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Sezer H, Yazıcı D, Terzioğlu T, Tezelman S, Canbaz HB, Yerlikaya A, Demirkol MO, Kapran Y, Çolakoğlu B, Çilingiroğlu EN, Alagöl F. Early Post-operative Stimulated Serum Thyroglobulin: Role in Preventing Unnecessary Radioactive Iodine Treatment in Low to Intermediate Risk Papillary Thyroid Cancer. Am Surg 2023; 89:5996-6004. [PMID: 37309609 DOI: 10.1177/00031348231157816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM The aims of the study are to evaluate the predictive value of early post-operative stimulated thyroglobulin (sTg) analysis on the recurrence risk, and to define a cut-off value that is related to recurrence risk in low to intermediate risk papillary thyroid cancer (PTC). METHODS This retrospective cohort study included individuals who were diagnosed with PTC aged 18 years or older and had been operated by experienced surgeons of a tertiary university hospital between the years 2011 and 2021. The American Thyroid Association thyroid cancer guidelines version 2015 was used as the risk stratification system. Early sTg measurement obtained at 3-4 weeks after surgery when TSH >30 µIU/mL. Data was collected from the hospital database. A total of 328 patients who had post-operative early sTg values with negative anti-Tg antibodies were included. RESULTS The median age was 44 years. Of the 328 patients, 223 (68%) were women. The median tumor diameter was 11 mm. One hundred ninety-one patients (58.2%) had low risk and 137 (41.8%) had intermediate risk for recurrent disease. Of the 328 patients, 4.0% had recurrent disease. In multivariate Cox regression, post-operative early sTg value [OR: 1.070 (1.038-1.116), P = .000], and the pre-operative malign cytology [OR: 1.483 (1.080-2.245), P = .042] were independent risk factors for recurrence. On the ROC curve analysis, the cut-off value of early sTg was 4.1 ng/mL for those with recurrent disease. CONCLUSION This study demonstrated that early sTg could predict recurrent disease in patients with low to intermediate risk PTC. A cut-off of 4.1 ng/mL was identified with a high negative predictive value.
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Affiliation(s)
- Havva Sezer
- Department of Endocrinology and Medicine, Koç University, Istanbul, Turkey
| | - Dilek Yazıcı
- Department of Endocrinology and Medicine, Koç University, Istanbul, Turkey
| | - Tarık Terzioğlu
- Department of General Surgery, American Hospital, Istanbul, Turkey
| | - Serdar Tezelman
- Department of General Surgery, American Hospital, Istanbul, Turkey
| | | | - Aslıhan Yerlikaya
- Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, USA
| | | | - Yersu Kapran
- Department of Pathology, Koc University, Istanbul, Turkey
| | | | | | - Faruk Alagöl
- Department of Endocrinology and Medicine, Koç University, Istanbul, Turkey
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Batman A, Yazıcı D, Dikbaş O, Ağbaht K, Saygılı ES, Demirci İ, Bursa N, Ayas G, Anıl C, Cesur M, Korkmaz FN, Bahçecioglu AB, Çorapçıoğlu D, Erdoğan MF, Bostan H, Calapkulu M, Hepşen S, Uçan B, Çakal E, Güler BY, Haymana C, İpekçi SH, Aydın S, Sezer H, Özışık S, Deyneli O, Alagöl F, Tanakol R, Eroğlu M, Mutlu Ü, Hacışahinoğulları H, Üzüm AK, Demir C, Koç G, Fırat SN, Omma T, İnce N, Polat ŞB, Topaloğlu O, Aydın C, Çakır B, Bahadır ÇT, Güven M, Sözen M, Selek A, Cantürk Z, Çetinarslan B, Aydemir M, Taşkaldıran I, Bozkuş Y, İyidir ÖT, Haydardedeoğlu FE, Basmaz SE, Ünal MÇ, Demir T, Oğuz A, Çelik Ö, Yilmaz M, Cimsir A, Kayıhan S, Uc ZA, Tekin S, Topaloğlu Ö, Saydam BÖ, Ünsal YA, Özer Ö, Yorulmaz G, Uğur K, Çakır SD, Aşık M, Unubol M, Genc S, Andac B, Okur M, Dogan O, Karakiliç E, Kocabas GU, Kirac CO, Cansu GB, Uygur MM, Pekkolay Z, Öztürk S, Güngüneş A, Gürkan E, Keskin L, Çağlayan K, Günay YE, İmre E, Şener SY, Kalkan AT, Gök DE, Şahin M. Subacute THYROiditis Related to SARS-CoV-2 VAccine and Covid-19 (THYROVAC Study): A Multicenter Nationwide Study. J Clin Endocrinol Metab 2023; 108:e1013-e1026. [PMID: 37186260 DOI: 10.1210/clinem/dgad235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
CONTEXT The aims of the study are to compare characteristics of subacute thyroiditis (SAT) related to different etiologies, and to identify predictors of recurrence of SAT and incident hypothyroidism. METHODS This nationwide, multicenter, retrospective cohort study included 53 endocrinology centers in Turkey. The study participants were divided into either COVID-19-related SAT (Cov-SAT), SARS-CoV-2 vaccine-related SAT (Vac-SAT), or control SAT (Cont-SAT) groups. RESULTS Of the 811 patients, 258 (31.8%) were included in the Vac-SAT group, 98 (12.1%) in the Cov-SAT group, and 455 (56.1%) in the Cont-SAT group. No difference was found between the groups with regard to laboratory and imaging findings. SAT etiology was not an independent predictor of recurrence or hypothyroidism. In the entire cohort, steroid therapy requirement and younger age were statistically significant predictors for SAT recurrence. C-reactive protein measured during SAT onset, female sex, absence of antithyroid peroxidase (TPO) positivity, and absence of steroid therapy were statistically significant predictors of incident (early) hypothyroidism, irrespective of SAT etiology. On the other hand, probable predictors of established hypothyroidism differed from that of incident hypothyroidism. CONCLUSION Since there is no difference in terms of follow-up parameters and outcomes, COVID-19- and SARS-CoV-2 vaccine-related SAT can be treated and followed up like classic SATs. Recurrence was determined by younger age and steroid therapy requirement. Steroid therapy independently predicts incident hypothyroidism that may sometimes be transient in overall SAT and is also associated with a lower risk of established hypothyroidism.
