Quantitative investigation of the effect of surgically induced hypoparathyroidism on cataract development.

INTRODUCTION: Although cataract formation is known in hypoparathyroidism, lens clarity and its correlation with clinical parameters have not been investigated quantitatively before in patients with hypoparathyroidism. The aim of this study was to compare the crystalline lens clarity of patients with surgically induced hypoparathyroidism and healthy subjects. MATERIALS AND METHODS: Forty female patients with surgically induced hypoparathyroidism and 38 age-matched healthy female subjects were enrolled in this study. Scheimpflug corneal topography was performed to measure lens density (LD) and thickness (LT). Serum calcium, inorganic phosphorus, parathyroid hormone (PTH) levels, and disease duration were recorded. RESULTS: No statistically significant difference was observed between the hypoparathyroidism and control groups in the Pentacam densitometry zones 1-2-3, LT, and average and maximum LD (p > 0.05 for all). Nine blue-dot-like, two cortical, and two posterior subcapsular cataracts were detected in the hypoparathyroidism group. The frequency of total and blue-dot-like cataracts was significantly higher in the hypoparathyroidism group than in the control group (p = 0.008 and p = 0.002, respectively). In the hypoparathyroidism group, a significant correlation was observed between the maximum LD and the hypoparathyroidism duration (ß = 0.420, p = 0.017), and the maximum LD and serum PTH level (ß = -0.332, p = 0.049). CONCLUSION: The clarity of the crystalline lens may decrease in surgically induced hypoparathyroidism patients depending on the disease duration and PTH levels. Additionally, this study detected an increased frequency of blue-dot-like cataract in the patient group, which may be due to the effect of hypoparathyroidism.

Is there a relationship between hypoparathyroidism and retinal microcirculation?

PURPOSE: To investigate the retinal microvasculature in patients with surgically induced hypoparathyroidism who have no clinical evidence of retinopathy and to compare these data with those of healthy control subjects. METHODS: Forty patients with a confirmed diagnosis of permanent hypoparathyroidism and no clinical evidence of retinopathy and 37 age- and sex-matched healthy control subjects were included in the study. After complete ophthalmological examination, all patients underwent optical coherence tomography angiography measurement (Optovue Inc., Fremont, California, USA) to assess the foveal avascular zone (FAZ) area; FAZ perimeter; acircularity index of FAZ; foveal density-300; radial peripapillary capillary plexus (RPCP) vessel density; superficial, middle and deep capillary plexus vessel densities (SCP, MCP and DCP). The data from the right eyes of all participants were used for statistical analysis. RESULTS: The SCP and MCP vessel densities were significantly lower, and the RPCP whole image and peripapillary vessel densities were significantly higher than those in healthy control subjects (p < 0.05 for all). The DCP vessel densities of patients with surgically induced hypoparathyroidism were not significantly different from those of healthy control subjects (p > 0.05 for all). No significant difference was found in the FAZ area, FAZ perimeter, acircularity index of FAZ, foveal density-300 measurements between patients and controls (p > 0.05 for all). CONCLUSIONS: Reduced retinal vessel density in patients with surgically induced hypoparathyroidism supports the hypothesis that parathyroid hormone is associated with regulation of vascular homeostasis, including macular microcirculation. Increased perfusion in the peripapillary area may suggest an early subclinic effect of hypoparathyroidism.

Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and platelet-tolymphocyte ratio in different etiological causes of thyrotoxicosis

Background/aim: The most common causes of thyrotoxicosis include Graves' disease (GD), toxic multinodular goiter (TMNG), toxic adenoma (TA), and subacute granulomatous thyroiditis (SAT). In our study, we aimed to see whether neutrophil­to­lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet­to­lymphocyte ratio (PLR), and mean platelet volume (MPV) may be helpful in the differential diagnosis of these diseases. Materials and methods: We retrospectively analyzed the hospital records of the Endocrinology Clinic of our hospital between 2016 and 2019. We included data from 66 GD, 37 TA, and 35 SAT patients. We compared the data with those of 35 healthy subjects as controls. Results: NLR, MLR, and PLR were found to be higher in the SAT group when compared to other groups. The post hoc analysis of comparison of NLR, MLR, and PLR in each group showed that NLR and PLR were significantly different in the SAT group when compared to the GD, TA, and controls groups (P < 0.001, P = 0.003, and P < 0.001 for NLR respectively and P < 0.001 for PLR in all groups). MPV levels were different between groups (P = 0.007). However, the intergroup analysis (Tukey's test) failed to show a statistically significant difference for any of the groups. In patients with SAT, PLR and NLR were significantly higher than in the GD, TA, and control groups. MLR was also higher in SAT when compared to other groups, but the difference was not statistically significant. Conclusion: High PLR and NLR may be helpful to differentiate SAT from GD and TA, the other common causes of thyrotoxicosis.

