Araştırma Makalesi
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Subklinik hipotiroidide aort elastisitesinin değerlendirilmesi

Yıl 2015, , 135 - 141, 28.11.2015
https://doi.org/10.5472/MMJoa.2803.03

Öz

Amaç: Bu çalışmada. subklinik hipotiroidili hastalarda aortun
elastikiyet özellikleri ve bunların sol ventrikül diyastolik
fonksiyonu ile ilişkileri transtorasik ekokardiyografik metod ile
araştırıldı.
Hastalar ve Yöntemler: Transtorasik ekokardiyografi
yapılarak aortun elastikiyet parametreleri olarak aortik strain. beta
indeksi ve distensibilite indeksine bakıldı.
Bulgular: Kontrol grubu ve subklinik hipotiroidili hasta grubu
arasında aortik strain (sırasıyla %9.45’e karşı %5.79. p < 0.001)
ve distensibilite (4.64’e karşı 3.02 10-3.cm2.dyn-1. p < 0.005)
yönünden anlamlı farklar vardı. Subklinik hipotiroidi grubunda
mitral erken diyastolik akım hızı (E) ortalaması (p < 0.05). mitral
diyastolik akım hızı/ mitral geç diyastolik akım hızı (E/A) (p < 0.01)
kontrol grubu ortalamasına göre anlamlı olarak düşük. mitral geç
diyastolik akım hızı ortalaması (A) ve izovolümetrik relaksasyon
zamanı ( IVRZ) (p < 0.05) kontrol grubu ortalamasına göre yüksek
bulundu.
Sonuç: Subklinik hipotiroidili hastalarda aortik stiffness’de
artış gözlenmektedir. Subklinik hipotiroidili hastalarda gözlenen
diyastolik fonksiyon bozukluğundan esas olarak aortik stiffness
artışı sorumlu olabilir.

