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Subakut Tiroidit Hastalarinda Anemi Sıklığı Ve Hastalık Aktivitesi İle İlişkisi

Year 2018, Volume: 81 Issue: 2, 46 - 50, 29.05.2018

Abstract

DOI: 10.26650/IUITFD.382521


Amaç: Subakut tiroidit hastalarında, tanı
konduğu anda ve klinik bulgular ile akut faz yanıtı geriledikten sonra anemi
sıklığını ve inflamasyon bulguları ile ilişkisini araştırmak.

Gereç ve Yöntem: İstanbul Tıp Fakültesi, İç
Hastalıkları Anabilim Dalı, Endokrinoloji ve Metabolizma Hastalıkları Bilim
Dalı Polikliniği’nde kayıtlı olan ve subakut tiroidit tanısı doğrulanan
hastalardan, hastalığın aktif olduğu dönemdeki ve klinik bulguları düzeldikten
ve/veya akut faz yanıtlarında düşme gözlendikten sonraki hemogram değerlerine
ulaşılabilen hastalar çalışma grubunu oluşturdu. Hasta kayıtları retrospektif
olarak incelendi. İstatistik incelemeler için eşleşmiş Student t testi ve ANOVA
testi kullanıldı.

Bulgular: Subakut tiroidit tanısı konan 60
hastanın 37’sinde (%65) anemi saptandı. Anemiye yönelik herhangi bir tedavi
yapılmaksızın, klinik bulguları düzelen hastaların 17’sinde (%28,3) anemi
bulundu. Klinik ve inflamasyon bulguları düzeldikten sonra hemoglobin
(1,08±0,98 g/dl) ve hematokrit değerlerinde (3,45±2,9) anlamlı artışlar
saptandı, ortalama eritrosit hacmi değerlerinde değişiklik olmadı. Klinik
bulgular düzeldiğinde kalıcı hipotiroidi gelişen 20 hastada (%33,3) başlangıç
ve klinik yanıt sonrası hemoglobin ve hematokrit değerleri ise diğer
hastalardan anlamlı olarak daha düşüktü.







Sonuç: Subakut tiroidit hastalarında
hastalık aktivitesi ile ilişkili olarak anemi gelişmekte ve klinik ve
inflamasyon bulgularının düzelmesi ile anlamlı bir düzelme saptanabilmektedir.
Bu nedenle, subakut tiroidit hastalarında anemiye yönelik gereksiz
incelemelerden kaçınılmalı ve ileri tetkikler için klinik ve inflamasyon
bulgularının düzelmesi beklenmelidir.

References

  • 1. Fatourechi V, Aniszewski JP, Fatourechi GZ, Atkinson EJ, Jacobsen SJ. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study. J Clin Endocrinol Metab 2003;88(5):2100-5.
  • 2. Nishihara E, Ohye H, Amino N, Takata K, Arishima T, Kudo T, et al. Clinical characteristics of 852 patients with subacute thyroiditis before treatment. Intern Med 2008;47(8):725-9.
  • 3. Ross AC. Impact of chronic and acute inflammation on extra- and intracellular iron homeostasis. Am J Clin Nutr 2017;106(Suppl 6):1581S-1587S.
  • 4. Akpınar H, Çetiner M, Keshav S, Örmeci N, Törüner M. Diagnosis and treatment of iron deficiency anemia in patients with inflammatory bowel disease and gastrointestinal bleeding: iron deficiency anemia working group consensus report. Turk J Gastroenterol 2017;28(2):81-7.
  • 5. Kimura M, Amino N, Takada K, Miyai K. Subacute thyroiditis associated with systemic multi-organ disorders. Endocrinol Jpn 1989;36(6):859-64.
  • 6. Hinterberger-Fischer M, Kier P, Forstinger I, Lechner K, Kornek G, Breyer S, et al. Coincidence of severe aplastic anaemia with multiple sclerosis or thyroid disorders. Report of 5 cases. Acta Haematol 1994;92(3):136-9.
  • 7. Hernán Martinez J, Corder E, Uzcategui M, Garcia M, Sostre S, Garcia A. Subacute thyroiditis and dyserythropoesis after influenza vaccination suggesting immune dysregulation. Bol Asoc Med P R 2011;103(2):48-52.
  • 8. Sangkhae V, Nemeth E. Regulation of the iron homeostatic hormone hepcidin. Adv Nutr 2017;8(1):126-36.
  • 9. Bartalena L, Brogioni S, Grasso L, Martino E. Increased serum interleukin-6 concentration in patients with subacute thyroiditis: relationship with concomitant changes in serum T4-binding globulin concentration. J Endocrinol Invest 1993;16(3):213-8.
  • 10. Yamada T, Sato A, Aizawa T. Dissociation between serum interleukin-6 rise and other parameters of disease activity in subacute thyroiditis during treatment with corticosteroid. J Clin Endocrinol Metab 1996;81(2):577-9.
  • 11. Chrobak C, Sidler JA, O’Meara A, Schaedelin S, Hug BL. Iron homeostasis in inflammation: a single centre prospective observational study in medical inpatients. Swiss Med Wkly 2017;147:w14431.
  • 12. Suchdev PS, Williams AM, Mei Z, Flores-Ayala R, Pasricha SR, Rogers LM, et al. Assessment of iron status in settings of inflammation: challenges and potential approaches. Am J Clin Nutr 2017;106(Suppl 6):1626S-33S.
  • 13. Suchdev PS, Namaste SM, Aaron GJ, Raiten DJ, Brown KH, Flores-Ayala R; BRINDA Working Group. overview of the biomarkers reflecting ınflammation and nutritional determinants of anemia (BRINDA) Project. Adv Nutr 2016;7(2):349-56.
  • 14. Namaste SM, Aaron GJ, Varadhan R, Peerson JM, Suchdev PS; BRINDA Working Group. methodologic approach for the biomarkers reflecting inflammation and nutritional determinants of anemia (BRINDA) project. Am J Clin Nutr 2017;106(Suppl 1):333S-347S.
  • 15. Namaste SM, Rohner F, Huang J, Bhushan NL, Flores-Ayala R, Kupka R, et al. Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr 2017;106(Suppl 1):359S-371S.
  • 16. Sakata S, Nagai K, Maekawa H, Kimata Y, Komaki T, Nakamura S, et al. Serum ferritin concentration in subacute thyroiditis. Metabolism 1991;40(7):683-8.
  • 17. Gianoukakis AG, Leigh MJ, Richards P, Christenson PD, Hakimian A, Fu P, et al. Characterization of the anaemia associated with Graves’ disease. Clin Endocrinol (Oxf) 2009;70(5):781-7.

