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Öğe Amiodarone induced thyrotoxicosis may not respond to therapeutic plasma exchange like patients with graves' disease: A report of two cases and literature review(2019) Yıldız, İsmail; Elbüken, Gülşah; Atasever, Tugay; Gürdal, Sibel Özkan; Zuhur, Sayid ShafiThe achievement of euthyroid state has been suggested in patients with thyrotoxicosis undergoing surgery to reduce the risk of thyroid storm. However, euthyroid state could not always be achieved by antithyroid drugs. Therefore, therapeutic plasma exchange (TPE) is an option in this condition. A 58-year-old male patient with a history of type-2 diabetes using 200 mg amiodarone per day, admitted for diabetic ketoacidosis (DKA), induced by thyrotoxicosis. with palpitation, sweating, polyuria, and polydipsia. Euthyroid state could not be achieved, despite all apropriate treatments for thyrotoxicosis. Therefore, preparation with TPE followed by total thyroidectomy was planned. A 35% decrease in fT3 (free T3) and fT4 (free T4) levels were achieved, after two sessions of TPE. A 74-year-old male patient, admitted for acute anterior myocardial infarction (AMI) induced by thyrotoxicosis due to Graves’ disease. Multiple vessel disease was detected on primer percutanous coronary angiography, and an emergency coronary artery bypass grafting (CABG) was planned. Therefore, preperation with TPE was planned before surgery. A substential decrease in fT4 and fT3 levels (45% and 72%, respectively) levels were achieved, after one session of TPE. Most of the studies evaluating the efficacy of TPE in patients with thyrotoxicosis are including patients with Graves’ disease and toxic multinodular goiter, and TPE was indicated as an effective option for preparation of these patients for surgery. However, as presented in case 1, TPE may not be effective in amiodarone induced thyrotoxicosis (AIT) as in cases with thyrotoxicosis due to Graves’ disease.Öğe Assessment of Metabolic Syndrome Components in Patients with Normocalcemic Hyperparathyroidism: A Retrospective Study(Aves, 2023) Baykut, Osman Alp; Elbüken, Gülşah; Tokuç, Burcu; Zuhur, Sayid ShafiObjective: Normocalcemic hyperparathyroidism is characterized by elevated parathormone levels persisting for 3 months or longer despite normal serum Ca levels. This study aimed to retrospectively compare the prevalence of individual metabolic syndrome components between patients with nor-mocalcemic hyperparathyroidism and an age-and sex-matched control group.Methods: Data of 82 normocalcemic hyperparathyroidism patients and 80 control subjects with nor-mal parathormone and calcium levels were reviewed retrospectively. Those meeting 3 or more of the 2001 metabolic syndrome diagnostic criteria of the US National Cholesterol Education Program Adult Treatment Panel III were considered as having metabolic syndrome. Also, Turkish waist circumfer-ence cutoff values were used to identify abdominal obesity and to estimate the metabolic syndrome frequency.Results: Considering that higher body mass index of normocalcemic patients would confound the analysis, analysis of covariance adjusted for body mass index was used to compare the groups, which showed increased waist circumference, waist/hip ratio, parathormone, 25 OH vitamin D3, fasting plasma glucose, and total cholesterol and low-density lipop rotei n-cho leste rol levels in normocal-cemic hyperparathyroidism patients than controls. The prevalence of metabolic syndrome among normocalcemic hyperparathyroidism patients was 32.9% (22.5% in controls) using the National Cholesterol Education Program Adult Treatment Panel III criteria versus 34.1% (23.8% in controls) using the Turkish waist circumference cutoff values.Conclusion: The percentage of patients meeting the metabolic syndrome criteria was higher com-pared to the control group. Even in the case of normocalcemic hyperparathyroidism, which is con-sidered to be a milder condition, the prevalence of metabolic syndrome was relatively higher than in the control group, suggesting that normocalcemic hyperparathyroidism may be a cardiovascular risk factor by predisposing to metabolic syndrome.