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    25 - Hydroxyvitamin D Status in Type 1 Diabetic Adults and its Relationship with Glycemic Control
    (2024) Andac, Burak; Bulbul, Buket Yılmaz; Tezel, Mehmet Ogulcan; Okur, Mine; Colak, Serpil Yanık; Ekıcı, Buse; Celık, Mehmet
    Objective: To assess the vitamin D levels between adults with type 1 diabetes mellitus and the healthy control group and evaluate the relationship between HbA1c levels and vitamin D status in the diabetic group. Material and Methods: Our cross-sectional, descriptive study included 98 type 1 diabetic patients over 18 years old who applied to the Endocrinology Outpatient Clinic and 95 age- and sex-matched individuals without chronic disease. Patients with advanced renal or liver disorders, primary hyperparathyroidism, metabolic bone disorders, or using medications that might change vitamin D concentrations were excluded from the study. HbA1c and 25(OH) Vitamin-D3 levels were measured three times in nine months, and the average of the measurements was used. Diabetic patients and control individuals were separated into three groups according to their vitamin D levels as follows: deficiency (<12 ng/ml), insufficiency (12-20 ng/ml), and sufficiency (> 20 ng/ml). Results: Serum 25 (OH) vitamin D levels of diabetic patients were significantly lower than in healthy individuals (p=0.024). However, when diabetic adults were separated into three groups according to 25(OH) vitamin D levels, there was no significant difference regarding HbA1c levels (p=0.905). Conclusion: Although preclinical data support the role of low serum vitamin D levels in the etiopathogenesis of type 1 diabetes mellitus, studies examining the connection between low serum vitamin D levels and the prevalence of type 1 diabetes or glycemic control are not sufficient to reach a clear conclusion, including our study.
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    Association of MG53 with presence of type 2 diabetes mellitus, glycemic control, and diabetic complications
    (Public Library Science, 2023) Andac, Burak; Ozgun, Eray; Bulbul, Buket Yilmaz; Colak, Serpil Yanik; Okur, Mine; Yekdes, Ali Cem; Ocal, Eftal
    ObjectivesMitsugumin 53 (MG53) is a myokine that acts as a membrane repair protein in tissues. Data on the effect of MG53 on insulin signaling and type 2 diabetes mellitus (T2 DM) are still unknown; most are from preclinical studies. Nevertheless, some researchers have argued that it may be a new pathogenic factor, and therapies targeting MG53 may be a new avenue for T2 DM. Our study aims to evaluate the relationship of circulating MG53 levels with the presence of diabetes, diabetic complications, and glycemic control.MethodsWe conducted a case-control study with 107 patients with T2 DM and 105 subjects without insulin resistance-related disease. Concurrent blood samples were used for serum MG53 levels and other biochemical laboratory data. MG53 concentration was measured using Human-MG53, an enzyme-linked immunosorbent assay kit (Cat# CSB-EL024511HU).ResultsWe found no difference in MG53 levels between the diabetic and control groups (p = 0.914). Furthermore, when the subjects were divided into tertiles according to their MG53 levels, we did not find any difference between the groups in terms of the presence of diabetes (p = 0.981). Additionally, no correlation was observed between weight, BMI, waist circumference, systolic and diastolic blood pressure, fasting blood glucose, HbA1c, albumin excretion in the urine, e-GFR levels, and MG53. Finally, MG53 levels were similar between the groups with and without microvascular and macrovascular complications of diabetes.ConclusionOur research finding provides insightful clinical evidence of lack of association between the levels of MG53 and T2 DM or glycemic control, at least in the studied population of Turkeys ethnicity. However, further clinical studies are warranted to establish solid evidence of the link between MG53, insulin resistance and glycemic control in a wider population elsewhere in the world.
