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Tiroid Bezinin Klinik Özellikleri Erken Yaşlılık ve İhtiyarlık Döneminde Farklılık Gösterir mi?

Yıl 2023, Cilt: 1 Sayı: 3, 74 - 77, 31.10.2023

Öz

Amaç: Bu çalışma, tiroid bezinin klinik özelliklerinin erken yaşlılık döneminde ve ihtiyarlık döneminde farklılık gösterip göstermediğini araştırmayı amaçlamıştır.
Gereç ve Yöntem: Üçüncü basamak bir hastanede yaşları 65 ile 84 arasında değişen hasta verilerinin retrospektif analizi yapıldı. Hastaların demografik verileri, tiroid fonksiyon testleri değerleri, tiroid ultrasonografi tarama sonuçları ve tiroid bezinin kesinleşmiş hastalığı araştırıldı. Hastalar Dünya Sağlık Örgütü sınıflandırmasına göre 65-74 yaş (G1; erken yaşlılık) ve 75-84 yaş (G2; ihtiyarlık) olmak üzere iki gruba ayrıldı. Her iki grubun verileri uygun istatistiksel testlerle karşılaştırıldı.
Bulgular: Toplam 426 hastanın 90’ı (%21,1) erkek, 336’sı (%78,9) kadındı. Hastaların yaş ortalaması 74,89±0,22 yıldı. Tiroid bezinde 208 (%48,8) hastada nodül yoktu, 218 (%51,2) hastada ise nodül mevcuttu. Nodülü olanların 140’ında (%32,9) multinodüler guatr (MNG), 78’sında (%18,3) tek soliter nodül vardı. G1 grubunda 144 (%33,8) hasta vardı, geri kalan hastalar ise G2 grubundaydı. G2 grubunun %22’sinde, G1 grubunun ise %11,1’inde 1 cm’den büyük soliter nodüller saptandı. Otoimmün hipotiroidili olanlar G1 grubunda daha sık görülürken, soliter nontoksik adenomlu olanlar G2 grubunda daha sıktı (p<0,005). Ötiroidik hasta oranı G1 ve G2 gruplarında benzer olup hipertiroidizm hasta oranı G2 grubunda daha yüksek idi.
Sonuç: Yaşlanma ilerledikçe tiroid nodülü saptanma oranı ve hipetiroidizm kliniği ile karşılaşma daha olasıdır. Bu durumların farkında olunarak geriatrik yaştaki hastaların değerlendirilmesi doğru takip ve tedavi açısından önemlidir.

