Subakut Tiroiditte Prognoz Öngörülebilir mi?

Year 2023, Volume: 7 Issue: 1, 14 - 20, 28.04.2023

Ali Saklamaz , Özcan Çiftçi

https://doi.org/10.29058/mjwbs.1221562

Abstract

Amaç: Subakut tiroidit (SAT), tiroid bezinin akut inflamasyonu nedeniyle oluşan hastalar için yaşam
kalitesini ciddi oranda etkileyen bir tiroid hastalığıdır. Klasik akut faz reaktanları dışında periferik
kan sayımından elde edilen değerler ve oranları da sistemik inflamasyonun pratik göstergesi olarak
kabul edilmektedir. Bu çalışmada amacımız, SAT tanısı olan hastalarımızın laboratuvar tetkiklerinde
sistemik inflamasyon markerlarının ve verilen tedavilerin, bir yıl sonraki hipotiroidik duruma etkisini
karşılaştırmaktır.
Gereç ve Yöntemler: Bu retrospektif çalışmada 133 hasta çalışmaya dahil edildi. Bu hastaların SAT
tanı anında ve 1 yıl sonraki tıbbi verileri incelendi. 37 hasta steroid grubunda, 97 hasta nonsteroid
antiinflamatuar ilaç (NSAİİ) grubunda yer aldı.
Bulgular: Her iki grupta erkek/kadın oranı benzerdi. SAT tanısı alan hastalarda kadın hakimiyeti her
iki grupta da görüldü. Grupların başlangıçta hipertiroidi ve bir yıl sonra ötiroid olan tiroid testleri gruplar
Welthandelarası
benzerdi (p>0.05). Her iki grupta da başlangıçta akut faz reaktanlarından artış (eritrosit sedimantasyon hızı [ESR] ve C-reaktif protein
(CRP) seviyeleri) ve tedavi sonrası normale gelmiştir. İnflamasyonun azalması ile nötrofil (p<0.05), lenfosit (p>0.05) ve trombosit (p<0.05)
sayıları azaldı. Monosit sayısı her iki grupta da azaldı, ancak steroid grubunda anlamlıydı, ancak NSAID grubunda değildi. Steroid ve
NSAİİ gruplarında kalıcı hipotiroidi gelişimi sırasıyla 8/37 (%21,6), 24/97 (%24,74) idi (p>0,05). Tedavi öncesi ve sonrasında, her iki grupta
da (steroid vs. NSAID) kalıcı hipotiroidizm tanısı alan/almayan arasında inflamasyon belirteçleri (CRP etc.) ve izlem parametrelerinde
istatistiksel olarak fark bulunmamıştır (p>0.05).
Sonuç: SAT hastalarında uygulanan inflamasyon belirteçleri ve tedavilerin prognoz üzerine anlamlı bir etkisi olmamıştır.

Keywords

Subakut tiroidit, glukokortikoid, NSAİİ, hipotiroidizm

Can the Prognosis be Predicted in Subacute Thyroiditis?

Abstract

Aim: Subacute thyroiditis (SAT) is a thyroid disease that seriously affects the quality of life for patients
caused by acute inflammation of the thyroid gland. Apart from classical acute phase reactants, the values
and rates obtained from peripheral blood count (mean platelet volume (MPV), neutrophil-to-lymphocyte
ratio (NLR), and platelet-to-lymphocyte ratio (PLR)) values are also accepted as practical indicators
of systemic inflammation. Our aim in this study is to compare the effects of systemic inflammation
markers and the treatments given in the laboratory tests of our patients with a diagnosis of SAT, on the
hypothyroid state one year later.
Material and Methods: In this study, which was carried out with a retrospective method, 133 patients
were included in the study. The medical data of these patients at the time of SAT diagnosis and one
year later were analyzed. 37 patients were in the steroid group and 97 patients were in the nonsteroidal
anti-inflammatory drug (NSAID) group.
Results: The male/female ratio was similar in both groups. Female dominance was observed in both
groups in patients diagnosed with SAT. The thyroid tests of the groups, which were hyperthyroid at the
beginning and euthyroid one year later, were similar between the groups (p>0.05). Both groups had
an increase in acute phase reactants at baseline (erythrocyte sedimentation rate [ESR] and C-reactive
protein (CRP) levels) and normalized after treatment. Neutrophil (p<0.05), lymphocyte (p>0.05) and
platelet (p<0.05) counts decreased with the reduction of inflammation. Monocyte count decreased in
both groups, but it was significant in the steroid group, but not in the NSAID group. The development of
permanent hypothyroidism was 8/37 (21.6%), 24/97 (24.74%) in steroid and NSAID groups respectively
(p˃0.05). There was no statistical difference in inflammation markers (CRP etc.) and follow-up parameters
before and after treatment in both groups (steroid vs. NSAID) with and without a diagnosis of permanent
hypothyroidism (p>0.05).
Conclusion: Inflammation markers and treatments applied in SAT patients did not have a significant
effect on the prognosis