Öğe B-mode ultrasound assessment of carotid artery structural features in patients with normocalcaemic hyperparathyroidism(Via Medica, 2023) Elbüken, Gülşah; Aydın, Cihan; Öztürk, Beyza Olcay; Aykaç, Hüseyin; Topçu, Birol; Zuhur, Sayid ShafiIntroduction: Normocalcaemic hyperparathyroidism is a condition first defined in 2008, characterized by normal se- rum calcium and high parathormone levels. Although normocalcaemic hyperparathyroidism is considered to have a milder clinical picture compared to asymptomatic primary hyperparathyroidism, recent studies have shown that it may be associated with osteoporosis, insulin resistance, metabolic syndrome, and cardiovascular risk factors. Considering that normo- calcaemic hyperparathyroidism may pose a cardiovascular risk in the setting of carotid atherosclerosis, we sought to examine the structural features of the carotid artery in patients with normocalcaemic hyperparathyroidism compared to a control group. Material and Methods: After excluding patients with hypertension, diabetes, and dyslipidaemia (other factors contributing to atheroscle- rosis), 37 (32 females, 5 males) patients with normocalcaemic hyperparathyroidism with a mean age of 51.2 +/- 8 (min: 32, max: 66) years and 40 controls (31 females, 9 males) with a mean age of 49.3 +/- 7.5 (min: 34, max: 64) years with normal serum albumin-corrected calcium and parathyroid hormone levels were included in the study. Structural features of the carotid artery including intima-media thickness (mean and maximum), lumen diameter, and the presence of plaque were assessed using B-mode ultrasound. Results: On ANCOVA analysis corrected for atherosclerotic factors (body mass index, waist circumference, fasting plasma glucose, serum cholesterol, lipid, and blood pressure), greater mean intima-media thickness was found in patients with normocalcaemic hyperparathyroidism than in controls (0.65 mm vs. 0.59 mm, respectively) (p = 0.023). Maximum ca- rotid intima-media thickness was also greater in patients with normocalcaemic hyperparathyroidism compared to controls (0.80 mm vs. 0.75 mm, respectively) (p = 0.044). The study groups did not show a significant difference in lumen diameter and the presence of carotid plaque. In addition, a negative correlation was found between parathormone (PTH) level and lumen diameter. Conclusion: The findings of this study show that as with asymptomatic primary hyperparathyroidism, normocalcaemic hyperparathy- roidism may be associated with increased cardiovascular risk by predisposing to atherosclerosis. (Endokrynol Pol 2023; 74 (1): 67-73)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 Diabetes Risk Assessment and Awareness in a University Academics and Employees(Kare Publ, 2021) Yıldız, Tülin; Zuhur, Senay; Zuhur, Sayid ShafiObjectives: Screening of the community for diabetes is generally costly and imposes a significant financial burden. Therefore, some non-invasive measures such as the Finnish Diabetes Risk Score (FINDRISK) Scale have been developed and are generally recommended for screening of people, particularly those with a high risk of diabetes. However, the screening of the university employees including academics with FINDRISK scale has not been performed so far. Therefore, in this study, we intended to assess the risk of diabetes by FINDRISC among the academics and other employees of a university as well as to make diabetes awareness among them. Methods: 442 subjects were included in this study. Diabetes awareness meetingswere organized, posters with awareness themes were displayed and brochures were distributed to academics and employees of our university. The FINDRISK was used for diabetes risk assessment. Participants' height, weight, waist circumference, and body mass indexes were measured and were recorded. Results: The mean age of the participants was 36.76 +/- 9.05. About 62%, 67%, and 32% of the participants were females, married, and academic staff, respectively. The mean waist circumference and body mass index of the participants were 84.71 +/- 14.49 cm and 26.8 +/- 4.91 kg/m2, respectively, and the median FINDRISK score was 7 (3-10). The 10-year risk of developing diabetes, assessed by FINDRISK score was very high and high, moderate, mild, and low in 8, 10.6, 32.4, and 43.9% of the participants, respectively. Significant differences were found between FINDRISK scores according to gender, age, marital status, smoking status, and occupational positions of the participants (p<0.001 for all parameters). However, the FINDRISK scores of the academics were significantly higher than in other groups. Conclusion: Our study results suggest that the 10-year risk of developing diabetes is higher in academics compared to the other employees. Therefore, to raise awareness among people, diabetes prevention training is of paramount importance, regardless of the education levels of the people, to prevent or delay the development of diabetes.