Didem Özdemir

Background/Objectives: Atypia of undetermined significance (AUS; Bethesda category III) remains a challenging thyroid cytological diagnosis because of its heterogeneous malignancy risk and limited preoperative certainty. Molecular testing can improve risk stratification but is not universally available. This study evaluated the diagnostic and incremental predictive value of preoperative complete blood count-derived systemic inflammatory indices in surgically treated Bethesda III thyroid nodules. Methods: This retrospective cohort included 352 patients who underwent thyroidectomy for Bethesda III thyroid nodules. Preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) were evaluated. Postoperative histopathology served as the reference standard. Receiver operating characteristic analysis and multivariable logistic regression were performed, followed by incremental model assessment, bootstrap internal validation, Hashimoto thyroiditis interaction analysis, and exploratory molecular subgroup analysis. Results: Among 352 patients, 197 (56.0%) had malignant histopathology. Malignant nodules showed higher NLR, PLR, SII, SIRI, and AISI and lower LMR. All six indices remained independently associated with malignancy after multivariable adjustment, with the strongest positive associations observed for SII (adjusted OR, 2.09; 95% CI, 1.60–2.72) and NLR (adjusted OR, 1.96; 95% CI, 1.51–2.54). SII demonstrated the numerically highest individual discrimination (AUC 0.687; 95% CI, 0.631–0.740), followed by NLR (AUC 0.661) and AISI (AUC 0.659); SII and NLR did not differ significantly (DeLong p = 0.182). Addition of SII increased the AUC of the clinico-ultrasonographic model from 0.695 to 0.761, with an optimism-corrected AUC of 0.721. Hashimoto thyroiditis did not significantly modify these associations. In the molecular subgroup, mutation status increased model discrimination from 0.765 to 0.824, whereas no statistically significant additional improvement with SII was detected in the exploratory molecular subgroup. Conclusions: Preoperative systemic inflammatory indices, particularly SII, provide modest but incremental predictive information beyond conventional clinical and ultrasonographic variables in surgically treated Bethesda III thyroid nodules. Their role appears complementary rather than diagnostic when used in isolation, particularly when comprehensive molecular testing is unavailable. Prospective external validation is required before clinical implementation.

Background/Objectives: Postprandial hypotension (PPH) is an important clinical condition in patients presenting with postprandial symptoms. The aims of this study were to determine the prevalence of PPH in patients with postprandial symptoms and to investigate the relationship between PPH and insulin, particularly in healthy adults. Methods: This study was conducted with 111 adult patients who were admitted to the clinic due to postprandial symptoms. Patients underwent the mixed meal test (MMT). Blood glucose, insulin, and C-peptide levels were measured at 0, 30, 60, 90, 120, 180, 240, and 300 min along with systolic blood pressure (sBP), diastolic blood pressure (dBP), and heart rate measurements during the MMT. Results: Serum adrenocorticotropic hormone (ACTH) levels were similar (p > 0.05), and cortisol levels were found to be higher in individuals without PPH compared to those with PPH before the MMT (p = 0.014). During the MMT, 23 patients (23.2%) had PPH. At the beginning of the test, serum glucose, insulin, C-peptide, and heart rate values were similar in patients with and without PPH; however sBP and dBP were significantly higher in the PPH group (p = 0.002 and p = 0.010, respectively). No correlation was found between sBP and insulin, glucose, and C-peptide at any time during the MMT except for a moderately significant positive correlation between glucose and sBP at 90 min in patients with PPH (r = 0.490, p = 0.018). A moderately negative correlation was found between the magnitude of sBP fall between 30 and 60 min and insulin and C-peptide levels in people with PPH (r = −0.420, p = 0.046; r = −0.564, p = 0.005; respectively). However, no significant relationships were observed between the magnitude of sBP fall at other time points and blood parameters (p > 0.05). Conclusions: A significant portion of adults with postprandial symptoms might have PPH, contributing to these symptoms. The lack of a relationship between insulin and glucose suggests that other physiological mechanisms beyond insulin and glucose may play a role in the pathogenesis of PPH in healthy individuals. Therefore, further research is needed to better understand the underlying causes of PPH.