HIGH THYROPEROXIDASE ANTIBODY TITERS MAY PREDICT RESPONSE TO ANTITHYROID DRUG TREATMENT IN GRAVES DISEASE: A PRELIMINARY STUDY.

Background and aim: Antithyroid drugs are first treatment for Graves hyperthyroidism worldwide. Although remission can be achieved in approximately 40-50% of patients in 12-18 months with antithyroid drugs, this period can be extended up to 24 months. We aimed to evaluate the effect of individual clinical/biochemical variables and GREAT score in predicting response to antithyroid drug in Graves disease. Material and methods: This is a retrospective single-center study including 99 patients with the first episode of Graves disease treated for at least 18 months. The patients were classified into two groups as those who responded to antithyroid medication at 18-24 months (group 1) and those who did not respond at 24 months and continued with low-dose antithyroid medication (group 2). Results: Medical treatment response was obtained in 38 (38.3%) of the patients at 18 months, and in 19 (19.1%) patients at 24 months. Long-term medical treatment (>24 months) was given to the remaining 43 patients due to the lack of response to medical treatment. Thyroid volume and free T4 levels were higher in those followed up with long-term antithyroid drugs, and orbitopathy was more common in this group. Median anti TPO value was significantly higher in group 1 when compared to group 2 (593 U/l and 191.6 U/l respectively). More patients were classified as GREAT class 3 in group 2 when compared to group 1 (46.5% and 12,5% respectively). We analyzed the Thyroperoxidase Antibody(anti TPO) titers, which we divided into three levels, according to groups 1 and 2. Post-hoc Chi-Square analysis revealed that falling into the highest anti TPO category was significantly associated with response to medical therapy in 24 months (p <0.05). Conclusion: According to our study, GREAT score and anti TPO Ab titers at presentation may help predict response to ATD in Graves disease.

Metabolic role of hepassocin in polycystic ovary syndrome.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a female endocrinopathy characterized by hyperandrogenemia, insulin resistance, glucose intolerance, dyslipidemia, non-alcoholic fatty liver disease (NAFLD), and obesity. Hepassocin (HPS) is a hepatokine involved in energy and lipid metabolism. We aimed to investigate the role of HPS in metabolic dysfunction and its relationship with fatty liver in patients with PCOS. PATIENTS AND METHODS: A total of 45 newly diagnosed PCOS patients and 42 healthy women of similar age were included in the study. Routine anthropometric, biochemical, and hormonal information were recorded. Serum HPS and high-sensitivity C-reactive protein (hsCRP) were measured, and NAFLD fibrosis score (NFS) and Fibrosis-4 (FIB-4) were calculated and correlated. RESULTS: HPS and hsCRP values of the PCOS group were found to be significantly higher than controls (p=0.005, p<0.001, respectively). A positive correlation was found between both HPS and hsCRP and luteinizing hormone (LH) (p<0.001). No correlation was observed between HPS and NFS and FIB-4, however, only a weak negative correlation was observed between hsCRP and FIB-4. A negative correlation was found between HPS and BMI, waist circumference, fat ratio, and HbA1c (p<0.05). In multivariate regression analysis for HPS, R-squared is 0.898, and hsCRP, neck circumference, fat amount, and LH are significant factors. CONCLUSIONS: NAFLD is an important dysmetabolic component of PCOS. Serum HPS is elevated in PCOS patients. We found a positive correlation between hsCRP and LH and a negative correlation between obesity indices, although we did not find an association between NFS and FIB-4, and HPS. In the future, large-scale molecular studies of HPS may be beneficial.

Sonographic evaluation of subclinical entheseal involvement in patients with hypoparathyroidism: a case control study.

PURPOSE: Hypoparathyroidism is a disease characterized by low serum calcium, increased serum phosphorus and low PTH levels. Although patients are treated with active vitamin D and calcium, a proper serum calcium phosphorus balance cannot always be achieved. Ectopic calcifications that develop in organs during treatment are the most common complications. To date, there is not any published study on enthesopathy in patients with hypoparathyroidism. The aim of this study was to evaluate subclinical enthesopathy in patients with hypoparathyroidism with ultrasound and to compare the results with those of the control group. METHODS: The study included patients aged 18-65 years with postoperative hypoparathyroidism and hypothyroidism (group hypoP + hypoT), patients with postoperative hypothyroidism (group hypoT), and healthy age and sex-matched volunteers (group C). Ultrasonographic findings of enthesopathy in both extremities were documented according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). RESULTS: GUESS scores in group hypoP + hypoT, were significantly higher when compared to the other groups. There was a statistically significant correlation between the total GUESS scores and total enthesophyte scores and the duration of hypoparathyroidism (p < 0.05, r = 0.43) (p < 0.05, r = 0.39) respectively. In the correlation analysis of all groups, a significant negative correlation was found between serum Ca and PTH levels and the total GUESS scores (p < 0.01, r = - 0.37; p < 0.01, r = - 0.54, respectively). CONCLUSION: This study showed that GUESS scores were significantly higher in patients with hypoparathyroidism compared to those with hypothyroidism and control subjects. GUESS scores were positively correlated with disease duration. Patients with hypoparathyroidism need to be evaluated for subclinical enthesopathy during follow-up.

