Naile Gokkaya’s research while affiliated with Lutfi Kirdar Kartal Education and Research Hospital and other places

The relationship between elevated ferritin levels and metabolic abnormalities in PCOS patients, and whether ferritin is a cause or a consequence, is still debated. This study aimed to evaluate the impacts of the fourth generation combined oral contraceptive containing ethinyl estradiol/drospirenone (EE 30 mcg/DRSP 3 mg), known for its favorable metabolic profile and lower side effect risk, on iron metabolism in PCOS patients, while also exploring the potential relationship between metabolic parameters and iron status. The retrospective analysis was conducted on 81 women aged 18–45, diagnosed with PCOS according to the Rotterdam criteria and treated with EE/DRSP for six months. Exclusion criteria were lack of data, secondary hyperandrogenemia, major medical conditions, or recent use of medications affecting hormone levels or iron metabolism. Pre- and post-treatment anthropometric measurements, hormonal and metabolic markers, and iron parameters were obtained from records. Post-treatment ferritin levels significantly increased (p = 0.001), while hemoglobin, hematocrit, and transferrin saturation decreased especially in overweight/obese patients (p = 0.012, p = 0.002, p = 0.017 respectively), suggesting a response to inflammation rather than iron storage disorders. Although overall CRP levels did not change significantly, post-treatment CRP levels were higher in overweight/obese patients compared to lean PCOS patients (p = 0.003). Ferritin levels were positively correlated with body mass index (p = 0.008, r = 0.310), insulin resistance indices (p = 0.027, r = 0.248), and the free androgen index (p = 0.001, r = 0.367) after treatment. Pre-treatment menstrual cycle length had no effect on ferritin. The study revealed a paradoxical increase in ferritin levels with EE/DRSP treatment, highlighting the complex role of ferritin as a metabolic marker in PCOS patients, particularly in relation to obesity, which is typically associated with low-grade chronic inflammation.

In light of research indicating that normal TSH levels do not necessarily reflect clinical euthyroidism in hypothyroid patients, and given the patient dissatisfaction with levothyroxine (LT4) monotherapy, we evaluate the response to weight loss treatment in patients with obesity and primary hypothyroidism who are euthyroid under LT4 therapy, with a focus on weight and metabolic parameters. The retrospective study included 138 subjects with obesity (BMI ≥ 30 kg/m²), 69 women with hypothyroidism on levothyroxine, and 69 age- and BMI-matched women without thyroid disease. Secondary causes of obesity, medications that may affect thyroid functions and metabolic parameters, chronic and oncological disease, pregnancy, TSH outside the reference range, follow-up periods of less than one year, and bariatric surgery were the exclusion criteria. Patients’ characteristics and metabolic responses to weight reduction treatment consisting of calorie restriction, moderate exercise, and metformin if needed were evaluated. TSH and fT4 levels were higher, and fT3 and T3/T4 ratios were lower all within the reference ranges in hypothyroid women. They were less insulin resistant. Both patient’ groups experienced a significant decrease in body weight, BMI, and atherogenic index of plasma (AIP) during the follow-up (p = 0.001). Insulin resistance was not changed. The groups’ body weight, BMI, HOMA-IR, and AIP changes were similar at the end of the study (p = 0.876, p = 0.850, p = 0.555, p = 0.293). The results suggest that achieving euthyroid status via levothyroxine monotherapy in hypothyroid women leads to weight loss responses comparable to those in women with normal thyroid. This supports the effectiveness of current hypothyroidism treatment strategies, emphasizing TSH level normalization, in achieving clinical euthyroidism concerning weight loss outcomes.

Objective: Subacute thyroiditis(SAT) is an acute inflammatory, self-limited, and destructive disease of the thyroid gland. Although it is a temporary disease, it has permanent consequences. We aim to investigate the influences of the treatment choice on permanent hypothyroidism occurring after SAT and whether there are predictive factors for the development of permanent hypothyroidism. Methods: We retrospectively investigated 57 SAT patients admitted to our tertiary hospital between 2017 and 2019. After excluding 6 patients, demographic, clinical, laboratory, and imaging findings of 36 patients treated with NSAIDs and 15 patients treated with corticosteroids were compared. The median duration of follow-up was 4 (3.5-5.5) years. Results: Permanent hypothyroidism occurred in 16 patients (31.4%) of 51 patients. It developed at a significantly higher rate in NSAID users (p=0.019). There was no significant difference in the occurrence of transient hypothyroidism and recurrence (p=0.472, p=0.082). The early maximum TSH values were strongly associated with permanent hypothyroidism. The Odds Ratio (OR) value was 2.59 (95% CI = 1.26 - 5.33, p=0.009), Nagelkerke R2 = 0.821. The early maximum TSH level had a predictive value, with an AUC of 0.966 for post-SAT permanent hypothyroidism (p<0.001). The cutoff values for the early maximum TSH were 9.07uIU/ml (81.3% sensitivity, 100% specificity), and 7.05 uIU/ml (87.5% sensitivity, 94.3% specificity). Conclusion: Corticosteroid therapy is significantly effective in preventing permanent hypothyroidism from developing after SAT. The early maximum TSH values are an indicator for the prediction of the development of permanent hypothyroidism.