Kaynakça

  • 1. Surks MI. Ortiz E. Daniels GH. et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004; 291:228-38. doi: 10.1001/ jama.291.2.228.
  • 2. Canaris GJ. Monowitz NR. Mayor G. et al. The Colorado thyroid disease prevalence study. Arch Intern Med 2000; 160:526-34.doi: 10.1001/archinte.160.4.526.
  • 3. Hollowell JG. Staehling NW. Flanders WD. et al. Serum TSH. T4 and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey ( NHANES III). J Clin Endocrinol Metab 2002; 87: 489-99.
  • 4. Biondi B. Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev 2008; 29:76-131. doi: http:// dx.doi.org/10.1210/er.2006-0043.
  • 5. Hak AE. Pols HA. Visser TJ. et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med 2000; 132:270-8. doi:10.7326/0003- 4819-132-4-20002150-00030
  • 6. Cappola AR. Razvi S. Walsh JP. et al. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 2010 ; 304: 1365-74. doi: 10.1001/ jama.2010.1361.
  • 7. Walsh JP. Bremner AP. Bulsara MK. et al. Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med 2005; 165 : 2467-72. doi:10.1001/ archinte.165.21.2467.
  • 8. Vaderpump MP. Tunbridge WM. French JM. et al. The development of schemic heart disease in relation to autoimmune thyroid disease in a 20- year follow-up study of an English community. Thyroid 1996; 6: 155-60.
  • 9. Schultz M. Kistorp C. Raymond I. et al. Cardiovascular events in thyroid disease: A population based. prospective study. Horm Metab Res 2011; 43: 653-9. doi: 10.1055/s-0031- 1283162.
  • 10. Stefanadis C. Wooley CF. Bush CA. Kolibash AL. Boudoulas J. Aortic distensibility anormalities in coronary artery disease. Am J Cardiol 1987; 59:1300-4.
  • 11. Eren M. Gorgulu Ş. Uslu N. Celik S. Dağdeviren B. Tezel T. Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension . diabetes. or both. Heart 2001;90:37-43. doi: 10.1136/heart.90.1.37
  • 12. Ikonomidis I. Lekakis J. Stamatelopoulos K. et al. Aortic elastic properties and left ventricular diastolic function in patients with Adamantiades-Behcet’s Disease. J Am Coll Cardiol 2004; 43: 1075-81.doi:10.1016/j.jacc.2003.10.042
  • 13. Lacombe F. Dart A. Dewar E. et al. Arterial elastic properties in man: a comparison of echo-Doppler indices of aortic stiffness. Eur Heart J 1992. 13: 1040-5. doi:http://dx.doi. org/1040-1045.
  • 14. Nicole M. Van Popole MD. Diederick E. Association between arterial stiffness and atherosclerosis. The Rotterdam Study. Stroke 2001;32:454-60. doi:10.1161/01.STR.32.2.454
  • 15. Cheitlin MD. Alpert JS. Armstrong WF. et al. ACC/AHA guidelines for the clinical application of echocardiography. A report of the American College of Cardiology /American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation 1997; 95: 1686-744. 253 . doi: 10.1161/01.CIR.95.6.1686.
  • 16. Stratos C. Stefanadis C. Kallikazaros I.et al. Ascending Aorta distensibility abnormalities in hypertensive patients and response to nifedipine administration.Am J Med 1992; 93:505-12. doi:http://dx.doi.org/10.1016/0002-9343(92) 90577-X
  • 17. Laurent S. Boutouyrie P. Asmar R. et al. Aortic stiffness is an indepent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001; 37: 1236-41. doi:10.1161/01.HYTP.37.5.1236
  • 18. Ochs N. Auer R. Bauer DC. et al. Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality. Ann Intern Med. 2008;148:832-45. doi:10.7326/0003-4819-148-11-200806030-00225
  • 19. Imaizumi M. Akahoshi M. Ichimaru S. et al. Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism. J Clin Endocrinol Metab. 2004;89:3365-70. doi:10.1210/jc.2003-031089
  • 20. Devdhar M. Ousman YH. Burman KD. Hypothyroidism. Endocrin Metab Clin.North Am. 2007; 36: 595-615. doi:10.1016/j.ecl.2007.04.008
  • 21. Biondi B. Fazio S. Palmieri EA. et al. Left ventricular diastolic dysfunction in patients with subclinical hypothyroidism. J Clin. Endocrinol Metab 1999; 84:2064-7.
  • 22. Niafar M. Tofan M. Ghafoori S. et al. Subclinical hypothyroidism effects on cardiac function. Pak J Biol Sci. 2009; 12:1056-62.
  • 23. Franklin SS. Khan SA. Wong ND.et al. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham Heart Study. Circulation 1999; 100:354-60. doi:10.1161/01.CIR.100.4.354
  • 24. Stefanadis C. Dernellis J. Vlachopoulos C. et al. Aortic function in arterial hypertension determined by pressurediameter relation: effects of diltiazem. Circulation 1997; 96:1853-8.doi: 10.1161/01.CIR.96.6.1853
  • 25. Lacombe F. Dart A. Dewar E. et al.Arterial elastic properties in man: a comparison of echo-Doppler indices of aortic stiffness. Eur Heart J1992; 13: 1040- 5. doi: http://dx.doi. org/1040-1045.
  • 26. Stehourwer CD. Henry RM. Ferreira I. Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiiovascular disease. Diabetologia 2008; 51: 527-39. doi:10.1007/s00125-007-0918-3.
  • 27. Lideman RD. Romero LJ. Schade DS.et al. Impact of subclinical hypothyroidism on serum total homocysteine concentrations. the prevalence of coronary heart disease (CHD). and CHD risk factors in the New Mexico Elder Health Survey. Thyroid 2003;13:595-600. doi:10.1089/105072503322238863.
  • 28. Plana N. Ferre R. Merinos J. et al. Heterozygous familial hypercholesterolaemic patients have increased stiffness. as determined using the augmentation Index. J Atheroscler Thromb 2011; 18: 1110-6. doi: http://doi.org/10.5551/ jat.9795.
  • 29. Ravzi S. Weaver JU. Vanderpump MP. et al. The incidence of ischemic heart disease and mortality in people with subclinical hypothyroidism : Reanalysis of the Whickham Surver cohort. J Clin Endocrinol Metab 2010; 95: 1734-40. doi:10.1210/ jc.2009-1749.
  • 30. Rodondi N. Bauer DC. Cappola AR. et al. Subclinical thyroid dysfunction. cardiac function. and the risk of heart failure. The Cardiovascular Health study. J Am Coll Cardiol 2008; 52: 1152-9. doi:10.1016/j.jacc.2008.07.009.
  • 31. Rodondi N. den Elzen WP. Baıer DC. et al. Thyroid Studies Collaboration . Subclinical hypothroidism and the risk of coronary heart disaese and mortality. JAMA 2010; 304: 1365- 74.
  • 32. Biondi B. Klein I. Hypothyroidism as a risk factor for cardiovascular disease. Endocrin2004; 24: 1-13.
  • 33. Duntas LH. Mantzou E. Koutras DA. Cırculating levels of oxidized low-density lipoprotein in overt and mild hypothyroidism. Thyroid 2002;12:1003-7. doi:10.1089/105072502320908349.
  • 34. Gen R. Akbay E. Sezer K.et al. Insulın resistance and cardiovascular risk factors in patients with mild severe subclinical hypothyroidism. Endocrinologist 2010; 20: 128- 30. doi:http://dx.doi.org/10.1097/TEN.Ob013e3181dfe618.
  • 35. Dardano A. Ghiadoni L. Plantinga Y. et al. Recombinant human thyrotropin reduced endothelium-dependent vasodilation in patients monitored for differentiated thyroid carcinoma. J Clin Endocrinol Metab 2006;91:4175-8. doi:http://dx.doi. org/10.1210/jc.2006-0440.
  • 36. Nagasaki T. Inaba M. Kumeda Y. et al. Increased pulse wave velocity in subclinical hypothyroidism. J Clin Endocrinol Metab 2006; 91: 154-158. doi:http://dx.doi.org/10.1210/ jc.2005-1342.
  • 37. Mishra TK. Routray SN. Das S.et al. Left ventricular dysfunction in patients with subclinical hypothyroidism and its reversibility after hormone therapy. J Assoc Physicians India 2005; 53:943-6.
  • 38. Shatynska-Mytsyk I. Rodrigo L. Cioccocioppo R.et al. The impact of thyroid hormone replacement therapy on left ventricular diastolic function in patients with subclinical hypothyroidism. J Endocrinol Invest 2015 mar 5. doi: 10.1007//s40618-015-0262-2.
  • 39. Owen PJ. Rajiv C. Vinereanu D. et al.Subclinial hypothyroidism. arterial stiffness and myocardial reserve. J Clin Endocrinol Metab. 2006; 91:2126-32.doi:http://dx.doi. org/10.1210/jc.2005-2108
  • 40. Malayeri AA. Natori S. Bahrami H. et al. Relation of aortic wall thickness and distensibility to cardiovascular risk factors. Am J Cardiol 2008; 102:491-6.doi:10.1016/j. amjcard.2008.04.010.
  • 41. Masaki M. Komamura K. Goda A. et al. Elevated arterial stiffness and diastolic dysfunction in subclinical hypothyroidism. Circulation Journal 2014; 78: 1494-1500. doi:http://doi.org/10.1253/circj.CJ-13-1556.
  • 42. Yurtdaş M. Gen R. Özcan T.et al. Assessment of the elasticity properties of the ascending aorta in patients with subclinical hypothyroidism by tissue Doppler imaging. Arq Bras Endocrinol Metab 2013; 57 : 132-8.doi:http://dx.doi. org/10.1590/S0004-27302013000200006.