Öğe Disease-free survival and the prognostic factors affecting disease-free survival in patients with medullary thyroid carcinoma: a multicenter cohort study(Springer, 2024) Zuhur, Sayid Shafi; Ozturk, Beyza Olcay; Keskin, Umran; Uysal, Serhat; Hacioglu, Aysa; Avci, Ugur; Karsli, SedaPurpose Despite several factors that may have been associated with poor disease-free survival (DFS) in patients with medullary thyroid carcinoma (MTC), only a few studies have evaluated the prognostic factors affecting DFS in MTC patients. Therefore, this study evaluated the prognostic factors affecting DFS, in a large number of patients with MTC. Methods Patients treated for MTC were retrospectively analyzed. Patients were stratified as having persistent/recurrent disease and no evidence of disease (NOD) at the last follow-up. The factors affecting DFS after the initial therapy and during the follow-up period were investigated. Results This study comprised 257 patients [females 160 (62.3%), hereditary disease 48 (18.7%), with a mean follow-up time of 66.8 +/- 48.5 months]. Persistent/recurrent disease and NOD were observed in 131 (51%) and 126 (49%) patients, respectively. In multivariate analysis, age > 55 (HR: 1.65, p = 0.033), distant metastasis (HR: 2.41, p = 0.035), CTN doubling time (HR: 2.7, p = 0.031), and stage III vs. stage II disease (HR 3.02, p = 0.048) were independent predictors of persistent/recurrent disease. Although 9 (8%) patients with an excellent response after the initial therapy experienced a structural recurrence, the absence of an excellent response was the strongest predictor of persistent/recurrent disease (HR: 5.74, p < 0.001). Conclusions The absence of an excellent response after initial therapy is the strongest predictor of a worse DFS. However, a significant proportion of patients who achieve an excellent response could experience a structural recurrence. Therefore, careful follow-up of patients, including those achieving an excellent response is essential.Öğe Do Histologically Aggressive Subtypes of Papillary Thyroid Microcarcinoma have Worse Clinical Outcome than Non-Aggressive Papillary Thyroid Microcarcinoma Subtypes? A Multicenter Cohort Study(Georg Thieme Verlag Kg, 2023) Zuhur, Sayid Shafi; Aggul, Hunkar; Avci, Ugur; Erol, Selvinaz; Tuna, Mazhar Muslum; Uysal, Serhat; Akbaba, GulhanHistologically aggressive micropapillary thyroid carcinomas (PTMC) subtypes are thought to be associated with an aggressive clinical course. However, evidence for unfavorable clinical outcomes in patients with aggressive PTMC subtypes is not clear. In this study, we intended to determine the difference in clinical outcomes between patients with aggressive and non-aggressive PTMC subtypes. In this multicenter cohort study, the computer-recorded clinical and histopathological data of patients who underwent thyroid surgery between January 2000 - January 2021 in 9 referral centers and were diagnosed as PTMC were analyzed. A total of 1585 patients [female 1340 (84.5%), male 245 (15.5%), mean age 47.9 +/- 11.63 years), with a mean follow-up time of 66.55 +/- 37.16 months], were included in the study. Ninety-eight cases were diagnosed as aggressive and 1487 as non-aggressive subtypes. Persistent/recurrent disease was observed in 33 (33.7% )and 41 (2.8%) patients with aggressive and non-aggressive subtypes (p < 0.001). Diseases-free survival rates were markedly lower in patients with aggressive than in those with non-aggressive PTMC subtypes (66.3 vs. 94.8%, log-rank p < 0.001). Moreover, in multivariate analysis, aggressive histology was an independent predictor of persistent/recurrent disease, after controlling for other contributing factors (HR 5.78, 95% CI 3.32-10, p < 0.001). Patients with aggressive PTMC subtypes had higher rates of incomplete biochemical and structural response than patients with non-aggressive subtypes as well (p < 0.001). Aggressive PTMC subtypes share many characteristics with histologically identical tumors > 1 cm in size. Therefore, the histopathological subtype of PTMC should be taken into consideration to tailor a personalized management plan.