BibTex RIS Kaynak Göster

Prevalence of thyroid disorders and the correlation of thyroid profile with liver enzymes, serum activin-A and follistatin during the treatment of patients with chronic hepatitis C genotype 1 and 4

Yıl 2014, Cilt: 5 Sayı: 3, 343 - 353, 01.09.2014
https://doi.org/10.5799/ahinjs.01.2014.03.0418

Öz

Objectives Chronic hepatitis C (CHC) and peg-interferon-α (Peg-INF-α) modulate serum activins and follistatin and are associated with thyroid disorders (TD).The aim of this study was to determine the frequency of CHC induced TD and to investigate the correlation of liver damage, serum activin-A and follistatin with the thyroid function parameters and thyroid autoantibodies. Methods: The study was cross-sectional and sera were obtained from 132 patients with CHC who were divided into 3 groups: 56 patients with no treatment, 30 after 24 weeks of Peg-INF-α and 46 at the end of 48 weeks Peg-INF-α. Thyroid stimulating hormone (TSH), free thyroxin (FT4), thyroid antibodies (Tabs), serum activin-A and follistatin levels were measured using ELISA. Results: Thyroid disorders were detected in 15% (n=20), more frequent in females (70%) and the majority were autoimmune thyroiditis (80%). TSH receptor antibodies (TSHR-Abs) were significantly prevalent compared to the other antibodies (p

