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Öğe Breast metastasis in follicular thyroid cancer patient(Wolters Kluwer Medknow Publications, 2022) Erturk, Seyit Ahmet; Hasbek, Zekiye; Duman, Gulhan; Sariakcali, BarisIn this case report, we aimed to present the findings of a follicular thyroid carcinoma patient with breast metastasis, which is rarely reported in the literature. A 33-year-old female who had been operated for thyroid cancer 17 years ago, but whose pathology report could not be reached was suspected of recurrence in the left lobe region of the thyroid gland. Fine-needle aspiration biopsy was done in this region, and the biopsy result was reported as thyroid follicular carcinoma. F-18-fluorodeoxyglucose (F-18-FDG) positron emission tomography/computed tomography (PET/CT) was performed for re-staging before surgery. In the PET/CT, it was found that there was residual thyroid tissue in the right and left lobe region and superior to these lesions in the left side, there were lesions which destruct to the hyoid bone, and there were multiple nodular lesions in both lungs which measured with maximum 15 mm x 12 mm, and all these lesions have increased F-18-FDG uptake. In addition to these lesions, a nodular lesion with the size of similar to 11 mm x10 mm in the upper-middle quadrant of the right breast, and it was showing increased F-18-FDG uptake (maximum standardized uptake value: 3). Pathology results of the left neck region operation materials were reported as papillary and follicular carcinoma of the thyroid gland. Right lumpectomy was performed for the lesion in the right breast during the same session with thyroid operation. The pathology result of this lesion was also reported as metastasis of thyroid follicular cancer. Posttreatment iodine-131 whole-body scan after surgery was reported as there was abnormal accumulation in residual thyroid tissues on the right side of the neck and lung metastases. In patients with thyroid cancer, the possibility of metastasis of the breasts should be considered when there is a lesion in the breast tissue.Öğe Does hepatic visualisation show residual/metastatic thyroid tissue in differentiated thyroid cancer?(DERMAN MEDICAL PUBL, 2019) Hasbek, Zekiye; Gul, Serdar Savas; Ciftci, Esra; Erturk, Seyit Ahmet; Cakmakcilar, Ali; Duman, Gulhan; Turgut, BulentAim: Diffuse homogen hepatic uptake in whole-body scan (WBS) after radioiodine remnant ablation (RRA) suggests that there is occult or visible remnant thyroid tissue and/or tumor tissue. It is thought that the reason is hepatic metabolization of radioiodine (1311) marked thyroglobulin fragments which are secreted by remnant/tumor tissue. The aims of this study were to investigate whether the hepatic visualisation after radioiodine remnant ablation showed the presence of metastatic or residual disease in patients with differentiated thyroid cancer and also to investigate whether early or late WBS after RRA (RxWBS) had an effect on the physiological hepatic uptake. Material and Method: 201 DTC patients were evaluated (F/M: 152/49; mean age: 49.61 +/- 13 years (range: 18-85 years)) who referred for RRA. The therapeutic 1311 dose ranged from 100mCi to 200mCi. RxWBS was performed earlier (in 1-4th-day after RRA) in 106 patients (Group 1) and was performed later (in 5-9th-day after RRA) in 95 patients (Group 2). Results: Diffuse hepatic uptake were seen only in three patients (2.8%) and was not seen in 103 patients (97.2%) in Group 1. However, in Group 2 diffuse hepatic uptake was seen in 93 patients (97.9%) (p<0.05) and not seen only in 2 patients (2.1%). There is not a statistically significant relationship between the hepatic uptake and serum Tg. LT4 and TSH level. There is a statistically significant relationship between anti-Tg level and hepatic uptake. Discussion: Physiological diffuse hepatic uptake of radioiodine in WBS after RRA may not be seen during the early WBS. Thus, metastatic foci may be missed with early scanning. We conclude that RxWBS after RRA should be done in late period.