Muzaffer Serdar Deniz

Aims: Subacute thyroiditis (SAT) is a self-limiting inflammatory thyroid disorder that frequently presents with neck pain, systemic symptoms, and biochemical thyrotoxicosis. Delayed recognition of SAT may lead to repeated healthcare visits, inappropriate antibiotic use, and postponement of appropriate treatment. This study aimed to evaluate healthcare-seeking behavior, referral patterns, antibiotic use, and treatment approaches among patients diagnosed with SAT at a tertiary referral center. Additionally, demographic characteristics of patients diagnosed during the study period were assessed. Methods: In this retrospective cross-sectional study, medical records of patients evaluated for SAT in the Endocrinology Department of Sincan Training and Research Hospital between June 2023 and March 2025 were reviewed. Among 117 identified cases, 100 patients with confirmed SAT and complete clinical data were included in the analysis. Demographic characteristics, departments visited before endocrinology referral, time from symptom onset to endocrinology evaluation, antibiotic use, laboratory findings, thyroid ultrasonography results, and treatment methods were analyzed. Results: The study population consisted predominantly of female (74%), with a mean age of 45.4±9.9 years. The mean interval between symptom onset and endocrinology referral was 23.7±17.3 days. Prior to endocrinology evaluation, patients most frequently presented to internal medicine (45.6%) and otorhinolaryngology (14.4%) clinics. Notably, some patients sought care from multiple specialties, including emergency departments. Elevated inflammatory markers were observed at presentation, with mean erythrocyte sedimentation rate and C-reactive protein levels of 52.7±30.8 mm/h and 7.9±18.0 mg/dl, respectively. Before receiving a diagnosis of SAT, 42% of patients had been prescribed antibiotics, most commonly cephalosporins and amoxicillinclavulanate. Typical ultrasonographic findings of SAT were present in 80% of patients. Following diagnosis, the most frequently prescribed treatment regimen was a combination of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (42%), followed by NSAID monotherapy (27%) and corticosteroid monotherapy (26%). Conclusion: A substantial proportion of patients with SAT underwent evaluation by multiple healthcare providers and received unnecessary antibiotic treatment before referral to endocrinology services. These findings underscore the continuing challenges in early recognition of SAT and the importance of increasing clinical awareness, particularly among first-contact healthcare providers. Earlier identification of SAT may reduce diagnostic delays, minimize inappropriate antibiotic use, and facilitate timely initiation of appropriate therapy.

Medullary thyroid carcinoma (MTC) treatment guidelines recommend surgical extent based primarily on calcitonin levels, yet the oncologic impact of deviatin

Aims: Pheochromocytoma is characterized by catecholamine excess, which may influence immune regulation and metabolic pathways. However, the relationship between catecholamine activity, systemic inflammation, and immune-nutritional status remains incompletely understood. This study aimed to evaluate inflammatory and nutritional indices in patients with pheochromocytoma and to investigate their association with tumor size and plasma metanephrine levels.Methods: In this retrospective study, 39 patients with pheochromocytoma were compared with 24 age-, sex-, and body mass index-matched healthy control subjects. Complete blood count parameters and inflammation-based indices, including neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) score, were analyzed. Correlation analyses were performed to assess the relationships between inflammatory indices, plasma metanephrine levels, and tumor size.Results: Patients with pheochromocytoma had significantly higher WBC, neutrophil, and platelet counts than controls. SII was significantly elevated, whereas NLR, CONUT, and PNI did not differ between groups. Fasting glucose levels were higher in the pheochromocytoma group, while lipid parameters were comparable. Correlation analyses demonstrated PNI was negatively correlated with both tumor size and plasma metanephrine levels. SII showed positive correlations with NLR and PNI, and CONUT was positively correlated with NLR.Conclusion: Pheochromocytoma is associated with systemic inflammatory activation, as reflected by elevated leukocyte parameters and increased SII. Although overall nutritional indices were not significantly altered, the inverse association between PNI and tumor burden suggests that catecholamine excess may adversely affect immune-nutritional status. These findings highlight the complex immune-metabolic interplay in pheochromocytoma.