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    Falsely Elevated Thyroid Stimulating Hormone in Two Cases Requiring Special Follow-up
    (Galenos Publ House, 2023) Colak, Serpil Yanik; Ozgun, Eray; Andac, Burak; Okur, Mine; Bulbul, Buket Yilmaz; Celik, Mehmet
    Inappropriate thyroid stimulating hormone (TSH) refers to an elevation in TSH levels that does not match the clinical findings and free T3 and free T4 levels. Several conditions can cause this, such as pituitary tumors that produce TSH, resistance to thyroid hormones, macro-TSH, and antibody interference. Macro-TSH is a condition that causes TSH to be measured high in the blood for a long time by forming a complex with immunoglobulins, mostly IgG. However, patients are clinically euthyroid because macro-TSH is not a bioactive complex. It is essential to exclude the diagnosis of falsely elevated TSH to protect patients from unnecessary or high -dose levothyroxine therapy. In our first case, we presented a patient in whom subclinical hypothyroidism was detected during in vitro fertilization treatment, and levothyroxine was started. The other case was an operated papillary thyroid cancer patient. In both cases, although the dose of levothyroxine was increased, insufficient TSH response to increased fT4/fT3 levels suggested inappropriate TSH elevation. The polyethylene glycol (PEG) precipitation method was used to detect the assay variability. TSH recovery after PEG was 0.96016 and 21016, respectively, supporting the diagnosis of macro-TSH. In both cases, detecting Macro-TSH was crucial in preventing thyrotoxicosis caused by excessive levothyroxine dosage. In addition, delay in treatment for infertility was prevented in the first case.
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    The Impact of Total Tumor Diameter on Lymph Node Metastasis and Tumor Recurrence in Papillary Thyroid Carcinomas
    (Mdpi, 2024) Can, Nuray; Bulbul, Buket Yilmaz; Ozyilmaz, Filiz; Sut, Necdet; Mercan, Meltem Ayyildiz; Andac, Burak; Celik, Mehmet
    (1) Introduction: The impact of multifocality/bilaterality on the prognosis of papillary thyroid carcinoma (PTC) is a matter of debate. In order to clarify this debate, several studies have attempted to identify additional parameters associated with poor prognosis, including total tumor diameter (TTD), in the context of multifocal PTCs. In this context, this study was carried out to investigate the impact of TTD on tumor recurrence and lymph node metastasis (LNM) in PTCs. (2) Materials and Methods: The sample of this single-center retrospective study consisted of 706 patients diagnosed with PTC. TTD was calculated as the sum of the largest diameters of tumor foci in multifocal tumors. The resulting TTDs were grouped into TTDs <= 10 mm, TTDs > 10 mm, TTDs <= 20 mm, and TTDs > 20 mm, using 10 mm and 20 mm as cutoff values. (3) Results: There was no significant difference between multifocal papillary microcarcinomas (PTMCs) with a TTD of >10 mm and unifocal PTCs with a primary tumor diameter (PTD) of >10 mm except for advanced age and lymphovascular invasion (LVI). In addition, perineural invasion (PNI) and TTD > 10 mm were found to be significant risk factors for LNM, and PNI, TTD > 10 mm, TTD > 20 mm, and bilaterality were found to be significant risk factors for recurrence. LVI, and TTD > 10 mm were found to be independent significant predictors for recurrence, and LVI and extrathyroidal extension (ETE) were found to be independent significant predictors for LNM. (4) Conclusions: Considering TTD > 10 mm in recurrence risk categorization models and adopting a clinical approach that takes into account multifocal PTMCs with TTD > 10 mm along with unifocal PTCs with PTD > 10 mm may be more useful in terms of clinical management of the disease.