Kaynakça

  • Kalayci T, Kartal M. Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, serum albumin and prognostic nutritional index as predictors of morbidity in super-elderly patients operated on for acute appendicitis. Eur Rev Med Pharmacol Sci. 2022;26(3):820-27.
  • Visser WE, Visser TJ, Peeters RP. Thyroid disorders in older adults. Endocrinol Metab Clin North Am. 2013 Jun;42(2):287-303.
  • Akbaş S, Saraç ZF. Yaşlıda tiroid hastalıkları. Geriatrik Endokrinoloji. 1. Baskı. Ankara: Türkiye Klinikleri; 2022. p.33-40.
  • Boelaert K, Torlinska B, Holder RL, et al. Older subjects with hyperthyroidism present with a paucity of symptoms and signs: a large cross-sectional study. J Clin Endocrinol Metab. 2010;95(6):2715-26.
  • Papaleontiou M, Haymart MR. Approach to and treatment of thyroid disorders in the elderly. Med Clin North Am. 2012;96(2):297-310.
  • Tunbridge WM, Evered DC, Hall R, et al. The spectrum of thyroid disease in a community: The Whickham survey. Clin Endocrinol. 1977 Dec;7(6):481-93.
  • Hegedus L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter: current status and future perspectives. Endocr Rev. 2003;24(1):102-32.
  • Esfandiari NH, Hughes DT, Reyes-Gastelum D, et al. Factors associated with diagnosis and treatment of thyroid microcarcinomas. J Clin Endocrinol Metab. 2019;104(12):6060-68.
  • Lim H, Devesa SS, Sosa JA, et al. Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA. 2017;317(13):1338-1348.
  • Haymart MR, Banerjee M, Reyes-Gastelum D, et al. Thyroid ultrasound and the increase in diagnosis of low-risk thyroid cancer. J Clin Endocrinol Metab. 2019;104(3):785–792.
  • Kuzu A, Aydın C, Yıldız M, ve ark. Dünya Sağlık Örgütü Avrupa Bölgesi’nde yaşlanma ile ilgili seçilmiş bazı ölçütlerin değerlendirilmesi. STED. 2019;28(1):17-27.
  • Tabatabaie V, Surks MI. The aging thyroid. Curr Opin Endocrinol Diabetes Obes. 2013;20(5):455-9.
  • Pearce EN. Hypothyroidism is associated with increased mortality risk in individuals 65 years of age or older. Clinical Thyroidology. 2018;30(8):350-2.
  • 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(2):489-99.
  • Ross DS, Burch HB, Cooper DS, Greenlee MC, et al. 2016 American Thyroid Association Guidelines for diagnosis and management of Hyperthyroidism and other Causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-421.
  • Rozing MP, Westendorp RG, de Craen AJ, et al. Low serum free triiodothyronine levels mark familial longevity: the Leiden Longevity Study. J Gerontol A Biol Sci Med Sci 2010;65:365–8.
  • Mariotti S, Franceschi C, Cossarizza A, et al. The aging thyroid. Endocr Rev 1995; 16:686-715.
  • Tibaldi JM, Barzel US, Albin j, et al. Thyrotoxicosis in the very old. Am J Med. 1986;81(4):619-22.
  • Mirza FS, Taxel P, Luthra P. Endocrine health and healthy aging. in: Coll pp, ed. Healthy aging. 1st ed. Switzerland: Springer; 2019. p.201-12
  • Laurberg P, Pedersen KM, Vestergaard H, et al. High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area: comparative surveys of thyrotoxicosis epidemiology in East-Jutland Denmark and Iceland. J Intern Med. 1991;229(5):415-20.
  • Abraham-Nordling M, Byström K, Törring O, et al. Incidence of hyperthyroidism in Sweden. Eur J Endocrinol. 2011;165(6):899-905.
  • Peeters RP. Thyroid hormones and aging. Hormones (Athens) 2008;7:28-35.
  • Rhee CM, Bhan I, Alexander EK, et al. Association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism. Arch Intern Med 2012;172:153-9.
  • Trivalle C, Doucet J, Chassagne P, et al. Differences in the signs and symptoms of hyperthyroidism in older and younger patients. J Am Geriatr Soc 1996;44:50-3.
  • Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012;18(6):988-1028.
  • Martino E, Aghini-Lombardi F, Bartalena L, et al. Enhanced susceptibility to amiodarone-induced hypothyroidism in patients with thyroid autoimmune disease. Arch Intern Med 1994;154:2722-6.
  • Diez JJ. Hypothyroidism in patients older than 55 years: an analysis of the etiology and assessment of the effectiveness of therapy. J Gerontol A Biol Sci Med Sci 2002;57:M315-20.
  • American thyroid association (ATA) Guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association Management Guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167-214.

Do the Clinical Features of the Thyroid Gland Differ in Early Senility Age and Old Age?

Yıl 2023, Cilt: 1 Sayı: 3, 74 - 77, 31.10.2023

Öz

Aim: This study aimed to investigate whether the clinical features of the thyroid gland differed in early senility age and old age.
Material and Method: The retrospective analysis of patient data, aged between 65 and 84 years, was conducted at a tertiary care hospital. The demographic data of the patients, the values of thyroid function tests, the results of thyroid ultrasonography screening, and finalized disease of thyroid gland were investigated. Patients were categorized into two groups, 65-74 years (G1; early senility) and 75-84 years (G2; old age), according to World Health Organisation classification. The data of both groups were compared with suitable statistical tests.
Results: Out of the 426 patients, 90 (21.1%) were male and 336 (78.9%) were female. The mean age of the patients was 74.89±0.22 years. The thyroid gland did not include any nodules in 208 (48.8%) patients while nodules were present in 218 (51.2%) patients. Of those with nodules, 140 (32.9%) had multinodular goiter (MNG) and 78 (18.3%) had a single solitary nodule. There were 144 (33.8%) patients in the G1 group, and the remaining patients were in the G2 group. Solitary nodules larger than 1 cm were detected in 22% of the G2 group and 11.1% of the G1 group. While those with autoimmune hypothyroidism were more common in the G1 group, those with solitary nontoxic adenoma were more common in the G2 group (p<0.005). The rate of euthyroidic patients was similar in the G1 and G2 groups, and the rate of hyperthyroidism patients was higher in the G2 group.
Conclusion: As aging progresses, the rate of thyroid nodule detection and hyperthyroidism clinic becomes more likely. Being aware of these conditions and evaluating geriatric patients is critical for correct follow-up and treatment.

Etik Beyan

The study protocol was approved by the Ethics Committee of Eskişehir Osmangazi University Medical Faculty Training and Research Hospital with the number E-25403353-050.99-2020 and decision number 206.

