The evaluation of retrobulbar fat tissue in Graves' orbitopathy with shear-wave ultrasound elastography.

PURPOSE: To evaluate retrobulbar adipose tissue of patients with active and inactive Graves' orbitopathy (GO) by shear-wave ultrasound elastography (SWE). METHODS: Followed-up in our ophthalmology clinic due to GO, 72 eyes of 36 patients and 38 eyes of 19 healthy controls were included in this cross-sectional case-control study. Graves' patients were divided into two subgroups under clinical activity score (CAS): active Graves' orbitopathy (AGO) (CAS ≥ 3) and inactive Graves' orbitopathy (IGO) (CAS < 3). SWE measurement values of retrobulbar adipose tissue of all participants were recorded in meters/second, and the intergroup comparisons were performed. RESULTS: Thirty-four eyes of 17 patients in AGO, 38 eyes of 19 patients in IGO, and 38 eyes of 19 participants in the control group were included in the study. Mean values measured from retrobulbar adipose tissue through SWE were 1.00 ± 0.01 m/sec in AGO, 1.16 ± 0.01 m/sec in IGO, and 0.94 ± 0.01 m/sec in the control groups. Even so, the mean SWE value was significantly higher in the IGO group than in the other groups (p < 0.001). Mean SWE values were significantly higher in the AGO group than in the controls (p = 0.008). In the correlation analysis performed, a significant positive correlation was found between SWE and Hertel exophthalmometer measurement values (p = 0.026, r = 0.212), and thyroid-stimulating hormone receptor antibody (TSHR-Ab) levels (p = 0.018, r = 0.224). CONCLUSION: We detected SWE values of retrobulbar adipose tissue high in GO, especially in the IGO group. Such a situation, which we associated with the development of fibrosis, may be an indicator of unresponsiveness to immunomodulatory treatments.

Vitamin D Deficiency and Gallbladder Stasis.

Cholelithiasis or presence of calculi/gallstones in the gallbladder occurs more frequently in pregnant women. Vitamin D deficiency is suggested to be associated with gallbladder stasis, and a role for vitamin D supplementation is thought to have potential to prevent gallstones in this special population.

Anti-Müllerian hormone as a marker of premature ovarian aging in autoimmune thyroid disease.

There is an increased incidence of autoimmune thyroid disease (AITD) in women with infertility. We hypothesized that serum anti-Müllerian hormone (AMH) levels will be lower in premenopausal women with AITD than controls. We evaluated ovarian reserve in women with AITD (n = 85) and healthy controls (n = 80), all <40 years old. Detailed data on reproductive history were obtained. Gonadotrophins, steroids, AMH, and inhibin B levels were measured during the follicular phase. The number of pregnancies as well as live births was lower in women with AITD (p < 0.01). No difference was observed in terms of FSH, estradiol, and inhibin B. AMH levels were lower in AITD women than in controls (1.16 + 0.17 versus 1.28 + 0.25 ng/ml, mean + SD, p = 0.001). According to the multiple regression analysis, even after age adjustment, AITD was significantly and independently affected AMH levels (t = 2.674, p = 0.008). Women with AITD seem to have a diminished ovarian follicular reserve and measurement of serum AMH level has the potential to be used to predict this comorbidity.

What are the clinical implications of nodular gastritis? Clues from histopathology.

There is no widely accepted histopathological definition for nodular gastritis. In this study we aim to uncover the pathologic entity responsible for the nodular appearance and to find clues about the clinical implications of nodular gastritis. Antral biopsy specimens of 160 patients with nodular gastritis and 133 patients without nodular gastritis were examined by an experienced pathologist for dysplasia, foveolar hyperplasia, inflammatory activity, intraepithelial lymphocytosis, intestinal metaplasia, and lymphoid follicle/aggregate formation, and comparative analysis was performed between the two groups of patients. The presence of intraepithelial lymphocytosis was more frequent in patients with nodular gastritis (P < 0.05). There was no difference between the two groups regarding the other pathological features such as presence of dysplasia, inflammatory activity, intestinal metaplasia, lymphoid hyperplasia, and Helicobacter pylori (H. pylori) infection. Increase of intraepithelial lymphocytes may contribute to formation of macroscopical nodules in this peculiar type of gastritis. Nodular gastritis would not indicate a new therapeutic approach in addition to the current measures for Helicobacter pylori infection.

A new approach for standardization and increased accuracy of lymph node washout thyroglobulin in patients with differentiated thyroid carcinoma.