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    RELATIONSHIP OF MAGNESIUM LEVEL WITH GLYCEMIC CONTROL AND LIPID PROFILE IN ADULT PATIENTS WITH TYPE 1 DIABETES MELLITUS
    (Polish Society Magnesium Research, 2021) Andac, Burak; Bulbul, Buket Yilmaz; Durak, Dudu Merve; Celik, Mehmet
    Type 1 diabetes mellitus (T1 DM) is a disease caused by the autoimmune destruction of pancreatic beta cells due to environmental factors in individuals with genetic predisposition. Magnesium (Mg) is one of the environmental factors suggested to be effective in the pathogenesis and progression of T1 DM. While studies link Mg deficiency with poor glycemic control and dyslipidemia, there are also findings suggesting no association. We aimed to assess the serum Mg levels in adults with T1 DM and evaluate its relationship with glycemic control and lipid profile. The study included 95 type 1 diabetic patients, who presented at the Endocrinology outpatient clinic, and 95 age- and gender-matched individuals without chronic disease. The comparison between the study groups was made using Student's t-test for qualitative data analysis and Mann-Whitney U test for quantitative data analysis without normal distribution. The Mg level of the diabetic patients was significantly lower than in the control group (p<0.001). In diabetic patients, the Mg level was significantly higher in the group with Hba1c <7% compared to the group with HbA1c >= 7%. The patients were divided into two groups according to the optimal Mg cut-off value (0.8 mmol L-1) determined by ROC analysis. The median (interquartile range (IQR)) values of HbA1c were 8.9% (10) in patients with Mg levels <0.8 mmol L-1; 7.6% (6) in patients with Mg levels >= 0.8 mmol L-1 (p<0.001). Although some studies have shown that Mg deficiency is associated with higher levels of LDL-cholesterol, triglyceride, and lower levels of HDL-cholesterol, there was no significant difference in the lipid profile parameters in our study. When the cut-off value of Mg level was taken as 0.8 mmol L-1, we did not find a significant relationship between the Mg level and lipid profile parameters. We conclude that Mg levels were lower in patients with T1 DM, and it was associated with poor glycemic control. However, Mg levels were not associated with dyslipidemia. Maintaining the Mg level above 0.8 mmol L-1 should be a supportive approach for glycemic control; however, more prospective studies are needed on this topic.
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    Tumor Microenvironment Features as Predictive Biomarkers in Metastatic Differentiated Thyroid Cancer and Their Relationship With 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) Metabolic Parameters
    (Springernature, 2023) Soyluoglu, Selin; Tastekin, Ebru; Andac, Burak; Korkmaz, Ulku; Orun, Seyma Gizem; Altun, Gulay Durmus
    Objective: The role of the tumor microenvironment in tumor progression and treatment response is being investigated for different types of cancer. This study aimed to determine the relationships between tumor microenvironment, histopathology, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)-based metabolic parameters, treatment response, and overall survival (OS) in metastatic differentiated thyroid cancer (DTC).Methods: Metastatic DTC patients who underwent 18F-FDG PET/CT between 2015-2019 were evaluated. Clinicopathological, histopathological features and PET/CT parameters of patients were recorded. Microenvironmental characteristics of the primary tumor, such as mitosis, intratumoral and peritumoral lymphocytosis, intratumoral and peritumoral fibrosis, were evaluated from the tissue samples. The relationships between these factors were statistically analyzed.Results: Sixty-five patients (38 females, 27 males, age: 49 +/- 15 years) were included. Mitosis, intra/peritumoral lymphocytosis, and intra/peritumoral fibrosis were frequent; however, none of them had a statistically significant association with PET-positive metastases, treatment response, or OS. Univariate analysis showed that gender, size, thyroglobulin values, residual thyroid tissue, PET-positive metastases, and maximum standardized uptake value (SUVmax) were significant predictors of OS. At multivariate analysis, PET-positive metastases (I-IR=-2.65, 95%CI 0.007-0.707, p=0.024) and SUVmax (I-IR=-2.74, 95%CI 0.006-0.687, p=0.023) were the only independent predictors for OS.Conclusion: Our study revealed that microenvironmental characteristics of the primary tumor did not show prognostic significance in metastatic DTC. PET-positive metastases and SUVmax levels were the only significant factors that predicted overall survival in DTC. Supporting the results of our study with further studies with a larger sample size may be necessary to determine the relationship between the tumor microenvironment and prognosis in DTC.