Öğe Evaluation of type 1 diabetic patients: A single center experience(2021) Elbüken, Gülşah; Yıldız, Resul; Yıldız, İsmail; Zuhur, Sayid ShafiWe evaluated patients diagnosed with type 1 DM who were followed at our clinic by conducting a retrospective chart review. Medical records of a total of 147 patientswith type 1 DM (70 females, 77 males) with a mean (±SD) age of 31.2±9.7 years were reviewed retrospectively. The study patients had a mean duration of follow-up of13.9±9.5 years, mean duration of follow-up of 4±2.6 years at our clinic and a mean HbA1c value of 8.3±2.1%. Microvascular complications were recorded in medicalfiles for 128 patients. There were 48 (37.5%) patients with at least one microvascular complication. Medical records showed that out of 128 patients, 23 (18%) had diabeticneuropathy alone, 4(3%) had diabetic retinopathy alone and 5 (4%) had diabetic nephropathy alone. Ten patients (8%) had both diabetic nephropathy and diabeticretinopathy and 6 (4.7%) patients had all three microvascular complications. No significant difference was observed between patients with or without microvascularcomplications in terms of HbA1c (HbA1c 8.3% versus 8.1%; p=0.85). A history of diabetic foot ulcer was present in 4 patients in the study sample (4/147=2.7% of allpatients).Twenty-two (15%) patients were on insulin pump therapy during follow-up. Insulin pump users had a significantly lower HbA1c value (7.9%) compared to thosenot using insulin pump (8.5%) (p=0.02). At our clinic, special efforts are being made to ensure type 1 diabetic individuals have regular outpatient examinations. Despiteall these measures, our patients are still far from reaching their target HbA1c values, suggesting that we have to do much more help patients achieve their glycemic goals.Öğe Expression of voltage gated potassium channel ether a go-go in pituitary adenomas of patients with acromegaly: A preliminary study(Maghira & Maas Publications, 2015) Zuhur, Sayid Shafi; Özkayalar, Hanife; Kuzu, İdris; Öztürk, Feyza Yener; Elbüken, Gülşah; Tanık, Canan; Altuntaş, YükselOBJECTIVE: To determine immunohistochemical expression of Eag1 in pituitary adenomas of patients with acromegaly and to assess the correlation between Eag1 expression with cavernous sinus invasion, tumoral Ki-67 labeling index (LI), age and gender of the patients. METHODS: The paraffin embedded pituitary adenoma tissue sections of 28 patients with acromegaly who were diagnosed as monohormonal growth hormone (GH) secreting adenomas were immunostained for Eag1 using the avidin-biotin-peroxidase complex method. Eag1 immunoreactivity was scored according to the extensity of the cytoplasm and cell membrane immunoreactivity for Eag1 (score 1 = <10%, score 2 = 10-25%, score 3 = 25-50% and score 4 = >50% of the adenoma cells showed immunoreactivity for Eag1, respectively). RESULTS: Overall, GH secreting pituitary adenomas displayed diverse levels of Eag1 immunoreactivity, however, 64% of the adenomas displayed a strong Eag1 immunoreactivity (score 3 and 4). Five of the tumors displayed Eag1 immunoreactivity score 1, 5 displayed score 2, 10 displayed score 3 and 8 displayed score 4, respectively. No correlation was found between Eag1 immunoreactivity with cavernous sinus invasion, Ki-67 LI, age and gender of the patients. CONCLUSIONS: Our results suggest Eag1 is strongly expressed in the majority of GH secreting pituitary adenomas. However, we could not find any correlation between immunoreactivity of Eag1 with cavernous sinus invasion, Ki-67 LI, age and gender of the patients. Further studies with larger sample sizes are required to demonstrate the role of Eag1 on tumorigenesis, angiogenesis, invasion and response to the treatment in GH secreting pituitary adenomas.Öğe External Validation of the GREAT Score in Turkish Patients with Graves' Hyperthyroidism Treated with the Titration Regimen Method of Antithyroid Drugs: A Multicenter Study(Georg Thieme Verlag Kg, 2019) Zuhur, Sayid Shafi; Elbüken, Gülşah; Yıldız, İsmail; Kadıoğlu, Pınar; Erol, Selvinaz; Şahin, Serdar; Altuntaş, YükselRecently, the Graves & apos; Recurrent Events After Therapy score (GREAT) was proposed as a useful tool to predict relapse before starting antithyroid drugs (ATD) in patients with Graves & apos; disease (GD). Therefore, we intended to assess the validity of the GREAT score in Turkish patients with GD, including patients who experienced a poorly controlled disease (multiple episodes of hyperthyroidism followed by euthyroidism or rarely hypothyroidism) during ATD dose titration. This is a retrospective multicenter study including 517 patients with the first episode of GD who were treated for at least 12 months. The patients were classified as relapse+poorly controlled disease (non-remission) and remission groups. During a median follow-up time of 35 months (12-144 months), 191 (37%) patients experienced a relapse, 136 (26.3%) a poorly controlled disease, and 190 (36.7%) remained in remission. Patients with non-remission disease tended to have significantly higher serum levels of TRAb, fT4, and fT3, and have larger goiter sizes on palpation at baseline, as compared with the remission group. Non-remission disease occurred in 12, 35, and, 53% of the patients falling into GREAT class I, II, and III, respectively (hazard ratio 2.56, 95% CI 2.02-3.51, p=0.012, and hazard ratio 3.54, 95% CI 2.12-5.91, p<0.001, for GREAT class II and III against class I, respectively). According to our study, the GREAT score is a useful tool to predict the risk of relapse as well as the occurrence of poorly controlled disease before starting treatment with ATDs.