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Öğe Decrease in TSH levels after lactose restriction in Hashimoto's thyroiditis patients with lactose intolerance(Springer, 2014) Asik, Mehmet; Gunes, Fahri; Binnetoglu, Emine; Eroglu, Mustafa; Bozkurt, Neslihan; Sen, Hacer; Akbal, ErdemWe aimed to evaluate the prevalence of lactose intolerance (LI) in patients with Hashimoto's thyroiditis (HT) and the effects of lactose restriction on thyroid function in these patients. Eighty-three HT patients taking l-thyroxine (LT4) were enrolled, and lactose tolerance tests were performed on all patients. Lactose intolerance was diagnosed in 75.9 % of the patients with HT. Thirty-eight patients with LI were started on a lactose-restricted diet for 8 weeks. Thirty-eight patients with LI (30 euthyroid and 8 with subclinical hypothyroidism), and 12 patients without LI were included in the final analysis. The level of TSH significantly decreased in the euthyroid and subclinical hypothyroid patients with LI [from 2.06 +/- A 1.02 to 1.51 +/- A 1.1 IU/mL and from 5.45 +/- A 0.74 to 2.25 +/- A 1.88 IU/mL, respectively (both P < 0.05)]. However, the level of TSH in patients without LI did not change significantly over the 8 weeks (P > 0.05). Lactose intolerance occurs at a high frequency in HT patients. Lactose restriction leads to decreased levels of TSH, and LI should be considered in hypothyroid patients who require increasing LT4 doses, have irregular TSH levels and are resistant to LT4 treatment.Öğe Hipertiroidi hastalarında serum sklerostin düzeyinin osteoporoz üzerindeki rolü(Çanakkale Onsekiz Mart Üniversitesi, 2016) Bozkurt, Neslihan; Şen, HacerAmaç: Subklinik ve aşikar hipertirodileri olan hastaların serum sklerostin seviyeleri kontrol grubunun serum sklerostin seviyeleri ile karşılaştırmayı amaçladık. Bu parametrenin hipertroidi süresi, tedavi süresi, tedavisiz kalan süre, kadın hastalar için menopoz durumu, gebelik sayısı, sigara ve alkol kullanımı, VKİ ile ilişkisini araştırdık. Yöntem: Çalışma için ÇOMÜ Tıp Fakültesi Uygulama ve Araştırma Hastanesi Endokrinoloji ve Metabolizma Polikliniğine başvurarak hipertiroidi tanısı alan 60 hasta seçildi. Kontrol grubu, hasta grubu ile benzer özelliklere sahip gönüllü 27 kişiden oluşturuldu. Serum TSH, sT3, sT4 değerleri ECLIA yöntemi ile Cobas e601 analizöründe Roche kitleri (Roche Diagnostics GmbH) kullanılarak ve serum sklerostin düzeyi ELISA yöntemine dayanan ticari kitler kullanılarak ölçüldü. Bulgular: Hasta grupları ve kontrol grupları arasında serum sklerostin seviyeleri açısıdan anlamlı bir fark saptanmadı. Tüm gruplarda baktığımızda serum sklerostin ile sT3 ve sT4 arasında pozitif yönde kuvvetli bir korelasyon saptadık (p=0268; p=0,227). Serum sklerostin seviyeri ile yaş, cinsiyet, VKİ, sigara ve alkol kullanımı arasında anlamlı bir ilşki saptamadık (p=-0,101, p=0,276, p=-0,182, p=0,402, p=0,451). Serum sklerostin ile hastalık süresi ve tedavi süresi arasında anlamlı ilişki kuramadık (p=-0,020, p=-0,069). Çalışmaya aldığımız kadın hastaların gebelik sayıları ve menopoz durumları ile serum sklerostin seviyelerini karşılaştırdığımızda anlamlı bir ilişki saptamadık (p=-0,034, p=0,386). Sonuç: Tüm gruplara baktığımızda sT3 ve sT4 yüksek olan hastalarda serum sklerostin seviyesini daha yüksek bulduk ama alt gruplara baktığımızda aşikar hipertiroidi ve subklinik hipertiroidi grupları ile kontrol grubu arasında serum sklerostin seviyleri arasında herhangi bir fark tespit edemedik. Literatüre baktığımızda bu konuda yapılmış benzer bir çalışma bulunmamaktadır. Yaptığımız çalışma Serum sklerostinin hipertiroidide meydana gelen osteoporozda etkili olduğunu düşündürmektedir. Osteoporozun erken tanısında serum düzeyi bakılarak ve osteoporoz tedavsinde anti sklerostin antikorları kullanılarak, sklerostinden yararlanılabilir. Bu konuda kesin kararlar alabilmek için daha fazla sayıda hasta grubu ile yapılmış gelecek çalışmalara ihtiyaç vardır.