Merkezimize başvuran hipotiroidili çocukların genel özelliklerinin değerlendirilmesi
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Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmamızda hipotiroidi nedeniyle takip edilen hastaların demografik, klinik laboratuvar verilerinin retrospektif olarak incelenmesi ve kalıcı hipotiroidi olma sıklığının saptanması amaçlanmıştır. Gereç ve Yöntem: Bu çalışmaya hipotiroidi tanısı olan toplam 209 hasta retrospektif olarak dahil edildi. Çalışma grubundaki hastaların demografik verileri (yaş, cinsiyet, beden kitle indeksi, boy, doğum ağırlığı, doğum yöntemi, doğum haftası), klinik özellikleri (serum elektrolitleri, Tiroglobulin, tiroid antikorları, TSH, sT4, hemoglobin, kreatinin, potasyum, ALT, AST, üre, tiroid volümü, takip süresi, tedavi için kullanılan ilaç ) kayıt edildi. Bunlara ek olarak tiroid ultrasonu ve sintigrafisi yapıldı. Bu hastalar, 3 yıllık tedavi ve izlem sürecindeki serum TSH ve sT4 seviyelerine göre üç gruba ayrıldı. Serum TSH düzeyi yüksek olanlar ve sT4 düzeyi normal sınırlarda olanlar subklinik hipotiroidi, TSH düzeyi ve sT4 normal sınırlarda olanlar geçici hipotiroidi, TSH düzeyi yüksek ve sT4 düzeyi düşük olanlara ise kalıcı hipotiroidi olarak değerlendirildi. Hastaların TSH, sT4 düzeyi, tiroid volümü, tiroglobulin düzeyi, cinsiyeti, doğum yöntemi, doğum haftası ve kromozom anomalisi (Down sendromu) verilerine göre gruplar arasında kıyaslama yapıldı. Bulgular: Hastaların %45 (94)'i kız ve %55 (115)'i ise erkekti. Hipoplazi anatomik yapısı %8,1 agenezi, %1 hipoplazi ve %90,9 normal idi. Hastaların %29,7'si geçici, %58,9'u kalıcı ve %11,5'i ise subklinik hipotiroidi idi. Erkeklerin %27'si geçici, %57,4'ü kalıcı, %15,7'si ise subklinik hipotiroidi. Kızların %33'si geçici, %60,6'sı kalıcı, %6,4'ü ise subklinik hipotiroidi idi. Olguların ilk başvurusu en erken 3 gün, en geç ise 1485 gün olup, ortalama 98,49 gün olarak saptandı. Tedavi süresi en kısa 2 ay, en uzun 94 ay olup, ortalama ise 41,99 ay olarak saptandı. Vucut ağırlığı SDs ortalaması -0,69, boy ortalaması 57,8 ± 11,08 cm, boya göre ağırılık ortalaması 113,5 ve doğum ağırlığı ise ortalama 2933 gr idi. Geçici hipotiroidinin %1,6 (1)'sı kalıcı olurken, %14,6 (18)'sı subklinik seyretti ve %12,5 (3)'i down sendromlu idi. Hem geçici hem de kalıcı hipotiroidi olanların TSH değeri subklinik olanlardan daha yüksekti ve bu fark istatiksel olarak da anlamlıydı (p<0,05). Geçici hipotiroidi olanlarda, kalıcı olanlara göre tiroid volümü daha yüksekti ve bu yükseklik istatiksel olarak da anlamlıydı (p<0,05). Down sendromlularda, geçici ve subklinik hipotiroidi oranında istatiksel olarak anlamlı farklılık bulunmadı. Kalıcı hipotiroidi ise geçici ve subklinik olanlara göre daha fazla orandaydı ve bu oran istatiksel olarak da anlamlıylı (p<0,05). Subklinik hipotiroidi olanlar, geçici hipotiroidi olanlar ve kalıcı hipotiroidi olanlar arasında tiroid volümü açısından istatiksel olarak anlamlı farklılık izlenmedi (p>0,05). Geçici ve kalıcı hipotiroidi olanlarda TSH değerleri açısından istatiksel olarak anlamlı farklılık izlenmedi (p>0,05). Hipotiroidi çeşidine göre cinsiyet, doğum yöntemi, doğum haftası ve doğum ağırlığı açısından istatiksel olarak anlamlı fark izlenmedi (p>0,05). Geçici hipotiroidi, kalıcı hipotiroidi, subklinik hipotiroidi olanlarda, Tiroglobulin değerleri sırasıyla cut-off 104, 34, 40,6 iken, duyarlılık %55,77, %72,12, %70, özgüllük ise, %100, %84,21, %75 olarak bulundu. Geçici hipotiroidi, kalıcı hipotiroidi, subklinik hipotiroidi olanlarda, TSH değerleri sırasıyla cut-off 10,3, 10,5, 10 iken, duyarlılık %100, %100, %100, özgüllük ise %88,4, %75,96, %25 olarak bulundu. Geçici hipotiroidi, kalıcı hipotiroidi, subklinik hipotiroidi olanlarda, sT4 değerleri sırasıyla cut-off 0,92, 0,93, 0,90 iken, duyarlılık %100, %100, %100, özgüllük ise %100, %100, %100 olarak bulundu. Sonuç: Hipotiroidi, çocuklarda erken dönemde tanı konulmadığında ve tedavi edilmediğinde büyümeyi ve nörolojik gelişimi etkileyen önemli bir endokrin hastalıkdır. Hipotiroidinin etiyolojisi ve türünün belirlenmesi, hastaların tedavi ve takiplerinde önemli rol oynar. Hipotiroidi önemli bir yer tutmaya devam etmektedir.. Hipotiroidi erken dönemde fark edildiğinde hipotiroidiye eşlik eden morbiditeler de azalacaktır. Subklinik hipotiroidi olanlar, geçici hipotiroidi olanlar ve kalıcı hipotiroidi olan hastaların kıyaslamasının yapıldığı çalışmalar sınırlı sayıdadır ve bundan dolayı çalışmamızın literatüre katkı sağlayacağını düşünmekteyiz.