The evaluation of aortic elasticity in subclinical hypothyroidism

Yıl 2015, , 135 - 141, 28.11.2015
https://doi.org/10.5472/MMJoa.2803.03

Öz

Objective: In this study we evaluated the elastic properties of
the aorta in patients with subclinical hypothyroidism and their
relation with left ventricular diastolic function by transthoracic
echocardiography.
Patients and Methods: Aortic transthoracic echocardiography
was performed and the aortic elasticity was evaluated using the
following parameters; strain, the beta index and distensibility.
Results: There was significant difference in terms of aortic
strain (5.79% vs. 9.45% p <0.001) and distensibility (4.64 versus
3.02 10-3.cm2. dyn-1. p <0.005) between the control group and
patients with subclinical hypothyroidism group. In the subclinical
hypothyroidism group the average mitral early diastolic velocity
(E). (p <0.05) were significantly lower than the mean mitral
diastolic flow velocity / mitral late diastolic flow velocity (E / A)
(p <0.01) observed in the control group. and higher than the mean
mitral late diastolic flow velocity (A) and isovolumetric relaxation
time (IVRT) (P <0.05) in the control group.
Conclusions: In patients with subclinical hypothyroidism
an increase in the aortic stiffness was observed. The diastolic
dysfunction observed in subclinical hypothyroidism is mainly
responsible for the increase in the aortic stiffness.
Keywords: Aortic stiffness. Subclinical hypothyroidism. Left
ventricular diastolic dysfunction