Keywords

Subakut tiroidit, glukokortikoid, NSAİİ, hipotiroidizm

References

• 1. Lazarus JH. Silent thyroiditis and subacute thyroiditis. In The Thyroid: A Fundamental and Clinical Text. 7th edition. Edited by Braverman LE, Utiger RD. Philadelphia: Lippincott Williams & Wilkins; 1996: 577.
• 2. Liu JF, Ba L, Lv H, Lv D, Du JT, Jing XM, Yang NJ, Wang SX, Li C, Li XX. Association between neutrophil-to-lymphocyte ratio and differentiated thyroid cancer: A meta-analysis. Sci Rep 2016;6:38551.
• 3. Shi L, Qin X, Wang H, Xia Y, Li Y, Chen X, Shang L, Tai YT, Feng X, Acharya P, Acharya C, Xu Y, Deng S, Hao M, Zou D, Zhao Y, Ru K, Qiu L, An G. Elevated neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio and decreased platelet-tolymphocyte ratio are associated with poor prognosis in multiple myeloma. Oncotarget 2017;8:18792-18801.
• 4. Leader A, Pereg D, Lishner M. Are platelet volume indices of clinical use? A multidisciplinary review. Ann Med 2012;44:805- 816.
• 5. Ergun Y, Tuzcu AK. Subakut tiroidit tanılı hastaların demografik özellikleri ve laboratuvar verilerinin analizi: Tek merkez deneyimi. Ege Tıp Dergisi 2019;58:282-288.
• 6. Taskaldiran I, Omma T, Onder CE, Firat SN, Koc G, Kilic MK, Kuskonmaz SM, Culha C. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and platelet-tolymphocyte ratio in different etiological causes of thyrotoxicosis. Turk J Med Sci 2019;49:1687-1692.
• 7. Calapkulu M, Sencar ME, Sakiz D, Duger H, Ozturk Unsal I, Ozbek M, Cakal E. The prognostic and diagnostic use of hematological parameters in subacute thyroiditis patients. Endocrine 2019;68:138-143.
• 8. Cengiz H, Demirci T, Varim C, Gonullu E. The relationship between serum calprotectin levels and disease activity in patients with subacute thyroiditis. Eur Rev Med Pharmacol Sci 2021;25:3745-3751.
• 9. Keskin C, Dilekci EN, Uc ZA, Cengiz D, Duran C. Can the systemic immune-inflammation index be used as a novel diagnostic tool in the diagnosis of subacute thyroiditis? Biomark Med 2022;16:791-797.
• 10. 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;88:2100-2105.
• 11. Schenke S, Klett R, Braun S, Zimny M. Thyroiditis de Quervain. Are there predictive factors for long-term hormonereplacement? Nuklearmedizin 2013;52(4):137-40.
• 12. Alfadda AA, Sallam RM, Elawad GE, Aldhukair H, Alyahya MM. Subacute thyroiditis: Clinical presentation and long term outcome. Int J Endocrinol 2014;2014:794943.
• 13. Sencar ME, Calapkulu M, Sakiz D, Hepsen S, Kus A, Akhanli P, Unsal IO, Kizilgul M, Ucan B, Ozbek M, Cakal E. An evaluation of the results of the steroid and non-steroidal anti-inflammatory drug treatments in subacute thyroiditis in relation to persistent hypothyroidism and recurrence. Sci Rep 2019;9:16899.
• 14. Sencar ME, Calapkulu M, Sakiz D, Akhanli P, Hepsen S, Duger H, Unsal IO, Kizilgul M, Cakal E. The contribution of ultrasonographic findings to the prognosis of subacute thyroiditis. Arch Endocrinol Metab 2020;64:306-311.
• 15. Pal’tsev MA, Zolotarevskii VB, Ivanov AA, Vetshev PS, Baranova OV, Gabaidze GI. Comparative study of Hashimoto thyroiditis and “focal thyroiditis”. Arkh Patol 1999;61:46-51.
• 16. Cappelli C, Pirola I, Gandossi E, Formenti AM, Agosti B, Castellano M. Ultrasound findings of subacute thyroiditis: A single institution retrospective review. Acta Radiol 2014;55:429- 433.
• 17. Shimada H, Takiguchi N, Kainuma O, Soda H, Ikeda A, Cho A, Miyazaki A, Gunji H, Yamamoto H, Nagata M. High preoperative neutrophil-lymphocyte ratio predicts poor survival in patients with gastric cancer. Gastric Cancer 2010;13:170- 176.
• 18. Omori N, Omori K, Takano K. Association of the ultrasonographic findings of subacute thyroiditis with thyroid pain and laboratory findings. Endocr J 2008;55:583-588.
• 19. Benbassat CA, Olchovsky D, Tsvetov G, Shimon I. Subacute thyroiditis: Clinical characteristics and treatment outcome in fifty-six consecutive patients diagnosed between 1999 and 2005. J Endocrinol Invest 2007;30:631-635.
• 20. Saklamaz A. Is there a drug effect on the development of permanent hypothyroidism in subacute thyroiditis? Acta Endocrinol (Buchar) 2017;13:119-123.