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Affiliation(s)
- Adnan Batman
- Department of Internal Medicine, Division of Endocrinology and Metabolism, School of Medicine, Koc University, 34010 Istanbul, Turkey
| | - Dilek Yazıcı
- Department of Internal Medicine, Division of Endocrinology and Metabolism, School of Medicine, Koc University, 34010 Istanbul, Turkey
| | - Oğuz Dikbaş
- Department of Endocrinology and Metabolism, Giresun University School of Medicine, 28200 Giresun, Turkey
| | - Kemal Ağbaht
- Department of Endocrinology and Metabolism, Defne Hospital, 31030 Hatay, Turkey
| | - Emre Sedar Saygılı
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Faculty of Medicine, Canakkale Onsekiz Mart University, 17020 Canakkale, Turkey
| | - İbrahim Demirci
- Department of Endocrinology and Metabolism, Gulhane Training and Research Hospital, University of Health Sciences Turkey, 06010 Ankara, Turkey
| | - Nurbanu Bursa
- Department of Statistics Beytepe, Hacettepe University, 06230 Ankara, Turkey
| | - Görkem Ayas
- School of Medicine, Koc University, 34450 Istanbul, Turkey
| | - Cüneyd Anıl
- Department of Endocrinology and Metabolic Diseases, Güven Hospital, 06540 Ankara, Turkey
| | - Mustafa Cesur
- Department of Endocrinology and Metabolic Diseases, Güven Hospital, 06540 Ankara, Turkey
| | - Fatma Nur Korkmaz
- Department of Endocrinology and Metabolism, Ankara University, School of Medicine, 06050 Ankara, Turkey
| | - Adile Begüm Bahçecioglu
- Department of Endocrinology and Metabolism, Ankara University, School of Medicine, 06050 Ankara, Turkey
| | - Demet Çorapçıoğlu
- Department of Endocrinology and Metabolism, Ankara University, School of Medicine, 06050 Ankara, Turkey
| | - Murat Faik Erdoğan
- Department of Endocrinology and Metabolism, Ankara University, School of Medicine, 06050 Ankara, Turkey
| | - Hayri Bostan
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey
| | - Murat Calapkulu
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey
| | - Sema Hepşen
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey
| | - Bekir Uçan
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey
| | - Erman Çakal
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey
| | - Bağdagül Yüksel Güler
- Department of Endocrinology and Metabolism, Gulhane Training and Research Hospital, University of Health Sciences Turkey, 06010 Ankara, Turkey
| | - Cem Haymana
- Department of Endocrinology and Metabolism, Gulhane Training and Research Hospital, University of Health Sciences Turkey, 06010 Ankara, Turkey
| | - Süleyman Hilmi İpekçi
- Department of Endocrinology, Hisar Intercontinental Hospital, 34768 Istanbul, Turkey
| | - Selami Aydın
- Department of Internal Medicine, Hisar Intercontinental Hospital, 34768 Istanbul, Turkey
| | - Havva Sezer
- Department of Internal Medicine, Division of Endocrinology and Metabolism, School of Medicine, Koc University, 34010 Istanbul, Turkey
| | - Seçil Özışık
- Department of Internal Medicine, Division of Endocrinology and Metabolism, School of Medicine, Koc University, 34010 Istanbul, Turkey
| | - Oğuzhan Deyneli
- Department of Internal Medicine, Division of Endocrinology and Metabolism, School of Medicine, Koc University, 34010 Istanbul, Turkey
| | - Faruk Alagöl
- Department of Endocrinology and Metabolism, VKV Amerikan Hospital-Koç University School of Medicine, 34365 Istanbul, Turkey
| | - Refik Tanakol
- Department of Endocrinology and Metabolism, VKV Amerikan Hospital-Koç University School of Medicine, 34365 Istanbul, Turkey
| | - Mustafa Eroğlu
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Balikesir University Faculty of Medicine, 10145 Balikesir, Turkey
| | - Ümmü Mutlu
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, Turkey
| | - Hülya Hacışahinoğulları
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, Turkey
| | - Ayşe Kubat Üzüm
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, Turkey
| | - Canan Demir
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Atilim University School of Medicine, 06830 Ankara, Turkey
| | - Gönül Koç
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Sevde Nur Fırat
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Tülay Omma
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Ankara Training and Reasearch Hospital, 06230 Ankara, Turkey
| | - Nurcan İnce
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara City Hospital, 06800 Ankara, Turkey
| | - Şefika Burçak Polat
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara City Hospital, 06800 Ankara, Turkey
| | - Oya Topaloğlu
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara City Hospital, 06800 Ankara, Turkey
| | - Cevdet Aydın
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara City Hospital, 06800 Ankara, Turkey
| | - Bekir Çakır
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara City Hospital, 06800 Ankara, Turkey
| | - Çiğdem Tura Bahadır
- Department of Endocrinology and Metabolism, Amasya University, School of Medicine, 05100 Amasya, Turkey
| | - Mehmet Güven
- Department of Endocrinology and Metabolism, Sirnak State Hospital, 73000 Sirnak, Turkey
| | - Mehmet Sözen
- Department of Endocrinology and Metabolism, Kocaeli University, School of Medicine, 41000 Kocaeli, Turkey
| | - Alev Selek
- Department of Endocrinology and Metabolism, Kocaeli University, School of Medicine, 41000 Kocaeli, Turkey
| | - Zeynep Cantürk
- Department of Endocrinology and Metabolism, Kocaeli University, School of Medicine, 41000 Kocaeli, Turkey
| | - Berrin Çetinarslan
- Department of Endocrinology and Metabolism, Kocaeli University, School of Medicine, 41000 Kocaeli, Turkey
| | - Mustafa Aydemir
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Akdeniz University, School of Medicine, 07050 Antalya, Turkey
| | - Işılay Taşkaldıran
- Department of Endocrinology and Metabolism, Faculty of Medicine, Baskent University, 06790 Ankara, Turkey
| | - Yusuf Bozkuş
- Department of Endocrinology and Metabolism, Faculty of Medicine, Baskent University, 06790 Ankara, Turkey
| | - Özlem Turhan İyidir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Baskent University, 06790 Ankara, Turkey
| | - Filiz Ekşi Haydardedeoğlu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Baskent University, 79097 Adana, Turkey
| | - Seda Erem Basmaz
- Department of Endocrinology and Metabolism, Kocaeli Derince Training and Research Hospital, 41900 Kocaeli, Turkey
| | - Mehmet Çağrı Ünal
- Department of Endocrinology and Metabolism, Faculty of Medicine, Dokuz Eylul University, 35330 Izmir, Turkey
| | - Tevfik Demir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Dokuz Eylul University, 35330 Izmir, Turkey
| | - Ayten Oğuz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Biruni University, 34295 Istanbul, Turkey
| | - Özlem Çelik
- Department of Endocrinology and Metabolism, Faculty of Medicine, Acıbadem University, 34752 Istanbul, Turkey
| | - Merve Yilmaz
- Department of Endocrinology and Metabolism, Samsun State Hospital, 55060 Samsun, Turkey
| | - Aykut Cimsir
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey
| | - Serdar Kayıhan
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey
| | - Ziynet Alphan Uc
- Department of Endocrinology and Metabolism, Usak University, Usak Training and Research Hospital, 64300 Usak, Turkey
| | - Sakin Tekin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Zonguldak Bulent Ecevit University, 67100 Zonguldak, Turkey
| | - Ömercan Topaloğlu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Zonguldak Bulent Ecevit University Obesity and Diabetes Practice and Research Center, 67100 Zonguldak, Turkey
| | - Başak Özgen Saydam
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Yenimahalle Training and Research Hospital, 06370 Ankara, Turkey
| | - Yasemin Aydoğan Ünsal
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Yenimahalle Training and Research Hospital, 06370 Ankara, Turkey
| | - Özge Özer
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Eskisehir Osmangazi University, 26040 Eskisehir, Turkey
| | - Göknur Yorulmaz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Eskisehir Osmangazi University, 26040 Eskisehir, Turkey
| | - Kader Uğur
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Fırat University, 23119 Elazıg, Turkey
| | - Sezin Doğan Çakır
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Istanbul Taksim Training and Research Hospital, 34433 Istanbul, Turkey
| | - Mehmet Aşık
- Endocrinologist, Private Office, Bodrum, 48400 Mugla, Turkey
| | - Mustafa Unubol
- Department of Endocrinology and Metabolism, School of Medicine, Adnan Menderes University, 09100 Aydin, Turkey
| | - Selin Genc
- Department of Endocrinology and Metabolism, School of Medicine, Inonu University, 44280 Malatya, Turkey
| | - Burak Andac
- Department of Endocrinology and Metabolism, School of Medicine, Trakya University, 22130 Edirne, Turkey
| | - Mine Okur
