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Background/aim: Muslims worship by fasting from predawn (suhoor) until sunset (iftar) for 30 days in the religious month of Ramadan. In addition to prolonged hunger, patients fasting with a diagnosis of hypothyroidism take their doses of levothyroxine (LT4) outside of daytime fasting hours. The purpose of our study is to compare the values of hypothyroid patients which have been obtained through thyroid function tests before and after Ramadan.Materials and methods: Ninety-seven patients; ranging from 18 to 65 years old, who were followed with a diagnosis of hypothyroidism, who fasted during Ramadan, and who had no change of their LT4 dose for at least 6 months were included in the study. Results:The median serum thyroid-stimulating hormone (TSH) level of patients prior to fasting was 2.19 mIU/L, while median serum TSH after fasting was 2.73 mIU/L. Serum TSH values after Ramadan increased significantly compared to those prior to Ramadan (P = 0.004). Conclusion:Our study demonstrates a significant increase in serum TSH levels after Ramadan but no significant change in serum free thyroxine (fT4) levels in hypothyroidism patients who are fasting. It may be appropriate to take precautions by making a small increase in LT4 dose before Ramadan in some hypothyroid patients wishing to fast.

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Objective:The aim of the present study was to evaluate whether arterial stiffness is affected in the patients with hypoparathyroidism through pulse wave analysis (PWA). Subjects and methods: Sixty-three patients diagnosed with hypoparathyroidism and sixty volunteers were evaluated for the study. When 21 patients were excluded in the hypoparathyroidism group due to exclusion criteria, the research continued with 42 patients and 60 volunteers who are similar to the patients in terms of age, gender and body mass index (BMI). Fasting plasma glucose after 10 hours of fasting, creatinine, thyroid stimulating hormone (TSH), free thyroxine (fT4), albumin, calcium, phosphorus, magnesium, 25-OH vitamin D, parathormone (PTH) and urine calcium results in 24-hour urine for the patients in the hypoparathyroidism group were recorded. Evaluation of arterial stiffness was performed by Mobil-O-Graph 24h PWA device. Results: Systolic blood pressure (SBP) (p = 0.01), diastolic blood pressure (DBP) (p = 0.005), mean blood pressure (p = 0.009), central SBP (p = 0.004), central DBP (p = 0.01) and pulse wave velocity (PWV) (p = 0.02) were found higher in the hypoparathyroidism group. A positive correlation was detected between phosphorus level and SBP [(p = 0.03. r = 0.327)], central SBP [(p = 0.04, r = 0.324)] and PWV [(p = 0.003, r = 0.449)]. We detected that age and serum phosphorus levels were independent predictor variables for PWV (B = 0.014, p < 0.001 and B = 0.035, p < 0.001, respectively). Conclusion: We detected that hypoparathyroidism causes an increase in blood pressure and arterial stiffness. The most significant determinant factors were detected as advanced age and hyperphosphatemia. The patients diagnosed with hypoparathyroidism should be closely monitored and treatment planning should include to prevent the patients from hyperphosphatemia.

Background: Bariatric surgery is an important treatment option of obesity over the last decade. While bariatric surgery reduces weight and helps maintanence, it significantly reduces the obesity-related comorbidities, as well. Secondary hyperparathyroidism is a common metabolic complication of bariatric surgery, despite the recommended dose of calcium and vitamin D replacement. We have presented in our article that one of the results of bariatric surgery may be parathyroid adenoma (PA), although the long-term results are unknown. Methods: A total of 838 patients who had undergone sleeve gastrectomy (SG) between 2015 and 2018 were screened retrospectively. We analyzed the data of five patients with parathyroidectomy with PA and indicative of operation according to international guideline. Parathormone (PTH), 25-OH vitamin D3 (25OHD), calcium, phosphate (P), albümin, and alkaline phosphatase were evaluated, which were measured before and after parathyroidectomy. Weight changes of patients before and after bariatric surgery were calculated. Results: Mean age of the 838 patients were 38.7 -10.4 (years) with SG. Six hundred and eighty three subjects (81.5%) were women and 155 (18.5%) were men. Mean body weight changed before and after SG was respectively, 45.04 -6.37 kg/m 2 , 35.80 -7.6937 kg/m 2 , ( p = 0.002). All patients with PA were female and the mean age was 41.4 -9.0 (years). The mean time from bariatric surgery to parathyroid surgery was 2 -1 years. In 838 cases, PA was detected in five cases and the prevalence was found to be 0.6%. Conclusion: Long-term hypocalcemia may cause development of PA as a result of parathyroid gland stimulation. Clarification of increased PTH secondary to hypocalcemia, intestinal adaptation mechanisms, local effect of the wnt signaling pathway, change in carrier proteins, and the effect of adipokines on multifactorial conditions are extremely important to prevent bone loss in patients who underwent bariatric surgery. Development of PA after bariatric surgery is a serious complication and should not be overlooked. Therefore, long-term and strict follow-up is very important after surgery.

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