Öğe Is Biochemical Assessment of Pheochromocytoma Necessary in Adrenal Incidentalomas with Magnetic Resonance Imaging Features Not Suggestive of Pheochromocytoma?(Amer Assoc Clinical Endocrinologists, 2016) Kuzu, İdris; Zuhur, Sayid Shafi; Özel, Alper; Öztürk, Feyza Yener; Altuntaş, YükselObjective: Currently, it is unclear whether pheochromocytomas can be ruled out based on low intensity on T2-weighted sequences and signal loss on out-of-phase magnetic resonance imaging (MRI) sequences. Hence, in this study, we investigated whether biochemical screening for pheochromocytoma in patients with adrenal incidentalomas (AIs) showing MRI features not suggesting pheochromocytoma would prove beneficial. Methods: We performed MRI for 300 AIs in 278 consecutive patients. All patients were screened for pheochromocytoma with plasma metanephrine and normetanephrine. Patients with high plasma levels of metanephrine and/or normetanephrine were also assessed for pheochromocytoma by urinary metanephrines. Results: Hyperintensity was detected on T2-weighted MRI sequences in 28 (9.3%) of the 300 AIs. Among these 28 incidentalomas, pheochromocytoma was diagnosed in 13 (46.4%) of the cases by histopathologic analysis. Hyperintensity on T2-weighted MRI was significantly higher in pheochromocytomas compared to the remaining AIs (P<.001). All 13 pheochromocytomas were characterized by hyperintensity on T2-weighted sequences and the absence of signal loss on out-of-phase MRI sequences. Pheochromocytoma was not detected in any of the 272 AIs that appeared hypointense or isointense on T2-weighted MRI sequences or in the 250 cases with signal loss on outof- phase sequences. Conclusion: The results of this study suggest that AIs that appear hypointense or isointense on T2-weighted MRI sequences and those with signal loss on out-of-phase sequences may not require routine biochemical screening for pheochromocytoma. Further studies including a higher number of pheochromocytomas are required to confirm our results.Öğe Relationship Among Pulmonary Hypertension, Autoimmunity, Thyroid Hormones and Dyspnea in Patients With Hyperthyroidism(Elsevier Science Inc, 2017) Zuhur, Sayid Shafi; Baykız, Derya; Kara, Sonat Pınar; Şahin, Ertan; Kuzu, İdris; Elbüken, GülşahObjective: Previous studies have reported conflicting results regarding the mechanisms underlying the pathophysiology of pulmonary hypertension (PHT) in patients with hyperthyroidism. Therefore, in this study, we investigated the association between PHT and thyroid-stimulating hormone (TSH) receptor antibody, thyroid peroxidase antibody, thyroglobulin antibody, TSH, fT3, fT4 and dyspnea during daily activities in a large population of patients with hyperthyroidism. Methods: A total of 129 consecutive patients with hyperthyroidism, 37 with hypothyroidism and 38 euthyroid controls were enrolled in this study. The modified medical research council scale was used for the assessment of dyspnea in daily activities. All the patients and euthyroid controls underwent transthoracic echocardiography for the assessment of PHT. Results: Mild PHT was present in 35%, 36%, 13.5% and 5% of the patients with Graves' disease, toxic multinodular goiter, hypothyroidism and euthyroid controls, respectively. Pulmonary vascular resistance (PVR) was higher in hyperthyroid patients with PHT than in those without PHT. Moreover, a significant positive correlation was found between modified medical research council scale and pulmonary artery systolic pressure as well as PVR in patients with hyperthyroidism. No association was found between PHT and serum TSH receptor antibody, thyroid peroxidase antibody, thyroglobulin antibody, TSH, fT3 and fT4 levels. Conclusions: Mild PHT is present in a significant proportion of patients with hyperthyroidism, regardless of etiology. PVR appears to be the main cause of PHT in patients with hyperthyroidism, and neither autoimmunity nor thyroid hormones are associated with PHT in these patients. Mild dyspnea during daily activities in patients with hyperthyroidism may be related to PHI; however, severe dyspnea requires further evaluation.