- Department of Endocrinology and Metabolism, School of Medicine, Trakya University, 22130 Edirne, Turkey
| | - Ozlem Dogan
- Department of Endocrinology and Metabolism, University of Health Sciences Turkey, Haseki Training and Research Hospital, 34096 Istanbul, Turkey
| | - Ersen Karakiliç
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Faculty of Medicine, Canakkale Onsekiz Mart University, 17020 Canakkale, Turkey
| | - Gokcen Unal Kocabas
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ege University, 35100 Izmir, Turkey
| | - Cem Onur Kirac
- Department of Endocrinology and Metabolism, Kahramanmaras Necip Fazil City Hospital, 46050 Kahramanmaras, Turkey
| | - Güven Barış Cansu
- Department of Endocrinology and Metabolism, School of Medicine, Kutahya University of Health Sciences, 43100 Kutahya, Turkey
| | - Meliha Melin Uygur
- Department of Endocrinology and Metabolism, School of Medicine, Marmara University, Pendik Training and Research Hospital, 34899 Istanbul, Turkey
| | - Zafer Pekkolay
- Department of Endocrinology and Metabolism, School of Medicine, Dicle University, 21100 Diyarbakir, Turkey
| | - Sadettin Öztürk
- Department of Endocrinology and Metabolism, School of Medicine, Gaziantep University, 27850 Gaziantep, Turkey
| | - Aşkın Güngüneş
- Department of Endocrinology and Metabolism, School of Medicine, Kırıkkale University, 71300 Kırıkkale, Turkey
| | - Eren Gürkan
- Department of Endocrinology and Metabolism, School of Medicine, Hatay Mustafa Kemal University, 31001 Hatay, Turkey
| | - Lezzan Keskin
- Department of Endocrinology and Metabolism, School of Medicine, Malatya Turgut Ozal University, Malatya Training and Research Hospital, 44000 Malatya, Turkey
| | - Kenan Çağlayan
- Department of Endocrinology and Metabolism, School of Medicine, Baskent University Istanbul Hospital, 34662 Istanbul, Turkey
| | - Yasemin Emur Günay
- Department of Endocrinology and Metabolism, School of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Eren İmre
- Department of Endocrinology and Metabolism, Dr Ersin Arslan Education and Research Hospital, 27010 Gaziantep, Turkey
| | - Selcuk Yusuf Şener
- Department of Endocrinology and Metabolism, Pendik Medikalpark Hospital, 34899 Istanbul, Turkey
| | - Ahmet Toygar Kalkan
- Department of Endocrinology and Metabolism, Kastamonu Research and Training Hospital, 37150 Kastamonu, Turkey
| | - Deniz Engin Gök
- Department of Endocrinology and Metabolism, Lokman Hekim Hospital, 06700 Ankara, Turkey
| | - Mustafa Şahin
- Department of Endocrinology and Metabolism, Ankara University, School of Medicine, 06050 Ankara, Turkey
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Sezer H, Bulut Canbaz H, Tezalman S, Terzioğlu T, Nur Çilingiroğlu E, Çolakoğlu B, Yazıcı D, Deyneli O, Demirkol MO, Batman A, Özışık S, Yapran Y, Alagöl F. Previous, simultaneous, or subsequent occurrence of malignant tumours in patients with primary hyperparathyroidism: a closer look at the single-tertiary-centre cases. Endokrynol Pol 2023:VM/OJS/J/94823. [PMID: 37577997 DOI: 10.5603/ep.a2023.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Our aims were to explore the relationship between primary hyperparathyroidism (pHPT) and malignant tumour development, to determine the frequency and the time of occurrence of malignant tumours in patients with pHPT, and to evaluate the characteristics of pHPT in these patients. MATERIAL AND METHODS This retrospective cohort study included consecutive individuals who were diagnosed with pHPT aged 18 years or older in a university hospital during a 7-year period. A total of 198 patients with pHPT were reviewed retrospectively. Demographic, clinical, biochemical, radiologic findings, and histopathological diagnosis were collected from the electronic medical records of the hospital system. RESULTS The mean age of the study population was 58 ± 13 years and was predominantly female (female/male: 162/36). There were 42 (21.2%) patients with malignant tumours. Five (12%) out of 42 patients had metachronous double malignancies. The most common 2 concurrent malignancies were breast (36.1%) and thyroid (17.0%). Sixty-eight per cent of the malignant tumours occurred before the diagnosis of pHPT. A higher percentage (87.5%) of simultaneous tumours was seen in the thyroid gland. No statistically significant differences were observed between patients with and without malignant tumours in terms of demographic, clinical, biochemical, radiological, and histopathological features. The median follow-up duration was 24 months after parathyroid surgery. CONCLUSION The results of this study revealed that pHPT was associated with various tumour types. The frequency of malignant tumours was 21.2%. Breast and thyroid cancers were the most common 2 cancers coexisting with pHPT. A large percentage of malignant tumours occurred before the diagnosis of pHPT. A higher percentage of simultaneous tumours was seen in the thyroid gland. pHPT patients with and without malignant tumours seemed to have similar characteristics.
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Affiliation(s)
- Havva Sezer
- Department of Internal Medicine, Division of Endocrinology, Koç University School of Medicine, Istanbul, Türkiye.
| | - Hande Bulut Canbaz
- Department of Medical Nursing, Koç University School of Nursing, Istanbul, Türkiye
| | - Serdar Tezalman
- Department of General Surgery, American Hospital, Istanbul, Türkiye
| | - Tarık Terzioğlu
- Department of General Surgery, American Hospital, Istanbul, Türkiye
| | - Eda Nur Çilingiroğlu
- Department of Medical Nursing, Koç University School of Nursing, Istanbul, Türkiye
| | | | - Dilek Yazıcı
- Department of Internal Medicine, Division of Endocrinology, Koç University School of Medicine, Istanbul, Türkiye
| | - Oğuzhan Deyneli
- Department of Internal Medicine, Division of Endocrinology, Koç University School of Medicine, Istanbul, Türkiye
| | - Mehmet Onur Demirkol
- Department of Nuclear Medicine, Koç University School of Medicine, Istanbul, Türkiye
| | - Adnan Batman
- Department of Internal Medicine, Division of Endocrinology, Koç University School of Medicine, Istanbul, Türkiye
| | - Seçil Özışık
- Department of Internal Medicine, Division of Endocrinology, Koç University School of Medicine, Istanbul, Türkiye
| | - Yersu Yapran
- Department of Pathology, Koç University School of Medicine, Istanbul, Türkiye
| | - Faruk Alagöl
- Department of Internal Medicine, Division of Endocrinology, Koç University School of Medicine, Istanbul, Türkiye
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Yazıcı D, Yapıcı Eser H, Kıyıcı S, Sancak S, Sezer H, Uygur M, Yumuk V. Clinical Impact of Glucagon-Like Peptide-1 Receptor Analogs on the Complications of Obesity. Obes Facts 2023; 16:149-163. [PMID: 36349778 PMCID: PMC10028372 DOI: 10.1159/000526808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/04/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Obesity is a chronic disease associated with increased morbidity and mortality due to its complications. The aims of obesity treatment are primarily to accomplish weight loss, and prevention or treatment of its complications. Lifestyle changes along with behavioral therapy constitute the first-line treatment of obesity followed by pharmacotherapy. Glucagon-like peptide receptor analogs (GLP-1 RAs) are among the approved pharmacotherapy options. Their central effect on suppressing appetite results in considerable weight loss. However, their effect on the complications of obesity has not been very well recognized. This review aims to analyze the effects of GLP-1 RAs on the complications of obesity, as diabetes mellitus, hypertension, nonalcoholic steatohepatitis (NASH), cardiovascular diseases, polycystic ovary syndrome, infertility, obstructive sleep apnea (OSA), osteoarthritis, cancer and central nervous system problems. SUMMARY Data from preclinical studies and clinical trials have been thoroughly evaluated. Effects regarding the complications as far as the scope of this review have covered can be summarized as blood glucose lowering, blood pressure lowering, resolution of NASH, improving major cardiovascular events, improving fertility and sex hormone levels, and improvement in OSA symptoms and in cognitive scores. Although the mechanisms are not fully elucidated, it is clear that the effects are not solely due to weight loss, but some pleiotropic effects like decreased inflammation, oxidative stress, and fibrosis also play a role in some of the complications. KEY MESSAGES Treating obesity is not only enabling weight loss but ameliorating complications related to obesity. Thus, any antiobesity medication has to have some favorable effects on the complications. As far as the GLP-RA's analogs are concerned, there seems to be an improvement in many of the complications regardless of the weight loss effect of these medications.
