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    A Comprehensive Diagnostic Assessment of Thyroid Nodules Utilizing Scintigraphy and Telomere Lengths (T/S ratios)
    (Galenos Publ House, 2025) Ozturk, Fulya Koc; Ozdemir, Semra Usta; Karakilic, Ersen; Silan, Fatma
    Objectives: This study aims to evaluate the effectiveness and role of telomere length measurements in leukocytes, plasma free cell DNA (cfDNA), and biopsy cells, along with technetium-99m (Tc-99m) methoxyisobutylisonitrile (MIBI) scintigraphy, as non-invasive methods for diagnosing malignant thyroid lesions. Methods: Data from 128 patients, who underwent ultrasound, Tc-99m MIBI scintigraphy, and fine-needle biopsy with a preliminary diagnosis of malignant thyroid nodules, were analyzed. In 98 patients, telomere lengths in leukocytes (from blood), cfDNA (from plasma), and biopsy cells were measured using the quantitative polymerase chain reaction method, and the relative telomere/single copy gene (T/S) ratio was calculated. Based on cytological examination results, patients were categorized into three groups: malignant, benign, and suspicious. Group differences were analyzed using the Kruskal-Wallis and Chi-square tests, and correlations between variables were examined with Spearman correlation analysis. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Tc-99m MIBI scintigraphy for diagnosing malignant thyroid nodules were 64.70%, 79.16%, 29.72%, 83.51%, and 67.96%, respectively. While these results align with the literature, the positive predictive value was notably lower. No significant differences were observed in telomere lengths (T/S ratios) in leukocytes, plasma, or tissue between the groups. Conclusion: Tc-99m MIBI scintigraphy demonstrates reasonable diagnostic accuracy for identifying malignancy in thyroid nodules. Contrary to limited reports, telomere length measurements may not be a reliable method for predicting thyroid malignancy. Larger studies are needed to further explore these findings.
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    Artificial Intelligence in Adrenal Diseases
    (Aves, 2025) Saygili, Emre Sedar; Karakilic, Ersen
    Adrenal diseases present significant clinical challenges due to their complex pathophysiology and prevalence. Artificial intelligence (AI) advances have shown transformative potential in their diagnosis and management. Machine learning, deep learning, and radiomics have been explored for lesion detection, tumor characterization, and functional assessments. Artificial intelligence-assisted imaging enhances adrenal lesion identification and segmentation, particularly with computed tomography and magnetic resonance imaging, improving diagnostic accuracy and workflow efficiency. Radiomics aids in tumor differentiation and prognostic evaluations. Artificial intelligence models demonstrate significant potential in diagnosing adrenal lesions, including Cushing's syndrome, primary aldosteronism, pheochromocytomas, and adrenocortical carcinoma. Machine learning applications improve subtype classification, reduce invasive procedures, and refine risk stratification. Integrated AI models combining clinical, biochemical, and imaging data enhance treatment outcome predictions. Despite these advances, challenges remain, including data variability, model interpretability, ethical concerns, and regulatory constraints. The black box nature of AI complicates clinical integration, necessitating robust validation across diverse datasets. Identifying key parameters influencing model outcomes through various methods is crucial. Additionally, disparities in AI accessibility highlight the need for equitable implementation. While AI holds promise for adrenal disease management, further research is needed to enhance generalizability, address ethical concerns, and establish regulatory frameworks.
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    Association Between Thyroid Antibodies and Ultrasonic Imaging in Patients with Hashimoto's Thyroiditis
    (Galenos Publ House, 2022) Unal, Mustafa; Duran, Iffet Dagdelen; Karakilic, Ersen; Basaran, Mehtap Navdar; Guler, Serdar
    Aim: The association between high levels of anti-thyroid antibodies and the extent of destruction of thyroid tissue is well documented. The aim of the present study was to analyze the relationship between anti-thyroid antibodies, thyroid hormones, and sonographic parenchymal changes. Methods: The study was designed as a case-control study. Four hundred and seventy-five patients with HT and 98 healthy subjects were included in the study. Serum levels of free thyroxine (fT4), free triiodothyronine (fT3), thyroid-stimulating hormone, and anti-thyroid antibodies (anti-thyroid peroxidase antibodies and anti-thyroglobulin antibodies) were measured. The ultrasonographic results of the patients were also recorded. Results: Serum levels of anti-TPO and anti-Tg were significantly associated with hypoechogenicity, heterogeneity, and pseudonodulation (p<0.001). There was no significant difference between the two groups in terms of cyst and nodule formation, however, a significant difference was found in terms of thyroid volume (p<0.001). Thyroid volumes were higher in the HT group. As serum anti-TPO levels increased in the HT group, parenchymal hypoechogenicity increased (p<0.001). Conclusion: Ultrasonography is a non-invasive method that provides information about the inflammatory activity of the thyroid gland. Significantly reduced echogenicity, heterogeneity, and multifocal pseudonodular infiltration were indicators of inflammatory activity and were associated with higher anti-TPO levels. Anti-TPO and ultrasonographical changes may be useful in the follow-up of Hashimoto's thyroiditis.
