AKUT KARACİĞER YETMEZLİĞİ OLAN ÇOCUKLARDA TİROİD HORMONLARININ VE HASTALIĞIN SEYRİ İLE İLİŞKİSİNİN DEĞERLENDİRİLMESİ

Year 2019, , 87 - 94, 26.03.2019

Zeren Barış , Oya Balcı Sezen Figen Özçay

https://doi.org/10.12956/tchd.507591

Abstract

Giriş: Çalışmamızda akut
karaciğer yetmezliği ile başvuran çocuk hastalarda TSH, serbest T4 ve serbest
T3 düzeylerinin hastalık seyrini belirlemedeki etkilerini inceledik.

Gereç ve Yöntemler: Çalışmaya
hastanemize 2000-2017 yılları arasında akut karaciğer yetmezliği ile başvuran
108 hasta içerisinden, başvuru sırasında tiroid hormonları bakılmış olan 39
hasta alındı. Bu hastaların geriye dönük olarak klinik ve laboratuvar bulguları
değerlendirilerek, başvuru sırasındaki tiroid hormonları ile hastalığın seyri
arasındaki ilişki incelendi.

Bulgular: TSH
düzeyleri hastaların 29/39’unda (%74,4) normalden düşük, serbest T3 düzeyleri 27/29
hastada (%93,1) normalden düşük saptanmıştır. Serbest T4 düzeyleri ise
hastaların %69,4’sında (25/36 hasta) normal düzeylerde bulunmuştur. Hastalar,
hastalığın seyrine göre, kendiliğinden düzelen hastalar (Grup 1) ile
kaybedilen/nakil olan hastalar (Grup 2) olarak iki gruba ayrılmıştır. Grup
2’deki hastaların başvuru sırasında bakılan INR, total ve direk bilirubin
düzeyleri ve PELD skorları grup 1’deki hastalara göre istatistiksel olarak
anlamlı şekilde yüksek bulunmuştur (sırasıyla p=0,022,
p<0,0001, p=0,003, p=0,004).
TSH düzeylerinin ensefalopati evresi ve hemoglobin düzeyi arttıkça azaldığı
(sırasıyla p=0,003, r=-0,464 ve p=0,046, r=-0,367),
sT4 düzeylerinin ise serum albümin düzeyi arttıkça arttığı (p=0,005, r=0,459) saptanmıştır.

Tartışma: Akut
karaciğer yetmezliğinde, serum TSH ve sT3 düzeyleri baskılanmaktadır. Serum TSH
düzeyleri ensefalopati evresi ve hemoglobin düzeyi arttıkça azalmakta, sT4
düzeyleri ise serum albümin düzeyi arttıkça artmaktadır. 

Keywords

akut karaciğer hastalığı, tiroid hormonları

EVALUATION of THE RELATIONSHIP BETWEEN THYROID FUNCTIONS and DISEASE OUTCOME in CHILDREN WITH ACUTE LIVER FAILURE

Abstract

Objective: We
investigated if serum TSH, free T4 and free T3 could be prognostic factors in
patients with acute liver failure.

Materials and Methods: There
were 39 out of 108 children with acute liver failure who applied to our
hospital between 2000-2017 and whose thyroid function tests were measured at
the time of arrival. We retrospectively collected the clinical and laboratory
parameters of these 39 patients, and evaluated the relationship between thyroid
hormones and prognosis of the patients.

Results: TSH levels were low in
29/39 (74.4%) patients, while 27/29 (93.1%) patients had low fT3 levels. Free
T4 levels were normal in 25/36 (69.4%) patients. Patients were divided into two
groups according to disease course: group 1 (n=17) included patients with
spontaneous resolution and group 2 (n=22) included patients who either died or
underwent liver transplantation. Total and direct bilirubin levels, INR and
PELD values were significantly higher in group 2 compared to the levels of
group 1 (p=0.022, p<0.0001, p=0.003, p=0.004, respectively). Serum TSH
levels were found to decrease with increasing levels of hemoglobin levels and
with increasing stages of encephalopathy, and these correlations were
statistically significant (p=0.003, r=-0.464 and p=0.046, r=-0.367, respectively).
Serum free T4 levels were found to decrease significantly with decreasing
levels of serum albumin levels (p=0.005, r=0.459).

Conclusion: Serum
TSH and free T3 levels are suppressed in pediatric patients with ALF. Serum TSH
levels negatively correlates with increasing stages of encephalopathy, while
fT4 levels decrease with decreasing levels of serum albümin.

Keywords

acute liver failure, thyroid hormones

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