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Affiliation(s)
- Dilek Yazıcı
- Koç University Medical School Section of Endocrinology and Metabolism, Istanbul, Turkey
- *Dilek Yazıcı,
| | - Hale Yapıcı Eser
- Koç University Medical School Department of Psychiatry, Istanbul, Turkey
| | - Sinem Kıyıcı
- Health Sciences University Bursa Yİ Education and Research Hospital, Bursa, Turkey
| | - Seda Sancak
- Health Sciences University Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Havva Sezer
- Koç University Medical School Section of Endocrinology and Metabolism, Istanbul, Turkey
| | - Melin Uygur
- Marmara University Medical School, Section of Endocrinology and Metabolism, Istanbul, Turkey
| | - Volkan Yumuk
- Cerrahpaşa U. Medical School Section of Endocrinology and Metabolism, Istanbul, Turkey
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Mirzajani H, Abbasiasl T, Mirlou F, Istif E, Bathaei MJ, Dağ Ç, Deyneli O, Yazıcı D, Beker L. An ultra-compact and wireless tag for battery-free sweat glucose monitoring. Biosens Bioelectron 2022; 213:114450. [PMID: 35688025 DOI: 10.1016/j.bios.2022.114450] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 11/02/2022]
Abstract
Glucose monitoring before, during, and after exercise is essential for people with diabetes as exercise increases the risk of activity-induced hyper- and hypo-glycemic events. The situation is even more challenging for athletes with diabetes as they have impaired metabolic control compared to sedentary individuals. In this regard, a compact and noninvasive wearable glucose monitoring device that can be easily worn is critical to enabling glucose monitoring. This report presents an ultra-compact glucose tag with a footprint and weight of 1.2 cm2 and 0.13 g, respectively, for sweat analysis. The device comprises a near field communication (NFC) chip, antenna, electrochemical sensor, and microfluidic channels implemented in different material layers. The device has a flexible and conformal structure and can be easily attached to different body parts. The battery-less operation of the device was enabled by NFC-based wireless power transmission and the compact antenna. Femtosecond laser ablation was employed to fabricate a highly compact and flexible NFC antenna. The proposed device demonstrated excellent operating characteristics with a limit of detection (LOD), limit of quantification (LOQ), and sensitivity of 24 μM, 74 μM, and 1.27 μA cm-2 mM-1, respectively. The response of the proposed sensor in sweat glucose detection and quantification was validated by nuclear magnetic resonance spectroscopy (NMR). Also, the device's capability in attachment to the body, sweat collection, and glucose measurement was demonstrated through in vitro and in vivo experiments, and satisfactory results were obtained.
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Affiliation(s)
- Hadi Mirzajani
- Department of Mechanical Engineering, Koç University, Rumelifeneri Yolu, Sarıyer, Istanbul, 34450, Turkey
| | - Taher Abbasiasl
- Department of Mechanical Engineering, Koç University, Rumelifeneri Yolu, Sarıyer, Istanbul, 34450, Turkey
| | - Fariborz Mirlou
- Department of Biomedical Sciences and Engineering, Koç University, Rumelifeneri Yolu, Sarıyer, Istanbul, 34450, Turkey
| | - Emin Istif
- Department of Mechanical Engineering, Koç University, Rumelifeneri Yolu, Sarıyer, Istanbul, 34450, Turkey
| | - Mohammad Javad Bathaei
- Department of Biomedical Sciences and Engineering, Koç University, Rumelifeneri Yolu, Sarıyer, Istanbul, 34450, Turkey
| | - Çağdaş Dağ
- Department of Molecular Biology and Genetics, Koç University, Rumelifeneri Yolu, Sarıyer, Istanbul, 34450, Turkey; Nanofabrication and Nanocharacterization Centre for Scientific and Technological Advanced Research, Koç University, Rumelifeneri Yolu, Sarıyer, Istanbul, 34450, Turkey; Koç University İşBank Centre for Infectious Diseases, Koç University, Rumelifeneri Yolu, Sarıyer, Istanbul, 34450, Turkey
| | - Oğuzhan Deyneli
- Division of Endocrinology, Department of Internal Medicine, School of Medicine, Koç University Hospital, Topkapı Caddesi, Zeytinburnu, Istanbul, Turkey
| | - Dilek Yazıcı
- Division of Endocrinology, Department of Internal Medicine, School of Medicine, Koç University Hospital, Topkapı Caddesi, Zeytinburnu, Istanbul, Turkey
| | - Levent Beker
- Department of Mechanical Engineering, Koç University, Rumelifeneri Yolu, Sarıyer, Istanbul, 34450, Turkey; Koç University Research Center for Translational Research (KUTTAM), Rumelifeneri Yolu, Sarıyer, Istanbul, 34450, Turkey.
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6
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Abstract
OBJECTIVE: We aimed to analyze the association between body mass index and mortality in patients with coronavirus disease 2019 induced acute respiratory distress syndrome. MATERIAL AND METHODS: In this retrospective cohort study, we analyzed 108 consecutive patients admitted in the intensive care unit for coronavirus disease 2019-induced lung disease in a single center between March 2020 and February 2021. Coronavirus disease 2019 infection was confirmed by real-time reverse transcription-polymerase chain reaction assay of nasal swabs or lower respiratory tract samples. Acute respiratory distress syndrome was defined using Berlin criteria. Acute respiratory distress syndrome severity was assessed with partial pressure of arterial oxygen/fraction of inspired oxygen ratio. We categorized patients according to the body mass index as underweight, <18.5 kg/m2; normal weight, from 18.5 kg/m2 to <25 kg/m2; overweight, from 25 kg/m2 to <30 kg/m2; obese, ≥30 kg/m2. Clinical characteristics and mortality were compared among groups. Demographic and clinical data were collected from electronic medical records of the hospital system. Results: The mean age was 67.3 ± 13.3 years. Study participants were predominantly males (66.7%). The mean BMI was 28.2 ± 5.6 kg/m2. There were 2 patients (2%), 28 (26%), 42 (39%), and 36 patients (33%) in the underweight, normal-weight, overweight, and obese groups, respectively. The hospital mortality was 40.7%. There was no association between body mass index and mortality (P = .09). In multivariate analysis, mortality was associated with the presence of cancer [odds ratio = 7.338 (1.636-32.914), P = .009], and time between diagnosis and intubation [odds ratio = 1.318 (1.150-1.509), P ≤ .001]. Conclusion: Neither acute respiratory distress syndrome severity nor mortality was higher in patients with higher body mass index compared to the ones with normal body mass index.
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Affiliation(s)
- Havva Sezer
- Division of Endocrinology and Metabolism, Koç University, School of Medicine, İstanbul, Turkey
- Corresponding author: Havva Sezer, e-mail:
| | | | - Fatma Yurdakul
- Department of Anesthesiology & Intensive Care Unit, Koç University, School of Medicine, İstanbul, Turkey
| | - Boğaç Özserezli
- Department of Anesthesiology & Intensive Care Unit, Koç University, School of Medicine, İstanbul, Turkey
| | - Dilek Yazıcı
- Division of Endocrinology and Metabolism, Koç University, School of Medicine, İstanbul, Turkey
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7
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Yazıcı D, Fersahoğlu MM, Fersahoğlu T, Bulut NE, Çiğiltepe H, Çeler Ö, Sancak S, Sulu C, Durcan E, Şahin S, Polat Korkmaz Ö, Bozdoğan Polat SH, Taşkın E, İşeri C, Gürsoy E, Küçük Yetgin M, Kaya T, Özdemir F, Mestanoğlu İstanbullu N, Kıyıcı S, Öztürk S, Güngör K, Can B, Sargın M, Tabak Z, Averi S, Nazlı A, Polat Y, Akbas F, Tekin S, Topaloğlu Ö, Boz Uzaldı E, Çatalçam S, Bayraktaroğlu T, Çalıkoğlu BF, Nasifova V, Soyluk Selçukbiricik Ö, Karşıdağ K, Sezer H, Özışık S, Bulut H, Bekdemir B, Deyneli O, Dinçer C, Gogas Yavuz D, İlkova H, Yumuk VD. Status of Weight Change, Lifestyle Behaviors, Depression, Anxiety, and Diabetes Mellitus in a Cohort with Obesity during the COVID-19 Lockdown: Turk-Com Study Group. Obes Facts 2022; 15:528-539. [PMID: 35545017 PMCID: PMC9372476 DOI: 10.1159/000522658] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/07/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic led to a lockdown period. Confinement periods have been related to unhealthy lifestyle behaviors. Our study aimed to determine weight change, changes in eating and exercise habits, the presence of depression and anxiety, and diabetes mellitus (DM) status in a cohort of patients with obesity. METHODS The study was undertaken in nine centers of Collaborative Obesity Management (COM) of the European Association for the Study of Obesity (EASO) in Turkey. An e-survey about weight change, eating habits, physical activity status, DM status, depression, and anxiety was completed by patients. The International Physical Activity Questionnaire (IPAQ) score was used to determine physical activity in terms of metabolic equivalents (METs). A healthy nutrition coefficient was calculated from the different categories of food consumption. The Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) Questionnaire were used for determining depression and anxiety, respectively. RESULTS Four hundred twenty-two patients (age 45 ± 12.7 years, W/M = 350/72) were included. The healthy nutrition coefficient before the pandemic was 38.9 ± 6.2 and decreased to 38.1 ± 6.4 during the pandemic (p < 0.001). Two hundred twenty-nine (54.8%) patients gained weight, 54 (12.9%) were weight neutral, and 135 (32.3%) lost weight. Patients in the weight loss group had higher MET scores and higher healthy nutrition coefficients compared with the weight gain and weight-neutral groups (p < 0.001). The PHQ and GAD scores were not different between the groups. Percent weight loss was related to healthy nutrition coefficient (CI: 0.884 [0.821-0.951], p = 0.001) and MET categories (CI: 0.408 [0.222-0.748], p = 0.004). One hundred seventy patients had DM. Considering glycemic control, only 12 (8.4%) had fasting blood glucose <100 mg/dL and 36 (25.2%) had postprandial BG <160 mg/dL. When patients with and without DM were compared in terms of dietary compliance, MET category, weight loss status, PHQ-9 scores, and GAD-7 scores, only MET categories were different; 29 (11.7%) of patients in the nondiabetic group were in the highly active group compared with 5 (2.9%) in the diabetic group. CONCLUSION The COVID-19 lockdown resulted in weight gain in about half of our patients, which was related to changes in physical activity and eating habits. Patients with DM who had moderate glycemic control were similar to the general population in terms of weight loss but were less active.
