Browsing by Author "Keskin, L"

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    Prevalence and predictors of gestational diabetes mellitus: a nationwide multicentre prospective study
    Aydin, H; Çelik, Ö; Yazici, D; Altunok, Ç; Tarçin, Ö; Deyneli, O; Sancak, S; Kiyici, S; Aydin, K; Yildiz, BO; Çakiroglu, AY; Özer, A; Tuzcu, AK; Kan, A; Çelik, A; Uysal, A; Atmaca, A; Evren, B; Taskiran, B; Bilir, BE; Duran, C; Arpaci, D; Tüzün, D; Kavak, EÇ; Aydeniz, E; Akbas, EM; Üstünyurt, E; Bil, E; Güney, E; Akbaba, E; Gürkan, E; Çagliyan, E; Karakiliç, E; Karakas, E; Kilinç, F; Söylemez, F; Küçükler, FK; Yorulmaz, G; Akbaba, G; Uysal, G; Kurt, G; Yaylali, GF; Selimoglu, H; Sari, H; Piskinpasa, H; Çelik, H; Peynirci, H; Bilal, I; Sahin, I; Gözükara, I; Anaforoglu, I; Senyuva, I; Ugur, K; Dogan, K; Keskin, L; Mert, M; Adas, M; Tonguç, M; Eroglu, M; Kulaksizoglu, M; Özcan, M; Çinar, N; Kutbay, NÖ; Dikbas, O; Bakiner, O; Turhan, ÖT; Tütüncüoglu, P; Sari, R; Melekoglu, R; Ayaz, R; Emral, R; Mumusoglu, S; Görar, S; Keskek, SÖ; Tosun, SA; Çetinkaya, SE; Temizkan, S; Ünsal, S; Demir, T; Yüce, T; Aksoy, Ü; Çinkir, Ü; Simsek, Y; Uyar, Y; Türk, Y; Pekkolay, Z; Hekimsoy, Z; Cantürk, Z; Üç, ZA
    Aim Prevalence rates of gestational diabetes mellitus (GDM) show considerable variation among different countries and regions of the world. The primary aim of this study was to determine the nationwide prevalence and predictors of GDM in Turkey. Methods We conducted prospective nationwide screening among pregnant women. Between August 2016 and November 2017, a total of 2643 pregnant women from 51 centres in 12 different regions were enrolled. A two-step screening method and Carpenter and Coustan criteria were used in the diagnosis of GDM. Clinical and biochemical data were obtained using electronic database software. Results The national prevalence of GDM was found to be 16.2% [95% confidence intervals (CI) 15.0% to 17.4%] without a significant difference between urban and rural regions. Women with GDM were older (mean age: 32 +/- 5 vs. 28 +/- 5 years, P < 0.001) and heavier (mean BMI: 27.2 +/- 5.1 vs. 24.7 +/- 4.7 kg/m(2), P < 0.001) than their counterparts without GDM. The prevalence of GDM tended to increase with age (< 25 years, 6.9%; 26-35 years, 15.6%; and 36-45 years, 32.7%; P < 0.001). Maternal age, maternal BMI, history of previous GDM and family history of diabetes mellitus were independent predictors of developing GDM (P < 0.05 for all). Low-risk women (age < 25 years, BMI < 25 kg/m(2), no family history of diabetes) comprised 10.7% of the total population and the prevalence of GDM in these women was 4.5% (95% CI 2.4% to 7.8%). Conclusion The results of this nationwide study indicate that GDM is very common, affecting one in seven pregnancies in Turkey. Implementation of international guidelines on screening and management of this public health problem is required.