Frequency Of Anemia And Its Association With Disease Activity In Subacute Thyroiditis

Year 2018, Volume: 81 Issue: 2, 46 - 50, 29.05.2018

Abstract

DOI: 10.26650/IUITFD.382521


Objective: To investigate the frequency of
anemia and its association with inflammation in patients with subacute
thyroiditis (ST) during diagnosis and after the resolution of clinical findings
and acute-phase response.

Materials and Methods: We retrospectively
reviewed the charts of patients with confirmed diagnosis of ST, followed at the
Endocrinology and Metabolism Outpatient Clinic of Istanbul Faculty of Medicine
(Turkey). The study cohort comprised those with acute-phase response and
hemogram results during diagnosis and after the resolution of clinical and
inflammation findings. Hemoglobin levels of <12 and <13 g/dl for females
and males, respectively, were defined as anemia.

Results: Anemia was detected in 37 of 60 ST
patients (65%) studied during diagnosis, and its frequency reduced to 28.3%
following the resolution of clinical and laboratory findings without additional
treatment. Notably, although a significant increase was observed in terms of
hemoglobin (1.08 ± 0.98 g/dl) and hematocrit (3.45 ± 2.9) levels, no change was
detected in terms of MCV values. During diagnosis and following the clinical
improvement, hemoglobin and hematocrit values of 20 patients (33.3%) who developed
permanent hypothyroidism following the resolution of clinical findings were
significantly lower than those of the remaining patients.







Conclusion: Anemia can develop in 65% of
patients with ST. A significant improvement can be observed following resolution
of clinical and laboratory findings. Therefore, further studies investigating
the causes of anemia should be avoided in patients with ST until clinical
findings and acute-phase response have been improved.