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Affiliation(s)
- Dilek Yazıcı
- Koç University Medical School COM (EASO Collaborating Centre for Obesity Management), Istanbul, Turkey
- *Dilek Yazıcı,
| | - Mehmet Mahir Fersahoğlu
- Health Sciences University Fatih Sultan Mehmet Education and Research Hospital COM, Istanbul, Turkey
| | - Tuba Fersahoğlu
- Health Sciences University Fatih Sultan Mehmet Education and Research Hospital COM, Istanbul, Turkey
| | - Nuriye Esen Bulut
- Health Sciences University Fatih Sultan Mehmet Education and Research Hospital COM, Istanbul, Turkey
| | - Hüseyin Çiğiltepe
- Health Sciences University Fatih Sultan Mehmet Education and Research Hospital COM, Istanbul, Turkey
| | - Özgen Çeler
- Health Sciences University Fatih Sultan Mehmet Education and Research Hospital COM, Istanbul, Turkey
| | - Seda Sancak
- Health Sciences University Fatih Sultan Mehmet Education and Research Hospital COM, Istanbul, Turkey
| | - Cem Sulu
- Cerrahpaşa Medical Faculty COM, Istanbul, Turkey
| | - Emre Durcan
- Cerrahpaşa Medical Faculty COM, Istanbul, Turkey
| | - Serdar Şahin
- Cerrahpaşa Medical Faculty COM, Istanbul, Turkey
| | | | | | - Eren Taşkın
- Cerrahpaşa Medical Faculty COM, Istanbul, Turkey
| | - Ceren İşeri
- Cerrahpaşa Medical Faculty COM, Istanbul, Turkey
| | - Evren Gürsoy
- Cerrahpaşa Medical Faculty COM, Istanbul, Turkey
| | | | - Tuğba Kaya
- Health Sciences University Bursa Yİ Education and Research Hospital COM, Bursa, Turkey
| | - Feyza Özdemir
- Health Sciences University Bursa Yİ Education and Research Hospital COM, Bursa, Turkey
| | | | - Sinem Kıyıcı
- Health Sciences University Bursa Yİ Education and Research Hospital COM, Bursa, Turkey
| | - Serkan Öztürk
- Medeniyet University Göztepe Education and Research Hospital COM, Istanbul, Turkey
| | - Kağan Güngör
- Medeniyet University Göztepe Education and Research Hospital COM, Istanbul, Turkey
| | - Bülent Can
- Medeniyet University Göztepe Education and Research Hospital COM, Istanbul, Turkey
| | - Mehmet Sargın
- Medeniyet University Göztepe Education and Research Hospital COM, Istanbul, Turkey
| | - Zeynep Tabak
- Health Sciences University Istanbul Education and Research Hospital COM, Istanbul, Turkey
| | - Sevda Averi
- Health Sciences University Istanbul Education and Research Hospital COM, Istanbul, Turkey
| | - Aysun Nazlı
- Health Sciences University Istanbul Education and Research Hospital COM, Istanbul, Turkey
| | - Yeliz Polat
- Health Sciences University Istanbul Education and Research Hospital COM, Istanbul, Turkey
| | - Feray Akbas
- Health Sciences University Istanbul Education and Research Hospital COM, Istanbul, Turkey
| | - Sakin Tekin
- Bülent Ecevit University Medical Faculty COM, Zonguldak, Turkey
| | | | - Ebru Boz Uzaldı
- Bülent Ecevit University Medical Faculty COM, Zonguldak, Turkey
| | - Safiye Çatalçam
- Bülent Ecevit University Medical Faculty COM, Zonguldak, Turkey
| | | | | | | | | | | | - Havva Sezer
- Koç University Medical School COM (EASO Collaborating Centre for Obesity Management), Istanbul, Turkey
| | - Seçil Özışık
- Koç University Medical School COM (EASO Collaborating Centre for Obesity Management), Istanbul, Turkey
| | - Hande Bulut
- Koç University Medical School COM (EASO Collaborating Centre for Obesity Management), Istanbul, Turkey
| | - Bahar Bekdemir
- Koç University Medical School COM (EASO Collaborating Centre for Obesity Management), Istanbul, Turkey
| | - Oğuzhan Deyneli
- Koç University Medical School COM (EASO Collaborating Centre for Obesity Management), Istanbul, Turkey
| | - Ceyda Dinçer
- Marmara University Medical Faculty COM, Istanbul, Turkey
| | | | - Hasan İlkova
- Cerrahpaşa Medical Faculty COM, Istanbul, Turkey
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8
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Sezer H, Yazıcı D, Tezelman S, Demirkol MO, Ünal ÖF, Dilege Ş, Taşkın OÇ, Peker Ö, Kapran Y, Çolakoğlu B, Aygün MS, Ferhanoğlu B, Alagöl F. Concomittant occurence of well-differentiated thyroid carcinoma metastasis and chronic lymphocytic leukemia in the same lymph node along with internal jugular vein thrombus: a case report. INDIAN J PATHOL MICR 2021; 64:149-151. [PMID: 33433427 DOI: 10.4103/ijpm.ijpm_537_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is the most common adult leukemia. The coexistence of CLL and papillary thyroid carcinoma (PTC) is extremely rare. PTC sometimes shows microscopic vascular invasion but rarely cause a tumor thrombus in the internal jugular vein (IJV). It is also rare to find both differentiated and poorly differentiated types of thyroid cancer in the same metastatic location. We report a case of 63-year-old Turkish man with history of CLL who had CLL/SLL involvement and PTC metastasis in the same lymph node. Additionally, there was macroscopic metastasis to the IJV with poorly differentiated areas in the removed tumor thrombus. Patient was treated with total thyroidectomy, left radical neck dissection, resection of the left IJV segment that contained the tumor thrombus and radioactive iodine (RAI) therapy. Furthermore, metastatic lesions were found in the brain, lung and bone. Radiotherapy and chemotherapy were performed. However, our patient died approximately 12 months after thyroidectomy. To our knowledge, our present report is the first description with its current features.
