ACTA ENDOCRINOLOGICA (BUC)

Aim. The aim of our study was to investigate the effect of pioglitazone on glycemic and blood pressure control, on inflammation markers in diabetic patients.\r\nPatients and methods. Forty-nine diabetic patients who had been followed up as outpatients for 2.7 years and HbA1c was >7% were included in the study. The patients had never received thiazolidinedione therapy before. Clinical, metabolic variables, high-sensitive Creactive protein (hsCRP), homocysteine (HCY) and asymmetric dimethylarginine (ADMA) levels were measured. 30 mg pioglitazone were administered. The patients were followed up for six months and all the measurements were re-evaluated for comparison.\r\nResults. Body mass index (BMI) significantly increased after treatment. Fasting glucose, HbA1c and HsCRP were decreased. Insulin resistance was improved and HOMA-IR index was decreased after pioglitazone treatment [8 (?6.5) vs 4(?3.1); p<0.0001]. Pioglitazone improved lipid metabolism. Mean total cholesterol and LDL cholesterol levels were decreased and HDL cholesterol was increased after treatment. The decrease in triglyceride and homocysteine levels did not reach significance. Mean ADMA level did not change after therapy [0.62 (?0.39) vs 0.61 (?0.44); p=0.85].\r\nConclusion. Pioglitazone treatment in type 2 DM produced significant improvements in measures of glycemic control, plasma lipids, blood pressure and homocysteine levels. Pioglitazone had no influence on ADMA levels.

Context. Overproduction of proinflammatory cytokines plays a significant role in the pathogenesis of Hashimoto’s thyroiditis (HT). Recent studies revealed a prominent role of newly discovered Th17 subset in the induction of autoimmune disorders and that the signaling induced by IL-23 on Th17 cells is crucial to obtain a pathogenic and sustained phenotype. The objective of this study was to provide the involvement of interleukin IL-23/ IL-17 axis in pathologic processes. Design. Serum levels of IL-23 and IL-17 in controls and HT patients were studied in different stages of disease activity. Subjects and methods. We investigated 93 patients with HT: 33 patients with newly diagnosed euthyroid HT (Group I), 11 patients with newly diagnosed hypothyroid HT (Group II), and 49 subjects treated with Levothyroxine (Group III). Thirty healthy subjects were included as controls. Concentrations of IL-23 and IL-17 in the serum samples of patients and controls were evaluated by enzymelinked immunosorbent assay. Results. Serum level of IL-23 was significantly higher in all HT patients (p<0.0001) as well as in subgroups of patients in comparison with controls (p<0.01). Serum concentrations of IL-17 were statistically increased in the group of HT patients (p=0.014); the differences in IL-17 levels between groups I and III in comparison to healthy controls were also significant, but not for group II. Conclusions. Our results highlight the involvement of the IL-23/IL-17 axis in the development of HT and its severity. Moreover, upregulated secretion of IL-23 could be a biomarker for progression and monitoring of HT.

Purpose. To investigate the association between papillary thyroid cancer (PTC) and Hashimoto’s thyroiditis (HT). Design. This study is a retrospective study that conducted during 7 consecutive years with a median 119.5 months follow-up. Subjects and Method. Patients who underwent thyroidectomy in Dokuz Eylül University Hospital during 7 consecutive years were included. Patients’ demographics, biochemical, radiological, and pathological results were retrospectively assessed. Results. Four hundred sixty nine patients were evaluated. Among 469 patients who underwent thyroidectomy, 132 (28.1%) were malignant, while 182 patients were diagnosed with HT (38.8%). PTC was ranked first at 92.4% (n: 122). The prevalence of HT was 54.9% in patients with PTC and 33.1% in patients without PTC diagnosis (p<0.001). Younger age and the presence of HT were independently associated with PTC. The presence of HT was associated with increased risk of development of PTC (OR: 2.2, %95 CI: 1.4-3.5, p<0.001) but not with TNM stage or recurrence. Lymph node metastasis at presentation was the strongest predictor of recurrence (OR: 13.9, CI: 3.5-54.6, p<0.001) Conclusions. HT was an independent risk factor for development of PTC. According to our findings, HT patients (particularly with nodular HT) should be observed carefully and thyroid fine needle aspiration biopsy (TFNAB) should be encouraged if necessary.

