Hashimoto Tiroiditi Tanısı Alan Vakaların Geriye Dönük Değerlendirilmesi

Öz

Amaç: Hashimoto tiroiditi HT , iyot eksikliğinin olmadığı bölgelerde çocuk ve ergenlerde, guatr ve edinilmiş hipotiroidinin en sık nedenidir. Klinik tablo; ötiroid durumdan aşikâr hipotiroidi veya hipertiroidiye kadar geniş bir yelpazede olabilir. Bu çalışmada HT’li vakaların epidemiyolojik, klinik ve laboratuvar bulgularının geriye dönük olarak değerlendirilmesi amaçlandı. Yöntem: Çalışmaya 2005 ile 2010 yılları arasında kliniğimizde Hashimoto tiroiditi tanısı alan 102 vaka alındı. Bulgular: Vakaların 90’ı % 88.2 kız, 12’si % 11.8 erkek; kız/erkek oranı 7.5/1 idi. Tanı anında yaş ortalaması 11.4±2.4 yıl 5.5-15.9 olup, 76 % 74.5 vaka pubertaldi. Vakaların % 50’sinde aile öyküsünde tiroid hastalığı, % 7.8’inde başka bir otoimmün hastalık vardı. Başvuru anında en sık yakınma guatr % 41.1 olup, bunu sırayla halsizlik % 12.7 ve büyümede duraklama % 11.7 izledi. Fizik muayenede tüm vakalarda guatr ve ikinci sıklıkta obezite % 19.6 saptandı. AntiTPO % 29.4 vakada, antiTg % 16.7 vakada tek başına pozitif bulunurken, % 53.9 vakada her ikisi de pozitifti. Tiroid ultrasonografisi yapılabilen 82 vakanın 70’inde % 85.3 tiroid parankim yapısında hastalığa özgün olan heterojenite ve/veya psödonodül oluşumu izlendi. Tanı anında 28 % 27.5 vaka ötiroidi, 56 % 55 vaka subklinik hipotiroidi ve 18 % 17.5 vaka aşikâr hipotiroidi kliniğine sahip olup, hipertiroidi olan vaka yoktu. Sonuç: Sonuç olarak, HT kız cinsiyette daha fazla görülmesine karşın, özellikle aile öyküsü pozitif olan guatrlı tüm vakalarda akla gelmelidir. Vakaların erken dönemde hipotiroidi kliniği geliştirmeden saptanması büyüme ve gelişmeleri açısından önemlidir.

Anahtar Kelimeler

• Hashimoto tiroiditi,guatr,ergen

A Retrospective Evaluation of the Cases Diagnosed as Hashimoto’s Thyroiditis

Öz

Aim: Hashimoto’s thyroiditis HT is the most common cause of goiter and acquired hypothyroidism in children and adolescents in iodine-replete areas. This study was planned retrospectively in order to find out the epidemiologic, clinical and laboratory characteristics of HT in childhood. Method: One hundred and two patients with diagnosis of HT who were followed up in our clinic from 2005 to 2010 were included in the study. Results: Ninety 88.2 % patients were girls, twelve 11.8 % were boys and female/male ratio was 7.5/1. Mean age at diagnosis was 11.4±2.4 years range 5.5-15.9 years and 76 74.5 % patients were in puberty. Fifty percent of patients had a family history of thyroid disease, 7.8 % had another autoimmune disease. In the patients the most common complaint and sign was goiter 41.1 % and 100 % respectively . AntiTPO and antiTg were positive in 29,4 % and 16.7 % of the patients, respectively. The remainders were positive for both of them. Thyroid ultrasonography was performed in 82 patients and heterogenity and/or pseudonodule of thyroid parenchyma were/was found in 70 85.3 % patients. At the time of diagnosis 28 27.5 % patients were euthyroid, 56 55 % patients had subclinical, and 18 17.5 % patients had overt hypothyroidism. In none of the patients hyperthyroidism was not found. Conclusion: As a result, HT is mostly seen in girls especially in patients with goiter and a positive family history. As hypothyroid state affect growth and development, early diagnosis of HT is very crucial.

