Turkiye Klinikleri Journal of Internal Medicine

.: ORIGINAL RESEARCH
Effects of Obesity on the Thyroid Hormone Levels: Retrospective Cross-Sectional Study
Obezitenin Tiroid Hormon Düzeyleri Üzerine Etkileri: Retrospektif Kesitsel Çalışma
Işılay KALAN SARIa, Şeyma YAVUZb, Serkan CEYLANc
aDivision of Endocrinology and Metabolic Disorders, University of Health Sciences Antalya Training and Research Hospital, Antalya, Türkiye
bClinic of Internal Medicine, Çanakkale Bayramiç State Hospital, Çanakkale, Türkiye
cDepartment of General Surgery, University of Health Sciences Antalya Training and Research Hospital, Antalya, Türkiye
Turkiye Klinikleri J Intern Med. 2023;8(1):1-7
doi: 10.5336/intermed.2021-87117
Article Language: EN
Full Text
ABSTRACT
Objective: The incidence of obesity is increasing. Thyroid dysfunction has been extensively studied in obesity. The aim of this study is to determine thyroid hormone levels in patients with obesity (Class I and II obesity) and morbid obesity, and to determine the correlation between body mass index (BMI) and thyroid hormones. Material and Methods: Data from one hundred fifty-seven patients with obesity, including 71 patients with a BMI of 30-39.9 kg/m2 (Group 1) and 86 patients with morbid obesity with a BMI≥40 kg/m2 (Group 2), and 60 control subjects with a BMI of 18.5-24.9 kg/m2 were retrospectively reviewed. Thyroid hormone levels were compared. Consent was obtained from the patients and, if necessary, their legal representatives. The study was a retrospective cross-sectional study. Ethics committee approval was obtained for our study. Results: The mean age of obese and normal-weight individuals was similar (p=0.94). Thyroidstimulating hormone (TSH) levels were higher in patients than in controls (3.7±1.8 μIU/mL and 2.5±1.7, respectively; p=0.01). The prevalence of subclinical hypothyroidism (SCH) was higher in patients than in controls (p=0.003). There was a positive correlation between TSH and BMI (r=0.44, p=0.001). In subgroup analysis, TSH level was similar in Group 1 and Group 2 (p=0.07). TSH was higher in Group 1 (p=0.03) and Group 2 (p=0.01) than in the control group. The frequency of SCH was similar in Group 1 and Group 2 (p=0.06). The frequency of SCH was higher in Group 1 (p=0.006) and Group 2 (p=0.002) than in the control group. Conclusion: TSH level was higher in patients with obesity than in healthy controls. There was a positive correlation between BMI and TSH. Thyroid hormone levels were similar in patients with a BMI of 30-39.9 kg/m2 and morbid obesity. We recommend thyroid hormone screening in obesity.

