and its relationship with insulin resistance, and to assess the effect of fibromyalgia on the anxiety and depressive symptoms in PCOS patients, and how the quality of life was affected by this combination. MEASUREMENTS: The study was conducted with 74 women with PCOS according to the Rotterdam criteria, which applied to our tertiary care clinic between January 2021 and January 2022, and 51 controls. Endocrinologic and rheumatologic examinations, biochemical and hormonal analyses, and radiologic imaging are made. Hospital anxiety and depression scale (HADs) and Short Form 36 (SF-36) quality of life scale were applied. RESULTS: There was no statistical difference between patients (n = 74 (23%)) and controls (n = 51 (13.7%)) in terms of fibromyalgia frequency. This frequency was 41.4% in PCOS patients with insulin resistance. The presence of insulin resistance was significantly higher in patients with PCOS and fibromyalgia (70.4%, 12 of 17 patients with fibromyalgia for the PCOS group; 8.3%, 1 of 7 patients with fibromyalgia for the control group) (χ2 = 9.130, p=0.003). Higher HOMA-IR levels (B = 1.278, p = 0.034) and age (B = 1.134, p = 0.022) were significant predictors of fibromyalgia in PCOS patients. Physical functioning (U = 1.960, P = 0.050), bodily pain subscales (U = 2.765, p = 0.006), and physical health summary measure (U = 2.296, p = 0.022) were significantly lower, VAS pain (U = 5.145, p < 0.0001) and fatigue (U = 5.997, p < 0.0001) scale scores were higher in PCOS patients with fibromyalgia. CONCLUSIONS: Our results show that fibromyalgia is frequent in PCOS patients with insulin resistance.
Assuntos
Fibromialgia , Resistência à Insulina , Síndrome do Ovário Policístico , Humanos , Feminino , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/diagnóstico , Fibromialgia/complicações , Fibromialgia/diagnóstico , Qualidade de Vida , Dor , InsulinaRESUMO
BACKGROUND: The sensitivity of cytological (CY) evaluation after fine-needle aspiration (FNA) for detecting medullary thyroid carcinoma (MTC) is a subject of controversy. The routine use of serum calcitonin (CT) in patients with thyroid nodules is not universally adopted. The authors conducted CT screening of FNA washout fluid (FNA-CT) to address the diagnostic challenges. The objective was to assess the contributions of serum CT, FNA cytology (FNA-CY), and FNA-CT to the diagnosis. METHODS: Between February 2019 and June 2022 (group 1), the authors prospectively screened the CT of patients with thyroid nodules. Both FNA-CY and FNA-CT were performed for patients with persistently elevated CT values. The sensitivity of FNA-CY, serum CT, and FNA-CT for accurate diagnosis was evaluated. Additionally, the authors retrospectively examined data from patients with thyroid nodules before CT screening (2008-2019) (group 2). They compared the characteristics of MTC patients in groups 1 and 2. RESULTS: MTC was identified in 30 patients (0.25%) in group 1 and 19 (0.07%) in group 2. A FNA-CT cutoff value of 4085.5 pg/mL detected MTC with a sensitivity of 96.8%, and a serum CT cutoff value of 28.3 pg/mL detected MTC with a sensitivity of 86.7%. In contrast, FNA-CY detected MTC with a sensitivity of 42.4%. In group 1, 18 patients (60%) with MTC were diagnosed with microcarcinoma, whereas only two patients (10.5%) in group 2 had microcarcinoma. CONCLUSIONS: This study detected MTC earlier by routinely measuring serum CT in all patients with nodular thyroid disease and performing FNA-CT in those with elevated values. FNA-CT and serum CT sensitivities were significantly higher than those of FNA-CY. This study revealed different FNA-CT cutoff values compared to other studies, emphasizing the need for determining clinic-specific cutoff values.
Assuntos
Carcinoma Neuroendócrino , Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Humanos , Nódulo da Glândula Tireoide/diagnóstico por imagem , Calcitonina , Estudos Retrospectivos , Amigos , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/patologia , Biópsia por Agulha FinaRESUMO
INTRODUCTION: Computerized thoracic tomography (CT) imaging was extensively employed, especially in the early months of the COVID-19 pandemic. An incidental thyroid nodule (ITN) is defined as a nodule not previously detected or suspected clinically but identified via an imaging study. The present study aimed to determine the incidence of thyroid nodules incidentally detected in thoracic CTs for the suspicion of COVID-19 pneumonia. MATERIALS AND METHODS: Adult patients who underwent thoracic CT in our hospital for COVID-19 management were retrospectively identified between March 2020 and September 2020. Medical information registered in the hospital and national health system was reviewed. The prevalence of incidental thyroid nodules at CT, thyroid function test results of patients with incidental lesions, correlation of CT findings with ultrasonography (US) findings, and fine-needle aspiration biopsy (FNAB) results were evaluated. RESULTS: We analyzed 35,113 patients who had COVID-19-indicated CT scans. There was information about the thyroid gland in CT reports of 3049 patients. The prevalence of ITN was 3.82% (1343/35,113 patients) and thyroid heterogeneity was 1.11% (388/35,113 patients). While it was explicitly stated that no pathology was found in the patient's thyroid gland in 3.75% of patients (1318/35,113), no information was given about the thyroid gland in 91.32% of the patients (32064/35,113). Thus, the number of patients informed about their thyroid was 3049 (8.68%) and the number of patients with thyroid pathology was 1731 (4.93%). It was observed that 308 of 1731 patients (17.80%) had follow-up thyroid US. An FNAB was indicated in 238 patients (87.50%). Of the 238 patients with indication for biopsy, only 115 (48.31%) underwent a thyroid FNAB. The cytological diagnosis was benign in 59 (51.30%), non-diagnostic in 30 (26.08%), atypia of uncertain significance in 22 (19.13%), and suspected follicular neoplasia/follicular neoplasia in four patients (3.46%). Thyroidectomy was performed in six more patients due to large nodules and the final diagnosis was benign in two and papillary thyroid cancer in three patients. CONCLUSION: Increased use of thoracic CT during the COVID-19 pandemic probably enabled improved detection of ITNs. In this large-scale study, the prevalence of thyroid nodules reported with thoracic CT was 3.82%, while thyroid cancer was detected in 1.30% of patients evaluated with US. We recommend against using thoracic CT scans as a direct means of assessing thyroid disease owing to the low number of detected cancer cases in our cohort of 35,113 patients. However, thoracic CT scans obtained for various reasons might provide the opportunity for early diagnosis and treatment of thyroid disease, including cancers.