Aims: We aimed to compare hormonal profiles, nutritional status, and bone health parameters among patients with Cushing’s disease (CD), adrenal Cushing syndrome (ACS), and mild autonomous cortisol secretion (MACS). Methods: A single-center, cross-sectional study was conducted involving 110 adults with confirmed endogenous Cushing syndrome (46 CD, 36 ACS, 28 MACS). Biochemical, hormonal, and nutritional parameters (assessed via Prognostic Nutritional Index [PNI] and Controlling Nutritional Status [CONUT] scores) were evaluated alongside BMD (dual-energy X-ray absorptiometry [DXA]) and 10-year fracture risk (FRAX®). Results: The cohort (median age:53 years; 83.6% female) demonstrated expected hormonal variations among CS subtypes. However, all groups were similar in terms of PNI, CONUT score, and (dys) nutritional states. Bone health analysis revealed similar BMD and FRAX® scores across groups, except for higher femoral neck Z-scores in MACS versus ACS (p=0.027). Osteoporosis (present in 38.2% overall) was associated with worse DXA parameters and elevated fracture risk (p

Thyroid nodules are common in clinical practice, with malignancy detected in about 5% of cases. Current risk-stratification approaches, which rely on sonographic features and cytopathological assessment, have notable limitations, especially for indeterminate nodules categorized as Bethesda III. To address these diagnostic challenges, this study evaluated the utility of preoperative serum interleukin (IL)-17A and calprotectin levels as potential biomarkers for distinguishing malignant from benign Bethesda III thyroid nodules. This single-center prospective methodological study. In this prospective study, 76 patients with Bethesda III nodules scheduled for thyroidectomy were enrolled. Based on histopathological findings, nodules were classified as benign (n = 41) or malignant (n = 35). Comprehensive patient information was collected, including demographics, medical history, and detailed clinical parameters related to nodule characteristics and laboratory results. Circulating biomarkers measured included thyroid-stimulating hormone, free T3, free T4, thyroglobulin (TG), anti-TG, anti-thyroid peroxidase, calcitonin, IL-17A, and calprotectin. Patients with malignant nodules (n = 35) exhibited significantly higher preoperative IL-17A and calprotectin levels compared with those with benign nodules (n = 41) (p < 0.001 and p = 0.038, respectively). receiver operating characteristic analysis demonstrated promising diagnostic performance for IL-17A [area under the curve (AUC) = 0.733] and calprotectin (AUC = 0.639). IL-17A and calprotectin emerge as promising biomarkers for refining Bethesda III nodule stratification. Incorporating these inflammatory markers into existing diagnostic protocols may substantially reduce unnecessary surgical interventions, thereby alleviating patient anxiety, surgical risks, and healthcare costs.

Aims: The polyuria–polydipsia syndrome encompasses three major disorders—arginine vasopressin (AVP) deficiency, AVP resistance, and primary polydipsia. This study aimed to differentiate AVP deficiency from primary polydipsia by evaluating clinical features, biochemical markers, and anterior pituitary hormone levels, using the water deprivation test as the primary diagnostic modality. Methods: This retrospective observational study included 34 adult patients with polyuria–polydipsia syndrome who underwent a standardized inpatient water deprivation test. Patients were categorized into AVP deficiency (complete or partial) or primary polydipsia based on urine osmolality responses to dehydration and desmopressin. Clinical data, daily fluid intake, and nocturia frequency were recorded. Serum electrolytes and anterior pituitary hormones (LH, GH) were analyzed. Results: AVP deficiency was diagnosed in 76.4% of patients (58.8% complete, 17.6% partial), while 23.5% had primary polydipsia. LH and GH levels were significantly higher in the primary polydipsia group (p=0.011 and p=0.028, respectively), whereas AVP deficiency was associated with lower gonadotropin levels, especially in postoperative cases. Serum sodium, chloride, and magnesium levels were significantly lower in primary polydipsia (p

