Browsing by Author "Nak, Demet"

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    İntraarteriyel kemoembolizasyon (Take) ve radyoembolizasyon (Tare) yapılan hastalarda tedavi yanıtını öngörmede f18-florotimidin pet/bt'nin yeri
    (Tıp Fakültesi, 2020) Nak, Demet; Küçük, Nuriye Özlem; Nükleer Tıp
    AMAÇ: Bu çalışmanın amacı, unrezektable primer ve metastatik karaciğer tümörü olan hastalarda intraarteriyel kemoembolizasyon ve radyoembolizasyon tedavilerine yanıt değerlendirmesinde 18F-FLT PET/BT'nin yerini tanımlamaktır. GEREÇ VE YÖNTEM: Prospektif ve retrospektif bileşenleri olan, tek merkezli bu çalışmaya Ağustos 2018-Aralık 2019 tarihleri arasında, TAKE ve TARE tedavisi verilen, tedavi sonrası erken dönemde yanıt değerlendirmesi amacıyla 18F-FLT PET/BT'si, geç dönemde anatomik görüntülemeleri yapılmış olan 29 hasta dahil edilmiş; 18F-FLT PET/BT görüntülerinden elde edilen hiper- izo- ve hipo-metabolik lezyonlar için elde edilen semikantitatif değerler, erken dönemde yapılan 18F-FDG PET/BT ve geç dönemde yapılan BT ve MR gibi anatomik görüntülemelerde saptanan tedavi yanıtları ile uyumu araştırılmıştır. BULGULAR: 18F-FLT PET/BT'de görüntülerinden elde edilen hipermetabolik, izometabolik ve hipometabolik lezyonların ΔSUVmax, ΔSUVmean ve ΔSUVpeak değerleri ile MR/BT ve 18F-FDG PET/BT'de saptanan yanıtları arasında; RECIST 1.1.kriterlerine göre tedaviye yanıt alınan hastalarda hiper, izo- ve hipo-metabolik lezyonların ΔSUVmax, ΔSUVmean, ΔSUVpeak ve cTLG arasında anlamlı ilişki saptanmamıştır. 18F-FLT PET/BT'de izlenen izometabolik lezyonların ΔSUVpeak değeri ile hedef lob ve tüm vücut için PFS ve OS arasında anlamlı ilişki saptanırken; ΔSUVmax ile sadece OS arasında anlamlı ilişki saptanmıştır. SONUÇ: Cerrahiye uygun olmayan primer ve metastatik karaciğer tümörü olan hastalarda embolizasyon tedavisi sonrası erken dönem tedavi yanıtı değerlendirmede 18F-FLT PET/BT görüntülemenin öncelikli başvurulması gereken metadolojilerden olduğu ve BT/MR gibi anatomik yöntemlerle yanıt değerlendirmede uyumu gösterilememiştir. Anahtar Sözcükler: karaciğer tümörü, kemoembolizasyon, radyoembolizasyon, tedavi yanıtı, 18F-FLT PET/BT
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    Is routine diagnostic radioiodine whole-body scintigraphy needed in patients who received ablative doses of radioiodine for differentiated thyroid carcinoma?
    (Cosmos Scholars, 2017-03-30) Soydal, Cigdem; Özkan, Elgin; Nak, Demet; Küçük, Nuriye Özlem; Kır, Kemal Metin; Tıp Fakültesi
    Aim:The present large-series retrospective sought to assess DWBS findings 6‒12 weeks after RIAT in DTC patients in various risk groups. In addition, the study compared patients’ simultaneous sTg levels. Material and Methods:The follow-up data of 2879 patients who had received RIAT for DTC between 1998 and 2016 were evaluated for inclusion in the study. The study retrospectively evaluated the following: age at the time of diagnosis; gender; histopathological features of thyroidectomy materials (histological subtype, variant, dimension, multi-focality, thyroid capsule, and vascular invasion of tumors); TNM stage; ATA classification; sTg, suppressed-serum Tg, and antiTg antibody levels; and DWBS findings. Patients were categorized according to sTg level (undetectable, 1‒10 ng/ml, and >10 ng/ml). Then, the DWBS findings were analyzed according to sTg level. Results: The study analyzed 2184 patients (1805 F, 379 M; mean age: 43.54±12.64). In 2077 (95%) patients, the DWBSs performed 6‒12 months after RIAT had shown no pathological uptake throughout the entire body. Pathological uptake had been detected in the neck and outside the neck in 88 (4%) and 19 (1%) patients, respectively. All patients who had had normal DWBSs also had had undetectable simultaneous sTg levels. In addition, the DWBSs had been normal in 187 (8%) patients who had had simultaneous sTg levels> 1 ng/ml and in 286 (13%) patients who had had levels > 10 ng/ml. In all patients who had pathological uptake in DWBSs, simultaneous sTg levels were > 1ng/ml, and in 47, they were> 10 ng/ml. Conclusion: Routine DWBS seems to be unnecessary, even in high-risk DTCs. However, in patients who have detectable levels of serum sTg, it could be performed to localize the disease and plan patient management.
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    Risk factors for predicting osteoporosis in patients who receive thyrotropin suppressive levothyroxine treatment for differentiated thyroid carcinoma
    (Galenos, 2019-05-29) Soydal, Çiğdem; Özkan, Elgin; Nak, Demet; Elhan, Atilla Halil; KÜçük, Nuriye Özlem; Kır, Kemal Metin; Tıp Fakültesi
    Objectives: Endogenous hyperthyroidism accelerates bone turnover and shortens the normal bone remodeling cycle, which results in reduced bone density. It is estimated that suppressive levothyroxine (LT4) therapy also decreases bone density. The aim of this study was to define risk factors for osteoporosis development in patients under thyrotropin-stimulating hormone (TSH) suppressive treatment for differentiated thyroid cancer (DTC). Methods: Patients with a diagnosis of low or intermediate risk group DTC according to the American Thyroid Association 2015 guidelines and who have been receiving LT4 suppression therapy and were physically fit to undergo femur and lumbar vertebra bone density study were included in the study. Patients lacking information on demographic data, medical history, preoperative thyroid hormone status, or routine follow-up data were excluded from the study. A study form consisting of patient information on possible risk factors for osteoporosis such as gender, age, menopausal status, smoking, family history of osteoporosis, preoperative thyroid hormone status, postoperative hypoparathyroidism history, mean serum TSH levels, and duration of TSH suppression was created and filled out for each participant. Bone mineral densitometries of the femur and lumbar vertebrae were measured along with serum vitamin D and parathyroid hormone levels. Results: During TSH suppression (mean 7.2±4.5 years, range: 1-26), osteoporosis was detected in 89 (9.6%) patients. The mean time to develop osteoporosis was significantly different in patients with or without a family history of osteoporosis (15.3±0.4 versus 20.3±0.6 years; p=0.002). Similarly, the mean time to develop osteoporosis for was found to be significantly shorter in postmenopausal patients than that for premenopausal women (18.6±0.7 versus 20.4±0.4 years; p<0.001). Male gender (p<0.001), a family history of osteoporosis (p=0.001) and menopausal state (p<0.001) were identified as independent predictive factors for developing osteoporosis. Conclusion: Postmenopausal women, men, and patients with a family history who receive TSH-suppression treatment have a tendency to develop osteoporosis. Keywords: Differentiated thyroid carcinoma, osteoporosis, thyroid-stimulating hormone suppression treatment