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Affiliation(s)
- Havva Sezer
- Department of Medicine, Division of Endocrinology, Koc University School of Medicine, Istanbul, Turkey
| | - Dilek Yazıcı
- Department of Medicine, Division of Endocrinology, Koc University School of Medicine, Istanbul, Turkey
| | - Serdar Tezelman
- Department of Medicine, Division of General Surgery, American Hospital, Istanbul, Turkey
| | - Mehmet O Demirkol
- Department of Medicine, Division of Nuclear Medicine, Koç University School of Medicine, Istanbul, Turkey
| | - Ömer F Ünal
- Department of Medicine, Division of Otorhinolaryngology, Koc University School of Medicine, Istanbul, Turkey
| | - Şükrü Dilege
- Department of Medicine, Division of Thoracic Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Orhun Ç Taşkın
- Department of Division of Pathology, Koc University School of Medicine, Istanbul, Turkey
| | - Önder Peker
- Department of Medicine, Division of Pathology, American Hospital, Istanbul, Turkey
| | - Yersu Kapran
- Department of Division of Pathology, Koc University School of Medicine, Istanbul, Turkey
| | - Bülent Çolakoğlu
- Department of Medicine, Division of Radyology, American Hospital, Istanbul, Turkey
| | - Murat S Aygün
- Department of Medicine, Division of Radyology, Koc University School of Medicine, Istanbul, Turkey
| | - Burhan Ferhanoğlu
- Department of Medicine, Division of Hematology, American Hospital, Istanbul, Turkey
| | - Faruk Alagöl
- Department of Medicine, Division of Endocrinology, Koc University School of Medicine, Istanbul, Turkey
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9
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Sezer H, Yazıcı D, Deyneli O, Meriçöz Ç, Esin A, Alper E. Empagliflozin-induced ketoacidosis in a patient presenting with new-onset type 2 diabetes mellitus due to indolent pancreatic cancer. Endokrynol Pol 2020; 71:283-284. [PMID: 32154575 DOI: 10.5603/ep.a2020.0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/16/2020] [Accepted: 02/21/2020] [Indexed: 11/25/2022]
Abstract
Not required for Clinical Vignette.
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Affiliation(s)
- Havva Sezer
- Koç University School of Medicine, İstanbul, Turkey.
| | - Dilek Yazıcı
- Koç University School of Medicine, İstanbul, Turkey
| | | | | | - Ayla Esin
- Koç University School of Medicine, İstanbul, Turkey
| | - Emrah Alper
- Koç University School of Medicine, İstanbul, Turkey
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10
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Yazıcı D, Çolakoğlu B, Sağlam B, Sezer H, Kapran Y, Aydın Ö, Demirkol MO, Alagöl F, Terzioğlu T. Effect of prophylactic central neck dissection on the surgical outcomes in papillary thyroid cancer: experience in a single center. Eur Arch Otorhinolaryngol 2020; 277:1491-1497. [PMID: 32052141 DOI: 10.1007/s00405-020-05830-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/24/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Morbidity due to papillary thyroid carcinoma (PTC) is increased mostly due to lymph node (LN) metastases, which lead to reoperations and complications associated with these operations. The aim is to compare the outcomes of PTC having total thyroidectomy and prophylactic central lymph node dissection (TT + PCND) with patients having total thyroidectomy (TT) alone. METHODS This study is a retrospective cohort analysis of 358 PTC patients that were operated by a single surgeon in a single center. Data about the patients were extracted from the medical records. RESULTS Of the patient cohort, 258 patients had TT + PCND (42.5 ± 11.3 years) and 100 patients (41.2 ± 11.9 years) had only TT. Total number of LN extracted in the TT + PCND group was 8.1 ± 6.9. The mean number of metastatic LN were 2.2 ± 1.9. Percentage of patients that had RAI were less in the TT + PCND group compared to the TT group. Seven patients (2.7%) in the TT + PCND group and 19 (19.0%) in TT group had recurrent disease (p < 0.0001). Of the complications, only transient hypoparathyroidism was increased in TT + PCND group compared to TT group (26.7% vs 10%, p < 0.0001). CONCLUSION TT + PCND performed by an experienced surgeon seems to decrease the number of LN recurrences, and the need for reoperations.
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Affiliation(s)
- Dilek Yazıcı
- Section of Endocrinology and Metabolism, Medical School, Koç University, Istanbul, Turkey.
| | | | - Burçin Sağlam
- Department of Internal Medicine, Koç University Hospital, Istanbul, Turkey
| | - Havva Sezer
- Section of Endocrinology and Metabolism, Medical School, Koç University, Istanbul, Turkey
| | - Yersu Kapran
- Department of Pathology, Koç University Medical School, Istanbul, Turkey
| | - Özlem Aydın
- Department of Pathology, Faculty of Medicine, Acıbadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Faruk Alagöl
- Section of Endocrinology and Metabolism, Medical School, Koç University, Istanbul, Turkey
| | - Tarık Terzioğlu
- Section of General and Endocrine Surgery, American Hospital, Istanbul, Turkey
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11
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Aydın H, Çelik Ö, Yazıcı D, Altunok Ç, Tarçın Ö, Deyneli O, Sancak S, Kıyıcı S, Aydın K, Yıldız BO. Prevalence and predictors of gestational diabetes mellitus: a nationwide multicentre prospective study. Diabet Med 2019; 36:221-227. [PMID: 30402933 DOI: 10.1111/dme.13857] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 12/17/2022]
Abstract
AIM Prevalence rates of gestational diabetes mellitus (GDM) show considerable variation among different countries and regions of the world. The primary aim of this study was to determine the nationwide prevalence and predictors of GDM in Turkey. METHODS We conducted prospective nationwide screening among pregnant women. Between August 2016 and November 2017, a total of 2643 pregnant women from 51 centres in 12 different regions were enrolled. A two-step screening method and Carpenter and Coustan criteria were used in the diagnosis of GDM. Clinical and biochemical data were obtained using electronic database software. RESULTS The national prevalence of GDM was found to be 16.2% [95% confidence intervals (CI) 15.0% to 17.4%] without a significant difference between urban and rural regions. Women with GDM were older (mean age: 32 ± 5 vs. 28 ± 5 years, P < 0.001) and heavier (mean BMI: 27.2 ± 5.1 vs. 24.7 ± 4.7 kg/m2 , P < 0.001) than their counterparts without GDM. The prevalence of GDM tended to increase with age (< 25 years, 6.9%; 26-35 years, 15.6%; and 36-45 years, 32.7%; P < 0.001). Maternal age, maternal BMI, history of previous GDM and family history of diabetes mellitus were independent predictors of developing GDM (P < 0.05 for all). Low-risk women (age < 25 years, BMI < 25 kg/m2 , no family history of diabetes) comprised 10.7% of the total population and the prevalence of GDM in these women was 4.5% (95% CI 2.4% to 7.8%). CONCLUSION The results of this nationwide study indicate that GDM is very common, affecting one in seven pregnancies in Turkey. Implementation of international guidelines on screening and management of this public health problem is required.
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Affiliation(s)
- H Aydın
- Department of Endocrinology and Metabolism, Istanbul, Turkey
| | - Ö Çelik
- Department of Endocrinology and Metabolism, Acıbadem University Medical Faculty, Istanbul, Turkey
| | - D Yazıcı
- Department of Endocrinology and Metabolism, Koç University Medical Faculty, Istanbul, Turkey
| | - Ç Altunok
- Department of Biostatistics, Yeditepe University Medical Faculty, Istanbul, Turkey
| | - Ö Tarçın
- Department of Endocrinology and Metabolism, Marmara University Medical Faculty, Istanbul, Turkey
| | - O Deyneli
- Department of Biostatistics, Yeditepe University Medical Faculty, Istanbul, Turkey
| | - S Sancak
- Department of Endocrinology and Metabolism, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - S Kıyıcı
- University of Health Sciences, Bursa Yuksek Ihtisas Education and Training Hospital, Department of Endocrinology and Metabolism, Bursa
| | - K Aydın
- Lütfi K?rdar Education and Training Hospital, Department of Endocrinology and Metabolism, Istanbul, Turkey
| | - B O Yıldız
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
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12
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Yavuz DG, Yazıcı D, Keskin L, Atmaca A, Sancak S, Saraç F, Şahin İ, Dikbaş O, Hekimsoy Z, Yalın S, Uygur M, Yılmaz M, Yirmibeşcik S, Asmaz Ö. Out-of-Reference Range Thyroid-Stimulating Hormone Levels in Levothyroxine-Treated Primary Hypothyroid Patients: A Multicenter Observational Study. Front Endocrinol (Lausanne) 2017; 8:215. [PMID: 28955301 PMCID: PMC5600911 DOI: 10.3389/fendo.2017.00215] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/10/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Although levothyroxine (LT4) replacement therapy for hypothyroidism has been established as safe, inexpensive and effective, many studies from different countries reported out-of-reference range thyroid-stimulating hormone (TSH) values for the hypothyroid patients under LT4 treatment. The aim of this study was to determine TSH levels of primary hypothyroid patients under LT4 treatment and to assess self-reported compliance with daily LT4 intake in tertiary care centers in Turkey. DESIGN In this cross-sectional, observational study, adult patients with primary hypothyroidism, receiving LT4 treatment for at least 6 months, were included. The patients were from 12 tertiary care centers in 9 cities of Turkey. TSH and free T4 levels were recorded from patient files and self-reported compliance with daily LT4 intake was assessed by interviewing the subjects at the last visit. RESULTS A total of 1,755 subjects (46 ± 13 years; F/M: 89.9/10.1%) with primary hypothyroidism were enrolled. Of the hypothyroid subjects, 44.8% had out-of-reference range serum TSH levels. TSH values were over the reference range (TSH > 4 mIU/L) in 26.2% and were under the reference range (TSH < 0.5 mIU/L) in 18.6% of the patients. Total duration of LT4 treatment was 5.9 ± 4.7 years and mean dose was 1.2 ± 0.6 μg/kg/day. Non-compliant patients (31.1%) had higher TSH levels (6.9 ± 16 vs 3.8 ± 0.9 mIU/L, P = 0.01) compared to compliant patients. CONCLUSION The results of this study revealed that nearly half of the hypothyroid patients had out-of-reference range serum TSH values, despite under LT4 treatment. Compliance with LT4 treatment seems to be one of the major determinants to reach the target TSH levels in hypothyroid patients.