BACKGROUND: High values of fine needle aspiration washout thyroglobulin (FNAB-Tg) are diagnostic for metastatic lesions of thyroid cancer. However, there is not a consensus on cutoff for high FNAB-Tg level. In this study, we aimed to determine a more accurate and standardized parameter for FNAB-Tg. METHODS: Ultrasonographically suspicious lymph nodes of patients with histopathologically confirmed differentiated thyroid cancer or malignant/suspicion for malignancy cytology were included. Tg washout was obtained by aspiration and nonaspiration fine needle biopsy (nonaspiration-FNB). Simultaneous Tg was measured from serum. Aspiration and washout procedures were also performed from whole blood and serum using syringes and needles identical to ones used for lymph node biopsy. RESULTS: Data of 19 lesions in 17 patients who underwent lymph node dissection were analyzed. Nonaspiration FNB-Tg, FNAB-Tg/whole blood washout-Tg, nonaspiration FNB-Tg/whole blood washout-Tg, nonaspiration FNB-Tg/serum washout-Tg, nonaspiration FNB-Tg/serum Tg ratios were significantly higher in malignant lymph nodes compared to benign ones. Areas under the ROC curve for nonaspiration FNB-Tg, FNAB-Tg/whole blood washout-Tg, FNAB-Tg/serum washout-Tg, nonaspiration FNB-Tg/whole blood washout-Tg, nonaspiration FNB-Tg/serum washout-Tg, and nonaspiration FNB-Tg/serum Tg were statistically significant for the discrimination of benign and malignant lymph nodes. Best cutoff value for nonaspiration FNB-Tg was 4.21. Among ratios, best cutoff values were 5.40 for nonaspiration FNB-Tg/whole blood washout-Tg and 3.28 for nonaspiration FNB-Tg/serum washout-Tg. CONCLUSION: For detection of malignant lymph nodes, determining ratios of nonaspiration FNB-Tg to whole blood and/or serum washout-Tg might be a promising method to increase accuracy and provide standardization of lymph node washout procedure.

Primary thyroid disorders in patients with endogenous hypercortisolism: an observational study.

Cushing's syndrome (CS) may alter the performance of the hypothalamic-hypophyseal-thyroid axis. We searched for a relationship between hypercortisolism and primary thyroid disorders. The medical records of 40 patients with CS were retrospectively examined. Thyroid ultrasonography (USG), basal thyroid function test results (TFT), and antithyroglobulin and antithyroperoxidase antibodies were analyzed. In 80 control subjects, matched by age and gender with CS patients, thyroid USG, TFTs, and autoantibody panel were obtained. Among the CS patients, 17 had nodular goiter, versus 24 controls (42.5% versus 30%, P > 0.05). Among the twenty-five patients with an available TFT and autoantibody panel-before and after surgical curative treatment-autoantibody positivity was detected in 2 (8%) patients before and 3 (12%) after surgery (P = 0.48). Regarding TFT results, 1 (2.5%) patient had subclinical hyperthyroidism and 1 (2.5%) had subclinical hypothyroidism, whereas 1 (2.5%) control had hyperthyroidism. In total, 21 (52.5%) patients and 32 (40%) controls had ≥1 of the features of thyroid disorder, including goiter, positive thyroid autoantibody, and thyroid function abnormality; the difference was not significant (P > 0.05). The prevalence of primary thyroid disorders is not significantly increased in patients with CS.

Thyroid autoimmunity in patients with hyperprolactinemia: an observational study.

OBJECTIVE: To establish whether there is a relationship between hyperprolactinemia and primary thyroid disorders, focusing on patients with autoimmune features. MATERIALS AND METHODS: The medical records of 100 patients with hyperprolactinemia (HPRL) were retrospectively examined. Records of thyroid ultrasonography (USG), basal serum levels of thyroid stimulating hormone, circulating free thyroxine, free triiodothyronine, antithyroglobulin (anti-Tg), and antithyroperoxidase (anti-TPO) antibodies were analyzed. In 100 control subjects, matched by age and gender with HPRL patients, thyroid USG, thyroid function tests (TFTs), and autoantibody panel were obtained. RESULTS: The median PRL in patients was 93 ng/mL (range: 37-470). Twenty-five patients (25%) and 22 controls (22%) had positive anti-Tg and/or anti-TPO titers (P = 0.739). The median serum PRL was 98 (37-470) ng/mL in patients with positive thyroid autoantibodies, and 92 (40-470) ng/mL in patients who were negative (P = 0.975). Among the individuals with autoantibody positivity TFTs abnormalities were more frequent in HPRL patients (60%, out of 25 patients, 14 with subclinical hypothyroidism and one with hyperthyroidism) than in controls (9.1%, out of 22 patients, 2 with subclinical hyperthyroidism) (P < 0.001). Twenty-seven patients with HPRL and 31 controls had goiter (27 vs. 31%, P = 0.437). Forty-six patients (46%) and 50 (50%) controls had one or more of the features of thyroid disorder, which were goiter, positive thyroid autoantibody, and thyroid function abnormality (P = 0.888). CONCLUSION: HPRL may be associated with more severe thyroid dysfunction in patients with thyroid autoimmunity.