Background and aim: Thyroid Stimulating Hormone (TSH) suppression treatment can induce signs and symptoms of hyperthyroidism and hypothyroidism due to inappropriate treatment or poor compliance to the treatment. The current study aimed to investigate TSH levels, frequency of being on target TSH, adherence to levothyroxine (LT4) suppression treatment in differentiated thyroid cancer (DTC) patients after surgery in a multicentric setting. Material and method: This multicentric cross-sectional study was conducted at 21 medical centers from 12 cities in Turkey. Clinical data, serum TSH, free thyroxine (FT4), Thyroglobulin (Tg) and antithyroglobulin (Anti-Tg) levels were all recorded during the most recent visit. Body Mass Index (BMI), systolic and diastolic blood pressures, pulse rate were measured. Drug ingestion habits and levothyroxine doses were recorded and doses per kilogram of body weight were calculated. Patients were evaluated using the Morisky Medication Adherence Scale (MMAS-8) and were categorised as good, moderate, or poor compliant based on their scores. Thyroid cancer risk was assessed using the American Joint Committee on Cancer-7th edition thyroid cancer staging calculator. TSH serum concentrations were classified as severe suppression (TSH < 0. 01 mU/L), moderate suppression (TSH 0.01-0.1 mU/L), mild suppression (TSH 0.1-0.5 mU/L), euthyroid (TSH 0.5-4 mU/L) and hypothyroid (TSH > 4 mU/L). TSH levels can also be classified as on being on target, under the target, or beyond over the target, according to the American Thyroid Association (ATA) recommendations. Results: A group of 1125 patients (F/M: 941/184,50.7±11.7 years) were included in the study. The mean LT4 daily dosage was 132.4±39.6 mcg/day. TSH levels showed severe suppression in 99 (%8.8) patients, moderate suppression in 277 (%24.6) patients, and mild suppression in 315 (%28) patients and euthyroid range in 332 (%29.5) patients and hypothyroid range in 97 (8.6%). TSH levels were in target in 29.2% of the patients 20.4% of the patients were undertreated, 50.4% overtreated. The daily LT4 dose and LT4 dose/kg were significantly higher in the severe suppression group (p<0.001, p<0.001). According to Morisky scale, 564 patients (50.1%) were good compliant, 368 patients (32.7%) were moderate compliant, and 193 patients (17.1%) were non-compliant. Patients with poor compliance need a higher dose of LT4 compared to the good compliance group (p<0.001). TSH levels of patients with good compliance were 0.67±1.96 mU/L and TSH with poor compliance was 2.74±7.47 mU/L (p<0.001). TSH levels were similar in patients on fixed and alternating dosages. Conclusion: In 29.2 percent of the patients, serum TSH levels were within normal limits. Despite the fact that more than half of DTC patients adhere to therapy, half of the group's TSH levels were under or over the treatment range, exposing the patient to medication side effects. This risk can be reduced by developing more applicable guidelines and following the recommendations. Keywords This article is protected by copyright. All rights reserved.

AbstractAim: Detailed evaluation of patients in preoperative stage is an important factor that reduces morbidity and mortality as well as the operation itself. In our study, we aimed to examine clinically, pathologically and endocrinologically, the patients who were decided to undergo transsphenoidal surgery, in light of the literature.Materials and Methods: In this retrospective observational study, preoperative and pathological data of consecutive pituitary adenoma patients who applied to our department from January 2019 to June 2020 and underwent transsphenoidal surgery with microscopic methods, were examined.Results: The study included a total of 31 patients. Distribution of patients in relation to pathological diagnoses was as follows: Functional pituitary adenoma (n: 15), non-functional adenoma (n: 11), apoplexy (n: 2), carcinoma metastasis (n: 2) and craniopharyngioma (n: 1). No statistically significant difference was found between functional and non-functional adenomas, in terms of tumor size, cavernous sinus invasion, Ki-67 index and p53 staining pattern (p> 0.05) whereas presence of suprasellar extension and visual field defect were significantly more in non-functional adenomas (p = 0.015, p = 0.045, respectively).Conclusion: Highly invasive character was detected in both functional and non-functional pituitary Ki-67 indexes were low in the study population, increased p53 expression was noticeable. We can state that the Ki-67 index may not be directly proportional to the invasive behavior of the disease. Keywords: Microscopic; pituitary adenoma; transsphenoidal pituitary surgery

Background/aim: We aimed to determine the effect of percutaneous ethanol injection (PEI) on volume of cystic and mixed thyroid nodules, thyroid function tests (TFTs), antibody titers and cytological changes for 1 year. Methods: Fifty-five nodules of 53 patients with cystic and mixed properties treated with PEI were included. Nodule volumes, TFTs, thyroid autoantibodies were analyzed at baseline, 6thand 12thmonths. Fine needle aspiration biopsy (FNAB) was performed to PEI applied nodules in the 12thmonth. Thyroid nodules were grouped into three by structural properties (pure cystic, predominant cystic, predominant solid). Results: PEI caused a volume reduction of 80.7 % at 6thmonth and 82.1 % at 12thmonth without any serious complication. PEI was repeated 1.4±0.4 times with a mean total ethanol amount of 3.6 ± 3.1 mL. Volume reduction in the pure cystic nodules at 6th and 12th months after PEI was greater than the volume reductions in predominant cystic and predominant solid nodules. We detected that smaller nodules have greater volume reductions after PEI at 12th month. During the study, patients remained euthyroid. Anti-thyroglobulin levels were decreased at 12thmonths. None of the FNAB results was compatible with a malignant or suspicious for malignancy cytology at 12thmonth. Conclusion: PEI is an effective way of treatment for benign cystic and mixed thyroid nodules without any serious side effects. We can also assume that PEI is not a trigger for autoimmunity and malignancy development for short term. Abbreviations: Anti-TG = Antithyroglobulin antibody; Anti-TPO = Antithyroid peroxidase antibody; FNAB = Fine needle aspiration biopsy; fT3 = free triiodothyronine; fT4 = free thyroxine; PEI = Percutaneous ethanol injection; TFTs = Thyroid function tests; TSH = Thyroid stimulating hormone; US = Ultrasonography.