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Affiliation(s)
- Dilek Gogas Yavuz
- Marmara University, Istanbul, Turkey
- *Correspondence: Dilek Gogas Yavuz,
| | | | | | | | - Seda Sancak
- Fatih Sultan Mehmet Eǧitim Ve Araştırma Hastanesi, Istanbul, Turkey
| | | | | | - Oğuz Dikbaş
- Abant İzzet Baysal University, Düzce, Turkey
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13
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Yazıcı D, Özben B, Toprak A, Yavuz D, Aydın H, Tarçın Ö, Deyneli O, Akalın S. Effects of restoration of the euthyroid state on epicardial adipose tissue and carotid intima media thickness in subclinical hypothyroid patients. Endocrine 2015; 48:909-15. [PMID: 25108389 DOI: 10.1007/s12020-014-0372-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/24/2014] [Indexed: 10/24/2022]
Abstract
Epicardial adipose tissue (EAT) thickness is a novel cardiovascular risk indicator, whereas carotid intima media thickness (CIMT) is a known marker of subclinical atherosclerosis. The aim of this study was to measure EAT thickness and CIMT in subclinical hypothyroid (SCH) patients and to determine the effect of restoration of the euthyroid state on these variables. The study included 43 patients with SCH (mean age: 35.2±10.7 years; F-M ratio: 42:1) and 30 healthy controls (mean age: 34.5±8.2 years; F-M ratio: 25:5). EAT thickness and CIMT were measured via conventional echocardiography and ultrasonography. Among the patients, 23 were followed up with L-thyroxine replacement until restoration of the euthyroid state and re-evaluated 6 months after baseline. Basal EAT thickness was higher in the SCH patients than in the controls (3.2±0.7 vs. 2.3±0.3 mm-p<0.0001), whereas CIMT was similar in both groups (0.50±0.09 vs. 0.48±0.04 mm). EAT thickness was correlated with CIMT in the patient group (r=0.39, p=0.01), but this correlation was not evident based on multivariate analysis when corrected for age and body mass index (r2=0.47 and p=0.0001 for the model). In the follow-up patient subgroup, both EAT thickness and CIMT decreased significantly following L-thyroxine treatment, when normal TSH levels were attained (3.4±0.7 vs. 2.3±0.5 mm-p=0.007 and 0.51±0.09 vs. 0.46±0.07 mm-p=0.01, respectively). EAT thickness was greater in the SCH patients than in controls, whereas CIMT was similar in both groups. Restoration of the euthyroid state with L-thyroxine treatment was associated with significant decreases in EAT thickness and CIMT in the group of patients that received L-thyroxine treatment and, as such, might reduce the cardiovascular risk associated with SCH.
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Affiliation(s)
- Dilek Yazıcı
- Section of Endocrinology and Metabolism, Marmara University Medical School, İskele Sok. Hüseyin Ayaz Apt. No:22/8 Caddebostan/Istanbul, Istanbul, Turkey,
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14
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Gogas Yavuz D, Keskin L, Kıyıcı S, Sert M, Yazıcı D, Şahin İ, Yüksel M, Deyneli O, Aydın H, Tuncel E, Akalın S. Vitamin D receptor gene BsmI, FokI, ApaI, TaqI polymorphisms and bone mineral density in a group of Turkish type 1 diabetic patients. Acta Diabetol 2011; 48:329-336. [PMID: 21538164 DOI: 10.1007/s00592-011-0284-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 04/09/2011] [Indexed: 01/02/2023]
Abstract
Previous studies have suggested an influence of vitamin D receptor alleles on bone metabolism and on susceptibility to type 1 diabetes mellitus in different ethnic populations. We aimed to investigate the distribution of vitamin D receptor (VDR) alleles in relation to biochemical bone turnover parameters and bone densitometry measurements in a group of Turkish type 1 diabetic patients. One hundred and seventeen patients (M/F 57/60, 27.6 ± 7.3 y duration of diabetes 8.1 ± 6.3 y) and 134 healthy controls (M/F 61/73, 26.2 ± 5.3 y) were included in the study. Bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry (DEXA). The vitamin D receptor gene (VDR) polymorphisms FokI, Bsm1, Apa1, and Taq1 were examined using a PCR-based restriction analysis. Serum levels of calcium, phosphor osteocalcin, intact parathyroid hormone, and C telopeptide were measured. Vitamin D receptor Bsm1 Fok1, Apa1, and Taq1 genotype distributions were not different between patient with diabetes and control groups. BMD was 0.77 ± 0.2 g/cm(2) vs. 0.97 ± 0.2 g/cm(2) (P = 0.0001) for the femur, 1.0 ± 0.1 g/cm(2) vs. 1.13 ± 0.1 g/cm(2) (P = 0.001) for type 1 diabetic patients and controls. Bone turnover markers were significantly lower in type 1 diabetic group. BMD measurements and bone metabolic markers were not different between the genotypes in either the patient with diabetes or the controls. The VDR gene polymorphisms, Bsm1, Fok 1, Apa1, and Taq1 showed no influence on bone metabolism in our group of type 1 diabetic patients.
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Affiliation(s)
- Dilek Gogas Yavuz
- Section of Endocrinology and Metabolism, Marmara University School of Medicine, Tibbiye caddesi. No: 49 Haydarpasa, Istanbul, Turkey.
