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    Case report on a switch from hypothyroidism to hyperthyroidism
    (The Endocrine Society, 2023-01-18)
    Todorova, Biljana
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    Stevcevska, Aleksandra
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    Hashimoto's thyroiditis and Graves’ disease are the most common autoimmune thyroid conditions and are more common in women than in men. Thyrotropin receptor (TSHR) antibodies that stimulate the thyroid (TSAb) cause Graves’ hyperthyroidism and TSHR antibodies which block thyrotropin action (TBAb) are occasionally responsible for hypothyroidism. Unusual patients switch from TSAb to TBAb (or vice versa) with concomitant thyroid function changes.The most common scenario is the evolution from Graves’ disease (GD) to Hashimoto's thyroiditis (HT), whereas the switch from HT into GD seems to be less common. 53-year-old woman presented with a several month's history of tiredness, cold intolerance and hoarseness in October 2020. She was diagnosed with autoimmune hypothyroidism and achieved euthyroid status following treatment with Tbl. Levothyroxine a 50 mcg S. 1×1. This almost stable status was interestingly interrupted after 9 months (January 2021) when the patient on a regular checkup got laboratory results that showed suppressed TSH levels and a high fT4. The substitution therapy was discontinued immediately. The ultrasound of the thyroid gland showed nonspecific changes: hypoechoic, inhomogeneous gland without any markable pathological formations. The patient was feeling tired, she had palpitations, sweating that is not connected to a physical activity, shaking of the hands and uncontrolled movements of the extremities and neck. Her hair started to fall rapidly in the past few months. She was given Tbl. Metoprolol a 100 mg S.1×1 and Tbl ASA a 100 mg S. 1X1.In October 2021, the new laboratory results showed TSH <0.005 mU/l; fT4 =33.36, aTP-O= 22.77 iU/ml thyroglobulin =46,62, Calcitonin=2.99, Vit. D3=27.3, TSH receptor antibodies= 15.40. Antithyroid therapy was required, and she was given Tbl Thiamazole, Tbl. Propronalol because of the developed clinically and laboratory confirmed hyperthyroidism. There were oscillations in the thyroid status in the first months after the switch to hyperthyroidism, and in December 2021 there was a discontinuation of the Thiamazole treatment for one month because of the unstable TSH level, but afterwards from January 2022 the therapy is administered again and the patient is so far clinically stable under regular control. The patient is feeling good. Conclusion:This rare switch from a state of hypothyroidism to a state of hyperthyroidism is not very common in the clinical endocrinology practice, but should not be missed or misdiagnosed. Suspicion should be raised in the very first moment of tapering the levothyroxine doses in any patient with diagnosed HT during a regular follow up. Our recommendation is doing the TRABs (if available) at the moment of lowering the levothyroxine doses along with the regular laboratory tests of fT4, TSH, ATP-O. If there are any TRABs elevated, the leading way is to think and manage the possible and probable onset of hyperthyroidism
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    Acute Thyroiditis Associated with Brucellosis: A Case Report
    (Македонска академија на науките и уметностите, Одделение за медицински науки = Macedonian Academy of Sciences and Arts, Section of Medical Sciences/ Sciendo, 2019-10-01)
    Cvetkova, Marija
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    Brucella thyroiditis represents an extremely rare focal form of brucellosis. In this case report we describe a 55 years old male, diagnosed with brucellosis and peripheral arthritis with subsequent development of acute thyroiditis. The symptoms duration consistent with brucellosis started two weeks before establishing the diagnosis. Only a day after diagnosis and initiation of antibrucellar treatment, acute non-suppurative thyroiditis suddenly manifested. Thyroiditis was diagnosed with clinical inspection and confirmed by ultrasound investigation. With the appropriate antibrucellar treatment, complete cure of thyroid affection was reached in ten days and the patient remained well during the follow-up period of two and a half years. In conclusion, in brucellosis endemic regions brucellosis should be included in the diagnostic consideration in patients with acute non-suppurative thyroiditis. Early recognition and adequate treatment of brucella thyroiditis results in favorable outcome.</jats:p>
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    Adrenal tumors as incidentalomas: report of our experience
    (Macedonian Association of Anatomists and Morphologists, 2017)
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    KLINEFELTER SYNDROME AND OTHER SEX CHROMOSOMAL ANEUPLOIDIES IN THE REPUBLIC OF NORTH MACEDONIA
    (Macedonian Association of Anatomists, 2022-05-04)
    Plaseski, Tosho
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    Mihajlovska, Dzuliana
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    Markovic-Temelkova, Snezana
    Chromosomal anomalies are frequent in male infertility with an incidence of 5.8%, higher than the incidence in general fertile population of 0.5%. Klinefelter syndrome (47, XXY) is the most common disorder of sex chromosomes in humans found in 11% of patients presenting with azoospermia and in 0.7% of patients presenting with oligozoospermia. Boys with 47,XXY are indistinguishable from other boys with normal karyotypes and are often detected when they are evaluated for infertility later in life. Other sex chromosomal anomalies occur less frequently in infertile men.It is considered that many of the 47, XYY men are fertile and this aneuploidy occurs rarely among infertile men. Cases of 46, XX males have also been reported. Molecular analysis shows that most of the 46, XX men have a translocation of the SRY(sex-determining gene) from the Y chromosome on the X chromosome. In our study we analysed the karyotypes of infertile men and identified 39 infertile men with sex chromosomal aneuploidies and Y chromosome micro-deletions. Most of 39 patients had Klinefelter syndrome (31/39 or 79.5%), 4 men had 46,XYY syndrome and 4 had 46,XX syndrome. All detected cases of chromosome aneuploidies were confirmed by cytogenetic analysis.