Context. Nonalcoholic fatty liver disease (NAFLD) includes simple steatosis, steatohepatitis (NASH) which can evolve with progressive fibrosis, cirrhosis and hepatocellular carcinoma. As liver biopsy cannot be used as a screening method, noninvasive markers are needed. Objective. The aim of this study was to test if there is a significant association between vitamin D deficit and the severity of NAFLD. Design. The patients were divided into two groups (vitamin D insufficiency/deficiency) and statistical analyses were performed on the correlation of clinical and biochemical characteristics with histopathological hepatic changes. Subjects and methods. We prospectively studied 64 obese patients referred for bariatric surgery between 2014 and 2016 to our Surgical Unit. Anthropometric, clinical measurements, general and specific biological balance were noted. NAFLD diagnosis and activity score (NAS) were evaluated on liver biopsies. Results. Increased serum fibrinogen was correlated with NASH (p=0.005) and higher NAS grade. T2DM was positively correlated with liver fibrosis (p=0.002). 84.37% of the patients had vitamin D deficit and 15.62% were vitamin D insufficient. Lobular inflammation correlated with vitamin D deficit (p=0.040). Fibrosis (p=0.050) and steatohepatitis (p=0.032) were independent predictors of low vitamin D concentration. Conclusions. Vitamin D status in conjunction with other parameters - such as T2DM - or serum biomarkers – namely fibrinogen level and PCR level - may point out the aggressive forms of NAFLD and the need for liver biopsy for appropriate management.

Background. Heart rate recovery after exercise is a predictor of mortality that is thought to reflect autonomic imbalance. The association between heart rate recovery and prediabetic stages is unclear. Aim. To evaluate the heart rate recovery in patients with diabetes and prediabetes. Patients and Methods. Thirtyfive patients with impaired fasting glucose, 32 patients with impaired glucose tolerance, and 34 patients with diabetes mellitus were included. The control group consisted of 30 healthy individuals. All study participants underwent a maximal graded exercise test, and heart rate recovery was calculated by subtracting the 1st, 2nd and 3rd minute heart rates from the maximum heart rate achieved during the stress testing. Results. The 1st, 2nd and 3rd minute heart rate recovery values of the diabetes mellitus, impaired glucose tolerance and impaired fasting glucose groups were significantly lower than that of the control group. For the 1st minute, heart rate recovery values of the diabetes mellitus patients were significantly lower than that of the control group (19.8±9.4 vs. 25.4±9.9, p<0.001) and the impaired fasting glucose group (19.8±9.4 vs. 22.1±9.3, p<0.01), and the 1st minute heart rate recovery of the diabetes mellitus patients was similar to that of the impaired glucose tolerance group (19.8±9.4 vs. 20.7±5.8, p=0.88). Similar results were obtained in the 2nd and 3rd minute heart rate recovery measurements. The heart rate recovery values of the impaired fasting glucose were significantly higher than those of the diabetes mellitus and impaired glucose tolerance patients. In comparing the impaired glucose tolerance and diabetes mellitus groups in terms of heart rate recovery values, there was no significant difference.

Context. Besides its typical features, hypothyroidism comes to notice sometimes with neurologic features like reversible cerebellar ataxia, dementia, peripheral neuropathy, coma, etc. Therefore hypothyroidism should be suspected in all cases of cerebellar ataxia, as it is easily treatable. Objective. Here we illustrate a case of hypothyroidism initially reported with cerebellar ataxia. Case report. A 40 year-old male presented with history of gait-ataxia. His investigations revealed frank primary hypothyroidism with positive anti-TPO antibody. The patient was put on thyroxine and he improved completely within eight weeks. Conclusions. This case report emphasizes that hypothyroidism can present with ataxia as one of the initial features. Therefore, hypothyroidism should be considered in all cases of cerebellar ataxia as it is a reversible cause of ataxia

Alzheimer’s disease(AD) is the leading cause of dementia and is characterized by the presence of extensive plaque deposition and neurofibrillary pathology. The aim of the present study was to make an update regarding the influence of estrogens and SERMs on inflammation and on the resolution of inflammation, respectively, focusing on these most important features implicated in the pathophysiology of AD. Several hypothesised mechanisms of action of estrogens and SERM are exposed and also some relevant clinical studies on this subject are analysed. The analyzed studies have a high heterogeneity of preparations used, of administration routes, of the female population included and of the periods of time from the appearance/ induction of menopause to the therapeutic intervention and also of follow-up periods of patients and of the means of evaluating their cognitive decline. One can say that all the ways of pharmacological influence on the membrane or intracellular signalling system associated to estrogens that may have clinical importance in the prevention and possibly in the treatment of AD have not been exhausted. Estrogens with selective ERα or G protein-coupled estrogen receptors (GPER1 or GqMER) effects could be used to influence the resolution of inflammation process, with positive effects on AD evolution.