Keywords: Obesity; thyroid hormones; thyroid-stimulating hormone
ÖZET
Amaç: Obezite insidansı giderek artmaktadır. Obezitede tiroid disfonksiyonu kapsamlı bir şekilde çalışılmıştır. Bu çalışmanın amacı obez (Sınıf I ve II obezite) ve morbid obez hastalarda tiroid hormon düzeylerini belirlemek ve beden kitle indeksi (BKİ) ile tiroid hormonları arasındaki korelasyonu tanımlamaktır. Gereç ve Yöntemler: Obez 157 hastanın verisi, BKİ 30-39,9 kg/m2 olan 71 birey (Grup 1), BKİ≥40 kg/m2 olan 86 morbid obez birey (Grup 2) ve BKİ of 18,5-24,9 kg/m2 olan 60 kontrol birey retrospektif olarak tarandı. Tiroid hormon seviyeleri karşılaştırıldı. Hastalardan ve gereğinde yasal temsilcilerinden onam alındı. Çalışmamız retrospektif kesitsel çalışmadır. Çalışmamız için etik kurul onayı alınmıştır. Bulgular: Obez ve normal kilolu bireylerin yaş ortalamaları benzer bulundu (p=0,94). Obez hastalarda tiroid uyarıcı hormon (TSH) düzeyleri normal kilolu kontrol grubuna göre daha yüksekti (3,7±1,8 μIU/mL ve 2,5±1,7, sırasıyla; p=0,01). Obezite grubunda subklinik hipotiroidizm prevalansı normal kilolu kontrol grubuna göre daha yüksekti (p=0,003). Obez hastalarda TSH konsantrasyonları ve BKİ arasında pozitif korelasyon saptandı (r=0,44, p=0,001). Subgrup analizde Grup 1 ve Grup 2'nin TSH seviyesi benzerdi (p:0,07). TSH Grup 1 (p=0,03) ve Grup 2'de (p=0,01) kontrol grubuna göre daha yüksek saptandı. Subklinik hipotiroidi sıklığı Grup 1 ve Grup 2'de benzerdi (p=0,06). Subklinik hipotiroidi sıklığı Grup 1 (p=0,006) ve Grup 2'de (p=0,002) kontrol grubuna göre daha yüksekti. Sonuç: Obez hastalarda TSH düzeyi sağlıklı kontrol grubuna göre daha yüksek idi. BKİ ile TSH arasında pozitif bir korelasyon bulunmaktadır. BKİ 30-39,9 kg/m2 olan ve morbid obezitesi olan hastalarda tiroid hormon düzeyleri benzerdi. Biz obezitede TSH düzeylerinin taranmasını öneriyoruz.