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    Assesment of attainment of recommended TSH levels and levothyroxine compliance in differentiated thyroid cancer patients
    Yavuz, DG; Yazan, CD; Hekimsoy, Z; Aydin, K; Gokkaya, N; Ersoy, C; Akalin, A; Topaloglu, O; Aydogan, BI; Dilekci, ENA; Uc, ZA; Cansu, GB; Ozsari, L; Iyidir, OT; Olgun, ME; Keskin, L; Mert, M; Can, B; Gungor, K; Galip, T; Cantürk, Z; Elbuken, G; Pekkolay, Z; Kutbay, NO; Yorulmaz, G; Kalkan, AT; Unsal, YA; Yay, A; Karagun, B; Bozkur, E
    Objective Thyroid-stimulating hormone (TSH) suppression treatment can induce signs and symptoms of hyperthyroidism and hypothyroidism due to inappropriate treatment or poor compliance to the treatment. The current study aimed to investigate TSH levels, frequency of being on target TSH, adherence to levothyroxine (LT4) suppression treatment in differentiated thyroid cancer (DTC) patients after surgery in a multicentric setting. Design and Patients This multicentric cross-sectional study was conducted at 21 medical centres from 12 cities in Turkey. DTC patients followed at least one year in the same center included in the study. Clinical data, serum TSH, free thyroxine (FT4), thyroglobulin (Tg) and anti-Tg levels were recorded during the most recent visit. Body mass index, systolic and diastolic blood pressures, pulse rate were measured. LT4 doses were recorded and doses per kilogram of bodyweight were calculated. Pill ingestion habits recorded and adherence to the therapy were evaluated using the Morisky Medication Adherence Scale and categorized as good, moderate or poor compliant based on their scores. Risk stratification forpredicting the disease persistance and/or reccurence was assessed using the American Joint Committee on Cancer-7th edition thyroid cancer staging calculator. TSH serum concentrations were classified as severe suppression (TSH < 0.01 mU/L), moderate suppression (TSH: 0.01-0.1 mU/L), mild suppression (TSHL 0.1-0.5 mU/L), euthyroid (TSH: 0.5-4 mU/L) and hypothyroid (TSH > 4 mU/L). TSH levels can also be classified as on being on target, under the target, or beyond over the target, according to the American Thyroid Association recommendations. Results A group of 1125 patients (F/M: 941/184, 50.7 +/- 11.7 years) were included in the study. The mean LT4 daily dosage was 132.4 +/- 39.6 mcg/day. TSH levels showed severe suppression in 99 (%8.8) patients, moderate suppression in 277 (%24.6) patients and mild suppression in 315 (%28) patients and euthyroid range in 332 (%29.5) patients and hypothyroid range in 97 (8.6%). TSH levels were in target in 29.2% of the patients 20.4% of the patients were undertreated, 50.4% overtreated. The daily LT4 dose and LT4 dose/kg were significantly higher in the severe suppression group (p < .001, p < .001). According to the Morisky scale, 564 patients (50.1%) were good compliant, 368 patients (32.7%) were moderate compliant, and 193 patients (17.1%) were noncompliant. Patients with poor compliance need a higher dose of LT4 compared to the good compliance group (p < .001). TSH levels of patients with good compliance were 0.67 +/- 1.96 mU/L and TSH with poor compliance was 2.74 +/- 7.47 mU/L (p < .001). TSH levels were similar in patients on fixed and alternating dosages. Conclusion In 29.2% of the DTC patients, serum TSH levels were at target levels. Remaining of the study group have TSH levels under or over treatment range, exposing the patient to medication side effects. Majorty of the study group 82.8% have good or moderate adherence to LT4 therapy. Reaching TSH targets requires simplified and applicable guidelines and following the guideline recommendations.
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    Out-of-Reference Range Thyroid-Stimulating Hormone Levels in Levothyroxine-Treated Primary Hypothyroid Patients: A Multicenter Observational Study
    Yavuz, DG; Yazici, D; Keskin, L; Atmaca, A; Sancak, S; Saraç, F; Sahin, I; Dikbas, O; Hekimsoy, Z; Yalin, S; Uygur, M; Yilmaz, M; Yirmibescik, S; Asmaz, ÖO
    Objective: Although levothyroxine (LT4) replacement therapy for hypothyroidism has been established as safe, inexpensive and effective, many studies from different countries reported out-of-reference range thyroid-stimulating hormone (TSH) values for the hypothyroid patients under LT4 treatment. The aim of this study was to determine TSH levels of primary hypothyroid patients under LT4 treatment and to assess self-reported compliance with daily LT4 intake in tertiary care centers in Turkey. Design: In this cross-sectional, observational study, adult patients with primary hypothyroidism, receiving LT4 treatment for at least 6 months, were included. The patients were from 12 tertiary care centers in 9 cities of Turkey. TSH and free T4 levels were recorded from patient files and self-reported compliance with daily LT4 intake was assessed by interviewing the subjects at the last visit. Results: A total of 1,755 subjects (46 +/- 13 years; F/M: 89.9/10.1%) with primary hypothyroidism were enrolled. Of the hypothyroid subjects, 44.8% had out-of-reference range serum TSH levels. TSH values were over the reference range (TSH > 4 mIU/L) in 26.2% and were under the reference range (TSH < 0.5 mIU/L) in 18.6% of the patients. Total duration of LT4 treatment was 5.9 +/- 4.7 years and mean dose was 1.2 +/- 0.6 mu g/kg/day. Non-compliant patients (31.1%) had higher TSH levels (6.9 +/- 16 vs 3.8 +/- 0.9 mIU/L, P = 0.01) compared to compliant patients. Conclusion: The results of this study revealed that nearly half of the hypothyroid patients had out-of-reference range serum TSH values, despite under LT4 treatment. Compliance with LT4 treatment seems to be one of the major determinants to reach the target TSH levels in hypothyroid patients.