A CASE OF HYPONATREMIA DUE TO PITUITARY METASTASIS OF LUNG CANCER.

Context: Hyponatremia is a common electrolyte abnormality. Objective: We report a patient who presented with hyponatremia and diagnosed as small cell lung cancer metastatic to hypothalamus and pituitary. Case report: A 68 year old male patient was admitted with fever and cough and pneumonia was considered. Serum sodium level was 113 mmol/L. Syndrome of inappropriate ADH (SIADH) is considered. Thyroid function tests and cortisol levels pointed out a central deficiency in both axes. Pituitary MRI was performed and a hypothalamic and pituitary mass were observed. Prednisolone therapy was started followed by L thyroxine replacement. A chest computer tomography (CT) was taken 2 weeks later revealed a mass lesion. Bronchoscopic biopsy was performed and histopathological diagnosis of the tumor was reported as small cell lung cancer. Result: Many mechanisms were considered as the cause of hyponatremia in our patient. SIADH, secondary adrenal insufficiency and secondary hypothyroidism due to pituitary metastasis are possible causes. Conclusion: The reason of hyponatremia is sometimes complex. When the underlying causes of hyponatremia are not evaluated in detail, many diagnoses can be missed.

Factors that affect the Glycemic Control Achieved by Switching to Insulin Degludec/ Aspart in Insulin-Treated Patients with Type 1 and Type 2 Diabetes in a Real-World Setting: a Non-interventional, Retrospective Cohort Study.

BACKGROUND: Insulin degludec/aspart (IDegAsp) is a co-formulation with IDeg and IAsp. Different insulin regimens may be switched to IDegAsp. In this study, we aimed to find out the effect of switch to IDegAsp on glycemic control and whether the basal characteristics and treatment modalities of the patients affect the change in glycemic control brought by switch to IDegAsp. METHODS: We retrospectively analyzed the records of 78 patients whose insulin therapies (basal+bolus, premixed analogues or basal only) were switched on a 1:1 unit basis to IDegAsp±bolus insulin. Oral antidiabetic agents (OADs) given were recorded. At the end of 12th and 24th week, total insulin doses of patients and HbA1c were compared to the baseline. RESULTS: There was a statistically significant decrease at HbA1c at 12 weeks (1.4%; p<0.001). There was not a significant difference in HbA1c between the OAD added group and the group with no new OADs(p=0.1). Basal insulin dose was not statistically different from baseline, whereas bolus insulin dose was significantly lower (p=0.007). At the end of 24 weeks the decrease in HbA1c level from baseline was preserved. CONCLUSION: Regardless of the baseline insulin regimen, diabetes type and oral antidiabetic drugs given, HbA1c is significantly lowered after switching to IDegAsp.

ECTOPIC LINGUAL THYROID PRESENTING WITH MASSIVE HEMATEMESIS.

Ectopic lingual thyroid is a rare developmental abnormality caused by aberrant embryogenesis during thyroid migration. Even though, most patients are asymptomatic, uncommonly the mass can be enlarged and cause dysphagia, dyspnea, upper airway obstruction, dysphonia, hypothyroidism. We report a very rare case of ectopic lingual thyroid presenting with massive hematemesis.

Vaspin, neutrophil gelatinase-associated lipocalin and apolipoprotein levels in patients with psoriatic arthritis.

OBJECTIVES: To examine the relationship between disease activity and vaspin, neutrophil gelatinase-associated lipocalin (NGAL) and apolipoprotein levels in patients with psoriatic arthritis (PsA). BACKGROUND: Psoriatic arthritis (PsA) is a chronic inflammatory arthritis, which is related with psoriasis. Adipokines are the mediators which play a role in metabolic homeostasis and inflammatory conditions. METHODS: The levels of vaspin, NGAL, apolipoproteins and their correlations with disease activity were compared in 50 psoriatic arthritis patients and 36 healthy controls. RESULTS: The levels of vaspin, NGAL and apolipoprotein B/A1 ratio were significantly higher in the patient group (p 0.05). CONCLUSION: This is the first study to have compared vaspin and NGAL levels in patients with PsA. Vaspin and NGAL can be used as a biomarker in PsA. Vaspin, NGAL and dyslipoproteinemia are not correlated with disease activity (Tab. 3, Ref. 63).