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Öğe Can Age at Diagnosis and Sex Improve the Performance of the American Thyroid Association Risk Stratification System for Prediction of Structural Persistent and Recurrent Disease in Patients With Differentiated Thyroid Carcinoma? A Multicenter Study(Elsevier B.V., 2022) Zuhur, Sayid Shafi; Ağgül, Hünkar; Çelik, M.; Avcı, U.; Erol, Selvinaz; Kılınç, F.; Altuntaş, Yüksel; Bilen, O.; Elbuken, G.; Topçu, B.Objective: Although the age at diagnosis has been suggested as a major determinant of disease-specific survival in the recent TNM staging system, it is not included in the recent American Thyroid Association (ATA) guidelines to estimate the risk of recurrence. Nevertheless, the effect of sex on differentiated thyroid carcinoma (DTC) recurrence is controversial. Therefore, this multicenter study was conducted to assess whether age at diagnosis and sex can improve the performance of the ATA 3-tiered risk stratification system in patients with DTC with at least 5 years of follow-up. Methods: In this study, the computer-recorded data of the patients diagnosed with DTC between January 1985 and January 2016 were analyzed. Only patients with proven structural persistent/recurrent disease were selected for comparisons. Results: This study consisted of 1691 patients (female, 1367) with DTC. In Kaplan-Meier analysis, disease-free survival (DFS) was markedly longer in females only in the ATA low-risk category (P = .045). Nevertheless, a markedly longer DFS was observed in patients aged <45 years in the ATA low- and intermediate-risk categories (P = .004 and P = .009, respectively), whereas in patients aged <55 years, DFS was markedly longer only in the ATA low-risk category (P < .001). In the Cox proportional hazards model, ages of ?45 and ?55 years at diagnosis and the ATA risk stratification system were all independent predictors of persistent/recurrent disease. Conclusion: Applying the age cutoff of 45 years in the ATA intermediate- and low-risk categories may identify patients at a higher risk of persistence/recurrence and may improve the performance of the ATA risk stratification system, whereas sex may improve the performance of only the ATA low-risk category. © 2021 AACEÖğe Denosumab Experience in a Patient with End-Stage Renal Disease and Paget’s Disease of the Bone(2022) Bilen, Ogün İrem; Elbüken, Gülşah; Ağgül, HünkarPaget’s disease of the bone (PDB) is a chronic bone disease which is characterized by accelerated bone turnover and disorganized bone remodeling. Diagnosis and treatment of PDB is particularly challenging in patients with chronic kidney disease (CKD). Denosumab administered subcutaneously at a single dose of 60 mg every 3 months reduced both serum total and bone-specific alkaline phosphatase (ALP) levels to near normal range in a 47-year-old male with CKD was suspected of having PDB due to very high serum total ALP levels and imaging findings suggestive of poliostotic involvement. Elevated serum total ALP levels detected at 3 months after denosumab suggests that serum total ALP starts to increase after 60 days of treatment but it is difficult to exactly determine the day when serum total ALP started to increase. It seems wise to administer denosumab at an interval of 60-120 days to maintain serum total ALP level within normal limits.Öğe The association of TSH-receptor antibody with the clinical and laboratory parameters in patients with newly diagnosed Graves' hyperthyroidism: experience from a tertiary referral center including a large number of patients with TSH-receptor antibody-negative patients with Graves' hyperthyroidism(Via Medica, 2021) Zuhur, Sayid Shafi; Bilen, Ogün; Ağgül, Hünkar; Topçu, Birol; Çelikkol, Aliye; Elbüken, GülşahIntroduction: Although the TSH-receptor antibody (TRAb) plays a central role in the pathogenesis of Graves' disease (GD), the association between TRAb at first diagnosis and clinical and laboratory parameters is not well known. On the other hand, a minority of patients with GD may be TRAb negative, and there is a lack of adequate evidence to