Choroidal changes and duration of diabetes.

PURPOSE: We investigate changes in macular choroidal thickness in eyes without diabetic retinopathy of patients with various durations of diabetes, using enhanced depth imaging optical coherence tomography (EDI OCT). METHODS: The 134 Type-2 diabetic patients who presented without diabetic retinopathy were prospectively imaged using EDI OCT on Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany) sd-OCT. The patients with diabetes were classified into three groups, according to the duration of diabetes: Group I (5-9 years, n = 63); Group II (10-14 years, n = 37); Group III (15-40 years, n = 34). The retinal and choroidal thickness was evaluated between these groups at central fovea and at the regions at 500-mm intervals up to 1500 mm temporal and nasal to the fovea. RESULTS: The central foveal retinal thickness was significantly different between groups (group I: 273.05 ± 19.51 µ, group II: 267.12 ± 20.78 µ, group III: 261.34 ± 22.27 µ; p = 0.04). The choroidal thickness measurements at central fovea, at 500, 1000, and 1500 micron intervals temporal and nasal to the center of the fovea were not significantly different between groups. The duration of diabetes was weakly correlated with choroidal thickness in all measured distances and they were not statistically significant. The central foveal choroidal thickness was weakly correlated with serum creatinine (r = -0.18, p = 0.03). CONCLUSION: Foveal retinal thickness was significantly decreased in patients with longer duration of diabetes. Duration of diabetes does not seem to be related to foveal chorodial thickness. On the other hand, the weak relation between creatinine and choroidal thickness may be evaluated further. The choroidal thickness changes that may be an early sign of nephropathy can be submitted to an easy, noninvasive scanning test at the same time.

"The diagnostic accuracy of thyroid nodule fine-needle aspiration cytology following thyroid surgery: a case-control study".

Thyroid surgery may cause regional scarring and some degree of fibrotic process which may extend into the perithyroidal soft tissues. This may result in problems when collecting thyroid fine-needle aspiration biopsy (FNAB) samples and evaluating the cellular abnormalities. This study aimed to determine if a history of thyroid surgery is a risk factor for nondiagnostic (ND) FNAB results. Patients with ≥1 discrete nodular lesion of the thyroid who underwent FNAB were included. The patients with a history of thyroid surgery constituted group 1, and the others constituted group 2. The factors which may influence FNAB results, including age, gender, presence of Hashimoto's thyroiditis, and ultrasound characteristics, were also evaluated. Group 1 included 123 patients with 200 nodules, and group 2 included 132 patients with 200 nodules. The two groups were similar with respect to demographic characteristics of the patients and ultrasonographic features of the nodules including diameter, content (cystic or solid), echogenicity, margin, and calcifications (P > 0.05). In all, 176 (44 %) of the participants had ND FNAB results. The median time interval between thyroid surgery and FNAB was 15 years [range, 1-45 years; interquartile range (IQR) 13 years]. Significantly more nodules in group 1 had ND FNAB results than in group 2 [98 (49 %) vs 78 (39 %), respectively, P = 0.028]. Multivariate analysis revealed that history of thyroid surgery was independently associated with ND FNAB [odds ratio (OR) 1.55, 95 % confidence interval (CI) 1-2.33, P = 0.033]. A history of thyroid surgery increases the risk of initial ND FNAB.

"Is there any association between insulin resistance and thyroid cancer? : A case control study".

