Aims:There are few data concerning the effects of thyroid disorders on intraocular pressure (IOP), central corneal thickness (CCT) and retinal thickness (RT) and to our knowledge no data have been reported in Hashimoto's thyroiditis (HT). In this study we aimed to evaluate the alterations in IOP, CCT and RT in patients with euthyroid HT. Methods:In this cross-sectional study we examined IOP, CCT and RT in patients with euthyroid HT and age and gender matched controls. Results:We evaluated 80 eyes of 40 patients with euthyroid HT and 96 eyes of 48 controls. Serum sensitive thyroid stimulating hormone (sTSH) (2.10±1.04 vs 1.92±1.23 uIU/ml), free triiodothyronine (fT3) (3.19±0.43 vs 3.14±0.34 pg/ml), and free tetraiodothyronine (fT4) (1.20±0.14 vs 1.18±0.13 ng/dl) levels were similar between the two groups. No statistically significant difference was observed in mean RT (266.93± 26.46 vs 275.35± 38.81 µm), CCT (533.68±29.28 vs 540.06±29.13 µm), or IOP (13.98±2.42 vs 14.32±2.62 mmHg) between HT patients and controls. In the HT group Anti-TPO was negatively correlated with mean RT (r = −0.227, p = 0.033). Conclusions:We have found no differences in CCT, RT and IOP between euthyroid HT patients and controls. In the present study, however there was a negative correlation between the anti-TPO levels and RT.

BackgroundDespite significant improvement in imaging quality and advanced scientific knowledge, it may still sometimes be difficult to distinguish different parathyroid lesions. The aims of this prospective study were to evaluate parathyroid lesions with ultrasound elastography and to determine whether strain index can help to differentiate parathyroid lesions.MethodsPatients with biochemically confirmed hyperparathyroidism and localised parathyroid lesions in ultrasonography were included. All patients underwent B-mode US and USE examination. Ultrasound elastography scores and strain index of lesions were determined. Strain index was defined as the ratio of strain of the thyroid parenchyma to the strain of the parathyroid lesion.ResultsData of 245 lesions of 230 patients were analysed. Histopathologically, there were 202 (82.45%) parathyroid adenomas, 26 (10.61%) atypical parathyroid adenomas, and 17 (6.94%) cases of parathyroid hyperplasia. Median serum Ca was significantly higher in atypical parathyroid adenoma patients than parathyroid hyperplasia patients (P = 0.019) and median PTH was significantly higher in APA compared to PA patients (P < 0.001). In 221 (90.2%) of the parathyroid lesions, USE score was 1 or 2. The median SI of atypical parathyroid adenomas was significantly higher than parathyroid adenomas and hyperplasia lesions (1.5 (0.56–4.86), 1.01 (0.21–8.43) and 0.91 (0.26–2.02), respectively, P = 0.003).ConclusionOur study revealed that SI of parathyroid lesions as well as serum calcium, parathyroid hormone levels, and B-mode US features may help to predict the atypical parathyroid adenoma. Ultrasound elastography can be used to differentiate among parathyroid lesions and guide a surgical approach.

Leydig cell aplasia/hypoplasia is an autosomal recessive condition. In its complete form, these patients are 46XY but are cryptorchid and phenotypically female. Most cases reported in literature presented with in adolescence with pubertal delay. We reported a case with a predefined mutation in the LHCGR gene, presenting with swelling in the inguinal region and therefore diagnosed in early childhood. We wanted to emphasize the necessity of keeping Leydig cell hypoplasia in mind in the differential diagnosis of sexual development disorders in early childhood.

Background: In this study, we aimed to evaluate ultrasonographical and cytological features of thyroid nodules in patients who were treated with radioactive iodine (RAI) for hyperthyroidism years ago. Methods:Patients who had a history of RAI treatment for hyperthyroidism and had thyroid nodules that were evaluated with fine-needle aspiration biopsy (FNAB) were included in the study.Results: There were 27 patients (22 female and 5 male) with a mean age of 59.3 ± 13.5.The indication for RAI treatment was Graves in 5 (18.6%), toxic nodular or multinodular goiter in 16 (69.2%), and unknown in 6 (22.2%) patients. A total of 48 thyroid nodules were evaluated with FNAB and cytological diagnosis were benign in 24 (50.0%), nondiagnostic in 15 (31.2%), atypia of undetermined significance in 5 (10.4%), suspicous for malignancy in 2 (4.2%), and malignant in 2 (4.2%) nodules. Thyroidectomy was performed in 10 patients, 5 were benign (50.0%), and 5 (50.0%) were malignant histopathologically. Ultrasonography features of 31 cytologically/histopathologically benign and five cytologically/histopathologically malignant nodules were compared. Prevalence of isoechoic nodules was higher in benign nodules (P = .025). Macrocalcification was observed in 4 (80.0%) of malignant and 10 (32.3%) of benign nodules (P = .042). Conclusion:In patients with a history of RAI treatment for hyperthyroidism, thyroid nodules with suspicious ultrasonography features, particulary hypoechoic appearence and macrocalcification, should be evaluated with FNAB irrespective of the time elapsed after RAI treatment. K E Y W O R D Scytology, fine-needle aspiration biopsy, histopathology, hyperthyroidism, radioactive iodine

