Objective: The aims of the study were to evaluate the disturbances in the coagulation system in patients with overt hypothyroidism (OH), to assess the effects of levothyroxine (LT4) on the coagulation parameters, and to determine whether subclinical hypothyroidism (SH) affects concentrations of coagulation markers and several biochemical parameters, thereby supporting early substitution. Design: The study included 15 patients with SH (TSH levels 5-10 mU/l), 15 patients with OH and 15 euthyroid controls. Methods: Blood urea nitrogen, creatinine, creatine phosphokinase, aspartate aminotransferase, lactate dehydrogenase, total-cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol and triglyceride levels, and bleeding time, prothrombin time (PT), activated partial thromboplastin time (APTT), factor VIII activity, von Willebrand factor activity (vWF), platelet count and clotting time were evaluated just before and three months after the maintenance of euthyroidism with LT4 treatment. Results: Factor VIII and vWF activities were lower in patients with SH than in controls (P , 0.01). Increased bleeding time, PT, APTT and clotting time and decreased factor VIII activity and vWF activity were observed in patients with OH when compared with controls. Bleeding time, PT, APTT and clotting time decreased and factor VIII activity, vWF and platelet count increased after LT4 in patients with OH. Increases in factor VIII activity and vWF (P , 0.01) were detected also in the SH group with treatment. Conclusions: OH is associated with significant abnormalities in clotting parameters which are reversed by LT4. In contrast, SH is associated with minor changes in factor VIII activity and vWF which are reversible by LT4. Serum lipids and other measured parameters are not improved by LT4 in patients with TSH ,10 mU/l and these data fail to demonstrate a need to treat such patients. European Journal of Endocrinology 152 355-361

Endemic goiter is an important public health problem in Turkey. Legislation for mandatory iodization of household salt was passed in July 1999. Current study is aimed at ascertaining the goiter prevalence and iodine nutrition in school-age children (SAC) living in known endemic areas of Turkey. Sonographic thyroid volumes (STV) and urinary iodine concentrations (UIC) of 5,948 SAC from 20 cities were measured between 1997-1999. STV of 31.8% of the SAC examined stayed above the upper-normal limits for the same age and gender recommended by the World Health Organization (WHO). Goiter prevalence ranged between 5 to 56% and median UIC ranged between 14 to 78 microg/l, indicating severe to moderate iodine deficiency (ID) in 14 and mild ID in 6 of the cities surveyed. Neither of the cities was found to have sufficient median UIC levels. The current study shows that endemic goiter is an important public health problem and iodine nutrition is inadequate nationwide. It also provides reliable scientific evidence and shows the need for a controlled and effective iodine supplementation program nationwide. Mandatory iodization of household salt seems to be the essential measure taken for the moment, additional measures may be needed in the near future.

Iodine deficiency (ID) and related disorders are still major, yet unresolved health concerns. Recently, in a systematic survey of school-age children (SAC), we reported severe to moderate ID, in Ankara and three cities from Black Sea region of Turkey. The current study attempted to evaluate selenium (Se) status, thiocyanate (SCN-) overload, and their possible contribution to the goiter endemics and thyroid hormone profile observed in these cities. Thyroid ultrasonography was performed and serum Se, SCN(-), thyroid hormones, sensitive TSH (sTSH) levels, and, urinary iodine concentrations (UICs) were determined from 251 SAC (9-11 yr old). Thyroid volumes (TVs) exceeding recommended upper normal limits and median UIC indicated goitre endemics and moderate to severe ID in the areas studied. Mean serum SCN(-) concentrations were found to be greater than the controls from the literature. The UIC/SCN(-) ratio was found to be lowest in Bayburt and Trabzon denoting that SCN(-) overload may contribute to the goiter endemics. Serum Se concentrations represent a marginal deficiency in the four areas studied. No significant correlations between serum Se concentrations and the other parameters studied (i.e., TV, SCN(-), thyroid hormones, sTSH, UIC) was detected. In conclusion, this study showed that selenium is also marginally deficient in the iodine-deficient endemic areas studied, but this has little or no impact on the thyroid hormone profile and the goiter endemics. SCN(-) overload may contribute to the endemics, especially for the areas where iodine is severely deficient. An effective iodine supplementation program will not only resolve the goiter endemics but also the consequence of SCN(-) overload as well in the endemic goiter areas studied.

Abstract.In this study, nine patients with Graves' ophthalmopathy with positive clinical activity score (CAS), who were either unresponsive or not suitable for glucocorticoid treatment, were given 100 pg of octreotide three times daily, subcutaneously, for three months. The mean age was 49± 13 years. All patients were under either propylthiouracil or methimazole therapy and were euthyroid for at least one month prior to the start of the octreotide treatment.The mean degree of proptosis as measured with the Hertel exophthalmometer decreased slightly after the treatment (22.0±3.0 vs 19.6±2.4 for the right eye and 22.2±1.9 vs 20.2±2.2 for the left eye; p<0.05).The mean activity score decreased from 3.2±0.8 to 1.7 ± 1.1 (p < 0.005) and the mean score of eye signs according to the NOSPECS classification showed improvement with octreotide therapy (3.2±0.7 vs. 2.2±1.4; p<0.05).Seven patients responded favorably to octreotide treatment.In the remaining two no improvement was observed. Four of the responders could be followed up for 20 months after the treatment and all maintained the favorable state of eye findings obtained with octreotide.We conclude that octreotide seems to be a safe and effective drug in Graves' ophthalmopathy, especially in improving soft tissue involvement, and can be used in patients who are unresponsive to glucocorticoid treatment or who cannot use these drugs for some reason.

