HASHIMOTO TİROİDİTİ YÖNETİMİNDE GLUTENSİZ BESLENMENİN YERİ

Öz

Otoimmün tiroid hastalıkları, kadınlar ağırlıklı olmak üzere, nüfusun %2-5’ini etkilemektedir. Sırasıyla hipotiroidi ve hipertiroidiye yol açan, Hashimoto tiroiditi ve Graves hastalığı, en yaygın görülen otoimmün tiroid hastalıklarıdır. Hashimoto tiroiditi, foliküler hücrelerin lenfositik infiltrat ve fibrozis ile yer değiştirmesinden kaynaklanmaktadır ve tiroid antikorlarından özellikle tiroid peroksidaz antikorları, tiroglobulin antikorları ve azalmış tiroid bezi ekojenitesi ile karakterizedir. Tiroid parankimasının sürekli yıkımı, hipotiroidizme neden olur ve levotiroksin gibi sentetik tiroid hormonları kronik tedavide yaygın olarak kullanılır. Son yıllarda Hashimoto tiroiditinde gluten tüketiminden kaçınmak, popüler bir eğilim haline gelmiştir. Glutensiz diyetin ana ilkesi, içerisinde gluten bulunan buğday, arpa, çavdar, yulaf ve bunları içeren bütün yiyecek, içecek, ilaç ve besin takviyelerinin diyetten çıkarılmasıdır. Ancak glutensiz diyet aslında bir ince bağırsak enteropatisi olan çölyak hastalığı için mevcut bir tedavi şeklidir. Ayrıca gluten eliminasyonundan sonra hastalar, selenyum, iyot, magnezyum, çinko ve bakır eksikliği açısından risk altında olmaktadır. Bunun yanında glutensiz diyetler, sürdürülmesi zor ve pahalı diyetlerdir. Yapılan çalışmalarda glutensiz diyetin, Hashimoto tiroiditi gibi otoimmün tiroid hastalıklarının progresyonu ve potansiyel komplikasyonları açısından fayda sağlayabileceği bildirilmektedir. Hashimoto tiroiditi hastaları değerlendirilirken, mutlaka eşlik eden çölyak hastalığının varlığı da sorgulanmalıdır. Glutensiz diyetin Hashimoto tiroiditi hastalığının yönetiminde kullanılmasına dair yapılan çalışmalar yetersizdir ve glutensiz diyetin Hashimoto tiroiditi olan hastalara önerilmesi için yeterli kanıt bulunmamaktadır. Bu çalışmada, otoimmün tiroid hastalıklarından Hashimoto tiroiditinin yönetiminde glutensiz diyet uygulamaları ile ilgili yapılan çalışmaları derlemek, bilimsel açıdan değerlendirmek ve literatüre yeni bilgiler kazandırmak amaçlanmıştır.

Anahtar Kelimeler

• Otoimmün
• Hashimoto tiroiditi
• Glutensiz diyet

THE PLACE OF A GLUTEN-FREE DIET IN THE MANAGEMENT OF HASHIMOTO THYROIDITIS

Abstract

Autoimmune thyroid diseases affect 2-5% of the population, predominantly women. Hashimoto's thyroiditis and Graves' disease, causing hypothyroidism and hyperthyroidism, respectively, are the most common autoimmune thyroid diseases. Hashimoto's thyroiditis results from replacement of follicular cells by lymphocytic infiltrate and fibrosis and is characterized by thyroid antibodies, particularly thyroid peroxidase antibodies, thyroglobulin antibodies, and decreased thyroid gland echogenicity. Persistent destruction of the thyroid parenchyma causes hypothyroidism, and synthetic thyroid hormones such as levothyroxine are widely used in chronic therapy. In recent years, avoiding gluten consumption in Hashimoto's thyroiditis has become a popular trend. The main principle of the gluten-free diet is the elimination of wheat, barley, rye, oats and all foods, beverages, medicines and nutritional supplements containing gluten from the diet. But the gluten-free diet is actually an existing form of treatment for celiac disease, a small intestinal enteropathy. In addition, after gluten elimination, patients are at risk for selenium, iodine, magnesium, zinc and copper deficiencies. In addition, gluten-free diets are difficult and expensive to maintain. Studies have reported that gluten-free diet may provide benefits in terms of progression and potential complications of autoimmune thyroid diseases such as Hashimoto's thyroiditis. When evaluating patients with Hashimoto's thyroiditis, the presence of concomitant celiac disease should also be questioned. Studies on the use of a gluten-free diet in the management of Hashimoto's thyroiditis are insufficient and there is insufficient evidence to recommend a gluten-free diet to patients with Hashimoto's thyroiditis. In this study, it was aimed to compile the studies on gluten-free diet practices in the management of Hashimoto's thyroiditis, one of the autoimmune thyroid diseases, to evaluate them scientifically and to bring new information to the literature.

Keywords

• Autoimmune;
• Hashimoto
• Gluten free diet

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