Differences in Calcium Metabolism and Thyroid Physiology After Sleeve Gastrectomy and Roux-En-Y Gastric Bypass.

INTRODUCTION: Bariatric surgery may modulate the hormones and elements which maintain thyroid and calcium homeostasis. These adaptations in hormonal and elemental aspects have previously been determined via some studies with variations in their findings. Thyroid volume and 24-h urinary calcium are two parameters which have not been investigated regarding whether they change during the bariatric postsurgical period. This study planned to examine the changes in calcium metabolism and thyroid gland functioning after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS: Seventy-three morbidly obese patients with planned bariatric surgery were enrolled in the study. Before and 12 months after the operation, parathormone (PTH), 25-OH-vitamin D3(25vitD3), TSH, free triiodothyronine (fT3), free thyroxine (fT4), calcium (Ca), 24-h urinary Ca and ultrasonography-guided thyroid volume were measured. RESULTS: In the beginning, 73 patients were examined and 12 months after surgery out of 25 patients continuing follow-up, 20 (80%) had undergone sleeve gastrectomy (SG) while five (20%) had undergone Roux-en-Y gastric bypass (RYGB). Accompanied by significant BMI decrease, 24-h urinary Ca and thyroid volume did not significantly increase in RYGB, SG, and the whole group after 12 months. The SG group showed a significant drop in TSH (p 0.03) level, while the RYGB group showed significant decreases in fT4 (p 0.00) and fT3 (p 0.00); and significant fT3 decrease (p 0.01) was recorded for the whole group. CONCLUSION: Bariatric surgery may modify Ca homeostasis and thyroid gland functional status. We documented that these were not statistically significant increases in 24-h urinary Ca level and thyroid volume after 1 year. Further studies are needed to understand the issue, enrolling more patients who underwent the same bariatric procedure and after accounting for the inhibition of supplementary vitamin and mineral effects.

Validity and Reliability of the Turkish Version of Needs Based Biopsychosocial Distress Instrument for Cancer Patients (CANDI).

BACKGROUND: Needs based biopsychosocial distress instrument for cancer patients (CANDI) is a scale based on needs arising due to the effects of cancer. OBJECTIVES: The aim of this research was to determine the reliability and validity of the CANDI scale in the Turkish language. PATIENTS AND METHODS: The study was performed with the participation of 172 cancer patients aged 18 and over. Factor analysis (principal components analysis) was used to assess construct validity. Criterion validities were tested by computing Spearman correlation between CANDI and hospital anxiety depression scale (HADS), and brief symptom inventory (BSI) (convergent validity) and quality of life scales (FACT-G) (divergent validity). Test-retest reliabilities and internal consistencies were measured with intraclass correlation (ICC) and Cronbach-α. RESULTS: A three-factor solution (emotional, physical and social) was found with factor analysis. Internal reliability (α = 0.94) and test-retest reliability (ICC = 0.87) were significantly high. Correlations between CANDI and HADS (rs = 0.67), and BSI (rs = 0.69) and FACT-G (rs = -0.76) were moderate and significant in the expected direction. CONCLUSIONS: CANDI is a valid and reliable scale in cancer patients with a three-factor structure (emotional, physical and social) in the Turkish language.