No abstract

In an epidemiological study carried out in eight different inland and coastal areas from northern part of Cyprus Island 625 School Age Children (SAC) aged 9 and 10 years, underwent thyroid ultrasonography for determination of thyroid volume (TV). Urinary iodine concentration (UIC) was measured from morning urine samples taken from all of the children. Mean TV was 3.2+/-1.0 ml, 3.3+/-0.8 ml and 3.8+/-1.1 ml, 3.7+/-1.1 ml for 9- and 10-year-old girls and boys respectively. None of the SAC had TV exceeding recommended upper limits for their age and gender. Median UIC of the whole group was 120 microg/l (11-900 microg/l) and only 12.6% of the SAC had UIC below 50 microg/l indicating adequate iodine intake. In this first epidemiological survey conducted in the northern part of the Cyprus Island, iodine status was found to be satisfactory and goiter does not pose a public health problem at the time of the study. Periodical surveys are required especially for the regions which have marginally adequate values and for a coastal region with a significantly higher median value of UIC compared to the others (ie 458 microg/l) (p<0.001).

Endemic goitre is still an important and underestimated health concern in Turkey. The overall prevalence had been calculated as 30.3% by palpation in a national survey conducted in 1995. However, direct evidence that iodine deficiency (ID) is the major cause of the endemic were lacking until now. We measured sonographic thyroid volumes (STV), urinary iodine concentrations (UIC) in 1226 school age children (SAC) (9-11 year old) from Ankara the capital of Turkey located in the central Anatolia, and three highly endemic goitre areas of the Black Sea region. A considerable number of school age children (SAC) were found to have STV exceeding the recommended upper normal limits for their age and gender obtained from iodine-replete European children (i.e. 26.7, 40.3, 44.8 and 51.7% of children from Ankara, Kastamonu, Bayburt and Trabzon respectively). UIC indicated moderate to severe ID in these areas with median concentrations of 25.5, 30.5, 16.0 and 14 microg/L respectively. This study showed severe to moderate ID as the primary etiological factor for the goitre endemic observed in Ankara and the Black Sea region of Turkey.

Abs tract ÖzetPrimary hyperparathyroidism is the most frequent cause of hypercalcemia in adults. Primary hyperparathyroidism generally leads to mildmoderate hypercalcemia. Severe hypercalcemia in these cases is rare. Coexistence of severe hypercalcemia and hypercalcemic encephalopathy is very unusual with very limited number of reported cases. Our case is a 50-year-old female who presented to the emergency department with the complaints of nausea and severe abdominal pain. Her serum calcium level was 19.7 mg/dL (8.8-10.2 mg/dL) and her PTH level was 73.5 ng/ dL (15-65) on presentation. After her hospitalization, she was treated with saline infusions and furosemide, however, her calcium level increased to 22.4 mg/dL. Her calcium levels were also refractory to subcutaneous calcitonin 200 mg twice a day and zoledronic acid 4 mg. Ultrasonography of the neck revealed a 3.2x2.7x4.6 cm mass suspicious for a left parathyroid adenoma hardly being distinguished from a left thyroid nodule. Considering her general situation getting worse despite maximum medical treatment, she underwent an emergency parathyroidectomy and total thyroidectomy. Early postoperatively, the patient's general condition deteriorated reaching a precoma state. Cranial computed tomography (CT) at this point revealed periventricular ischemia compatible with metabolic encephalopathy. During the follow-up postoperatively, the patient's serum calcium levels normalized eventually requiring active vitamin D and calcium pills and she no longer had symptoms of encephalopathy. The pathology specimen was reported as a parathyroid neoplasm compatible with atypical parathyroid adenoma. Although mild-moderate hypercalcemia is frequent in primary hyperparathyroidism, it should be noted that it can be severe and refractory to maximum medical treatment requiring emergency surgical intervention. In addition, not being one of the most frequent reasons, severe hypercalcemia due to primary hyperparathyroidism should be considered as an important cause of metabolic encephalopathy. Turk Jem 2015; 19: 105-108Erişkinlerde hiperkalseminin en sık görülen sebebi primer hiperparatiroididir. Primer hiperparatiroidinin yol açtığı kalsiyum yüksekliği genellikle ılımlıdır. Bu olgularda ciddi hiperkalsemi seyrektir. Bu olgularda ciddi hiperkalsemi ile birlikte hiperkalsemik ensefalopati birlikteliği seyrek görülmekte olup sınırlı sayıda olgu sunumu literatürde bildirilmiştir. Elli yaşındaki kadın olgumuz bulantı ve ciddi karın ağrısı şikayeti ile acil servise başvurusunda serum kalsiyum düzeyi 19,7 mg/dL (8,8-10,2 mg/dL) ve serum PTH düzeyi 73,5 (13-65) ng/dL olarak saptandı. Hastaneye yatışının ardından serum fizyolojik infüzyonu ve furosemid tedavisine rağmen kalsiyum düzeyi 22,4 mg/dL'ye kadar yükseldi. Kalsitonin günde 2 kez 200 mg subkutan ve zoledronik asit 4 mg intravenöz verilmesi sonrası da yanıt alınamadı. Boyun ultrasonografisinde sol lob inferiorunda tiroid nodülünden zor ayrılabilen ve paratiroid ile uyumlu olabilecek 3,2x2,7x4,6 cm kitle izlendi. Genel durumunun tedaviye ...