demonstrate the clinical and laboratory characteristics of these patients. Therefore, we aimed to investigate the association of TRAb at the initial diagnosis of GD with the clinical and laboratory parameters in a large number of patients with GD and to compare the clinical and laboratory parameters between patients with high TRAb levels and TRAb-negative patients. Material and methods: This study included 440 patients [326 (74%) female, 114 (26%) male]. All patients were classified according to gender, age, smoking habit, and TRAb levels. Results: TRAb levels were significantly higher in male compared to female patients and in smokers compared to non-smokers. Smoking male patients had the highest TRAb levels. In regression analysis, goiter size, male gender, cigarette smoking, Graves' orbitopathy, fT3, and anti-TPO antibody levels were independently associated with high TRAb levels, while age at diagnosis and fT4 levels were not independently associated with high TRAb levels. TRAb-negative GD was diagnosed in 80 (18%) patients. TRA-negative patients had markedly less severe clinical and laboratory hyperthyroidism compared to patients with high TRAb levels. Moreover, the smoking habit was significantly lower in patients with TRAb-negative GD. Conclusions: According to our study results, TRAb levels at the initial diagnosis of GD are differently associated with clinical and laboratory parameters. Male patients and smoking patients with GD tended to have markedly higher TRAb levels and more severe clinical hyperthyroidism. Therefore, besides other contributing factors, male gender and smoking may affect TRAb levels and consequently the severity of hyperthyroidism in patients with GD. Furthermore, male gender and smoking may have a synergistic effect on TRAb levels and consequently on the severity of hyperthyroidism in patients with GD.Öğe Üçüncü Primer Tümör Nedeniyle Gelişen, Tümör İlişkili Osteomalaziye Bağlı Bir Hipofosfatemi Olgusu.(Eskişehir Osmangazi Üniversitesi, 2022) Elbüken, Gülşah; Ağgül, Hünkar; Bilen, Ogün; Zuhur, Sayid ShafiTümörle ilişkili osteomalazi (TİO), genellikle mezenkimal kaynaklı bir tümörün sıklıkla Fibroblast Büyüme Faktörü‐23 (FGF-23) üreterek osteomalaziye neden olduğu paraneoplastik bir durumdur. FGF-23, fosfatürik etki ile hipofosfatemiye neden olur. Olgu: Altmışbeş yaşında erkek hasta, kas güçsüzlüğü, zor yürüme ve şiddetli kemik ağrıları şikayetleri ile başvurdu. Tıbbi öyküsünde: 4 cm çapta orta riskli gastrointestinal sistem stromal tümör (GİST) sebebiyle distal gastrektomi, Billroth 2 antekolik gastroenterostomi ve sonrasında Evre 1 multisentrik mikropapiller karsinom (CA) sebebiyle total tiroidektomi operasyonları mevcuttu. Kemik sintigrafisindeki yaygın lezyonları GİST’in kemik metastazı olarak kabul edilmişti. Laboratuvar tetkiklerinde: Kalsiyum (Ca):8.3 mg/dL, fosfor (P): 1.5 mg/dL, parathormon (PTH): 75 pg/mL, 25-OH vit D3: 31 ng/mL, 1-25-(OH)2 vit D3: 36 pg/mL, kreatinin: 0.75 mg/dL alkalen fosfataz (ALP: 109 IU/L, idrar fosforu: 2.54 gr/gün idi. Hastanın hipofosfatemisinin olası sebebi GIST kemik metastazlarına bağlı olarak gelişmiş TİO’ye bağlı olduğu düşünüldü. Metastazların cerrahi olarak çıkartılması mümkün olmadığından, hastaya oral fosfat ve kalsitriol tedavisi başlandı. Ancak tedavi başlandıktan sonra Ca düzeyleri düzelmesine rağmen, P düzeyleri yaklaşık 2 mg/dl düzeylerinde seyretti. Tedavi başlandıktan bir yıl sonra sağ ayak birinci parmağında ülser gelişmesi üzerine, bu lezyon eksize edildi ve patoloji sonucu “ekstraskeletal miksoid kondrosarkom” olarak raporlandı. Tümörün eksizyonu sonrasında Ca ve P değerleri tamamen normale geldi. GIST ve tiroid CA ile TİO gözlenmesi genellikle beklenilen bir durum değildir. Nitekim hipofosfatemi sebebi olarak, hastamızda üçüncü primer tümöre bağlı olarak gelişmiş bir TİO tespit edildi. Üçüncü primer tümöre bağlı olarak gelişen TİO bildiğimiz kadarıyla literatürde ilk ve tek olgudur. Eğer hastada halihazırda primer bir tümör var ve bu tümör TİO’ye sık neden olan tümörlerden değilse, başka bir primer tümör odağının olup olmadığı dikkatle araştırılmalıdır.
