DİFERANSİYE TİROİD KANSERLİ HASTALARDA TİROTROPİN SUPRESYON DÜZEYİNİN DİYASTOLİK KALP FONKSİYONLARI ÜZERİNE ETKİSİ

Year 2024, Volume: 25 Issue: 4, 484 - 489, 21.10.2024

Ziynet Alphan Üç , Semih Çelik , Ozkan Candan

https://doi.org/10.18229/kocatepetip.1445719

Abstract

AMAÇ: Bu çalışmanın amacı opere diferansiye tiroid kanserli (DTK) hastalarda tiroid-stimüle edici hormon (TSH) supresyon düzeylerine göre kardiyak yapı ve diyastolik fonksiyonlardaki değişikliklerin araştırılmasıdır.
GEREÇ VE YÖNTEM: Kesitsel olarak dizayn edilen bu araştırmaya hastanemiz endokrinoloji polikliniğinde takipli, tiroid cerrahisi sonrası bir yıldan uzun süredir tiroid hormon replasmanı ve TSH supresyon tedavisi alan 125 DTK’lı hasta dahil edildi. Çalışmamızda olgular American Thyroid Association (ATA) 2015 kılavuzu risk değerlendirmelerine uygun olarak gruplara ayrılmıştır. Buna göre hastalar birinci grup TSH seviyesi <0,1 mIU/L olanlar (n:30), ikinci grup TSH düzeyi 0,1-0,5 mIU/L arasında olanlar (n:56) ve üçüncü grup ise TSH düzeyi 0,5-2 mIU/L arasında olanlar (n:39) şeklinde üç gruba kategorize edilmiştir. İlk iki grup supresyon, 3. grup ise replasman (kontrol) grubu olarak belirlenmiştir. Tüm hastalara M-mode ve pulse-vave doku dopler ekokardiyografi yapılmıştır.
BULGULAR: Sol ventrikül diyastol sonu çapı (EDD), TSH aralığı <0,1 mIU/L olan grupta, replasman grubuna göre anlamlı olarak daha uzun bulunmuştur (45,35±3,54 ve 42,74±6,08; p=0,016). Yine erken diastolik dolumda mitral kapak velositesini gösteren E velocity grup 1 de, replasman grubuna göre anlamlı olarak daha düşük bulunmuştur (0,7(0,6-0,8) ve 0,84(0,7-0,98); p=0,010). A, E’ velositeleri ve E/A oranı gruplar arasında farklılık göstermemiştir.
SONUÇ: Diferansiye tiroid kanseri nedeniyle TSH supresyon tedavisi alan hastalarda, klinik semptom olmamasına rağmen, farklı TSH supresyon düzeylerinde, miyokard yapı ve fonksiyonlarında değişiklikler farklı olabilmektedir. Diyastolik disfonksiyonun erken saptanması açısından özellikle yüksek riskli DTK grubunda kardiyak değerlendirmelerin yapılması önemlidir. TSH supresyonu yapılan hastaların takiplerinin aksatılmaması ve supresyon seviyelerinin bireysel olarak uyarlanması gereklidir.

Keywords

Diferansiye tiroid kanseri, TSH supresyon düzeyi, Diyastolik disfonksiyon.

EFFECT OF THYROTROPIN SUPPRESSION LEVEL ON DIASTOLIC HEART FUNCTIONS IN PATIENTS WITH DIFFERENTIATED THYROID CANCER

Abstract

OBJECTIVE: The aim of this study was to investigate the changes in cardiac structure and diastolic functions according to thyroid-stimulating hormone (TSH) suppression treatment degree in patients with differentiated thyroid cancer (DTC).
MATERIAL AND METHODS: This cross-sectional study included 125 patients with DTC who were being followed in the endocrinology clinic of our hospital and had been receiving thyroid hormone replacement and TSH suppression therapy for more than one year following thyroid surgery. In our study, patients were divided into groups based on the American Thyroid Association (ATA) 2015 guideline risk assessments. The patients were divided into three groups: first group patients with TSH levels <0.1 mIU/L (n=30), second group those with TSH levels between 0.1-0.5 mIU/L (n=56), and third group those with TSH levels between 0.5-2 mIU/L (n=39). The first two groups were classified as suppression groups, and the third as replacement (control) group. All patients underwent M-mode and pulse-vave tissue doppler echocardiography.
RESULTS: The group 1 with TSH interval <0.1 mIU/L had significantly longer left ventricular end-diastolic diameter (EDD) than the replacement group (45.35±3.54 vs. 42.74±6.08; p=0.016). E velocity, which measures mitral valve velocity at early diastolic filling, was found to be significantly lower in group 1 than in the replacement group (0.7(0.6-0.8) and 0.84(0.7-0.98); p=0.010). The groups did not differ in terms of A, E' velocities, or E/A ratio.
CONCLUSIONS: In patients receiving TSH suppression therapy for differentiated thyroid cancer, changes in myocardial structure and function may vary depending on the level of TSH suppression, even if clinical symptoms are absent. Cardiac evaluations are critical for early detection of diastolic dysfunction, particularly in the high-risk DTK group. Follow-up of patients receiving TSH suppression should not be interrupted, and suppression levels should be adjusted individually.

Keywords

Differentiated thyroid cancer, TSH suppression level, Diastolic disfunctions.

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