Hipotiroidizm

Abstract

Hipotiroidizm endokrin pratiğinde en sık karşılaşılan hastalıklardan biridir. Hipotiroidizm, perifer dokuda tiroit hormon etkisinin azalması olarak tanımlanabilir. Vakaların büyük çoğunluğu tiroit bezinin hormon sentez ve salgılanmasının bozulması sonucunda gelişir. Sensitif biyokimyasal testlerin ve etkin tedavi imkanlarının mevcudiyeti bu endokrin hastalığın tanı ve tedavisini kolaylaştırmıştır. Bu makalede hipotiroidinin epidemiyolojisi, etyolojisi, klinik prezentasyonu, tanı ve tedavisi ele alınacaktır. J. Exp. Clin. Med., 2012; 29:S301-S308 Hypothyroidism Hypothyroidism is one of the most common disorders encountered in an endocrine practice. Hypothyroidism results from reduced thyroid hormone actions at the peripheral tissues. This reduction in thyroid hormone action is, in the vast majority of cases, secondary to reduced thyroid hormone synthesis and secretion by the thyroid gland. The availability of sensitive biochemical tests and effective therapies have simplified the diagnosis and management of this endocrine condition. This article reviews the epidemiology, etiology, clinical presentation, diagnosis, and treatment of hypothyroidism.

Keywords

• Primer hipotiroidizm
• Hashimoto tiroiditi
• Santral hipotiroidizm
• Subklinik hipotiroidizm
• Miksödem koması
• Tiroksin

References

1. American Thyroid Association (ATA), Endocrine Society, American Association of Clinical Endocrinologists 2004. Joint statement on the U.S. food and drug administration's decision regarding bioequivalence of levothyroxine sodium, Thyroid. 14, 486.
2. Atmaca, H., 2011. Tiroid bezi fonksiyonlarının değerlendirilmesi. Yoğun Bakım Sorunları ve Tedavileri içinde, 3. baskı, H. Şahinoğlu, A. Dilek ve A. Kaya, eds. Nobel Matbaacılık, İstanbul, pp. 1430-1432.
3. Atmaca, H., Tanrıverdi, F., Gökçe, C., Unluhizarci, K., Keleştimur, F., 2007. Do we still need the TRH stimulation test? Thyroid. 17, 529- 533.
4. Bauer, D.C., Ettinger, B., Nevitt, M.C., Stone, K.L., 2001. Study of Osteoporotic Fractures Research Group. Risk for fracture in women with low serum levels of thyroid-stimulating hormone. Ann. Intern. Med. 134, 561-568.
5. Bindels, A.J., Westendorp, R.G., Frölich, M., Seidell, J.C., Blokstra, A., Smelt, A.H., 1999. The prevalence of subclinical hypothyroidism at dif- ferent total plasma cholesterol levels in middle aged men and women: A need for case finding? Clin. Endocrinol. 50, 217-220.
6. Blakesley, V., Awni, W., Locke, C., Ludden, T., Granneman, G.R., Braverman, L.E., 2004. Are bioequivalence studies of levothyroxine sodium formulations in euthyroid volunteers reliable? Thyroid. 14, 191-200.
7. Devdhar, M., Ousman Y.H., Burman, K.D., 2007. Hypothyroidism. Endocrin. Metab. Clin. 36, 595-615.
8. Fish, L.H., Schwartz, H.L., Cavanaugh, J., Steffes, M.W., Bantle, J.P., Oppenheimer, J.H., 1987. Replacement dose, metabolism, and bioavail- ability of levothyroxine in the treatment of hypothyroidism. Role of triiodothyronine in pituitary feedback in humans. New Engl. J. Med. 316, 764-770.

9. Greenspan, F.S., 2001. The thyroid gland. In Basic and Clinical Endocrinology, 6th. Ed, F.S. Greenspan and D.G. Gardner, eds. McGraw-Hill, New York, 201-272.
10. Haddow, J.E., Palomaki, G.E., Allan, W.C., Williams, J.R., Knight, G.J., Gagnon, J., O'Heir, C.E., Mitchell, M.L., Hermos, R.J., Waisbren, S.E., Faix, J.D., Klein, R.Z., 1999. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. New Engl. J. Med. 341, 549-555.
11. Hak, A.E., Pols, H.A., Visser, T.J., Drexhage, H.A., Hofman, A., Witteman, J.C., 2000. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam study. Ann. Intern. Med. 132, 270-278.
12. Hamburger, J.I., Meier, D.A., Szpunar, W.E., 1985. Factitious elevation of thyrotropin in euthyroid patients [letter]. New Engl. J. Med. 313, 267-268.
13. Jonklaas, J., Davidson, B., Bhagat, S., Soldin, S.J., 2008. Triiodothyronine levels in athyreotic individuals during levothyroxine therapy. JAMA 299, 769-777.
14. Kahaly, G.J., 2000. Cardiovascular and atherogenic aspects of subclinical hypothyroidism. Thyroid. 10, 665-679.
15. Larsen, P.R., Davies, T.F., 2003. Hypothyroidism and thyroiditis. In: Williams Textbook of Endocrinology, 10th. Ed, L. Kronenberg and M. Polonsky, eds. W.B. Saunders, Philadelphia, pp. 423-456.
16. Michalopoulou, G., Alevizaki, M., Piperingos, G., Mitsibounas, D., Mantzos, E., Adamopoulos, P., Koutras, D.A., 1998. High serum cholesterol levels in persons with ‘high normal’ TSH levels: Should one extend the definition of subclinical hypothyroidism. Eur. J. Endocrinol. 138, 141-145.
17. Negro, R., Formoso, G., Mangieri, T., Pezzarossa, A., Dazzi, D., Hassan, H., 2006. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: Effects on obstetrical complications. J. Clin. Endocr. Metab. 91, 2587-2591.
18. Ross, D.S., 2010. Diagnosis of and screening for hypothyroidism. http://www.uptodate.com 2012.
19. Sawin, C.T., Geller, A., Wolf, P.A., Belanger, A.J., Baker, E., Bacharach, P., Wilson, P.W., Benjamin, E.J., D'Agostino, R.B., 1994. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. New Engl. J. Med. 331, 1249-1252.
20. Utiger, D.U., 2001. The thyroid: Physiology, thyrotoxicosis, hypothyroidism, and the painful thyroid. In Endocrinology and Metabolism, 4th. Ed, P. Felig and L.A. Frohman, eds. McGraw-Hill, New York, pp. 261-330.
21. Vanderpump, M.P., 2004. The epidemiology of thyroid diseases. In The thyroid: A fundamental and clinical text, 9th edition. L.E. Braverman and R.D. Utiger, eds. Lippincott Williams and Wilkins, Philadelphia, pp. 398-406.
22. Wiersinga, W.M., 2010. Adult hypothyroidism. http//www. Thyroidmanager. Org/Chapter 9/9. 2012.