Destekleyen Kurum

yok

Kaynakça

  • Kalayci T, Kartal M. Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, serum albumin and prognostic nutritional index as predictors of morbidity in super-elderly patients operated on for acute appendicitis. Eur Rev Med Pharmacol Sci. 2022;26(3):820-27.
  • Visser WE, Visser TJ, Peeters RP. Thyroid disorders in older adults. Endocrinol Metab Clin North Am. 2013 Jun;42(2):287-303.
  • Akbaş S, Saraç ZF. Yaşlıda tiroid hastalıkları. Geriatrik Endokrinoloji. 1. Baskı. Ankara: Türkiye Klinikleri; 2022. p.33-40.
  • Boelaert K, Torlinska B, Holder RL, et al. Older subjects with hyperthyroidism present with a paucity of symptoms and signs: a large cross-sectional study. J Clin Endocrinol Metab. 2010;95(6):2715-26.
  • Papaleontiou M, Haymart MR. Approach to and treatment of thyroid disorders in the elderly. Med Clin North Am. 2012;96(2):297-310.
  • Tunbridge WM, Evered DC, Hall R, et al. The spectrum of thyroid disease in a community: The Whickham survey. Clin Endocrinol. 1977 Dec;7(6):481-93.
  • Hegedus L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter: current status and future perspectives. Endocr Rev. 2003;24(1):102-32.
  • Esfandiari NH, Hughes DT, Reyes-Gastelum D, et al. Factors associated with diagnosis and treatment of thyroid microcarcinomas. J Clin Endocrinol Metab. 2019;104(12):6060-68.
  • Lim H, Devesa SS, Sosa JA, et al. Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA. 2017;317(13):1338-1348.
  • Haymart MR, Banerjee M, Reyes-Gastelum D, et al. Thyroid ultrasound and the increase in diagnosis of low-risk thyroid cancer. J Clin Endocrinol Metab. 2019;104(3):785–792.
  • Kuzu A, Aydın C, Yıldız M, ve ark. Dünya Sağlık Örgütü Avrupa Bölgesi’nde yaşlanma ile ilgili seçilmiş bazı ölçütlerin değerlendirilmesi. STED. 2019;28(1):17-27.
  • Tabatabaie V, Surks MI. The aging thyroid. Curr Opin Endocrinol Diabetes Obes. 2013;20(5):455-9.
  • Pearce EN. Hypothyroidism is associated with increased mortality risk in individuals 65 years of age or older. Clinical Thyroidology. 2018;30(8):350-2.
  • 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(2):489-99.
  • Ross DS, Burch HB, Cooper DS, Greenlee MC, et al. 2016 American Thyroid Association Guidelines for diagnosis and management of Hyperthyroidism and other Causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-421.
  • Rozing MP, Westendorp RG, de Craen AJ, et al. Low serum free triiodothyronine levels mark familial longevity: the Leiden Longevity Study. J Gerontol A Biol Sci Med Sci 2010;65:365–8.
  • Mariotti S, Franceschi C, Cossarizza A, et al. The aging thyroid. Endocr Rev 1995; 16:686-715.
  • Tibaldi JM, Barzel US, Albin j, et al. Thyrotoxicosis in the very old. Am J Med. 1986;81(4):619-22.
  • Mirza FS, Taxel P, Luthra P. Endocrine health and healthy aging. in: Coll pp, ed. Healthy aging. 1st ed. Switzerland: Springer; 2019. p.201-12
  • Laurberg P, Pedersen KM, Vestergaard H, et al. High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area: comparative surveys of thyrotoxicosis epidemiology in East-Jutland Denmark and Iceland. J Intern Med. 1991;229(5):415-20.
  • Abraham-Nordling M, Byström K, Törring O, et al. Incidence of hyperthyroidism in Sweden. Eur J Endocrinol. 2011;165(6):899-905.
  • Peeters RP. Thyroid hormones and aging. Hormones (Athens) 2008;7:28-35.
  • Rhee CM, Bhan I, Alexander EK, et al. Association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism. Arch Intern Med 2012;172:153-9.
  • Trivalle C, Doucet J, Chassagne P, et al. Differences in the signs and symptoms of hyperthyroidism in older and younger patients. J Am Geriatr Soc 1996;44:50-3.
  • Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012;18(6):988-1028.
  • Martino E, Aghini-Lombardi F, Bartalena L, et al. Enhanced susceptibility to amiodarone-induced hypothyroidism in patients with thyroid autoimmune disease. Arch Intern Med 1994;154:2722-6.
  • Diez JJ. Hypothyroidism in patients older than 55 years: an analysis of the etiology and assessment of the effectiveness of therapy. J Gerontol A Biol Sci Med Sci 2002;57:M315-20.
  • American thyroid association (ATA) Guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association Management Guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167-214.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular İç Hastalıkları
Bölüm Araştırma Makalesi
Yazarlar

Hatice Hamarat 0000-0001-8694-5686

Göknur Yorulmaz 0000-0001-8596-9344

Yayımlanma Tarihi 31 Ekim 2023
Gönderilme Tarihi 3 Eylül 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 1 Sayı: 3

Kaynak Göster

AMA Hamarat H, Yorulmaz G. Do the Clinical Features of the Thyroid Gland Differ in Early Senility Age and Old Age?. Ağrı Med J. Ekim 2023;1(3):74-77.