In this study, it was aimed to retrospectively analyze the demographic and clinical laboratory data of the patients who were followed up for hypothyroidism and to determine the frequency of having permanent hypothyroidism. Material and Method: A total of 209 patients with hypothyroidism were included in this study retrospectively. Demographic data (age, sex, body mass index, height, birth weight, birth method, birth week), clinical features (serum electrolytes, Thyroglobulin, thyroid antibodies, TSH, fT4, hemoglobin, creatinine, potassium, ALT, AST in the study group urea, thyroid volume, follow-up time, medication used for treatment). In addition, thyroid ultrasound and scintigraphy were performed. These patients were divided into three groups according to serum TSH and sT4 levels during the 3-year treatment and follow-up period. Those with high serum TSH levels and those with normal STT4 levels were considered as subclinical hypothyroidism, those with normal TSH levels and fT4 were temporary hypothyroidism, and those with high TSH levels and low sT4 levels were considered permanent hypothyroidism. Comparison was made between the groups according to the TSH, fT4 level, thyroid volume, thyroglobulin level, gender, delivery method, birth week and chromosomal anomaly (Down syndrome) data. Results: 45% (94) of the patients were female and 55% (115) were male. The anatomical structure of hypoplasia was 8.1% agenesis, 1% hypoplasia and 90.9% normal. 29.7% of the patients were temporary, 58.9% permanent and 11.5% were subclinical hypothyroidism. 27% of men are temporary, 57.4% are permanent and 15.7% are subclinical hypothyroidism. 33% of the girls were temporary, 60.6% of them were permanent and 6.4% of them were subclinical hypothyroidism. The first admission of the cases was 3 days at the earliest and 1485 days at the latest, with an average of 98.49 days. The duration of treatment was the shortest 2 months, the longest 94 months, and the average was 41.99 months. Body weight SDs mean was -0.69, height average was 57.8±11.08 cm, weight average was 113.5 and birth weight was 2933 gr. While 1.6% (1) of the temporary hypothyroidism was permanent, 14.6% (18) was subclinical and 12.5% (3) was with down syndrome. Those with both temporary and permanent hypothyroidism had higher TSH than subclinical ones, and this difference was statistically significant (p <0.05). Those with transient hypothyroidism had higher thyroid volumes than permanent ones, and this height was statistically significant (p <0.05). There was no statistically significant difference in the rate of transient and subclinical hypothyroidism in Down syndrome patients. Permanent hypothyroidism was higher than transient and subclinical ones, and this rate was statistically significant (p<0.05). There was no statistically significant difference in terms of thyroid volume between those with subclinical hypothyroidism, those with temporary hypothyroidism and those with permanent hypothyroidism (p>0.05). In patients with temporary and permanent hypothyroidism, no statistically significant difference was observed in terms of TSH values (p>0.05). There was no statistically significant difference in terms of gender, delivery method, birth week and birth weight according to the type of hypothyroidism (p>0.05). In patients with transient hypothyroidism, permanent hypothyroidism, subclinical hypothyroidism, thyroglobulin values were cut-off 104, 34, 40.6 respectively, while sensitivity was 55.77%, 72.12, 70%, and specificity was 100%, 84.21%. It was found as 75%. In patients with transient hypothyroidism, persistent hypothyroidism, subclinical hypothyroidism, TSH values were cut-off 10.3, 10.5, 10, respectively, while sensitivity was 100%, 100%, 100%, specificity 88.4%, 75.96%, Found to be 25. In patients with transient hypothyroidism, permanent hypothyroidism, subclinical hypothyroidism, the cut-off values of sT4 are 0.92, 0.93, 0.90, respectively, while sensitivity is 100%, 100%, 100%, specificity is 100%, 100%, 100%. She found. Conclusion: Hypothyroidism is an important endocrine disease that affects growth and neurological development when children are not diagnosed and treated early. Determining the etiology and type of hypothyroidism plays an important role in the treatment and follow-up of patients. Hypothyroidism continues to take an important place. When hypothyroidism is detected early, morbidities accompanying hypothyroidism will also decrease. Studies comparing patients with subclinical hypothyroidism, transient hypothyroidism and permanent hypothyroidism are limited and therefore we think that our study will contribute to the literature.