Kaynakça

  • 1. Surks MI. Ortiz E. Daniels GH. et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004; 291:228-38. doi: 10.1001/ jama.291.2.228.
  • 2. Canaris GJ. Monowitz NR. Mayor G. et al. The Colorado thyroid disease prevalence study. Arch Intern Med 2000; 160:526-34.doi: 10.1001/archinte.160.4.526.
  • 3. Hollowell JG. Staehling NW. Flanders WD. et al. Serum TSH. T4 and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey ( NHANES III). J Clin Endocrinol Metab 2002; 87: 489-99.
  • 4. Biondi B. Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev 2008; 29:76-131. doi: http:// dx.doi.org/10.1210/er.2006-0043.
  • 5. Hak AE. Pols HA. Visser TJ. et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med 2000; 132:270-8. doi:10.7326/0003- 4819-132-4-20002150-00030
  • 6. Cappola AR. Razvi S. Walsh JP. et al. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 2010 ; 304: 1365-74. doi: 10.1001/ jama.2010.1361.
  • 7. Walsh JP. Bremner AP. Bulsara MK. et al. Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med 2005; 165 : 2467-72. doi:10.1001/ archinte.165.21.2467.
  • 8. Vaderpump MP. Tunbridge WM. French JM. et al. The development of schemic heart disease in relation to autoimmune thyroid disease in a 20- year follow-up study of an English community. Thyroid 1996; 6: 155-60.
  • 9. Schultz M. Kistorp C. Raymond I. et al. Cardiovascular events in thyroid disease: A population based. prospective study. Horm Metab Res 2011; 43: 653-9. doi: 10.1055/s-0031- 1283162.
  • 10. Stefanadis C. Wooley CF. Bush CA. Kolibash AL. Boudoulas J. Aortic distensibility anormalities in coronary artery disease. Am J Cardiol 1987; 59:1300-4.
  • 11. Eren M. Gorgulu Ş. Uslu N. Celik S. Dağdeviren B. Tezel T. Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension . diabetes. or both. Heart 2001;90:37-43. doi: 10.1136/heart.90.1.37
  • 12. Ikonomidis I. Lekakis J. Stamatelopoulos K. et al. Aortic elastic properties and left ventricular diastolic function in patients with Adamantiades-Behcet’s Disease. J Am Coll Cardiol 2004; 43: 1075-81.doi:10.1016/j.jacc.2003.10.042
  • 13. Lacombe F. Dart A. Dewar E. et al. Arterial elastic properties in man: a comparison of echo-Doppler indices of aortic stiffness. Eur Heart J 1992. 13: 1040-5. doi:http://dx.doi. org/1040-1045.
  • 14. Nicole M. Van Popole MD. Diederick E. Association between arterial stiffness and atherosclerosis. The Rotterdam Study. Stroke 2001;32:454-60. doi:10.1161/01.STR.32.2.454
  • 15. Cheitlin MD. Alpert JS. Armstrong WF. et al. ACC/AHA guidelines for the clinical application of echocardiography. A report of the American College of Cardiology /American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation 1997; 95: 1686-744. 253 . doi: 10.1161/01.CIR.95.6.1686.
  • 16. Stratos C. Stefanadis C. Kallikazaros I.et al. Ascending Aorta distensibility abnormalities in hypertensive patients and response to nifedipine administration.Am J Med 1992; 93:505-12. doi:http://dx.doi.org/10.1016/0002-9343(92) 90577-X
  • 17. Laurent S. Boutouyrie P. Asmar R. et al. Aortic stiffness is an indepent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001; 37: 1236-41. doi:10.1161/01.HYTP.37.5.1236
  • 18. Ochs N. Auer R. Bauer DC. et al. Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality. Ann Intern Med. 2008;148:832-45. doi:10.7326/0003-4819-148-11-200806030-00225
  • 19. Imaizumi M. Akahoshi M. Ichimaru S. et al. Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism. J Clin Endocrinol Metab. 2004;89:3365-70. doi:10.1210/jc.2003-031089
  • 20. Devdhar M. Ousman YH. Burman KD. Hypothyroidism. Endocrin Metab Clin.North Am. 2007; 36: 595-615. doi:10.1016/j.ecl.2007.04.008
  • 21. Biondi B. Fazio S. Palmieri EA. et al. Left ventricular diastolic dysfunction in patients with subclinical hypothyroidism. J Clin. Endocrinol Metab 1999; 84:2064-7.
  • 22. Niafar M. Tofan M. Ghafoori S. et al. Subclinical hypothyroidism effects on cardiac function. Pak J Biol Sci. 2009; 12:1056-62.
  • 23. Franklin SS. Khan SA. Wong ND.et al. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham Heart Study. Circulation 1999; 100:354-60. doi:10.1161/01.CIR.100.4.354