References

  • 1. Fatourechi V, Aniszewski JP, Fatourechi GZ, Atkinson EJ, Jacobsen SJ. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study. J Clin Endocrinol Metab 2003;88(5):2100-5.
  • 2. Nishihara E, Ohye H, Amino N, Takata K, Arishima T, Kudo T, et al. Clinical characteristics of 852 patients with subacute thyroiditis before treatment. Intern Med 2008;47(8):725-9.
  • 3. Ross AC. Impact of chronic and acute inflammation on extra- and intracellular iron homeostasis. Am J Clin Nutr 2017;106(Suppl 6):1581S-1587S.
  • 4. Akpınar H, Çetiner M, Keshav S, Örmeci N, Törüner M. Diagnosis and treatment of iron deficiency anemia in patients with inflammatory bowel disease and gastrointestinal bleeding: iron deficiency anemia working group consensus report. Turk J Gastroenterol 2017;28(2):81-7.
  • 5. Kimura M, Amino N, Takada K, Miyai K. Subacute thyroiditis associated with systemic multi-organ disorders. Endocrinol Jpn 1989;36(6):859-64.
  • 6. Hinterberger-Fischer M, Kier P, Forstinger I, Lechner K, Kornek G, Breyer S, et al. Coincidence of severe aplastic anaemia with multiple sclerosis or thyroid disorders. Report of 5 cases. Acta Haematol 1994;92(3):136-9.
  • 7. Hernán Martinez J, Corder E, Uzcategui M, Garcia M, Sostre S, Garcia A. Subacute thyroiditis and dyserythropoesis after influenza vaccination suggesting immune dysregulation. Bol Asoc Med P R 2011;103(2):48-52.
  • 8. Sangkhae V, Nemeth E. Regulation of the iron homeostatic hormone hepcidin. Adv Nutr 2017;8(1):126-36.
  • 9. Bartalena L, Brogioni S, Grasso L, Martino E. Increased serum interleukin-6 concentration in patients with subacute thyroiditis: relationship with concomitant changes in serum T4-binding globulin concentration. J Endocrinol Invest 1993;16(3):213-8.
  • 10. Yamada T, Sato A, Aizawa T. Dissociation between serum interleukin-6 rise and other parameters of disease activity in subacute thyroiditis during treatment with corticosteroid. J Clin Endocrinol Metab 1996;81(2):577-9.
  • 11. Chrobak C, Sidler JA, O’Meara A, Schaedelin S, Hug BL. Iron homeostasis in inflammation: a single centre prospective observational study in medical inpatients. Swiss Med Wkly 2017;147:w14431.
  • 12. Suchdev PS, Williams AM, Mei Z, Flores-Ayala R, Pasricha SR, Rogers LM, et al. Assessment of iron status in settings of inflammation: challenges and potential approaches. Am J Clin Nutr 2017;106(Suppl 6):1626S-33S.
  • 13. Suchdev PS, Namaste SM, Aaron GJ, Raiten DJ, Brown KH, Flores-Ayala R; BRINDA Working Group. overview of the biomarkers reflecting ınflammation and nutritional determinants of anemia (BRINDA) Project. Adv Nutr 2016;7(2):349-56.
  • 14. Namaste SM, Aaron GJ, Varadhan R, Peerson JM, Suchdev PS; BRINDA Working Group. methodologic approach for the biomarkers reflecting inflammation and nutritional determinants of anemia (BRINDA) project. Am J Clin Nutr 2017;106(Suppl 1):333S-347S.
  • 15. Namaste SM, Rohner F, Huang J, Bhushan NL, Flores-Ayala R, Kupka R, et al. Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr 2017;106(Suppl 1):359S-371S.
  • 16. Sakata S, Nagai K, Maekawa H, Kimata Y, Komaki T, Nakamura S, et al. Serum ferritin concentration in subacute thyroiditis. Metabolism 1991;40(7):683-8.
  • 17. Gianoukakis AG, Leigh MJ, Richards P, Christenson PD, Hakimian A, Fu P, et al. Characterization of the anaemia associated with Graves’ disease. Clin Endocrinol (Oxf) 2009;70(5):781-7.
There are 17 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Nurdan Gül 0000-0002-1187-944X

Publication Date May 29, 2018
Submission Date January 22, 2018
Published in Issue Year 2018 Volume: 81 Issue: 2

Cite

APA Gül, N. (2018). Subakut Tiroidit Hastalarinda Anemi Sıklığı Ve Hastalık Aktivitesi İle İlişkisi. Journal of Istanbul Faculty of Medicine, 81(2), 46-50.
AMA Gül N. Subakut Tiroidit Hastalarinda Anemi Sıklığı Ve Hastalık Aktivitesi İle İlişkisi. İst Tıp Fak Derg. May 2018;81(2):46-50.
Chicago Gül, Nurdan. “Subakut Tiroidit Hastalarinda Anemi Sıklığı Ve Hastalık Aktivitesi İle İlişkisi”. Journal of Istanbul Faculty of Medicine 81, no. 2 (May 2018): 46-50.
EndNote Gül N (May 1, 2018) Subakut Tiroidit Hastalarinda Anemi Sıklığı Ve Hastalık Aktivitesi İle İlişkisi. Journal of Istanbul Faculty of Medicine 81 2 46–50.
IEEE N. Gül, “Subakut Tiroidit Hastalarinda Anemi Sıklığı Ve Hastalık Aktivitesi İle İlişkisi”, İst Tıp Fak Derg, vol. 81, no. 2, pp. 46–50, 2018.
ISNAD Gül, Nurdan. “Subakut Tiroidit Hastalarinda Anemi Sıklığı Ve Hastalık Aktivitesi İle İlişkisi”. Journal of Istanbul Faculty of Medicine 81/2 (May 2018), 46-50.
JAMA Gül N. Subakut Tiroidit Hastalarinda Anemi Sıklığı Ve Hastalık Aktivitesi İle İlişkisi. İst Tıp Fak Derg. 2018;81:46–50.
MLA Gül, Nurdan. “Subakut Tiroidit Hastalarinda Anemi Sıklığı Ve Hastalık Aktivitesi İle İlişkisi”. Journal of Istanbul Faculty of Medicine, vol. 81, no. 2, 2018, pp. 46-50.
Vancouver Gül N. Subakut Tiroidit Hastalarinda Anemi Sıklığı Ve Hastalık Aktivitesi İle İlişkisi. İst Tıp Fak Derg. 2018;81(2):46-50.

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Email: itfdergisi@istanbul.edu.tr

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