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    Cabergoline monotherapy in polycystic ovary syndrome patients with elevated prolactin: a viable option?
    (Springer, 2025) Siginir, Asli; Bostan, Hayri; Saygili, Emre Sedar; Tufan, Ceren; Karakilic, Ersen
    Purpose Cabergoline is widely used to treat hyperprolactinemia, but its effects on polycystic ovary syndrome (PCOS) remain unclear. Since hyperprolactinemia is present in nearly 30% of PCOS cases, this study aims to assess the impact of cabergoline on androgen levels and clinical outcomes in PCOS with elevated prolactin cases, discussing these findings with the results in prolactinoma cases. Methods A total of 66 women aged 18-40 were included in this retrospective cohort study, with 36 in the PCOS with elevated prolactin group (median 24.0 (22.0-27.5) years) and 30 in the prolactinoma group (median 28.0 (23.7-33.0) years). Only patients who had been started on cabergoline treatment and had available follow-up data were included. Hormonal profiles and clinical findings, including hirsutism, and menstrual cycle regularity, were assessed before and after cabergoline treatment. Results After cabergoline treatment, significant reductions in prolactin and total testosterone levels were observed in both groups. In the PCOS group, total testosterone decreased from 0.65-0.49 ng/mL (p < 0.001) and dehydroepiandrosterone-sulphate levels from 407.5-301.0 g/dL (p < 0.001). In the prolactinoma group, total testosterone decreased from 0.39-0.29 ng/mL (p < 0.001). Menstrual irregularities improved markedly in both groups, with prevalence decreasing from 83.3-5.6% in PCOS group and from 80.0-10.0% in the prolactinoma group (p < 0.001). Furthermore, in PCOS group, the prevalence of hirsutism was decreased from 86.1-61.1% (p = 0.007). Conclusion Cabergoline is effective in lowering prolactin and androgen levels while improving menstrual regularity in both PCOS and prolactinoma patients, highlighting its potential as a valuable therapeutic option for patients with PCOS with elevated prolactin.
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    Permanent central diabetes insipidus after mild head injury
    (Bmj Publishing Group, 2019) Karakilic, Ersen; Ahci, Serhat
    We report a case of a patient with mild traumatic brain injury (TBI) who was diagnosed with permanent central diabetes insipidus (DI). A 21-year-old man was admitted to our outpatient clinic with polyuria and polydipsia 1week after a mild head injury. He was well, except for these complaints. The initial laboratory workup was consistent with DI. There was no abnormality with other laboratory and hormone values. MRI showed lack of neurohypophyseal hyperintensity with no other abnormal findings. The patient responded well to desmopressin therapy. At the first year of the diagnosis, the patient still needed to use desmopressin treatment as we concluded that DI is permanent. DI is not uncommon after TBI, but it is often seen after severe TBI. We present here an extraordinary case of developing permanent DI after mild TBI with the absence of neurohypophyseal bright spot on MRI with no other abnormal findings.
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    Predicting stimulated C-peptide in type 1 diabetes using machine learning: a web-based tool from the T1D exchange registry
    (Elsevier Ireland Ltd, 2025) Saygili, Emre Sedar; Batman, Adnan; Karakilic, Ersen
    Aims: The mixed-meal tolerance test (MMTT), though considered the gold standard for evaluating residual beta-cell function in type 1 diabetes mellitus (T1D), is impractical for routine use. We aimed to develop and validate a machine learning (ML) model to predict MMTT-stimulated C-peptide categories using routine clinical data. Methods: Data from 319 individuals in the T1D Exchange Registry with complete MMTT and clinical information were analyzed. The cohort was randomly split into training (70%) and test (30%) sets. Five clinical variables-age at diagnosis, diabetes duration, HbA1c, non-fasting glucose, and non-fasting C-peptide-were selected via recursive feature elimination. Four ML algorithms (random forest [RF], XGBoost, LightGBM, and ordinal logistic regression) were trained with 10-fold cross-validation. Results: The RF model showed the highest performance: AUC 0.94 (95% CI: 0.92-0.96), sensitivity 0.84 (95% CI: 0.80-0.89), and specificity 0.92 (95% CI: 0.90-0.94) in cross-validation. In the test set, AUC was 0.97, sensitivity 88%, and specificity 94%. Notably, 17.7% of individuals with undetectable non-fasting C-peptide had measurable levels after MMTT. Conclusions: This ML model provides a practical, non-invasive tool for estimating beta-cell function in T1D and is available online at https://cpeptide.streamlit.app.