Anahtar Kelimeler: Obezite; tiroid hormonları; tiroid uyarıcı hormon
REFERENCES:
  1. Sogabe M, Okahisa T, Kimura T, Okamoto K, Miyamoto H, Muguruma N, et al. Influence of metabolic syndrome on upper gastrointestinal disease. Clin J Gastroenterol. 2016;9(4):191-202. [Crossref]  [PubMed] 
  2. Sturm R. Increases in morbid obesity in the USA: 2000-2005. Public Health. 2007;121(7):492-6. [Crossref]  [PubMed]  [PMC] 
  3. El-Serag HB, Graham DY, Satia JA, Rabeneck L. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol. 2005;100(6):1243-50. [Crossref]  [PubMed] 
  4. Sakaguchi M, Oka H, Hashimoto T, Asakuma Y, Takao M, Gon G, et al. Obesity as a risk factor for GERD in Japan. J Gastroenterol. 2008;43(1):57-62. [Crossref]  [PubMed] 
  5. Pi-Sunyer X. The medical risks of obesity. Postgrad Med. 2009;121(6):21-33. [Crossref]  [PubMed]  [PMC] 
  6. Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev. 2008;29(1):76-131. [Crossref]  [PubMed] 
  7. Salerno M, Capalbo D, Cerbone M, De Luca F. Subclinical hypothyroidism in childhood - current knowledge and open issues. Nat Rev Endocrinol. 2016;12(12):734-46. [Crossref]  [PubMed] 
  8. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al; American Association Of Clinical Endocrinologists And American Thyroid Association Taskforce On Hypothyroidism In Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012;22(12):1200-35. Erratum in: Thyroid. 2013;23(2):251. Erratum in: Thyroid. 2013;23(1):129. [Crossref]  [PubMed] 
  9. Hennessey JV, Espaillat R. Diagnosis and management of subclinical hypothyroidism in elderly adults: a review of the literature. J Am Geriatr Soc. 2015;63(8):1663-73. [Crossref]  [PubMed] 
  10. Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev. 2014;13(4-5):391-7. [Crossref]  [PubMed] 
  11. Sanyal D, Raychaudhuri M. Hypothyroidism and obesity: An intriguing link. Indian J Endocrinol Metab. 2016;20(4):554-7. [Crossref]  [PubMed]  [PMC] 
  12. Sari R, Balci MK, Altunbas H, Karayalcin U. The effect of body weight and weight loss on thyroid volume and function in obese women. Clin Endocrinol (Oxf). 2003;59(2):258-62. [Crossref]  [PubMed] 
  13. Michalaki MA, Vagenakis AG, Leonardou AS, Argentou MN, Habeos IG, Makri MG, et al. Thyroid function in humans with morbid obesity. Thyroid. 2006;16(1):73-8. [Crossref]  [PubMed] 
  14. Bastemir M, Akin F, Alkis E, Kaptanoglu B. Obesity is associated with increased serum TSH level, independent of thyroid function. Swiss Med Wkly. 2007;137(29-30):431-4. [Crossref]  [PubMed] 
  15. Knudsen N, Laurberg P, Rasmussen LB, Bülow I, Perrild H, Ovesen L, et al. Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metab. 2005;90(7):4019-24. [Crossref]  [PubMed] 
  16. Duntas LH, Biondi B. The interconnections between obesity, thyroid function, and autoimmunity: the multifold role of leptin. Thyroid. 2013;23(6):646-53. [Crossref]  [PubMed] 
  17. García-Solís P, García OP, Hernández-Puga G, Sánchez-Tusie AA, Sáenz-Luna CE, Hernández-Montiel HL, et al. Thyroid hormones and obesity: a known but poorly understood relationship. Endokrynol Pol. 2018;69(3):292-303. [Crossref]  [PubMed] 
  18. Reinehr T. Obesity and thyroid function. Mol Cell Endocrinol. 2010;316(2):165-71. [Crossref]  [PubMed] 
  19. Mehta S, Mathur D, Chaturvedi M, Devpura G, Jat VS. Thyroid hormone profile in obese subjects--a clinical study. J Indian Med Assoc. 2001;99(5):260-1, 272. [PubMed] 
  20. Bhowmick SK, Dasari G, Levens KL, Rettig KR. The prevalence of elevated serum thyroid-stimulating hormone in childhood/adolescent obesity and of autoimmune thyroid diseases in a subgroup. J Natl Med Assoc. 2007;99(7):773-6. [PubMed]  [PMC] 
  21. Teixeira PFDS, Dos Santos PB, Pazos-Moura CC. The role of thyroid hormone in metabolism and metabolic syndrome. Ther Adv Endocrinol Metab. 2020;11:2042018820917869. [Crossref]  [PubMed]  [PMC] 
  22. Juiz-Vali-a P, Outeiri-o-Blanco E, Pértega S, Varela-Rodriguez BM, García-Brao MJ, Mena E, et al. Effect of weight loss after bariatric surgery on thyroid-stimulating hormone levels in euthyroid patients with morbid obesity. Nutrients. 2019;11(5):1121. [Crossref]  [PubMed]  [PMC] 
  23. Alkaç Ç, Akbaş F, Alkaç B, Usta Atmaca H. Obesity and thyroid functions. Journal of Academic Research in Medicine. 2014;4(2):74-6. [Crossref] 
  24. Marzullo P, Minocci A, Tagliaferri MA, Guzzaloni G, Di Blasio A, De Medici C, et al. Investigations of thyroid hormones and antibodies in obesity: leptin levels are associated with thyroid autoimmunity independent of bioanthropometric, hormonal, and weight-related determinants. J Clin Endocrinol Metab. 2010;95(8):3965-72. [Crossref]  [PubMed] 
  25. Topaloğlu Ö, Sümer F, Çetin S, Yoloğlu S, Kayaalp C, Şahin İ. Alterations of thyroid functions in obesity: is there any impact of co-existence of type 2 diabetes mellitus? Turkish Journal of Diabetes and Obesity. 2018;2(1):23-7. [Link] 
  26. Sosa-López JG, Alarcón-González P, Sánchez-Hernández VH, Cruz-Estrada A, Aguilar-Serralde CA, Velasco-Medina AA. Impact of obesity on the thyroid profile, long-term experience at the General Hospital of Mexico, "Dr. Eduardo Liceaga". Revista médica del Hospital General de México. 2021;84(1):4-10. [Crossref] 
  27. Koritschoner NP, Alvarez-Dolado M, Kurz SM, Heikenwälder MF, Hacker C, Vogel F, et al. Thyroid hormone regulates the obesity gene tub. EMBO Rep. 2001;2(6):499-504. [Crossref]  [PubMed]  [PMC] 

.: Up To Date

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com