Öğe Elevated Levels of Activin-A, TNF-Alpha and IL-6 in Acromegaly(Maik Nauka/Interperiodica/Springer, 2021) Dogan, Kubra; Yildiz, Seyma Nur; Sariakcali, Baris; Duman, Gulhan; Bolat, SerkanAlthough systemic inflammation has been linked to acromegaly, little is known about the abnormalities in cytokine networks during the disease. The aim of this study was to evaluate the serum concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6), and activin-A in acromegaly, and to investigate the relationship between TNF-alpha, IL-6, activin-A and comorbidities of acromegaly. A total of 56 subjects were recruited to the study. Serum samples were collected from 31 acromegaly patients and 25 healthy control subjects. Serum activin-A, IL-6 and TNF-alpha were determined using the enzyme-linked immunosorbent assay. Circulating levels of activin-A, TNF-alpha, and IL-6 were higher in patients than in the control group. Receiver operating characteristic analysis for activin-A for the differentiation of acromegaly patients from healthy control subjects showed an area under the curve of 0.90. Higher activin-A levels were determined in patients with residual pituitary tumor. These findings provide evidence for the role of activin-A, TNF-alpha and IL-6 in acromegaly. Serum activin-A levels could be used as a novel biomarker to diagnose acromegaly. These findings confirm previous studies that inflammation might be involved in the pathogenesis of acromegaly. Finally, treatment strategies targeting the regulation of inflammation cannot be sufficient alone in reducing comorbidities.Öğe Evaluation of Apoptosis Markers Caspas-8, Cytochrome C Levels in PCOS Patients(Lahore Medical Research Center Llp, 2022) Sariakcali, Baris; Duman, GulhanBackground: Apoptosis is defined as a programmed cell death that eliminates dysfunctional, damaged, and fulfilled cells as a result of a certain stimulus. PCOS, IR, ovarian hyperandrogenism, hyperinsulinemia, and alterations in follicular endocrine signaling may impact the activation, growth, survival, and atresia of follicles. As a result of this impact, polycystic morphology may be observed in the ovaries, follicle development may be inhibited, and anovulation may occur. Aim: We aimed to investigate the relationship between the apoptosis markers caspase-8 and cytochrome-c levels and PCOS patients. Methods: Thirty female patients diagnosed with PCOS and 30 healthy volunteers were included in the study as a control group. Caspase-8 and cytochrome-c levels were measured by ELISA method in the sera of patients and healthy volunteers. Results: 30 PCOS female patients and 30 healthy control group were included in the study. No difference was found between the caspase-8 and cytochrome-c levels of PCOS patients and the caspase-8 and cytochrome-c levels of the healthy control group. (p <0.092, p <0.473). The mean ages of the patient and control groups were similar (mean age of patients: 24, mean age of control: 25). In the patient group, there was no relationship between total testosterone and caspase-8 and cytochrome-c levels (p <0.276, p <0.291). Conclusion: In polycystic ovary patients, the values of caspase-8, the apoptosis marker involved in the extrinsic pathway, and cytochrome-c, which is involved in the intrinsic pathway, similar to the control group. In order to investigate the relationship between PCOS and apoptosis, we suggest that apoptosis markers should be examined in the follicle fluids of PCOS patients.Öğe Evaluation of the Relationship Between Mobile Phone Usage and miRNA-574-5p and miRNA-30C-5p Levels in Thyroid Cancer Patients(Galenos Publ House, 2024) Hasbek, Zekiye; Tas, Ayca; Erturk, Seyit Ahmet; Sariakcali, Baris; Babacan, Ozge Ulas; Duman, Gulhan; Silig, YavuzObjectives: This study aimed to evaluate the relationship between mobile phone usage and miRNA-574-5p and miRNA-30C-5p levels in patients diagnosed with differentiated thyroid cancer (DTC). Methods: Fifty patients diagnosed with DTC and 50 healthy volunteers were included in the study. miRNA-574-5p and miRNA-30C-5p gene expression levels in the blood of all subjects were analyzed by real time-polymerase chain reaction, and a questionnaire including various questions was administered to both groups. Results: Although there was a 7.60 -fold increase in miRNA-30C-5p gene expression levels in the patient group compared with the control group, it was not found to be statistically significant. Considering the miRNA-574-5p gene expression levels, although there was a 2.96 -fold increase in the patient group compared with the control group, no significant relationship was found. In our study, 85% of our patients were using mobile phones with internet access, whereas 98% of our healthy volunteers were using mobile phones (p<0.05). While 53.5% of the patients had their mobile phones with them while they were sleeping, this rate was 83.7% in healthy volunteers (p<0.05). However, 93.9% of the healthy volunteers did not have a Wi-Fi device in their bedrooms, and this rate was 75% in the patient group (p<0.05). Conclusion: Although miRNA-30C-5p and miRNA-574-5p gene expression levels were higher in patients than in healthy volunteers, the differences were not statistically significant. Although there was no significant difference in miRNA levels, we believe that due to the higher rate of Wi-Fi device presence in bedrooms in patients compared with healthy volunteers, the effects of electromagnetic radiation on the thyroid can be reduced by paying attention to this simple change.