Öğe Relationship between Empty Sella Syndrome and Hashimoto's Thyroiditis(Galenos Yayincilik, 2016) Kuzu, İdris; Zuhur, Sayid Shafi; Özel, Alper; Ojalvo, David; Öztürk, Feyza Yener; Altuntaş, YükselPurpose: It is not clear if Hashimoto's thyroiditis leads to Empty sella syndrome. In the present study, we aimed to investigate if Hashimoto's thyroiditis was associated with Empty sella syndrome, and Hashimoto's thyroiditis was a secondary cause od some cases of primary Empty sella syndrome. Material and Method: Eighty-one patients who were diagnosed with primary Empty sella syndrome were included in the study. All patients underwent thyroid ultrasonography and biochemical tests for thyroid-stimulating hormone, free triiodothyronine, free thyroxine, anti thyroid peroxidase, anti thyroglobulin, follicle stimulating hormone, luteinizing hormone, 17 beta estradiol, growth hormone, insulin-like growth factor 1, adrenocorticotropic hormone and total testosterone for Hashimoto's thyroiditis and pituitary hormone deficiency. Results: Out of 81 patients, thyroid disease was diagnosed in 34 (42%) patients; 18 of them had Hashimoto's thyroiditis (22.2%) and 16 (19.8%) had central hypothyroidism. Among Hashimoto's thyroiditis patients, 11 (13.6%) had hypothyroidism and 7 (8.6%) were euthyroid. Discussion: In conclusion, it is possible that some cases of primary Empty sella syndrome are caused by Hashimoto's thyroiditis. It is recommended that the presence of Hashimoto's thyroiditis should be investigated in patients with primary Empty sella syndrome. Further studies investigating anti-pituitary antibody in patients with primary Empty sella syndrome, are needed to further declare this relationship.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 The diagnostic value of late-night salivary cortisol for diagnosis of subclinical Cushing's syndrome(Via Medica, 2016) Kuzu, İdris; Zuhur, Sayid Shafi; Demir, Nazan; Aktaş, Gökce; Öztürk, Feyza Yener; Altuntaş, YükselIntroduction: Late-night salivary cortisol is a frequently used and easily implemented diagnostically valuable test for the diagnosis of overt Cushing's syndrome. The use of late-night salivary cortisol in the diagnosis of subclinical Cushing's syndrome is somewhat controversial. In this study, we aimed to determine the diagnostic value of late-night salivary cortisol in diagnosing subclinical Cushing's syndrome and compare it with 24-hour urinary free cortisol levels (UFC). Material and methods: The study consisted of 33 cases of subclinical Cushing's syndrome, 59 cases of non-functioning adrenal adenoma, and 41 control subjects. Late-night salivary cortisol and UFC were measured in all the cases. The diagnosis of subclinical Cushing's syndrome was based on combined results of 1 mg dexamethasone suppression test > 1.8 mu g/dL and ACTH < 10 pg/mL. Results: Mean late-night salivary cortisol levels in subjects with subclinical Cushing's syndrome were significantly higher than in subjects with non-functioning adrenal adenoma and the control group (p < 0.001). Using a cut-off value of 0.18 mu g/dL, the sensitivity and specificity of late-night salivary cortisol for diagnosing subclinical Cushing's syndrome were determined as 82% and 60%, respectively. Using a cut-off value of 137 mu g/day, the sensitivity and specificity of UFC was determined as 18% and 90%, respectively. Conclusions: Because the sensitivity of late-night salivary cortisol for the diagnosis of subclinical Cushing's syndrome is limited, using it as the sole screening test for subclinical Cushing's syndrome may lead to false negative results. However, using it as an adjunct test to other tests may be beneficial in the diagnosis of subclinical Cushing's syndrome.Öğe The effect of gender on response to antithyroid drugs and risk of relapse after discontinuation of the antithyroid drugs in patients with Graves' hyperthyroidism: a multicentre study(Via Medica, 2020) Zuhur, Sayid Shafi; Yıldız, İsmail; Altuntaş, Yüksel; Bayraktaroğlu, Taner; Erol, Selvinaz; Şahin, Serdar; Kadıoğlu, Pınar; Elbüken, Gülşah; Topçu, BirolIntroduction: The outcome of medical treatment in patients with Graves' disease (GD) is generally difficult to predict. In this study, we examined the hypothesis that gender may affect the outcome of treatment with antithyroid drugs (ATDs). Material and methods: This is a retrospective multicentre study including 717 (514 female