Hypothyroidism has been associated with atherosclerosis. The mechanisms of atherosclerosis in patients with thyroid failure remain controversial. Hypofibrinolysis might be a risk factor for thromboembolic disease in subclinical hypothyroidism (SH). We measured fibrinolytic activity in patients with SH before and after levothyroxine (LT(4)) treatment and compared it to those of controls. We prospectively included 35 patients with SH and 30 healthy controls. We treated patients with LT(4) until almost 6 months after the euthyroid state has been achieved. We measured fibrinogen, D-dimer, antithrombin III (ATIII), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA) activity, and factor VII. Clinical and anthropometric variables were recorded for both groups. We found increased levels of fibrinogen, PAI-1, and factor VII and decreased levels of ATIII activity in patients compared to control (p < 0.001 and p < 0.05). Decrease of tPA was not significant (p > 0.05). At the end of the LT(4) treatment, significant decreases were determined in PAI-1 and factor VII (p < 0.05). In conclusion, our data suggest an important role of hypofibrinolytic and hypercoagulable state on the development of atherosclerosis in patients with SH and beneficial effects of LT(4 )treatment for decreasing the risk of atherosclerosis.

The relationship between subclinical hypothyroidism (SH) and cardiovascular disease has been one of the most popular topics recently. There is still some controversy concerning its cardiovascular impact and management protocols. Our study aims to investigate the presence of the well known preceding clinical situations of atherosclerosis like endothelial dysfunction and inflammation in subclinical hypothyroidism. Thirty-seven patients with subclinical hypothyroidism (29 women, 8 men) and 23 healthy volunteers (19 women, 4 men) were recruited for the study. Endothelial dysfunction was measured by examining brachial artery responses to endothelium-dependent (flow mediated dilation, FMD) and endothelium-independent stimuli (sublingual nitroglycerin (NTG)). Serum TNF-alpha, interleukin-6, and hs-CRP were measured. The estimate of insulin resistance by HOMA score was calculated with the formula: fasting serum insulin (µIU/mL) x fasting plasma glucose (µM/L) / 22.5. There were no significant differences in age, body mass index, waist circumference, HOMA scores. There was a statistically significant difference in endothelium-dependent (FMD) and endothelium-independent vascular responses (NTG) between the patients with subclinical hypothyroidism and the normal healthy controls. The groups were well matched for baseline brachial artery diameter. The TSH and LDL, IL-6, TNF-alpha and hs-CRP levels in the patient group were significantly higher than those in control group. A positive correlation was found only between endothelium-dependent vasodilation and TNF-alpha, hs-CRP and IL-6, TSH, total cholesterol, LDL and triglycerides. Endothelium-independent vascular response was not correlated with any of the metabolic or hormonal parameters. Neither of the groups were insulin resistant and there was not any difference either in fasting insulin or in glucose levels. We found endothelial dysfunction in subclinical hypothyroidism group. Endothelium-dependent (FMD) and endothelium-independent vascular responses (NTG) were lower in patient group. Our findings suggest that there is endothelial dysfunction and low grade chronic inflammation in SH due to autoimmune thyroiditis. There are several contributing factors which can cause endothelial dysfunction in SH such as changes in lipid profile, hyperhomocysteinemia. According to our results low grade chronic inflammation may be one of these factors.

CANTÜ RK, ZEYNEP, NUH ZAFER CANTÜ RK, BERRIN Ç ETINARSLAN, NIHAT ZAFER UTKAN, AND ILHAN TARKUN. Nosocomial infections and obesity in surgical patients. Obes Res. 2003;11:769-775. Objective: There is an increased morbidity and mortality associated with surgery in the obese patient. This study was conducted to determine risk factors and compare the nosocomial infection rate in obese and nonobese surgical patients. Research Methods and Procedures:A total of 395 surgical patients were evaluated. BMI was calculated for each patient. Various conventional risk factors for nosocomial infections were recorded. Biochemical parameters with plasma total cholesterol and high-density lipoproteincholesterol levels were measured. The diagnosis of infection was made according to the Centers for Disease Control and Prevention criteria. Univariate and two-step multivariate logistic regression methods were used for determination of nosocomial infection risk factors. Results: There were 117 nosocomial infections identified in 96 of 395 surgically operated patients. A significant increase in the total number of nosocomial infections was determined in obese patients compared with the normalweight patients (p Ͻ 0.05). High-density lipoprotein-cholesterol below the 10th percentile increased risk of surgical site infection. Discussion: Our results suggest that obesity is an important risk factor for postoperative nosocomial infection.

The study demonstrated that TNF-alpha and IL-6 concentrations were elevated in normal weight women with PCOS. The findings may contribute to evidence of insulin resistance in lean women with PCOS.

Objective: Women with polycystic ovary syndrome (PCOS) exhibit elevated levels of serum C-reactive protein (CRP) and impaired endothelium dysfunction which are directly correlated with insulin resistance. Because rosiglitazone improves insulin sensitivity, we tested whether rosiglitazone treatment ameliorates high-sensitivity (hs)CRP levels and endothelial dysfunction in these patients. Design: Thirty-one women with PCOS were recruited (mean age, 24.7^3.9 (S.E.) years; mean body mass index (BMI), 25.6^3.2 kg/m 2 ). All women were treated with 4 mg rosiglitazone daily for 12 months. Methods: Serum levels of testosterone, LH, FSH, sex hormone-binding globulin (SHBG), insulin and hsCRP were measured. The BMI, hirsutism scores and insulin sensitivity indices were calculated before and after treatment. Arterial endothelium and smooth muscle function was measured by examining brachial artery responses to endothelium-dependent and endothelium-independent stimuli before and after treatment. Results: After treatment with rosigitazone there were significant decreases in serum testosterone (91.2^37.5 vs 56.1^21.8 ng/dl; P , 0.01) and fasting insulin concentrations (12.5^7.6 vs 8.75^4.03 mU/ml; P ¼ 0.015). Insulin resistance indices were significantly improved after rosiglitazone treatment (P , 0.05). There were no significant changes in BMI, waist circumference, serum total cholesterol, low-density lipoprotein (LDL)-cholesterol, FSH and LH levels. Hirsutism score was decreased significantly after treatment (10.8^1.8 vs 7.6^1.7; P , 0.05). Twenty-four of the women reverted to regular menstrual cycles. Levels of SHBG increased significantly after treatment (28.7^8.7 vs 48.4^11.2 nmol/l; P , 0.01). Serum hsCRP levels were decreased significantly after rosiglitazone treatment (0.25^0.1 vs 0.09^0.02 mg/dl; P ¼ 0.006). There was also significant improvement in endothelium-dependent vascular responses after rosiglitazone treatment (9.9^3.9 vs 16.4^5.1%; P , 0.01). Conclusions: We conclude that rosiglitazone treatment improves insulin sensitivity in women with PCOS. It also decreases androgen production without significant weight gain. More importantly, it has beneficial effects on endothelial dysfunction and low-grade chronic inflammation in normal weight young women with PCOS.