Öğe Necroptosis mediated by receptor interacting protein kinase 3 as critical players in experimental congenital hypothyroidism related neuronal damage(Kare Publ, 2021) Duman, Gulhan; Alcigir, Mehmet Eray; Yavuz, HayrettinOBJECTIVE: Congenital hypothyroidism (CH) is literally described as congenital thyroid hormone imperfection. The primary objective of this research was to reveal the possible relation between receptor-acting protein kinase 3 (RIPK3) activity and neuronal damages in rat pups with CH. In addition, we evaluated the favorable impacts of 3.6-dibromo-alpha-([phenylamino] methyl)-9H-carbazole-9-ethanol (P7C3) reducing RIPK3 activity. METHODS: Adult rats were accordingly assigned into four groups: Group 1, which is called congenital hypothyroid; Group 2, which is called congenital hypothyroid administered P7C3; Group 3, called CH administered P7C3 and L-thyroxine; and Group 4, control group. RIPK3 level in plasma concentration and its expression in tissue was determined in all groups. RESULTS: Increased RIPK3 expressions were detected as high in the CH group when it is compared to the control group. Furthermore; the expressions in neuronal cytoplasm were found similar among Groups II and III. RIPK3 expressions in those two groups were relatively higher than in the control group. Most reacted parts of the brain were especially Purkinje cells in the cerebellum. CONCLUSION: It is concluded that there is excellent parallelism among damaged neurons and high RIPK3 activity in CH pathogenesis. P7C3 compounds may have a safeguarding impact on CH due to decreasing RIPK3 activity.Öğe Serum NOX-2 concentrations and paraoxanase-1 activity in subclinical hypothyroidism: a pilot study(Walter De Gruyter Gmbh, 2020) Duman, Gulhan; Dugan, Halef OkanObjective: Subclinical hypothyroidism (SH) is one of the most prevalent endocrine disorders. Although recent data suggest an imbalanced oxidative status in SH, the mechanisms of increased oxidative stress are poorly figured out. The primary goal of this research was to analyze potential sources of ROS and the relationship between serum NOX-2 levels and paraoxonase-1 (PON-1) activity in SH. Serum lipid changes in SH patients which had been determined were compared to healthy control group. Materials and methods: Thirty-one patients diagnosed with SI' and 30 healthy controls were included in the study. The quantitative sandwich ELISA was used for the detection of serum NOX-2 levels. Spectrophotometric method was used to determine serum PON-1 activity. Results: higher median serum NOX-2 levels were determined in patients than in the control group (p= 0.004). Lower median serum PON-1 activity was determined in patients as to aforementioned control group (p<0.0001). As a consequence, no statistically remarkable correlation was identified between PON-1 activity and NOX-2 levels. Triglyceride (TG) concentrations were determined as superior in patients to control group (p <0.0001). Conclusion: Over-production of NOX-2 and decreased PON-1 activity contribute to the increased oxidative stress in SH patients. Larger prospective studies required to confirm these findings.Öğe Serum WNT-induced secreted protein 1 level as a potential biomarker for thyroid nodules(Zaslavsky Publishing House, 2021) Duman, Gulhan; Sariakcali, BarisBackground. Thyroid nodule (TN) is a common thyroid disease worldwide, and it has increased significantly last decades. Most TNs are usually incidental findings of asymptomatic, benign lesions discovered by imaging modalities performed for reasons unrelated to thyroid diseases. The purpose of this study was to investigate the value of serum WNT-induced secreted protein 1 (WISP1) level as a supporting biomarker to perform differential diagnosis of benign and non-benign thyroid nodules. Materials and methods. The study was completed with the 89 patients undergone fine needle aspiration biopsy and 43 controls. The patients were composed of 96 (72.7 %) females and 36 (27.3 %) males. And they were divided into 2 group according to the Bethesda cytological evaluation as Benign (Bethesda 2) and Non-Benign (Bethesda 3–6) groups. Their serum WISP1 levels were measured by an ELISA method. Results. There were 58 (43.9 %) patients in Benign (Bethesda 2) and 31 (23.5 %) in non-Benign (Bethesda 3–6) groups. In the contrary nodule size was bigger in the Non-benign group than that benign group (p = 0.006). The serum WISP1 level in the Benign (Bethesda 2) group was significantly higher than that in the and Non-Benign (Bethesda 3–6) group, and controls (p < 0). The difference between benign and non-benign group accordingly to their echogenicitiy was significant (p < 0.05). In benign group there was 76.9 % mixed echoic nodules, 76.7 % isoechoic nodules 68.4 % isohypoechoic nodules and 35.7 % hypoechoic nodules. In the non-benign group, the highest hypoechoic echo (64.3 %), the least mixed echo (23.1 %), while in the benign group, the most mixed echo (76.9 %), the least hypoechoic echo (35.7 %) was present. There was no relation between WISP1 levels and echogenicity with Kruskal-Wallis H test. Conclusions. According to the preliminary results of current study, addition of serum WISP1 measurement to the differential diagnostic work-up of thyroid nodules patients may provide supportive information. In thyroid nodules patients with Benign (Bethesda 2) category of cytological evaluation, a higher level of serum WISP1 may support cytological diagnosis. © 2021. The Authors.Öğe Subacute thyroid and SARS-CoV-2 relationship(Lahore Medical & Dental Coll, 2021) Sariakcali, Baris; Duman, GulhanBackground: This study aims to research the relationship of subacute thyroiditis with SARS-CoV-2. The prevailing risks of predisposition to certain diseases or organ dysfunctions even after surviving the disease are discussed more frequently each day. Aim: Could SARS-CoV-2 be considered as a triggering factor in patients diagnosed with subacute thyroiditis? Investigating the relationship between subacute thyroiditis and SARS-CoV-2. Methods: Thirty-three patients diagnosed with subacute thyroiditis between 01.11.2020 and 01.04.2020 were included in the study. Patients who tested positive for SARS-CoV-2 throughout the examinations performed at the time of the diagnosis for subacute thyroiditis and patients who were previously diagnosed with Covid-19, who tested positive for SARS-CoV-2, and subsequently diagnosed with subacute thyroiditis within 30 days have been included in the study. Clinical evaluation of the patient, thyroid hormone values, CRP values, sedimentation levels, and thyroid ultrasonography images were considered to diagnose subacute thyroiditis; patients whose results were compatible with subacute thyroiditis were diagnosed with subacute thyroiditis, and they were included in the study. Results: It was found that 5 (15%) of the 33 patients included in the study had Covid-19 disease before the diagnosis of subacute thyroiditis and were isolated for the SARS-CoV-2 virus. Conclusion: The SARS-CoV-2 virus can be considered a triggering factor for subacute thyroiditis. We believe that researching this relationship on a broader patient population will bring more clarity to the subject. Although encountered in only one of our cases, the Coronavirus vaccine and SAT relationship may shed light on future studies.Öğe The impact of Dicer, Drosha, and Exportin-5 levels in polycystic ovary syndrome (PCOS) diagnosis and phenotyping(Via Medica, 2022) Duman, Gulhan; Sariakcali, Baris; Ersan, Serpil; Bakir, SevtapIntroduction: Polycystic ovary syndrome (PCOS) is a very common heterogeneous endocrine and gynaecological disease in reproductive women. Early identification and treatment of patients are necessary to prevent future cardiometabolic and reproductive complications. In our study, we aimed to investigate whether Drosha, Exportin-5 (XPO5), and Dicer, which are involved in miRNA formation, are useful markers in the diagnosis of the disease. Material and methods: Patients who presented to our clinic with complaints such as menstrual irregularity, hirsutism, and acne were diagnosed with polycystic ovary after excluding other possible diagnoses, and if they meet two-thirds of the Rotterdam diagnostic criteria, they were included in the study. Thirty patients with polycystic ovaries and 35 healthy controls were included in this study. Results: The mean values of XPO5, Drosha, and Dicer markers were significantly higher in the PCOS group when compared with the control group. With an XPO5 value > 1.70, we found the PCOS with 94% probability, 86.7% sensitivity, and 91.4% specificity. Moreover, if the Drosha value was > 0.166, it was expected that the patient would be diagnosed as PCOS with a probability of 75%, with 66.7% sensitivity and 71.4% specifidty. A statistically significant cut-off value could not be obtained for Dicer. Conclusions: In our study, the levels of all three markers were found to be significantly higher in the PCOS group compared to the control group. It suggests that they can be used in the early diagnosis of PCOS patients without full-blown disease. However, this preliminary study should be supported by larger-scale studies.