  • 24. Stefanadis C. Dernellis J. Vlachopoulos C. et al. Aortic function in arterial hypertension determined by pressurediameter relation: effects of diltiazem. Circulation 1997; 96:1853-8.doi: 10.1161/01.CIR.96.6.1853
  • 25. Lacombe F. Dart A. Dewar E. et al.Arterial elastic properties in man: a comparison of echo-Doppler indices of aortic stiffness. Eur Heart J1992; 13: 1040- 5. doi: http://dx.doi. org/1040-1045.
  • 26. Stehourwer CD. Henry RM. Ferreira I. Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiiovascular disease. Diabetologia 2008; 51: 527-39. doi:10.1007/s00125-007-0918-3.
  • 27. Lideman RD. Romero LJ. Schade DS.et al. Impact of subclinical hypothyroidism on serum total homocysteine concentrations. the prevalence of coronary heart disease (CHD). and CHD risk factors in the New Mexico Elder Health Survey. Thyroid 2003;13:595-600. doi:10.1089/105072503322238863.
  • 28. Plana N. Ferre R. Merinos J. et al. Heterozygous familial hypercholesterolaemic patients have increased stiffness. as determined using the augmentation Index. J Atheroscler Thromb 2011; 18: 1110-6. doi: http://doi.org/10.5551/ jat.9795.
  • 29. Ravzi S. Weaver JU. Vanderpump MP. et al. The incidence of ischemic heart disease and mortality in people with subclinical hypothyroidism : Reanalysis of the Whickham Surver cohort. J Clin Endocrinol Metab 2010; 95: 1734-40. doi:10.1210/ jc.2009-1749.
  • 30. Rodondi N. Bauer DC. Cappola AR. et al. Subclinical thyroid dysfunction. cardiac function. and the risk of heart failure. The Cardiovascular Health study. J Am Coll Cardiol 2008; 52: 1152-9. doi:10.1016/j.jacc.2008.07.009.
  • 31. Rodondi N. den Elzen WP. Baıer DC. et al. Thyroid Studies Collaboration . Subclinical hypothroidism and the risk of coronary heart disaese and mortality. JAMA 2010; 304: 1365- 74.
  • 32. Biondi B. Klein I. Hypothyroidism as a risk factor for cardiovascular disease. Endocrin2004; 24: 1-13.
  • 33. Duntas LH. Mantzou E. Koutras DA. Cırculating levels of oxidized low-density lipoprotein in overt and mild hypothyroidism. Thyroid 2002;12:1003-7. doi:10.1089/105072502320908349.
  • 34. Gen R. Akbay E. Sezer K.et al. Insulın resistance and cardiovascular risk factors in patients with mild severe subclinical hypothyroidism. Endocrinologist 2010; 20: 128- 30. doi:http://dx.doi.org/10.1097/TEN.Ob013e3181dfe618.
  • 35. Dardano A. Ghiadoni L. Plantinga Y. et al. Recombinant human thyrotropin reduced endothelium-dependent vasodilation in patients monitored for differentiated thyroid carcinoma. J Clin Endocrinol Metab 2006;91:4175-8. doi:http://dx.doi. org/10.1210/jc.2006-0440.
  • 36. Nagasaki T. Inaba M. Kumeda Y. et al. Increased pulse wave velocity in subclinical hypothyroidism. J Clin Endocrinol Metab 2006; 91: 154-158. doi:http://dx.doi.org/10.1210/ jc.2005-1342.
  • 37. Mishra TK. Routray SN. Das S.et al. Left ventricular dysfunction in patients with subclinical hypothyroidism and its reversibility after hormone therapy. J Assoc Physicians India 2005; 53:943-6.
  • 38. Shatynska-Mytsyk I. Rodrigo L. Cioccocioppo R.et al. The impact of thyroid hormone replacement therapy on left ventricular diastolic function in patients with subclinical hypothyroidism. J Endocrinol Invest 2015 mar 5. doi: 10.1007//s40618-015-0262-2.
  • 39. Owen PJ. Rajiv C. Vinereanu D. et al.Subclinial hypothyroidism. arterial stiffness and myocardial reserve. J Clin Endocrinol Metab. 2006; 91:2126-32.doi:http://dx.doi. org/10.1210/jc.2005-2108
  • 40. Malayeri AA. Natori S. Bahrami H. et al. Relation of aortic wall thickness and distensibility to cardiovascular risk factors. Am J Cardiol 2008; 102:491-6.doi:10.1016/j. amjcard.2008.04.010.
  • 41. Masaki M. Komamura K. Goda A. et al. Elevated arterial stiffness and diastolic dysfunction in subclinical hypothyroidism. Circulation Journal 2014; 78: 1494-1500. doi:http://doi.org/10.1253/circj.CJ-13-1556.
  • 42. Yurtdaş M. Gen R. Özcan T.et al. Assessment of the elasticity properties of the ascending aorta in patients with subclinical hypothyroidism by tissue Doppler imaging. Arq Bras Endocrinol Metab 2013; 57 : 132-8.doi:http://dx.doi. org/10.1590/S0004-27302013000200006.
Toplam 42 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Makaleler
Yazarlar