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    Impact of hormone replacement therapy on hyperandrogenicity and glucose homeostasis in postmenopausal women with diabetes
    (Medical Faculty, Ss Cyril and Methodius University in Skopje, 2016)
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    Temelkova Markovikj, Snezana
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    Malnutrition cause of Secondary Osteoporosis after surgical operation of Glucagonoma
    (Bioscientifica, 2013-04-01)
    Jovanoska, Biljana
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    Temelkova, Snezana Markovik
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    Dimitrovski, Cedomir
    Introduction: Glucagonoma is a rare condition with annual incidence 1 in 20 million, associated with diabetes mellitus, dermatitis, deep vein trombosis and depression. Case report: A 55-year-old woman patient was hospitalized at our department because of intense discomfort of the skin lesions that were pruritic and painful, erythematous area of skin with blisters that breach after a few days, red tongue, cracks on the mouth corners. She had a constant weight loss accompanied with bloody diarrhea. Her weight was 36 kg, height 150 cm and her BMI was 16. We made 75 g OGTT and it was normal. She was misdiagnosed like contact dermatitis magnum et pedum, stomatitis protetica, erythema exsudativum multiforme, colitis. On the examination she had cheilitis angularis, atrophic glossitis, stomatitis, normochromic normocytic anemia and the Hct was 0.27, SE 70/100. She had dermatological changes – erythematous patch, blisters centrally, erodes, crusts, heals with hyperpigmentation. We made a lab test and we got that her glucagonemia was increased twice than normal. The normal values are 200 ng/l and she had 400 ng/l. We made a CT scan where a round form of a tumor was noticed in the pancreas with dimensions 5 cm width and 8 cm length. After that, she underwent a surgical operation and the surgeon made a distal splenopancreatectomy to remove the tumor. The tumor immunohistochemistry was positive of glucagon, synaptophysin and chromogranin-A. After the operation, she suffered from malnutrition and she came again at our department to check herself for osteoporosis. We made a DXA scan and we saw that she had a generalized secondary osteoporosis caused due to malnutrition after operation (T score=−4.0 on the spin, T score=−3.8 on the right hip and T score=−3.6 on the left hip). Conclusion: Long-term misdiagnosed glucagonoma explain appearance of other co-morbidites such as osteoporosis and anemia.
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    Менопауза, липиден профил и кардиоваскуларни болести
    (MACEDONIAN ASSOCIATION OF ANATOMISTS AND MORPHOLOGISTS, 2008)
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    Pashoska, Milkica
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    Mishevska, Petranka
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    A primary adrenal adenomatoid tumor in a young woman
    (Bioscientifica, 2014-04-17)
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    Jovanovska, Biljana
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    Adenomatoid tumors are relatively uncommon neoplasms of mesothelial origin, usually occuring in the male and female genital tracts. Rare extragenital adenomatoid tumor has been identified in adrenal gland. The differential diagnosis includes metastatic carcinoma and adrenocortical carcinoma. We present a case of 30 years old woman with incidentally radiological (ultrasound) finding of unilateral tumor in the right adrenal gland. CT and MRI were of great value in localizing this tumor. The tumor ranged from 5.6 to 6.4 sm in greatest dimension. Clinical and hormonal examinations excluded Sy. Cushing, M. Conn and pheochromocytoma. She underwent a right adrenalectomy using classic laparatomy. The large tumor (d: 8×7×3 sm) was removed and there were no extra-adrenal extension into periadrenal adipose tissue, infiltration of the adrenal cortex or medulla. Histologic examination showed numerous cystic spaces lined by flattened of cuboidal epithelial cells. The small cystic spaces are separated by oedematous fibrovascular stroma with rare epitheloid cells with vacuolated cytoplasm. Immunohistochemical steins were positive for Vimetin(+), s100(+), MCA mesothelial Ag(+), CD 68 (+) and negative for Acitin (−), CK7(−), CD3(−). Conclusions: Adenomatoid tumor is a rare neoplasm that should be added in the differential diagnosis of any adrenal tumor occurring in adrenal gland. The immunohistochemical profile of this adrenal adenomatoid tumor is very supportive of a mesothelial cell origin.