Kaynakça

  • Ghany MG, Strader DB, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology 2009;49:1335-1374.
  • Tomer Y, Blackard JT and Akeno N. Interferon alpha treatment and thyroid dysfunction. Endocrinol Metab Clin North Am 2007;36:1051-1066.
  • Tomer Y. Hepatitis C and interferon induced thyroiditis. J Autoimmun 2010;34:322-326.
  • Andrade LJ, Atta AM, Atta ML, et al. Thyroid disorders in patients with chronic hepatitis C using interferon-alpha and ribavirin therapy. Braz J Infect Dis 2011;15:377-381.
  • Soppi E. Concurrent subacute thyroiditis and Graves dis- ease. Duodecim 2012;128:1808-1810.
  • Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489-499.
  • Bostancı M and Taşkesen F. Thyroid dysfunction during pregnancy and evaluation of its results. J Clin Exp In- vest 2011;2:6.
  • Karakas O, Karakas E, Cullu N, et al. Evaluation of patients with thyrotoxic autoimmune thyroiditis by color flow doppler ultrasonography. J Clin Exp Invest 2013;4:73-79.
  • Wong V, Fu AX, George J, et al. Thyrotoxicosis induced by alpha-interferon therapy in chronic viral hepatitis. Clin Endocrinol (Oxf) 2002;56:793-798.
  • Refaat BA, Bahathiq AO, Sockanathan S, et al. Produc- tion and localization of activins and activin type IIA and IIB receptors by the human endosalpinx. Reproduction 2004;128:249-255.
  • Werner S and Alzheimer C. Roles of activin in tissue repair, fibrosis, and inflammatory disease. Cytokine Growth Factor Rev 2006;17:157-171.
  • Phillips DJ, de Kretser DM, and Hedger MP. Activin and related proteins in inflammation: not just interested bystanders. Cytokine Growth Factor Rev 2009;20:153- 164.
  • Sugino K, Mimura T, Ozaki O, et al. Preoperative change of thyroid stimulating hormone receptor antibody level: possible marker for predicting recurrent hyperthyroid- ism in patients with Graves’ disease after subtotal thy- roidectomy. World J Surg 1996;20:801-806; discussion 806-807.
  • Franzen A, Piek E, Westermark B, et al. Expression of transforming growth factor-beta1, activin A, and their receptors in thyroid follicle cells: negative regula- tion of thyrocyte growth and function. Endocrinology 1999;140:4300-4310.
  • Bilezikjian LM, Corrigan AZ, and Vale W. Activin-A mod- ulates growth hormone secretion from cultures of rat anterior pituitary cells. Endocrinology 1990;126:2369- 2376.
  • Matsuo SE, Fiore AP, Siguematu SM, et al. Expression of SMAD proteins, TGF-beta/activin signaling media- tors, in human thyroid tissues. Arq Bras Endocrinol Me- tabol 2010;54:406-412.
  • Harada K, Shintani Y, Sakamoto Y, et al. Serum immu- noreactive activin A levels in normal subjects and pa- tients with various diseases. J Clin Endocrinol Metab 1996;81:2125-2130.
  • Morpurgo PS, Beck-Peccoz P, Reschini E, et al. Serum activin A levels in different thyroid disorders. Thyroid 2002;12:1113-1117.
  • Kotajima A, Miyamoto Y, Tsuruo M, et al. Effects of activin A on deoxyribonucleic acid synthesis, iodine metabolism, and cyclic adenosine monophosphate accumulation in porcine thyroid cells. Endocrinology 1995;136:1214-1218.
  • Refaat B, Ashshi AM, El-Shemi AG, et al. Effects of chronic hepatitis C genotype 1 and 4 on serum activ- ins and follistatin in treatment naive patients and their correlations with interleukin-6, tumour necrosis factor- alpha, viral load and liver damage. Clin Exp Med 2014.
  • Refaat B, El-Shemi AG, Ashshi AM, et al. Serum activins and follistatin during the treatment of chronic hepatitis c genotypes 1 and 4 and their correlations with viral load and liver enzymes: A preliminary report. Gastroenterol Res Pract 2014;2014:628683.
  • Baloch Z, Carayon P, Conte-Devolx B, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003;13:3-126.
  • Vezali E, Elefsiniotis I, Mihas C, et al. Thyroid dysfunc- tion in patients with chronic hepatitis C: virus- or therapy- related? J Gastroenterol Hepatol 2009;24:1024-1029.
  • Mohran ZY, Abdel Kader NA, Abdel Moez AT, et al. Sub- clinical autoimmune thyroid disorders in Egyptian pa- tients with untreated chronic hepatitis C virus infection. J Egypt Soc Parasitol 2010;40:45-56.
  • Cesur S, Akin K, Albayrak F, et al. [Prevalence of extra- hepatic illnesses in patients with chronic hepatitis b and hepatitis c: retrospective study of 435 patients]. Mikrobi- yol Bul 2003;37:187-193.
  • Nadeem A and Aslam M. Association of interferon-alpha and ribavirin-induced thyroid dysfunction with sever- ity of disease and response to treatment in pakistani asian patients of chronic hepatitis C. Hepat Res Treat 2012;2012:864315.
  • Yan Z, Fan K, Fan Y, et al. Thyroid dysfunction in chi- nese patients with chronic hepatitis C treated with inter- feron alpha: incidence, long-term outcome and predic- tive factors. Hepat Mon 2012;12:e6390.
  • Costelloe SJ, Wassef N, Schulz J, et al. Thyroid dys- function in a UK hepatitis C population treated with interferon-alpha and ribavirin combination therapy. Clin Endocrinol (Oxf) 2010;73:249-256.
  • Huang JF, Chuang WL, Dai CY, et al. The role of thyroid autoantibodies in the development of thyroid dysfunc- tion in Taiwanese chronic hepatitis C patients with in- terferon-alpha and ribavirin combination therapy. J Viral Hepat 2006;13:396-401.
  • Tran HA, Jones TL, and Batey RG. The spectrum of thyroid dysfunction in an Australian hepatitis C popula- tion treated with combination Interferon-alpha2beta and Ribavirin. BMC Endocr Disord 2005;5:8.
  • Gehring S, Kullmer U, Koeppelmann S, et al. Preva- lence of autoantibodies and the risk of autoimmune thy- roid disease in children with chronic hepatitis C virus infection treated with interferon-alpha. World J Gastro- enterol 2006;12:5787-5792.
  • Mandac JC, Chaudhry S, Sherman KE, et al. The clini- cal and physiological spectrum of interferon-alpha in- duced thyroiditis: toward a new classification. Hepatol- ogy 2006;43:661-672.
  • Carella C, Mazziotti G, Amato G, et al. Clinical review 169: Interferon-alpha-related thyroid disease: patho- physiological, epidemiological, and clinical aspects. J Clin Endocrinol Metab 2004;89:3656-3661.
  • Chung HS, Cho SJ, and Park CS. Effects of liver func- tion on ionized hypocalcaemia following rapid blood transfusion. J Int Med Res 2012;40:572-582.
  • El-Kabbany ZA, Hamza RT, Abd El Hakim AS, et al. Thyroid and Hepatic Haemodynamic Alterations among Egyptian Children with Liver Cirrhosis. ISRN Gastroen- terol 2012;2012:595734.
  • Khan TM, Malik S, and Diju IU. Correlation between plasma thyroid hormones and liver enzymes level in thyrotoxic cases and controls in Hazara Division. J Ayub Med Coll Abbottabad 2010;22:176-179.
  • Ittermann T, Haring R, Wallaschofski H, et al. Inverse association between serum free thyroxine levels and hepatic steatosis: results from the Study of Health in Pomerania. Thyroid 2012;22:568-574.
  • Tas A, Koklu S, Beyazit Y, et al. Thyroid hormone levels predict mortality in intensive care patients with cirrhosis. Am J Med Sci 2012;344:175-179.
  • Wai CT, Greenson JK, Fontana RJ, et al. A simple non- invasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38:518-526.
  • El-Gendi SS, Moniem AE, Tawfik NM, et al. Value of serum and synovial fluid activin A and inhibin A in some rheumatic diseases. Int J Rheum Dis 2010;13:273-279.
  • Torricelli M, Bellisai F, Novembri R, et al. High levels of maternal serum IL-17 and activin A in pregnant women affected by systemic lupus erythematosus. Am J Re- prod Immunol 2011;66:84-89.
  • Semitekolou M, Alissafi T, Aggelakopoulou M, et al. Ac- tivin-A induces regulatory T cells that suppress T helper cell immune responses and protect from allergic airway disease. J Exp Med 2009;206:1769-1785.