Insulin stimulates proliferation of thyroid cells in culture. The presence of insulin resistance (IR) is associated with larger thyroid gland volume and an increased prevalence of thyroid nodules. The aim of this study was to investigate the presence of any possible association between IR and thyroid cancer. Forty-one patients with diffuse thyroid cancer (Group 1) were matched for age and gender with 41 patients with nodular goiter (Group 2). Both groups were compared in terms of frequency of IR, as estimated by the homeostasis model assessment, as well as other parameters of the metabolic syndrome (MetS). Fourteen patients (34.1 %) in each group had MetS. Twelve patients (29.3 %) in group 1 had IR compared to 10 (24.4 %) in group 2. Mean HOMA-IR scores in group 1 and 2 were 2.5 ± 2.2 and 1.8 ± 1.1, respectively. Thirty-two patients (78 %) in group 1 had a body mass index (BMI) of more than 25 compared to 33 patients (80.5 %) in group 2. The difference between groups with regard to HOMA-IR, the frequency of IR, BMI, and any of the parameters of MetS was statistically insignificant (p > 0.05). A subgroup analysis based on tumor size did not reveal a significant difference between patients with microcarcinoma (≤10 mm) and macrocarcinoma (>10 mm) in terms of any of the study parameters (p > 0.05). Neither MetS nor IR was a significant risk factor for thyroid cancer following logistic regression analysis (p > 0.05). IR is not more prevalent in patients with thyroid cancer. Some other pathologic mechanisms may be more prominent during thyroid carcinogenesis.

Evaluation of left ventricle functions by tissue Doppler, strain, and strain rate echocardiography in patients with primary hyperparathyroidism.

Cardiovascular morbidity and mortality are increased in patients with primary hyperparathyroidism (PHPT). We aimed to evaluate left ventricle systolic and diastolic functions with tissue Doppler imaging (TDI) and strain and strain rate echocardiography in patients with PHPT. Thirty-one patients with PHPT and 29 healthy controls were evaluated with conventional and pulse Doppler echocardiography, TDI and strain and strain rate echocardiography. Myocardial performance index (MPI) was calculated. Strain and peak systolic strain rate in mid and basal segments of lateral, anterior, inferior, and septal walls of left ventricle were determined. TDI showed similar late diastolic myocardial peak velocity in two groups. Peak systolic mitral annular velocity, early diastolic myocardial peak velocity, and ratio of early to late diastolic myocardial peak velocity were lower in PHPT patients (p = 0.01, p < 0.001 and p < 0.001, respectively). MPI calculated by TDI was 0.53 ± 0.15 in PHPT group and 0.44 ± 0.09 in control group (p = 0.013). Strain values were lower in mid and basal segments of septum, lateral and anterior walls, and basal segment of inferior wall in PHPT patients. Mean systolic strain was -20.88 ± 2.30 and -24.25 ± 2.13 in PHPT patients and control group, respectively (p < 0.001). Mean strain rate was lower in PHPT patients compared to control group (-1.38 ± 0.19 vs -1.57 ± 0.25) (p = 0.002). Patients with PHPT, but no cardiac symptoms or documented cardiovascular disease, have subclinical systolic and diastolic myocardial dysfunction. Evaluation of these patients with TDI and S and Sr echocardiography in addition to conventional echocardiography might be valuable to detect subclinical cardiac involvement.

Thyroid autoimmunity in patients with hyperprolactinemia: an observational study / Autoimunidade tireoidiana em pacientes com hiperprolactinemia: um estudo observacional

Objective : To establish whether there is a relationship between hyperprolactinemia and primary thyroid disorders, focusing on patients with autoimmune features. Materials and methods : The medical records of 100 patients with hyperprolactinemia (HPRL) were retrospectively examined. Records of thyroid ultrasonography (USG), basal serum levels of thyroid stimulating hormone, circulating free thyroxine, free triiodothyronine, antithyroglobulin (anti-Tg), and antithyroperoxidase (anti-TPO) antibodies were analyzed. In 100 control subjects, matched by age and gender with HPRL patients, thyroid USG, thyroid function tests (TFTs), and autoantibody panel were obtained. Results : The median PRL in patients was 93 ng/mL (range: 37-470). Twenty-five patients (25%) and 22 controls (22%) had positive anti-Tg and/or anti-TPO titers (P = 0.739). The median serum PRL was 98 (37-470) ng/mL in patients with positive thyroid autoantibodies, and 92 (40-470) ng/mL in patients who were negative (P = 0.975). Among the individuals with autoantibody positivity TFTs abnormalities were more frequent in HPRL patients (60%, out of 25 patients, 14 with subclinical hypothyroidism and one with hyperthyroidism) than in controls (9.1%, out of 22 patients, 2 with subclinical hyperthyroidism) (P < 0.001). Twenty-seven patients with HPRL and 31 controls had goiter (27 vs. 31%, P = 0.437). Forty-six patients (46%) and 50 (50%) controls had one or more of the features of thyroid disorder, which were goiter, positive thyroid autoantibody, and thyroid function abnormality (P = 0.888). Conclusion : HPRL may be associated with more severe thyroid dysfunction in patients with thyroid autoimmunity. .