Quality of English-language videos available on YouTube as a source of information on osteoporosis.

Osteoporosis awareness is essential for preventing osteoporotic fractures. Social media platforms have enormous potential to both support and deter patients' decisions on healthcare. The current study demonstrated that the majority of YouTube videos on osteoporosis provide useful information with sufficient quality. PURPOSE: YouTube is the most popular video-sharing platform for patients seeking online information about their medical condition. However, there are concerns regarding the accuracy and quality of YouTube content. We aimed to analyze the quality of English-language YouTube videos on osteoporosis. METHODS: A YouTube search was performed on April 21, 2021, using the keywords "osteoporosis," "osteoporosis exercise," "osteoporosis diet," and "osteoporosis treatment." The reviewers recorded the content, source, and detailed characteristics of the included videos. The reliability and quality of the videos were analyzed using the modified DISCERN score and Global Quality Scale (GQS) score by a rheumatologist and endocrinologist. RESULTS: Of the 400 videos screened, 238 were included in the study after applying the exclusion criteria. A total of 205 (86.1%) videos revealed useful information about osteoporosis whereas 33 (13.9%) were misleading. In terms of quality, 48% of the videos were of high quality, 34% were of moderate quality, and 18% were of low quality. The videos posted by universities and professional organizations had the highest modified DISCERN and GQS scores indicating high reliability and quality. CONCLUSION: This study demonstrated that the majority of YouTube videos on osteoporosis contained useful information with sufficient quality. However, physicians should be aware of misleading information and correct any misinformation during face-to-face meetings with patients. YouTube should consider creating partnerships with professional organizations in the field of osteoporosis to produce high-quality videos in line with their new health content policy.

Biochemical characteristics and calcium and PTH levels of patients with high normal and elevated serum 25(OH)D levels in Turkey: DeVIT-TOX survey.

Vitamin D intake over the recommended dose is usually associated with high serum 25(OH)D levels and generally not associated with symptoms of hypercalcemia. High doses of cholecalciferol need to be avoided to protect against vitamin D toxicity and related complications. Strict adherence to the clinical guidelines for treating vitamin D deficiency can ensure safe and effective treatment. PURPOSE: We observed a tendency to use high doses of cholecalciferol for vitamin D deficiency treatment or vitamin D supplementation. We aimed to determine the biochemical characteristics of patients with high normal and elevated serum 25(OH)D levels. METHODS: An online invitation was sent to all tertiary endocrinology clinics in Turkey to complete an online retrospective survey (DeVIT-TOX Survey) for patients diagnosed with high serum 25(OH)D levels (> 88 ng/mL) between January 2019 and December 2019. The patients were evaluated according to the presence of signs and symptoms of hypercalcemia and doses of vitamin D intake, evaluated into the following three groups according to their 25(OH)D levels: group 1, > 150 ng/mL; group 2, 149-100 ng/mL; and group 3, 99-88 ng/mL. RESULTS: A total of 253 patients were included in the final analysis (female/male: 215/38; mean age, 51.5 ± 15.6 years). The average serum 25(OH)D level was 119.9 ± 33 (range, 88-455) ng/mL, and the average serum calcium level was 9.8 ± 0.7 (range, 8.1-13.1) mg/dL. Most (n = 201; 75.4%) patients were asymptomatic despite having high serum 25(OH)D and calcium levels. The serum 25(OH)D level was significantly higher in the symptomatic groups than in the asymptomatic groups (138.6 ± 64 ng/mL vs. 117.7 ± 31 ng/mL, p < 0.05). The most common cause (73.5%) associated with high serum 25(OH)D levels was the inappropriate prescription of a high dose of oral vitamin D (600.000-1.500.000 IU) for treating vitamin D deficiency/insufficiency in a short time (1-3 months). The cut-off value of 25 (OH) D level in patients with hypercalcemia was found to be 89 ng/mL [median 116.5 (89-216)]. CONCLUSIONS: High dose of vitamin D intake is associated with a high serum 25 OH D level, without symptoms of hypercalcemia. Inappropriate prescription of vitamin D is the primary cause for elevated 25(OH) D levels and related hypercalcemia. Hypercalcemia may not be observed in every patient at very high 25(OH) D levels. Adherence to the recommendation of guidelines is essential to ensure safe and effective treatment of vitamin D deficiency.