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Introduction: Cushing's syndrome (CS) is characterized by excessive cortisol production. Notably, 50% of deaths were due to cardiovascular disease. CS may associate with cardiomyopathies (CMPs), whose pathophysiology is poorly understood. We describe a patient presenting with acute heart failure and recently diagnosed with CMP who was found to have hypercortisolism secondary to an adrenal adenoma. Case: A 31-year-old male patient was admitted to the cardiology department due to dyspnea. He had a weight gain of 25 in the last year. His blood pressure was 135/85 mmHg, and his pulse rate was 102bpm. He had central obesity (body mass index: 31 kg/m2), buffalo hump, and abdominal purple-blue wide striae. Transthoracic echocardiography revealed global hypokinesia [left ventricle end-diastolic diameter of 6 cm/m2 (normal range < 3.2 cm/m2) on M-mode], and 20%of LVEF (standard: 50–70%). Laboratory evaluation revealed increased plasma cortisol levels with an absence of circadian rhythm. Serum cortisol levels were not suppressed after the overnight 1 mg and two-day low-dose dexamethasone suppression test (LDDST). The hormonal evaluation indicated ACTH-independent CS (Table-1). Magnetic-resonance imaging of the adrenal gland revealed a 37x28mm adenoma in the lateral limb of the left adrenal gland. The patient was diagnosed with CS. Metyrapone was used to reduce cortisol levels before the surgery. The plasma cortisol level decreased to 14.8 µg/dL on the 20th day of metyrapone treatment. Although the ejection fraction of the left ventricle was still 40% on echocardiography (Table-2), improvement of heart failure symptoms was achieved (New York Heart Association (NYHA) class II). After reducing plasma cortisol levels and improving the EF, he underwent a successful left adrenalectomy procedure. Clinical and laboratory findings improved significantly soon after surgery. The pathology result was reported as diffuse nodular hyperplasia. The patient's LVEF was 50% at the 6th month follow-up and > 60% at the 1st year follow-up. Conclusion: CS CMP is a reversible entity induced by hypercortisolism. It is characterized by cell hypertrophy, myofibrillolysis, and myocardial fibrosis that revert after adrenalectomy. In addition, preoperative anesthesia risk may increase due to low LVEF because of the CMP. Therefore, patients may need to be treated preoperatively with rapid-acting adrenolytic drugs.

Background In this study, we aimed to evaluate ultrasonographical and cytological features of thyroid nodules in patients who were treated with radioactive iodine (RAI) for hyperthyroidism years ago. Methods Patients who had a history of RAI treatment for hyperthyroidism and had thyroid nodules that were evaluated with fine‐needle aspiration biopsy (FNAB) were included in the study. Results There were 27 patients (22 female and 5 male) with a mean age of 59.3 ± 13.5. The indication for RAI treatment was Graves in 5 (18.6%), toxic nodular or multinodular goiter in 16 (69.2%), and unknown in 6 (22.2%) patients. A total of 48 thyroid nodules were evaluated with FNAB and cytological diagnosis were benign in 24 (50.0%), nondiagnostic in 15 (31.2%), atypia of undetermined significance in 5 (10.4%), suspicous for malignancy in 2 (4.2%), and malignant in 2 (4.2%) nodules. Thyroidectomy was performed in 10 patients, 5 were benign (50.0%), and 5 (50.0%) were malignant histopathologically. Ultrasonography features of 31 cytologically/histopathologically benign and five cytologically/histopathologically malignant nodules were compared. Prevalence of isoechoic nodules was higher in benign nodules (P = .025). Macrocalcification was observed in 4 (80.0%) of malignant and 10 (32.3%) of benign nodules (P = .042). Conclusion In patients with a history of RAI treatment for hyperthyroidism, thyroid nodules with suspicious ultrasonography features, particulary hypoechoic appearence and macrocalcification, should be evaluated with FNAB irrespective of the time elapsed after RAI treatment.

Objective: To evaluate the changes in thyroid functions in Ramadan, and compare late evening and pre-seheri use of levothyroxine in patients with hypothyroidism.