Sevil Özkan

Mehmet Tarım Bu kişi benim

Refik Demirtunç Bu kişi benim

Dursun Duman Bu kişi benim

Yayımlanma Tarihi 28 Kasım 2015
Yayımlandığı Sayı Yıl 2015

Kaynak Göster

APA Özkan, S., Tarım, M., Demirtunç, R., Duman, D. (2015). The evaluation of aortic elasticity in subclinical hypothyroidism. Marmara Medical Journal, 28(3), 135-141. https://doi.org/10.5472/MMJoa.2803.03
AMA Özkan S, Tarım M, Demirtunç R, Duman D. The evaluation of aortic elasticity in subclinical hypothyroidism. Marmara Med J. Aralık 2015;28(3):135-141. doi:10.5472/MMJoa.2803.03
Chicago Özkan, Sevil, Mehmet Tarım, Refik Demirtunç, ve Dursun Duman. “The Evaluation of Aortic Elasticity in Subclinical Hypothyroidism”. Marmara Medical Journal 28, sy. 3 (Aralık 2015): 135-41. https://doi.org/10.5472/MMJoa.2803.03.
EndNote Özkan S, Tarım M, Demirtunç R, Duman D (01 Aralık 2015) The evaluation of aortic elasticity in subclinical hypothyroidism. Marmara Medical Journal 28 3 135–141.
IEEE S. Özkan, M. Tarım, R. Demirtunç, ve D. Duman, “The evaluation of aortic elasticity in subclinical hypothyroidism”, Marmara Med J, c. 28, sy. 3, ss. 135–141, 2015, doi: 10.5472/MMJoa.2803.03.
ISNAD Özkan, Sevil vd. “The Evaluation of Aortic Elasticity in Subclinical Hypothyroidism”. Marmara Medical Journal 28/3 (Aralık 2015), 135-141. https://doi.org/10.5472/MMJoa.2803.03.
JAMA Özkan S, Tarım M, Demirtunç R, Duman D. The evaluation of aortic elasticity in subclinical hypothyroidism. Marmara Med J. 2015;28:135–141.
MLA Özkan, Sevil vd. “The Evaluation of Aortic Elasticity in Subclinical Hypothyroidism”. Marmara Medical Journal, c. 28, sy. 3, 2015, ss. 135-41, doi:10.5472/MMJoa.2803.03.
Vancouver Özkan S, Tarım M, Demirtunç R, Duman D. The evaluation of aortic elasticity in subclinical hypothyroidism. Marmara Med J. 2015;28(3):135-41.