Kronik hepatit C genotip 1 ve 4 hastaların tedavisi sırasında tiroid bozuklukları prevalansı ve tiroid profili ile karaciğer enzimleri, serum activin-A ve follistatin arasındaki ilişki

Yıl 2014, Cilt: 5 Sayı: 3, 343 - 353, 01.09.2014
https://doi.org/10.5799/ahinjs.01.2014.03.0418

Öz

Amaç: Kronik hepatit C (KHC) ve Peg-interferon- alfa (Peg-INF-α) serum aktivinleri ve follistatini düzenler ve tiroid hastalıkları (TH) ile birliktedir. Bu çalışmanın amacı KHC\'nin indüklediği TH sıklığını belirlemek ve karaciğer hasarı, serum activin-A ve follistatin\'in tiroid fonksiyonları ve tiroid otoantikorları ile ilişkisini araştırmaktır. Yöntemler: Bu çalışma kesitsel olup, 3 gruba ayrılan 132 KHC\'li hastadan serumları alınmıştır: Tedavisiz 56 hasta, 24 haftalık Peg-INF-α tedavisi almış 30 hasta ve Peg-INF-α tedavisi tamamlanmış 46 hasta. Tiroid stimülan hormon (TSH), serbest tiroksin (FT4) ve tiroid otoantikorları, serum activin-A ve follistatin düzeyleri ELISA yöntemiyle ölçüldü. Bulgular: Hastaların %15\'inde (n=20) tiroid hastalığı saptandı, bunların çoğunluğu (%80) otoimmün tiroidit olup, kadınlarda daha sık (%70) idi. TSH reseptör antikorları (TSHR-Abs), diğer antikorlardan anlamlı yüksek bulundu (p