Aim. To evaluate the malignancy rates of Atypia of undetermined significance /follicular lesion of undetermined significance (AUS/FLUS) cases in the light of clinical and sonographic features. Material and Methods. The percentage of AUS/ FLUS cases, second fine needle aspiration cytology (FNAC) results, cyto-histopathological correlations and risk of malignancy were analyzed. Results. 113 out of 1461 thyroid FNAC samples (7.7%) were diagnosed as AUS/FLUS and included in the study. Seventy three out of 113 cases (64.6 %) underwent repeat biopsies or surgery. From 45 cases repeat biopsies were taken and 28 had thyroidectomy or lobectomy. There was a significant relation between nodule size and underwent surgery or repeat FNAC (p=0.036). Malignancy rate was 24.6% for cases which had any managements. The malignancy rates were higher in AUS/FLUS cases with cytological atypia (28.8%). After surgery the most common malignancy was papillary thyroid carcinoma, followed by follicular carcinoma. Conclusion. The risk of malignancy of AUS/ FLUS cases is quite high because of the heterogeneity of the group. The sub-classification of this category according to cytological or/and architecture atypia may be more useful in predicting malignancy risk. Further larger studies with ancillary techniques including molecular analysis may be more useful in determining the malignancy risk and appropriate management of this heterogeneous category.

Polycystic ovary syndrome (PCOS), the main cause of androgen excess in women of reproductive age, is a multifaceted, dynamic and clinically heterogenic disorder. Rotterdam 2003 ESHRE/ASRM definition criteria were recently reinforced at the NIH Consensus Meeting 2012. Concomitant identification of the clinical phenotypes of the syndrome is mandatory in medical care and clinical studies, as these are strongly related to reproductive, cardiovascular and metabolic outcomes. Documentation of polycystic ovarian morphology (PCOM) is challenging, with the AE/PCOS Task Force 2014 suggesting a threshold of ≥25 follicles/ovary in 18- 35 years old women when using high-frequency transducers. Elevated levels of total testosterone and/or free testosterone and/or low sex hormone-binding globulin (SHBG) stand for androgen excess in women, as stated by the ESE Position Statement 2014. Despite evidence of increased metabolic and cardiovascular risk, increased prevalence of cardiovascular events linked to PCOS status per se is still insufficient documented, mainly because of the clinical heterogeneity of studies populations and lack of prospective data. First-line therapy in the medical management of PCOS is metformin, at least 1.5 g/d, in all patients with documented insulin resistance and hyperinsulinemia. According to Endocrine Society Guidelines 2013, other insulin-sensitizers (e.g. thiazolidinediones) raise safety concerns on the long-term, whereas statins need further evaluation to demonstrate their benefits in the treatment of PCOS, however, are indicated in dyslipidemic patients. Anti-androgens and combined oral contraceptives (COC) are targeting androgen excess, particularly in non-insulin resistant patients, with an overall benefit to risk ratio in PCOS favoring benefits.

Radioiodine treatment of hyperthyroidism is easy to perform, has a low cost and presents a low risk adverse effects.\r\nDespite many reports on the efficiency and results, the number of studies investigating the efficiency of radioiodine treatment in subclinical hyperthyroidism is limited.\r\nAim. Therefore, this study aimed to investigate the efficiency of radioiodine treatment in subclinical hyperthyroidism.\r\nMethods. The study involved 50 patients with subclinical hyperthyroidism (42 females, 8 males, mean age: 60.3?10.8)\r\ntreated by radioiodine in our department. Thirtyfour (68%) of the 50 patients had multinodular hyperplasia; 9 (18%) had diffuse hyperplasia, and 7 (14%) had solitary nodule.\r\nThe patients were applied I-131 treatment with a dose of 5-20 mCi (mean 11.52?3.63 mCi) based on the thyroid gland volumes, TSH levels, age, any clinical findings, and\r\nalso, the type of hyperplasia (diffuse or nodular hyperplasia). The patients were followed for 5.13 to 46.5 months (mean: 24.62?11.47).\r\nResults. Forty-three (86%) of the 50 patients were euthyroid after a mean of 2.36?1.18 months following radioiodine\r\ntreatment. The mean dose of radioiodine was 11.91?3.73 mCi. Only 5 (10%) of 50 patients developed hypothyroidism 1-5 months (mean: 2.8?1.48) after radioiodine therapy with 8-10\r\nmCi (mean: 8.4?0.89) I-131 administration. When hypothyroidism is also considered as a criterion for cure in addition to euthyroidism, the success rate of radioiodine treatment was 96% (48/50) in the patients with subclinical\r\nhyperthyroidism.\r\nConclusion. Radioiodine treatment provides quick and high efficiency of recovery, easy application, and quick\r\nadaptation by patient; thus, it can be a preferred choice of subclinical hyperthyroidism treatment, particularly for the\r\nelderly patients who cannot adapt treatment with antithyroid tablets easily.