and 203 male) patients with the first episode of GD treated for at least 12 months. Patients were classified as relapse, poorly controlled (several episodes of hyperthyroidism followed by euthyroidism and rarely hypothyroidism, occurring after titration of ATDs), and remission. Results: During the mean follow-up time of 26.75 +/- 21.25 months (between 1 and 120 months), 269 (37.5%),176 (24.5%), and 272 (37.9%) patients experienced a relapse, a poorly controlled disease, and remained in remission, respectively. During the follow-up time, 223 (43.4%) of the female and only 49 (24%) of the male patients remained in remission. Relapse and poorly controlled disease (non-remitting GD) were more common in male compared to female patients with GD (hazard ratio 1.26, 95% CI: 1.03-133, p - 0.025). Graves' disease in male patients tended to relapse earlier, and male patients tended to have larger goiter sizes at diagnosis as well. The smoking habit was also significantly inure frequent in males compared to female patients with GD. Conclusion: Male patients with GD have a markedly higher frequency of relapse and poorly controlled disease, as compared to female patients. Larger goiter sizes and higher frequency of smoking may contribute to the higher frequency of relapse and poorly controlled disease in male patients.Öğe THE EFFECT OF VITAMIN-D ON THE DIABETIC RETHINOPATHY(Carbone Editore, 2022) Erol, R. Selvinaz; Zuhur, Sayid Shafi; Öztürk, F. Yener; Şen, Esra Çil; Yıldız, Ayşegül Mavi; Canat, M. Masum; Erol, M. KazımBackground: To determine the relationship between grade of diabetic retinopathy and serum vitamin D levels in diabetic Methods: The study included a total of 173 diabetic patients consisting of patients without retinopathy ( n=67), patients with non proliferative diabetic retinopathy (NPDRP group n=47), patients with proliferative diabetic retinopathy (PDRP group n=59). Age and sex-matched 55 healthy subjects was taken as a control group. Patients with type 1 DM, those taking vitamin D, multivitamin including vitamin D, drug affecting vitamin D metabolism like rifampin, phenytoin was excluded from the study. Patients with chronic renal failure was also excluded. Dilated fundoscopic examination of all subject was done and serum creatinine, Hb A1c, 25 hydroxyvitamin D (25 (OH) D) level of all subject were measured between may 2012 and September 2012 Results: There were no statistical difference in age, sex, systolic tension, diastolic tension and body mass index between groups. Serum creatinine level was also not statistically different between groups (p = 0.11). Serum fasting glucose and HbA1c level were significantly lower in the control group than diabetic groups (p < 0.001). The mean 25 (OH)D levels of PDRP group, NPDRP group, diabetic patients without retinopathy and control group were 11,9 +/- 6,4 ng/ml, 18,8 +/- 10,2 ng/ml, 16,6 +/- 7,5 ng/ml and 20,1 +/- 9,2 ng/ml respectively. There was statistically significant difference between the PDRP group and other groups in univariate analysis (p < 0.001). When 173 diabetic patients, were compared, with control group, 25 (OH) D levels were significantly lower in diabetic patients than control group regardless of retinopathy status (p = 0.004). Conclusions: Diabetic patients especially, patients with proliferative diabetic retinopathy had lower serum vitamin D levels than healthy subjects. Additionally randomized, controlled, prospective studies are necessary to determine whether vitamin D treatment will stop or slow the progression of diabetic retinopathy in diabetic patients.Öğe The frequency of Cushing's disease, ACTH-independent Cushing's syndrome and autonomous cortisol secretion among Turkish patients with obesity(Kare Publ, 2020) Atar, Resit Volkan; Yıldız, İsmail; Topçu, Birol; Elbüken, Gülşah; Zuhur, Sayid ShafiOBJECTIVE: The frequency of Cushing's disease (CD), ACTH-independent Cushing's syndrome (CS) and autonomous cortisol secretion (ACS) in patients with obesity is not well known. Therefore, in the present study, we aimed to assess the frequency of CD, CS and ACS among the patients with obesity. METHODS: This study included 813 patients (683 female, mean age 46.47 +/- 14.23 yr; mean body mass index (BMI) 37.31 +/- 6.50 kg/m(2)). Patients with obesity were classified further to stages 1, 2, and 3, according to BMI. All patients underwent a low dose dexamethasone suppression test (LDDST). The patients with CD, CS, and ACS and patients with simple obesity were compared concerning gender, age, type-2 diabetes, hypertension (HT) and hyperlipidemia (HL). RESULTS: Forty-four (5.4%) out of 813 patients were diagnosed as CD, CS or ACS. CD, CS, and ACS were diagnosed in four (0.4%), two (0.2%), and 33 (4%) patients, respectively. When patients with CD, CS and ACS were compared to the patients with simple obesity, older age at diagnosis, the presence of stage-1 obesity, the presence of HT, and uncontrolled type-2 diabetes were more frequent in patients with CD, CS and ACS (p=0.001, p=0.007, p=0.004, and p=0.0026, respectively). CONCLUSION: The frequency of CD, CS, and ACS is high among patients with obesity. Screening for CD, CS, and ACS in patients with stage-I obesity who are older than 50 years of age with uncontrolled type-2 diabetes and HT may be a reasonable approach.Öğe The impact of microscopic extrathyroidal extension on the clinical outcome of classic subtype papillary thyroid microcarcinoma: a multicenter study(Springer, 2024) Zuhur, Sayid Shafi; Aggul, Hunkar; Avci, Ugur; Erol, Selvinaz; Tuna, Mazhar Muslum; Uysal, Serhat; Akbaba, GulhanObjectives Despite the presumed overdiagnosis of papillary thyroid microcarcinoma (PTMC) which has resulted in a new trend toward less-extensive surgery and a preference for active surveillance, the impact of microscopic extrathyroidal extension (mETE) on the clinical outcomes of PTMC is still controversial. This study assessed the impact of mETE on the clinical outcomes of patients with classic subtype PTMC. Methods The data of consecutive patients who underwent thyroidectomy and were histopathologically diagnosed as classic subtype PTMC were analyzed. Cox's proportional hazards model was used to assess the impact of contributing variables on persistent/recurrent disease. Disease-free survival was estimated using the Kaplan-Meier method. Results This study included 1013 patients (84% females), with a mean follow-up period of 62.5 +/- 35.3 months. Patients with mETE had a significantly higher rate of locoregional persistent/recurrent disease than patients without mETE (9.8% vs 2.1%, p < 0.001). The disease-free survival rate was significantly lower in patients with mETE than in those without (90.2% vs 97%, Log-Rank p < 0.001). Furthermore, mETE and neck lymph node involvement were independent predictors of persistent/recurrent disease in multivariate analysis (HR: 2.43, 95% CI:1.02-5.81, p = 0.043; HR: 4.38, 95% CI: 1.7-11.2, p = 0.002, respectively). Conclusions In patients with the classic subtype of PTMC, mETE is an independent predictor of persistent/recurrent disease and is associated with a lower DFS rate. However, neck lymph node involvement is the strongest predictor of persistent/recurrent disease. Therefore, PTMCs with mETE and neck lymph node involvement are at a higher risk of persistent/recurrent disease than individuals lacking both characteristics.Öğe The Role of Endoscopic Ultrasonography for Localization of Insulinomas without a Pancreatic Lesion on Magnetic Resonance Imaging: A Short Series and Literature Review(Galenos Yayincilik, 2015) Zuhur, Sayid Shafi; Kuzu, İdris; Öztürk, Feyza Yener; Erdamar, Sibel; Altuntaş, YükselInsulinoma is a rare neuroendocrine tumor of the pancreas and is the most common cause of endogenous hyperinsulinemic hypoglycemia. Although 90% of insulinomas are benign tumors, recurrent episodes of hypoglycemia may lead to life-threatening consequences. Since surgery is the only curative method for patients with insulinomas, the preoperative localization of these tumors by appropriate imaging methods is important. In this case series, we report 5 patients with endogenous hyperinsulinemic hypoglycemia, including one with MEN-1 syndrome, who were diagnosed with insulinoma according to the prolonged fasting test. All patients had normal pancreas on upper abdominal magnetic resonance imaging (MRI), therefore, they underwent endoscopic ultrasonography (EUS) for localization of the insulinomas and were operated according to the EUS results. EUS demonstrated well-demarcated tumors in the tail of the pancreas in 4 subjects and in the head of the pancreas in one patient. However, in contrast to EUS results, one patient with MEN-1 syndrome had a glucagonoma and two insulinomas and one patient had not any tumor on histopathological evaluation of the distal pancreas after surgery. In this case series, we aimed to present the diagnostic performance of EUS and the treatment outcomes in a cluster of patients with insulinomas who had not a pancreatic lesion on upper abdominal MRI and to briefly review the currently available imaging methods for localization of insulinomas.