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    Predictors of Hypothyroidism Following Empirical Dose Radioiodine in Toxic Thyroid Nodules: Real-Life Experience
    (Elsevier Inc, 2022) Demir, Busra Kuyumcu; Karakilic, Ersen; Saygili, Emre Sedar; Araci, Nilgun; Ozdemir, Semra
    Objective: We aimed to determine the factors predicting hypothyroidism after radioactive iodine (RAI) treatment in patients with toxic adenoma and toxic multinodular goiter.Methods: We retrospectively collected the data of 237 patients with toxic multinodular goiter or toxic adenoma who had consecutively received RAI treatment between 2014 and 2020 at 2 medical centers. Patients who received the second RAI treatment and whose medical records could not be accessed were excluded from the study. Finally, 133 patients were included in the study. RAI was administered at an empirical dose of 15 or 20 mCi.Results: The median age of the 133 participants was 69 years (interquartile range, 62-75 years), and 64.7% of the participants were women. A total of 42.1% of the patients had toxic adenoma, whereas 57.9% of patients had toxic multinodular goiter. The median follow-up was 24 months (interquartile range, 11-38 months). During the follow-up, 61.7% of patients became euthyroid, 30.8% developed hypothy-roidism, and 7.5% remained hyperthyroid. The median month of hypothyroidism onset was 4 months (interquartile range, 2-9 months). Regression analysis revealed 2 factors that could predict hypothy-roidism: thyroid-stimulating hormone (odds ratio, 2.548; 95% CI, 1.042-6.231; P = .04) and thyroid volume (odds ratio, 0.930; 95% CI, 0.885-0.978; P = .005).Conclusion: Overall, 30.8% of the cases developed hypothyroidism after the RAI treatment. Approxi-mately 78% of hypothyroidism developed within the first 10 months. The risk of hypothyroidism was higher in patients with higher thyroid-stimulating hormone and smaller thyroid volume.(c) 2022 AACE. Published by Elsevier Inc. All rights reserved.
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    The Relationship Between the Admission Blood Glucose Level and 90-Day Mortality in Non-Diabetic Patients with Coronavirus Disease-2019
    (Galenos Publ House, 2022) Saygili, Emre Sedar; Karakilic, Ersen
    Introduction: The admission blood glucose (ABG) level is associated with increased mortality in non-diabetics patients with Coronavirus disease-2019 (COVID-19) in short-term follow-up studies. However, post-discharge mortality has also increased in COVID-19. Thus, this study aimed to examine the relationship between ABG and 90-day mortality including the post-discharge period. Methods: Non-diabetic patients who are hospitalized due to COVID-19 in 2020 were evaluated. Patients were divided into groups according to the ABG level. Groups 1, 2, and 3 have ABG level of <100 mg/dL, 100-139 mg/dL, and 140-199 mg/dL, respectively. Intensive care unit admission, in-hospital mortality, and 30- and 90-day mortality rates were evaluated as outcomes. COX regression analyzes were used to assess mortality risk factors. Results: A total of 1207 non-diabetic patients, of whom 49.2% were females, with a mean age of 65.2 +/- 13.4 years, were included in the study. The patients were followed up for a median of 153 (inter quartile range: 107.5-251, maximum: 369) days. The in-hospital and 30-day mortality of group 2 was higher than group 1 in the univariate analysis but without statistical significance in multivariate analysis. Group 3 had worse outcomes than group 1 in both univariate and multivariate analysis at all endpoints. Group 3 had 2.533 adjusted hazard ratios (95% confidence interval: 1.628-3.941, p<0.001) 90-day mortality compared with group 1. Conclusion: Non-diabetic patients with COVID-19 with an admission glucose level of >= 140 mg/dl had 2.5-fold increased all-cause mortality at 90 days. Therefore, being more careful in treating and following non-diabetic patients with COVID-19, especially those with hyperglycemia at admission, was recommended.