Kaynakça

  • Ghany MG, Strader DB, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology 2009;49:1335-1374.
  • Tomer Y, Blackard JT and Akeno N. Interferon alpha treatment and thyroid dysfunction. Endocrinol Metab Clin North Am 2007;36:1051-1066.
  • Tomer Y. Hepatitis C and interferon induced thyroiditis. J Autoimmun 2010;34:322-326.
  • Andrade LJ, Atta AM, Atta ML, et al. Thyroid disorders in patients with chronic hepatitis C using interferon-alpha and ribavirin therapy. Braz J Infect Dis 2011;15:377-381.
  • Soppi E. Concurrent subacute thyroiditis and Graves dis- ease. Duodecim 2012;128:1808-1810.
  • Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489-499.
  • Bostancı M and Taşkesen F. Thyroid dysfunction during pregnancy and evaluation of its results. J Clin Exp In- vest 2011;2:6.
  • Karakas O, Karakas E, Cullu N, et al. Evaluation of patients with thyrotoxic autoimmune thyroiditis by color flow doppler ultrasonography. J Clin Exp Invest 2013;4:73-79.
  • Wong V, Fu AX, George J, et al. Thyrotoxicosis induced by alpha-interferon therapy in chronic viral hepatitis. Clin Endocrinol (Oxf) 2002;56:793-798.
  • Refaat BA, Bahathiq AO, Sockanathan S, et al. Produc- tion and localization of activins and activin type IIA and IIB receptors by the human endosalpinx. Reproduction 2004;128:249-255.
  • Werner S and Alzheimer C. Roles of activin in tissue repair, fibrosis, and inflammatory disease. Cytokine Growth Factor Rev 2006;17:157-171.
  • Phillips DJ, de Kretser DM, and Hedger MP. Activin and related proteins in inflammation: not just interested bystanders. Cytokine Growth Factor Rev 2009;20:153- 164.
  • Sugino K, Mimura T, Ozaki O, et al. Preoperative change of thyroid stimulating hormone receptor antibody level: possible marker for predicting recurrent hyperthyroid- ism in patients with Graves’ disease after subtotal thy- roidectomy. World J Surg 1996;20:801-806; discussion 806-807.
  • Franzen A, Piek E, Westermark B, et al. Expression of transforming growth factor-beta1, activin A, and their receptors in thyroid follicle cells: negative regula- tion of thyrocyte growth and function. Endocrinology 1999;140:4300-4310.
  • Bilezikjian LM, Corrigan AZ, and Vale W. Activin-A mod- ulates growth hormone secretion from cultures of rat anterior pituitary cells. Endocrinology 1990;126:2369- 2376.
  • Matsuo SE, Fiore AP, Siguematu SM, et al. Expression of SMAD proteins, TGF-beta/activin signaling media- tors, in human thyroid tissues. Arq Bras Endocrinol Me- tabol 2010;54:406-412.
  • Harada K, Shintani Y, Sakamoto Y, et al. Serum immu- noreactive activin A levels in normal subjects and pa- tients with various diseases. J Clin Endocrinol Metab 1996;81:2125-2130.
  • Morpurgo PS, Beck-Peccoz P, Reschini E, et al. Serum activin A levels in different thyroid disorders. Thyroid 2002;12:1113-1117.
  • Kotajima A, Miyamoto Y, Tsuruo M, et al. Effects of activin A on deoxyribonucleic acid synthesis, iodine metabolism, and cyclic adenosine monophosphate accumulation in porcine thyroid cells. Endocrinology 1995;136:1214-1218.
  • Refaat B, Ashshi AM, El-Shemi AG, et al. Effects of chronic hepatitis C genotype 1 and 4 on serum activ- ins and follistatin in treatment naive patients and their correlations with interleukin-6, tumour necrosis factor- alpha, viral load and liver damage. Clin Exp Med 2014.
  • Refaat B, El-Shemi AG, Ashshi AM, et al. Serum activins and follistatin during the treatment of chronic hepatitis c genotypes 1 and 4 and their correlations with viral load and liver enzymes: A preliminary report. Gastroenterol Res Pract 2014;2014:628683.
  • Baloch Z, Carayon P, Conte-Devolx B, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003;13:3-126.
  • Vezali E, Elefsiniotis I, Mihas C, et al. Thyroid dysfunc- tion in patients with chronic hepatitis C: virus- or therapy- related? J Gastroenterol Hepatol 2009;24:1024-1029.
