Aim: Vitamin D (vitD) is primarily responsible for bone formation and mineralization. However, in recent years, it has been suggested that vitD may play a role as an immune modulator in the development of numerous diseases, including autoimmune diseases. It has been observed that there is an association between chronic autoimmune thyroiditis (AIT) and vitD levels. This study aims to investigate whether there are differences in the levels of 25-hydroxy vitamin D [25(OH)D], calcium, and phosphorus in patients with subclinical hypothyroidism (SCH) due to AIT, in patients with antibody-negative subclinical hypothyroidism (ANSCH), and in healthy control subjects. Material and Method: Data from 50 newly diagnosed patients with SCH (35 of whom AIT) and 50 euthyroid and antibody-negative healthy controls who presented to the Department of Endocrinology and Internal Medicine at our hospital between 2018 and 2020 were retrospectively reviewed. Calcium, phosphorus, and 25(OH)D levels of patients and controls were compared. Results: Serum 25(OH)D levels were significantly lower in patients compared to controls (16.2±7.8 ng/ml and 20.4±8.2 ng/ml, respectively; p=0.024). Serum levels of calcium (p=0.081) and phosphorus (p=0.712) did not differ between groups. In a subgroup analysis, patients with AIT had significantly lower 25(OH)D values than controls (p=0.009). Compared to controls, 25(OH)D levels were comparable in the ANSCH group (p=0.096). 25(OH)D level was higher in the AIT group than in the ANSCH group (p=0.01). Conclusion: Our results show that patients with SCH have lower 25(OH)D levels than healthy controls. However, this difference is significant in patients with AIT. It is recommended to screen for vitD deficiency in patients with SCH due to AIT.

Hyperthyroidism is a hypermetabolic condition associated with excessive production of thyroid hormones by the thyroid gland. Thyroid hormones play an important role in bone and calcium metabolism. Mild to moderate hypercalcemia due to hyperthyroidism has been reported in approximately one in five patients. Hypercalcemia due to hyperthyroidism is associated with decreased or subnormal parathyroid hormone levels. The co-occurrence of hyperthyroidism and primary hyperparathyroidism is rare. However, in patients with hyperthyroidism, it is necessary to evaluate the parathyroid glands if hypercalcemia persists after an euthyroid state is reached.Here, we report the case of a 30-year-old man with hypercalcemia who had Graves' disease and primary hyperparathyroidism and was successfully treated with combined thyroid and parathyroid surgery.

Objective: Adherence to insulin therapy is poor in diabetic patients. Insulin pens with many different features have been developed to increase patient satisfaction and compliance to treatment. In our study, we aimed to investigate the usability and acceptance of prefilled or reusable insulin pens.Material and Methods: One hundred and twenty-six patients with a mean age of 55.3±11.1 years were included. Eighty-nine (71%) patients were female. Sixty-three patients were in prefilled pen group. A questionnaire was used to assess patients’ opinions about their use of insulin pens. Glycemic control parameters, demographic characteristics, treatment protocol and microvascular complications were recorded.Results: There was no significant difference between the two groups for age (p=0.3), gender (p=0.1), educational status (p=0.6), duration of diabetes (p=0.8), duration of insulin therapy (p=0.2) and mean insulin dose (p=0.1). Ease of use (p=0.8), ergonomics (p=0.3), ease of dose selection (p=0.6), ease of reading the dose scale (p=0.3) did not significantly differ when two groups were compared. Only the number of patients who found to change the needle as 'moderately difficult' was significantly higher in the prefilled pen group (p=0.04).Conclusion: The applicability of the treatment and patient satisfaction is as important as the treatment given to the patients. However we did not find any important difference between prefilled or reusable pen device in terms of usability and patient satisfaction.

Introduction: Obesity is a growing health problem. Many drugs have been developed to treat obesity. Orlistat is a widely used drug to treat this disease. Metformin is an antidiabetic drug. Clinicians often prescribe it to treat insulin resistance and achieve weight loss. Our research aims to compare the effects of orlistat alone and its combination with metformin on weight loss and insulin resistance. Material and Method: This retrospective study was conducted by scanning the data of patients who presented to Antalya Training and Research Hospital Endocrinology, and General Surgery Clinics between 2016 and 2021. 42 morbidly obese patients who met inclusion and exclusion criteria and were prescribed orlistat plus metformin (group 1, n: 28) or orlistat alone (group 2, n: 14) along with a low-calorie diet for three months and were taking it regularly were included. Subsequently, weight, body mass index, fasting blood glucose, fasting insulin, and HOMA-IR (homeostasis model assessment for insulin resistance) were recorded and analyzed at baseline and after three months of taking the medications. Results: After 3 months of treatment, significant weight loss was achieved in both groups compared to baseline weight (p=0.001 group 1, p=0.003 group 2). HOMA-IR values decreased significantly in both groups (p=0.001 group 1, p=0.01 group 2). Both groups lost the same amount of weight after three months (p=0.06). Conclusion: In morbidly obese patients without prediabetes or diabetes, the addition of metformin to orlistat therapy did not add benefits in terms of weight loss or insulin resistance.

Aim: Adherence to the insulin regimen is poor. The use of an insulin pen contributes positively to glycemic control by increasing patient satisfaction and adherence. The aim of this study is to analyze the influence of patients' opinions of insulin pen use on glycemic control in type 2 diabetes mellitus (T2DM). Material and Method: 126 patients with T2DM who use insulin and inject it with insulin pens were included in the study. Patients' evaluations about the pens (ergonomics, ease of reading the dosage scale, dose selection, needle change, and ease of use of the insulin pen in general) were assessed. Glycemic parameters, demographic characteristics, and treatment protocol were recorded. Results: Patients who perceived the use of the insulin pen as ergonomically 'excellent’ had a significantly lower HbA1c (8.0±1.4%) (p=0.04). HbA1c was significantly lower in patients who perceived needle tip replacement as ‘very easy’ (8.0±1.6%) (p=0.04). No statistically significant relationship was found between the ease of reading the dosage scale and the HbA1c value (p=0.53). The HbA1c value decreased significantly in patients who rated the dosage selection as 'very easy' (8.1±1.7%) (p=0.02). The HbA1c value increased significantly in patients who rated the pen as ‘difficult’ to use (12.2±1.6%) (p=0.01). Conclusion: In our study, we found that patients' opinions of insulin pen use may influence glycemic control parameters. HbA1c was better in patients who found the insulin pen as easy to use and good in ergonomics. In T2DM, patient assessment of insulin pen injection is related to glycemic control. New studies are needed to say whether this situation is related to the appropriate dose of insulin injection or adherence to therapy.