Background and Objectives: Medullary thyroid carcinoma is a rare neuroendocrine malignancy, with sporadic and hereditary forms accounting for 75% and 25% of cases, respectively. This study compares the clinicopathological features of sporadic medullary thyroid carcinoma (sMTC) and hereditary medullary thyroid carcinoma (hMTC) using real-world data to provide risk factors that aid in the early detection of the disease. Materials and Methods: The retrospective study comprised 77 patients with confirmed MTC treated at a tertiary referral center between January 2019 and December 2024. Patients were classified as hMTC (n = 11) or sMTC (n = 66) based on RET proto-oncogene (RET) genetic testing, whereas harboring a germline RET mutation indicated hMTC. Demographic, clinical, laboratory, radiological, histopathological, and genetic data were collected. Results: hMTC patients were significantly younger at diagnosis, with a comparable gender distribution (p = 0.738), and more often had a previous case of MTC within the family history. Pheochromocytoma occurred exclusively in hMTC. Multicentric tumors were more frequent in hMTC, and non-diagnostic Bethesda I cytology was higher in hMTC. Conclusions: While confirming established differences, this study provides detailed pre-operative diagnostic parameters and surgical approaches that can guide clinical decision-making in resource-limited settings where genetic testing may not be immediately available.

Aims: Hashimoto's thyroiditis (HT) is an autoimmune disorder impacting majorly females. HT is asymptomatic long-term and known to be affected by metabolic factors, genetics, and inflammation. The study aimed to compare inflammatory and metabolic markers in HT and assess their value in the diagnosis. Methods: An HT group (n=103) and a control group with euthyroidism (n=103) were included in the study. The demographics, anthropometric measurements, and circulation-based inflammatory and metabolic markers, triglyceride-glucose index, FIB-4 score, non-alcoholic fatty liver disease score, APRI, ATH score, systemic immune-inflammation index, systemic inflammation response index, prognostic nutritional index, monocyte-to-HDL cholesterol ratio, atherogenic index of plasma, neutrophil-to lymphocyte ratio, platelet-to-lymphocyte ratio, PV, PDW, and RDW were recorded. Results: Consistent with the literature, we found a 10-fold difference in the HT prevalence in females (90.3%) compared with males (9.7%). Anthropometric measurements revealed that increased hip circumference increases the risk of HT (118.0 cm [107.0–132.0]) compared to control (110.0 cm [103.0–119.0]). We failed to find any difference in metabolic or inflammatory indices in the HT vs. control group. Conclusion: This study reinforces the well-documented association between HT and female predominance and metabolic factors such as obesity and diabetes. However, inflammatory markers did not show a significant association with HT, urging the need for larger cohorts.

Amaç: Yaşlı hastalarda yaşam kalitesini artırmak ve ciddi patolojileri önlemek için diabetes mellitus (DM) ile ilişkili komplikasyonların saptanması çok önemlidir. Bu çalışmanın amacı, DM'li yaşlı erişkinlerde üriner mikroalbümin-kreatinin oranı (uMCR), üriner protein-kreatinin oranı (uPCR) ve kendi kendine kan şekeri takibinin (SMBG) nöropati, retinopati ve nefropatiyi gibi mikrovasküler komplikasyonları tahmin etmedeki tanısal performansını değerlendirmektir. Yöntem: Bu tanısal metodolojik çalışmada, endokrinoloji kliniğinde takip edilen 64 yaş üstü DM hastalarının (n=99) serum hemoglobin A1c (HbA1c), serum trigliserid-glukoz indeksi (TyG indeksi), SMBG ile ölçülen en yüksek ve en düşük kan şekeri düzeyleri farkı (SMBGfarkı) ve SMBGfarkı ile en yüksek SMBG düzeyinin oranı (SMBGoranı), uMCR ve uPCR değerleri, mikrovasküler komplikasyonları tahmin etmedeki tanısal güçleri ROC analiziyle değerlendirildi. Tanısal performansa sahip olanların kesim değerleri ve sensitivite ve spesifiteleri hesaplanmıştır. Bulgular: DM hastalarının %70'inin erkek olduğunu, %48,5'inde nöropati, %25,3'ünde retinopati ve %25,3'ünde nefropati olduğunu göstermiştir. Lipid metabolizması ve karaciğerle ilgili göstergeler normal aralıkta olmasına rağmen, hastalarda D vitamini eksikliği görülmüştür. ROC analizi, uMCR ve uPCR düzeylerinin bağımsız olarak nefropati ile ilişkili olduğunu (p