  • Mohran ZY, Abdel Kader NA, Abdel Moez AT, et al. Sub- clinical autoimmune thyroid disorders in Egyptian pa- tients with untreated chronic hepatitis C virus infection. J Egypt Soc Parasitol 2010;40:45-56.
  • Cesur S, Akin K, Albayrak F, et al. [Prevalence of extra- hepatic illnesses in patients with chronic hepatitis b and hepatitis c: retrospective study of 435 patients]. Mikrobi- yol Bul 2003;37:187-193.
  • Nadeem A and Aslam M. Association of interferon-alpha and ribavirin-induced thyroid dysfunction with sever- ity of disease and response to treatment in pakistani asian patients of chronic hepatitis C. Hepat Res Treat 2012;2012:864315.
  • Yan Z, Fan K, Fan Y, et al. Thyroid dysfunction in chi- nese patients with chronic hepatitis C treated with inter- feron alpha: incidence, long-term outcome and predic- tive factors. Hepat Mon 2012;12:e6390.
  • Costelloe SJ, Wassef N, Schulz J, et al. Thyroid dys- function in a UK hepatitis C population treated with interferon-alpha and ribavirin combination therapy. Clin Endocrinol (Oxf) 2010;73:249-256.
  • Huang JF, Chuang WL, Dai CY, et al. The role of thyroid autoantibodies in the development of thyroid dysfunc- tion in Taiwanese chronic hepatitis C patients with in- terferon-alpha and ribavirin combination therapy. J Viral Hepat 2006;13:396-401.
  • Tran HA, Jones TL, and Batey RG. The spectrum of thyroid dysfunction in an Australian hepatitis C popula- tion treated with combination Interferon-alpha2beta and Ribavirin. BMC Endocr Disord 2005;5:8.
  • Gehring S, Kullmer U, Koeppelmann S, et al. Preva- lence of autoantibodies and the risk of autoimmune thy- roid disease in children with chronic hepatitis C virus infection treated with interferon-alpha. World J Gastro- enterol 2006;12:5787-5792.
  • Mandac JC, Chaudhry S, Sherman KE, et al. The clini- cal and physiological spectrum of interferon-alpha in- duced thyroiditis: toward a new classification. Hepatol- ogy 2006;43:661-672.
  • Carella C, Mazziotti G, Amato G, et al. Clinical review 169: Interferon-alpha-related thyroid disease: patho- physiological, epidemiological, and clinical aspects. J Clin Endocrinol Metab 2004;89:3656-3661.
  • Chung HS, Cho SJ, and Park CS. Effects of liver func- tion on ionized hypocalcaemia following rapid blood transfusion. J Int Med Res 2012;40:572-582.
  • El-Kabbany ZA, Hamza RT, Abd El Hakim AS, et al. Thyroid and Hepatic Haemodynamic Alterations among Egyptian Children with Liver Cirrhosis. ISRN Gastroen- terol 2012;2012:595734.
  • Khan TM, Malik S, and Diju IU. Correlation between plasma thyroid hormones and liver enzymes level in thyrotoxic cases and controls in Hazara Division. J Ayub Med Coll Abbottabad 2010;22:176-179.
  • Ittermann T, Haring R, Wallaschofski H, et al. Inverse association between serum free thyroxine levels and hepatic steatosis: results from the Study of Health in Pomerania. Thyroid 2012;22:568-574.
  • Tas A, Koklu S, Beyazit Y, et al. Thyroid hormone levels predict mortality in intensive care patients with cirrhosis. Am J Med Sci 2012;344:175-179.
  • Wai CT, Greenson JK, Fontana RJ, et al. A simple non- invasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38:518-526.
  • El-Gendi SS, Moniem AE, Tawfik NM, et al. Value of serum and synovial fluid activin A and inhibin A in some rheumatic diseases. Int J Rheum Dis 2010;13:273-279.
  • Torricelli M, Bellisai F, Novembri R, et al. High levels of maternal serum IL-17 and activin A in pregnant women affected by systemic lupus erythematosus. Am J Re- prod Immunol 2011;66:84-89.
  • Semitekolou M, Alissafi T, Aggelakopoulou M, et al. Ac- tivin-A induces regulatory T cells that suppress T helper cell immune responses and protect from allergic airway disease. J Exp Med 2009;206:1769-1785.
Toplam 42 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Araştırma Yazısı
Yazarlar