| | - Lezan Keskin
- Section of Endocrinology and Metabolism, Inonu University Medical School, Malatya, Turkey
| | - Sinem Kıyıcı
- Section of Endocrinology and Metabolism, Uludağ University Medical School, Bursa, Turkey
| | - Murat Sert
- Section of Endocrinology and Metabolism, Cukurova University Medical School, Adana, Turkey
| | - Dilek Yazıcı
- Section of Endocrinology and Metabolism, Marmara University School of Medicine, Tibbiye caddesi. No: 49 Haydarpasa, Istanbul, Turkey
| | - İbrahim Şahin
- Section of Endocrinology and Metabolism, Inonu University Medical School, Malatya, Turkey
| | - Meral Yüksel
- Marmara University Vocational School of Health, Istanbul, Turkey
| | - Oğuzhan Deyneli
- Section of Endocrinology and Metabolism, Marmara University School of Medicine, Tibbiye caddesi. No: 49 Haydarpasa, Istanbul, Turkey
| | - Hasan Aydın
- Section of Endocrinology and Metabolism, Marmara University School of Medicine, Tibbiye caddesi. No: 49 Haydarpasa, Istanbul, Turkey
| | - Ercan Tuncel
- Section of Endocrinology and Metabolism, Uludağ University Medical School, Bursa, Turkey
| | - Sema Akalın
- Section of Endocrinology and Metabolism, Marmara University School of Medicine, Tibbiye caddesi. No: 49 Haydarpasa, Istanbul, Turkey
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15
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Yazıcı D, Özben B, Yavuz D, Deyneli O, Aydın H, Tarcin Ö, Akalın S. Epicardial adipose tissue thickness in type 1 diabetic patients. Endocrine 2011; 40:250-5. [PMID: 21553302 DOI: 10.1007/s12020-011-9478-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 04/12/2011] [Indexed: 12/22/2022]
Abstract
Insulin resistance is getting important in the course of type 1 diabetes mellitus. Visceral fat depot is associated with insulin resistance and assessment of epicardial fat thickness is a way of measuring visceral fat. The aim of the study was to measure epicardial adipose tissue (EAT) thickness and to determine its relationship with waist-hip-ratio (WHR) and estimated glucose disposal rate (eGDR) in adult type 1 diabetic patients. Thirty-six type 1 diabetic patients (aged 31±8 years; Female/Male: 22/14) and 43 age, gender and BMI matched healthy controls were included. Fasting blood glucose (FBG), hemoglobin A1c, and lipid profiles were measured. Waist-hip-ratio (WHR) was calculated. Daily insulin dose/kg of patients were recorded and eGDR of all subjects was calculated. Epicardial adipose tissue (EAT) thickness was evaluated by echocardiography. EAT thickness of the type 1 diabetic patients was significantly higher than controls (3.30±1.06 vs. 2.30±0.34 mm, P<0.0001). EAT thickness was correlated with age (P=0.05; r=0.35), WHR (P=0.003; r=0.67), daily insulin dose/kg (r=0.45, P=0.005), and eGDR (r=-0.55, P=0.0004). Multivariate analysis revealed WHR and eGDR to be related to EAT among age, WHR, daily insulin dose/kg, eGDR, FBG, and hemoglobin A1c (r2 of the model=0.64). Epicardial adipose tissue thickness is increased in type 1 diabetic patients compared to controls and is related to WHR and eGDR in this group of patients. This measurement may point to the presence of insulin resistance in type 1 diabetic patients.
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Affiliation(s)
- Dilek Yazıcı
- Section of Endocrinology and Metabolism, Marmara University Medical School, Istanbul, Turkey.
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16
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Yazıcı D, Yavuz D, Öğünç AV, Sirikçi Ö, Toprak A, Deyneli O, Akalın S. Serum adipokine levels in type 1 diabetic patients: association with carotid intima media thickness. Metab Syndr Relat Disord 2011; 10:26-31. [PMID: 21933002 DOI: 10.1089/met.2011.0052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Adipokines are markers of insulin resistance and play a role in the atherosclerotic process. The association of adipokines with the macrovascular complications of type 1 diabetes mellitus (DM) needs to be determined. The aim of this study was to measure serum adiponectin, leptin, and resistin levels in type 1 DM patients and investigate their relationship with carotid intima media thickness (CIMT), a clinical marker of atherosclerosis. METHODS Seventy-five type 1 DM patients and 115 sex and age-matched healthy controls were included in the study. Serum adiponectin, leptin, and resistin levels were measured by the enzyme-linked immunosorbent assay (ELISA method). CIMT was assessed by Doppler ultrasonography. RESULTS Adiponectin levels in diabetics were higher (25.8±14.8 μg/mL vs. 5.5±7.3 μg/mL; P<0.0001) and leptin levels were lower than controls (9.4±6.2 ng/mL vs. 12.8±8.6 ng/mL; P=0.01). Resistin levels were also higher in the diabetic group compared to controls (2.1±1.4 ng/mL vs. 1.6±0.8 ng/mL; P=0.04). Adiponectin was correlated negatively with CIMT (r=-0.24, P=0.03), age (r=-0.30, P=0.02), BMI (r=-0.33, P=0.02), waist-to-hip ratio (WHR) (r=-0.38, P=0.01) and positively with creatinine (r=0.44, P=0.004). Leptin levels were correlated with total cholesterol (r=0.53, P=0.01) and high-density lipoprotein (HDL) (r=0.67, P=0.001). Resistin was correlated with CIMT (r=0.24, P=0.03) and systolic blood pressure (r=0.48, P=0.009). Multivariate analysis revealed resistin and creatinine to be independent predictors of CIMT among adiponectin, leptin, resistin, WHR, glycosylated hemoglobin (HbA1c), and creatinine. CONCLUSIONS Increased adiponectin correlates negatively and resistin positively with CIMT in type 1 diabetic patients, but adjusting for other known predictors reveals only resistin to be associated with subclinical atherosclerosis in this group of patients.
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Affiliation(s)
- Dilek Yazıcı
- Section of Endocrinology and Metabolism, Marmara University Medical School, Istanbul, Turkey.
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17
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Yazıcı D, Aydın SZ, Yavuz D, Tarçın O, Deyneli O, Direskeneli H, Akalın S. Anti-Saccaromyces Cerevisiae antibodies (ASCA) are elevated in autoimmune thyroid disease ASCA in autoimmune thyroid disease. Endocrine 2010; 38:194-8. [PMID: 21046480 DOI: 10.1007/s12020-010-9372-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 07/01/2010] [Indexed: 10/19/2022]
Abstract
Environmental factors have been implicated in the development of autoimmune thyroid disease (AITD). Anti-Saccaromyces Cerevisiae Antibodies (ASCA) were shown to be elevated in several autoimmune diseases. The aim of the study was to determine ASCA levels and their relationship with thyroid autoantibodies in patients with AITD. One-hundred and twelve patients with AITD (age 41.1±12.8 years; F/M:96/16) and 103 healthy controls (38.5±10.3 years; F/M:82/21) were included. Twenty-four patients had Graves disease (GD), and 88 had Hashimoto's thyroiditis (HT). ASCA IgA and IgG, TSH, free T4, anti-thyroglobulin, and anti-thyroid peroxidase antibody concentrations were determined. ASCA IgA positivity in patients with GD (16.6%) was similar to patients with HT (13.6%) and was higher than controls (5.8%). No significant difference was present between the frequencies of IgG positivity among GD (12.5%), HT (7.9%), and control groups (5.8%). The mean levels of ASCA IgA and IgG were comparable within the groups. No correlation of ASCA and anti-thyroglobulin and anti-thyroid peroxidase levels was observed. Increased IgA ASCA positivity is observed in patients with GD, suggesting a role of environmental stimuli in its pathogenesis. The role of ASCA in the etiology of AITD needs to be further examined.
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Affiliation(s)
- Dilek Yazıcı
- Section of Endocrinology and Metabolism, Marmara University Medical School, Istanbul, Turkey.
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Aydın H, Toprak A, Deyneli O, Yazıcı D, Tarçın Ö, Sancak S, Yavuz D, Akalın S. Epicardial Fat Tissue Thickness Correlates with Endothelial Dysfunction and Other Cardiovascular Risk Factors in Patients with Metabolic Syndrome. Metab Syndr Relat Disord 2010; 8:229-34. [PMID: 20156077 DOI: 10.1089/met.2009.0080] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Hasan Aydın
- Department of Internal Medicine, Section of Endocrinology and Metabolism, Yeditepe University Medical Faculty, Istanbul, Turkey
| | - Ahmet Toprak
- Department of Internal Medicine, Marmara University Medical Faculty, Istanbul, Turkey
| | - Oğuzhan Deyneli
- Section of Endocrinology and Metabolism, Marmara University Medical Faculty, Istanbul, Turkey
| | - Dilek Yazıcı
- Division of Endocrinology and Metabolism, Kosuyolu Teaching and Research Hospital, Istanbul, Turkey
| | - Özlem Tarçın
- Division of Endocrinology and Metabolism, Siyami Ersek Teaching and Research Hospital, Istanbul, Turkey
| | - Seda Sancak
- Section of Endocrinology and Metabolism, Marmara University Medical Faculty, Istanbul, Turkey
| | - Dilek Yavuz
- Section of Endocrinology and Metabolism, Marmara University Medical Faculty, Istanbul, Turkey
| | - Sema Akalın
- Section of Endocrinology and Metabolism, Marmara University Medical Faculty, Istanbul, Turkey
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