Objetivo : Verificar se existe uma relação entre a hiperprolactinemia e distúrbios primários da tireoide, focando em pacientes com características autoimunes. Materiais e métodos : Os prontuários de 100 pacientes com hiperprolactinemia (HPRL) foram examinados retrospectivamente. Foram analisados registros de ultrassonografia da tireoide (USG), níveis séricos basais de hormônio tireoestimulante, tiroxina livre, triiodotironina livre e anticorpos antitireoglobulina (anti-Tg) e antitireoperoxidase (anti-TPO). Foram obtidos de 100 controles, pareados por idade e sexo com pacientes com HPRL, USG, testes de função da tireoide (TFTs) e painel de autoanticorpos. Resultados : A média de PRL em pacientes foi de 93 ng/mL (variação: 37-470). Vinte e cinco pacientes (25%) e 22 controles (22%) foram positivos para títulos de anti-Tg e/ou anti-TPO (P = 0,739). A mediana de PRL sérica foi de 98 (37-470) ng/mL em pacientes positivos para autoanticorpos tiroidianos e 92 (40-470) ng/mL em pacientes negativos (P = 0,975). Entre os indivíduos positivos para autoanticorpos, as anormalidades da TFTs foram mais frequentes em pacientes HPRL (60%; de 25 pacientes, 14 com hipotireoidismo subclínico e um com hipertireoidismo) do que nos controles (9,1%; de 22 pacientes, 2 com hipertireoidismo subclínico) (P < 0,001). Vinte e sete pacientes com HPRL e 31 controles apresentavam bócio (27 contra 31%; P = 0,437). Quarenta e seis pacientes (46%) e 50 (50%) controles tiveram uma ou mais das características de problemas de tireoide, como bócio, autoanticorpos antitireoide e anormalidades da função tiroidiana (P = 0,888). Conclusão : A HPRL pode estar associada à disfunção da tireoide mais grave em pacientes com autoimunidade contra a tireoide. .

Serum levels of MMP-9 and TIMP-1 in primary hypertension and effect of antihypertensive treatment.

BACKGROUND: Matrix metalloproteinases, a family of proteolytic enzymes are thought to be involved in extracellular matrix accumulation during development of hypertensive target organ disease. The present study was designed to compare hypertensive patients with normotensive individuals with respect to serum levels of matrix metalloproteinase (MMP)-9 and tissue inhibitor of metalloproteinase (TIMP)-1 and to search for the effect of antihypertensive treatment on the serum enzyme levels. METHODS: Thirty-three patients with stage 1 primary hypertension and sixteen age- and sexmatched control subjects were enrolled into the study. Serum MMP-9 and TIMP-1 levels were assessed in the hypertensive group before and after a 3-month-antihypertensive treatment (candesartan 8 mg/day to 17 patients and lisinopril 10 mg/day to 16 patients). RESULTS: Pre-treatment serum MMP-9 levels were higher in the hypertensive group (p=0.309) while serum TIMP-1 levels were lower (p=0.296). Serum MMP-9 levels were decreased (p<0.001) and TIMP-1 levels were increased (p=0.022) after the antihypertensive treatment. CONCLUSIONS: In hypertensive patients, increased MMP-9 activity could result in increased degradation of elastin relative to collagen and non-elasticity, while decreased TIMP-1 activity could lead to accumulation of poorly cross-linked, immature and unstable fibril degradation products, which result in misdirected deposition of collagen. Our study is important for revealing the role of the MMP enzyme system in the pathogenesis of hypertensive target organ disease.

Successful outpatient management of pelvic actinomycosis by ceftriaxone: a report of three cases.

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by actinomyces israeli. Intravenous penicillin is the preferred antimicrobial but it requires hospitalization up to one month. An outpatient treatment strategy would be cost effective and a good choice for patients. Here we present three cases in which intramuscular ceftriaxone was successfully used in the outpatient settings following surgery and IV penicillin treatment in the hospital.