Öğe The relationship between thyroid hormone levels, insulin resistance and body mass index, in patients with subclinical hypothyroidism and euthyroid patients(Zaslavsky Publishing House, 2022) Okan, Kasim; Sencan, Mehmet; Duman, GulhanBackground. Hypothyroidism is a common thyroid disorder with female predominance. In general population its prevalance is 2–5 % while 10 times higher in female than in men. Insulin resistance, one of the most discussed issues recently, is an inadequate response to insulin in peripheral tissues despite the normal secretory function of pancreatic islet cells. In this study, we analyzed relationship between thyroid hormone levels, body mass index and insulin resistance calculated with Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI) and Atherogenic Index of Plasma (AIP) in SCH and euthyroid patients under levothyroxine treatment. Materials and methods. The clinical and laboratory data of approximately 14 000 patients between the ages of 18–60 were retrospectively evaluated. After these exclusion criteria were applied, 371 eligible individuals were included in the study. All 371 individuals divided into three groups according to TSH levels. Group 1 is eutyhroid patients under levothyroxine treatment with TSH levels between 0.27– 4.2 ?IU/mL. Group 2 is subclinical hypothyroid patients with TSH levels between 4.2–10 ?IU/mL. Group 3 is healthy control group with TSH levels between 0.27–4.2 ?IU/mL. Results. The euthyroid patient group has the highest (25.66 ± 3.36 kg/m2) mean BMI. On the other hand the mean BMI was higher in SCH (24.0400 ± 3.8436 kg/m2) group than in control group (22.48 ± 2.74 kg/m2) (p < 0.05). Fasting plasma glucose (FPG), serum triglyserid, low density lipoprotein (LDL), anti-thyroid peroxidase (TPO) and insulin levels were significantly higher in euthyroid patient and SCH groups (p < 0.05). Notably, total cholesterol, LDL and TPO levels were higher in euthyroid patient group (p < 0.05). On the other hand, there were no difference between euthyroid patients and SCH group. Conclusions. This study found significantly elevated insulin resistance and cholesterol levels in SCH patients, so we hypothesized that SCH is also a risk factor for insulin resistance disorders such as cardiovascular diseases and metabolic syndrome. As a consequence, lipid metabolism defects and insulin resistance should be screened and treated in SCH patients. Thanks to the strong and significant correlation between HOMA and QUICKI in our study, we suggest the combined use of HOMA and QUICKI in these patients. Further and large-scale studies are needed to evaluate the relationship of HOMA, QUICKI, AIP, and BMI in detecting insulin resistance in SCH patients. © 2022. The Authors.Öğe Thyroid Nodules Located in the Lower Pole Have a Higher Risk of Malignancy than Located in the Isthmus: A Single-Center Experience(Hindawi Ltd, 2021) Duman, Gulhan; Sariakcali, BarisPurpose. The aim of our study is to investigate whether thyroid nodules (TNs) localization has value as a predictor of malignancy. Ultrasonography provides very valuable information in the evaluation of TNs, but it does not correlate perfectly with histopathologic findings. Therefore, studies that will include new diagnostic methods that can improve these unknowns can be welcomed gratefully. Methods. This study was carried out retrospectively in a tertiary care center from September 2016 to January 2020. The study included 862 adult patients who have one or more nodules. Ultrasonography of characteristics of nodules such as echogenicity, content, margins, calcifications, size, and localization was recorded. Fine-needle aspiration biopsy (FNAB) was performed on dominant and suspicious 1142 nodules. Results. The patients were composed of 692 (80.3%) females and 170 (19.7%) males. Compared to nodules located in the isthmus; the malignancy risk increased 8.39 (OR: 8.39 (2.34-30.12), p = 0.001) times in the lower pole, 4.27 (OR: 4.27 (1.16-15.72), p = 0.029), times in the middle pole, 8.09 (OR: 8.09 (2.11-30.94), p = 0.002) times in the upper pole, and 7.63 (OR: 7.63 (1.95-29.81), p = 0.003) times in the nodules covering the whole of the lobe. Although the most nodular location was in the middle pole, the risk of malignancy was less than that in the lower and upper poles. Conclusions. Unlike the other localization studies, we found a higher risk of malignancy in the lower and similarly upper thyroid poles. Besides well-defined malignancy indicators in the literature and guidelines, localization information is promising for this purpose in the future.