Öğe Pantoprazole-induced thrombocytopenia in patients with upper gastrointestinal bleeding(Taylor & Francis Inc, 2015) Binnetogolu, Emine; Akbal, Erdem; Sen, Hacer; Gunes, Fahri; Erbag, Gokhan; Asik, Mehmet; Bozkurt, NeslihanProton pump inhibitors (PPIs) are highly effective drugs for patients suffering from peptic ulcer and gastro-esophageal reflux diseases, but recent studies have indicated possible risks with the long-term use of PPIs, such as osteoporosis, fractures, increased risk of pneumonia, diarrhea, iron and vitamin B12 deficiencies. There are publications written as a case study that indicate thrombocytopenia as side effects of PPIs, but there is no study on this subject. This study aimed to investigate the development of thrombocytopenia in patients with short-term use of PPI-infusion therapy. In this study, the records of the patients were evaluated retrospectively, for the period between January 2012 and January 2013. Thirty-five patients with upper gastrointestinal bleeding were enrolled. Platelet counts were analyzed before treatment, and on the first, second and third day of treatment, respectively. All patients were treated with intravenous pantoprazole. Hemogram values of patients were analyzed before and after PPI infusion treatment. Platelet counts were found to decrease from the first day to the third day of treatment (249 714.29/mu l, 197 314.29/mu l, 193 941.18/mu l, 183 500/mu l, respectively). The platelet count decrease was statistically significant (p<0.001). After cessation of infusion therapy, platelet counts began to rise on the fourth day. Three patients had severe thrombocytopenia on the third day of the treatment. (69 000/mu l, 97 000/mu l and 49 000/mu l respectively). Platelet counts recovered after discontinuation of treatment. In conclusion, this study demonstrates that PPIs may cause thrombocytopenia, and this result should not be ignored. In particular, patients with PPI infusion therapy should be monitored more closely.Öğe Serum H-FABP levels in patients with hypothyroidism(Springer Wien, 2014) Gunes, Fahri; Asik, Mehmet; Temiz, Ahmet; Vural, Ahmet; Sen, Hacer; Binnetoglu, Emine; Bozkurt, NeslihanHypothyroidism (HT) has an increased risk for cardiovascular mortality and morbidity due to increased atherosclerosis. Heart-type fatty acid binding protein (H-FABP) is abundant in the cytosol of cardiomyocytes, and transports fatty acids into these cells. Although H-FABP has been shown to increase in several atherosclerotic and inflammatory conditions, there is no literature data indicating an alteration in other atherosclerotic processes such as HT. A total of 39 patients with subclinical hypothyroidism (SCH), 26 patients with overt hypothyroidism (OH), and 29 healthy subjects were enrolled in this study. Carotid artery intima media thickness (CIMT) was measured by high resolution B mode ultrasonography. H-FABP levels, thyroid function test, and biochemical tests of all subjects were measured. The associations between H-FABP and thyroid test and CIMT were examined with correlation and regression analysis. OH patients had higher H-FABP levels (mean, 6.18 +/- A 3.08 ng/mL) than both the SCH (mean, 3.81 +/- A 2.16 ng/mL) and the controls (mean, 2.12 +/- A 1.27 ng/mL) (P < 0.01 and < 0.001, respectively). SCH patients had increased serum H-FABP levels compared with control subjects (P < 0.01). CIMT of both OH and SCH patients was also significantly greater compared with control subjects (both of p < 0.01). H-FABP was significantly and positively correlated with age, systolic blood pressure, thyroid stimulating hormone (TSH) levels, and CIMT, and negatively correlated with fT4 levels. The H-FABP levels retained an independent and positive association with systolic blood pressure, and a negative association with fT4 levels. Serum H-FABP levels progressively increased from the control group to the OH group. This suggests that H-FABP may be an indicator of low-level myocardial damage in HT, especially when used together with CIMT. Decreasing serum fT4 levels seem also to have an effect on H-FABP levels.