In this study, it was aimed to retrospectively analyze the demographic and clinical laboratory data of the patients who were followed up for hypothyroidism and to determine the frequency of having permanent hypothyroidism. Material and Method: A total of 209 patients with hypothyroidism were included in this study retrospectively. Demographic data (age, sex, body mass index, height, birth weight, birth method, birth week), clinical features (serum electrolytes, Thyroglobulin, thyroid antibodies, TSH, fT4, hemoglobin, creatinine, potassium, ALT, AST in the study group urea, thyroid volume, follow-up time, medication used for treatment). In addition, thyroid ultrasound and scintigraphy were performed. These patients were divided into three groups according to serum TSH and sT4 levels during the 3-year treatment and follow-up period. Those with high serum TSH levels and those with normal STT4 levels were considered as subclinical hypothyroidism, those with normal TSH levels and fT4 were temporary hypothyroidism, and those with high TSH levels and low sT4 levels were considered permanent hypothyroidism. Comparison was made between the groups according to the TSH, fT4 level, thyroid volume, thyroglobulin level, gender, delivery method, birth week and chromosomal anomaly (Down syndrome) data. Results: 45% (94) of the patients were female and 55% (115) were male. The anatomical structure of hypoplasia was 8.1% agenesis, 1% hypoplasia and 90.9% normal. 29.7% of the patients were temporary, 58.9% permanent and 11.5% were subclinical hypothyroidism. 27% of men are temporary, 57.4% are permanent and 15.7% are subclinical hypothyroidism. 33% of the girls were temporary, 60.6% of them were permanent and 6.4% of them were subclinical hypothyroidism. The first admission of the cases was 3 days at the earliest and 1485 days at the latest, with an average of 98.49 days. The duration of treatment was the shortest 2 months, the longest 94 months, and the average was 41.99 months. Body weight SDs mean was -0.69, height average was 57.8±11.08 cm, weight average was 113.5 and birth weight was 2933 gr. While 1.6% (1) of the temporary hypothyroidism was permanent, 14.6% (18) was subclinical and 12.5% (3) was with down syndrome. Those with both temporary and permanent hypothyroidism had higher TSH than subclinical ones, and this difference was statistically significant (p <0.05). Those with transient hypothyroidism had higher thyroid volumes than permanent ones, and this height was statistically significant (p <0.05). There was no statistically significant difference in the rate of transient and subclinical hypothyroidism in Down syndrome patients. Permanent hypothyroidism was higher than transient and subclinical ones, and this rate was statistically significant (p<0.05). There was no statistically significant difference in terms of thyroid volume between those with subclinical hypothyroidism, those with temporary hypothyroidism and those with permanent hypothyroidism (p>0.05). In patients with temporary and permanent hypothyroidism, no statistically significant difference was observed in terms of TSH values (p>0.05). There was no statistically significant difference in terms of gender, delivery method, birth week and birth weight according to the type of hypothyroidism (p>0.05). In patients with transient hypothyroidism, permanent hypothyroidism, subclinical hypothyroidism, thyroglobulin values were cut-off 104, 34, 40.6 respectively, while sensitivity was 55.77%, 72.12, 70%, and specificity was 100%, 84.21%. It was found as 75%. In patients with transient hypothyroidism, persistent hypothyroidism, subclinical hypothyroidism, TSH values were cut-off 10.3, 10.5, 10, respectively, while sensitivity was 100%, 100%, 100%, specificity 88.4%, 75.96%, Found to be 25. In patients with transient hypothyroidism, permanent hypothyroidism, subclinical hypothyroidism, the cut-off values of sT4 are 0.92, 0.93, 0.90, respectively, while sensitivity is 100%, 100%, 100%, specificity is 100%, 100%, 100%. She found. Conclusion: Hypothyroidism is an important endocrine disease that affects growth and neurological development when children are not diagnosed and treated early. Determining the etiology and type of hypothyroidism plays an important role in the treatment and follow-up of patients. Hypothyroidism continues to take an important place. When hypothyroidism is detected early, morbidities accompanying hypothyroidism will also decrease. Studies comparing patients with subclinical hypothyroidism, transient hypothyroidism and permanent hypothyroidism are limited and therefore we think that our study will contribute to the literature.
Açıklama
Anahtar Kelimeler
Hpotiroid, Hypothyroid, Demografi, Demography
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Bulut, E. (2020). Merkezimize başvuran hipotiroidili çocukların genel özelliklerinin değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