Ahmed Mohammed Ashshi Bu kişi benim

Adel Galal El-shemi Bu kişi benim

Adnan Alzanbagi Bu kişi benim

Bassem Refaat Bu kişi benim

Yayımlanma Tarihi 1 Eylül 2014
Yayımlandığı Sayı Yıl 2014 Cilt: 5 Sayı: 3

Kaynak Göster

APA Ashshi, A. M., El-shemi, A. G., Alzanbagi, A., Refaat, B. (2014). Kronik hepatit C genotip 1 ve 4 hastaların tedavisi sırasında tiroid bozuklukları prevalansı ve tiroid profili ile karaciğer enzimleri, serum activin-A ve follistatin arasındaki ilişki. Journal of Clinical and Experimental Investigations, 5(3), 343-353. https://doi.org/10.5799/ahinjs.01.2014.03.0418
AMA Ashshi AM, El-shemi AG, Alzanbagi A, Refaat B. Kronik hepatit C genotip 1 ve 4 hastaların tedavisi sırasında tiroid bozuklukları prevalansı ve tiroid profili ile karaciğer enzimleri, serum activin-A ve follistatin arasındaki ilişki. J Clin Exp Invest. Eylül 2014;5(3):343-353. doi:10.5799/ahinjs.01.2014.03.0418
Chicago Ashshi, Ahmed Mohammed, Adel Galal El-shemi, Adnan Alzanbagi, ve Bassem Refaat. “Kronik Hepatit C Genotip 1 Ve 4 hastaların Tedavisi sırasında Tiroid Bozuklukları Prevalansı Ve Tiroid Profili Ile karaciğer Enzimleri, Serum Activin-A Ve Follistatin arasındaki ilişki”. Journal of Clinical and Experimental Investigations 5, sy. 3 (Eylül 2014): 343-53. https://doi.org/10.5799/ahinjs.01.2014.03.0418.
EndNote Ashshi AM, El-shemi AG, Alzanbagi A, Refaat B (01 Eylül 2014) Kronik hepatit C genotip 1 ve 4 hastaların tedavisi sırasında tiroid bozuklukları prevalansı ve tiroid profili ile karaciğer enzimleri, serum activin-A ve follistatin arasındaki ilişki. Journal of Clinical and Experimental Investigations 5 3 343–353.
IEEE A. M. Ashshi, A. G. El-shemi, A. Alzanbagi, ve B. Refaat, “Kronik hepatit C genotip 1 ve 4 hastaların tedavisi sırasında tiroid bozuklukları prevalansı ve tiroid profili ile karaciğer enzimleri, serum activin-A ve follistatin arasındaki ilişki”, J Clin Exp Invest, c. 5, sy. 3, ss. 343–353, 2014, doi: 10.5799/ahinjs.01.2014.03.0418.
ISNAD Ashshi, Ahmed Mohammed vd. “Kronik Hepatit C Genotip 1 Ve 4 hastaların Tedavisi sırasında Tiroid Bozuklukları Prevalansı Ve Tiroid Profili Ile karaciğer Enzimleri, Serum Activin-A Ve Follistatin arasındaki ilişki”. Journal of Clinical and Experimental Investigations 5/3 (Eylül 2014), 343-353. https://doi.org/10.5799/ahinjs.01.2014.03.0418.
JAMA Ashshi AM, El-shemi AG, Alzanbagi A, Refaat B. Kronik hepatit C genotip 1 ve 4 hastaların tedavisi sırasında tiroid bozuklukları prevalansı ve tiroid profili ile karaciğer enzimleri, serum activin-A ve follistatin arasındaki ilişki. J Clin Exp Invest. 2014;5:343–353.
MLA Ashshi, Ahmed Mohammed vd. “Kronik Hepatit C Genotip 1 Ve 4 hastaların Tedavisi sırasında Tiroid Bozuklukları Prevalansı Ve Tiroid Profili Ile karaciğer Enzimleri, Serum Activin-A Ve Follistatin arasındaki ilişki”. Journal of Clinical and Experimental Investigations, c. 5, sy. 3, 2014, ss. 343-5, doi:10.5799/ahinjs.01.2014.03.0418.
Vancouver Ashshi AM, El-shemi AG, Alzanbagi A, Refaat B. Kronik hepatit C genotip 1 ve 4 hastaların tedavisi sırasında tiroid bozuklukları prevalansı ve tiroid profili ile karaciğer enzimleri, serum activin-A ve follistatin arasındaki ilişki. J Clin Exp Invest. 2014;5(3):343-5.