Anahtar Kelimeler

• Hashimoto’s thyroiditis,goiter,adolescence

Kaynakça

1. 1. Fisher DA. Thyroid disorders in childhood and adolecence. In: Sperling MA, editör. Pediatric Endocrinology. 3rd ed. Philadelphia: Saunders Elsevier, 2008; 227-53.
2. 2. Huang SA. Hypothyroidism. In: Lifshitz F, editor. Pediatric Endocrinology. 5th ed. New York: Informa Healthcare USA, 2007; 405-13.
3. 3. Brown RS. The thyroid. In: Brook CGD, Clayton PE, Brown RS, editors. Brook’s clinical pediatric endocrinology. 6th ed. Oxford: Wiley-Blackwell, 2009; 250-82.
4. 4. Gönç EN, Yordam N. Çocukluk ve adölesanda tiroid hastalıkları. In: Günöz H, Öcal G, Yordam N, Kurtoğlu S, editors. Pediatrik Endokrinoloji. Ankara: Kalkan Matbaacılık, 2003; 261-360.
5. 5. Demirbilek H, Kandemir N, Gonc EN, Ozon A, Alikaşifoğlu A, Yordam N. Hashimoto’s thyroiditis in children and adolescents: a retrospective study on clinical, epidemiological and laboratory properties of the disease. J Pediatr Endocrinol Metab 2007;20:1199-205. http://dx.doi.org/10.1515/JPEM.2007.20.11.1199
6. 6. Zak T, Noczynska A, Wasikowa R, Zaleska-Dorobisz U, Golenko A. Chronic autoimmune thyroid disease in children and adolescents in the years 1999-2004 in Lower Silesia, Poland. Hormones 2005;4(1):45-8. PMid:16574631
7. 7. Setian N. Hypothyroidism in children: diagnosis and treatment. J Pediatr 2007;83(5):209-16. http://dx.doi.org/10.1590/S0021-75572007000700013 PMid:18000629
8. 8. Lorini R, Gastaldi R, Traggiai C, Perucchin PP. Hashimoto’s thyroiditis. Pediatr Endocrinol Rev 2003;2:205-11.

9. 9. Yeşilkaya E, Belen B, Bideci A, Çamurdan O, Boyraz M, Cinaz P. Kronik otoimmün tiroiditli çocuk ve ergenlerin klinik özellikleri. Gülhane Tıp Dergisi 2008;50:147-50.
10. 10. Segni M, Wood J, Pucarelli I, Toscano V, Toscano R, Pasquino AM. Clustering of autoimmune thyroid diseases in children and adolescents: a study of 66 families. J Pediatr Endocrinol Metab 2001;14 Suppl 5:1271-5; discussion 1297-8. PMid:11964022
11. 11. de Vries L, Phillip M. Chronic autoimmune thyroiditis in children and adolescents: at presentation and during long-term follow-up. Arch Dis Child 2009;94(1):33-7. http://dx.doi.org/10.1136/adc.2007.134841 PMid:18703546
12. 12. Wang SY, Tung YC, Tsai WY, Lee JS, Hsiao PH. Long term outcome of hormonal status in Taiwanese children with Hashimoto’s thyroiditis. Eur J Pediatr 2006;165:481-3. http://dx.doi.org/10.1007/s00431-006-0112-5 PMid:16557403
13. 13. Karagüzel G, Şimşek S, Değer O, Otken A. Screening of diabetes, thyroid, and celiac diseases-related autoantibodies in a sample of Turkish children with type 1 diabetes and their siblings. Diabetes Res Clin Pract 2008;80(2):238-43. http://dx.doi.org/10.1016/j.diabres.2007.12.007 PMid:18241952
14. 14. Karavanaki K, Kakleas K, Paschali E, et al. Screening for associated autoimmunity in children and adolescents with type 1 diabetes mellitus. Horm Res 2009;71(4):201-6. http://dx.doi.org/10.1159/000201108 PMid:19258711
15. 15. Gopalakrishnan SG, Chugh PK, Chhillar M, Ambardar VK, Sahoo M. Goitrous autoimmune thyroiditis in a pediatric population: a longitudinal study. Pediatrics 2008;122:670-4. http://dx.doi.org/10.1542/peds.2008-0493 PMid:18678601
16. 16. Maenpaa J, Raatikka M, Rasanen J, Taskinen E, Wager O. Natural course of juvenile autoimmune thyroiditis. J Pediatr 1985;107(6):898-904. http://dx.doi.org/10.1016/S0022-3476(85)80183-9
17. 17. Marinovic D, Leger J, Garel C, Czernichow P. Chronic autoimmune thyroiditis in the child. Arch Pediatr 2000;7(12):1284-92. http://dx.doi.org/10.1016/S0929-693X(00)00144-5
18. 18. Sklar CA, Qazi R, David R. Juvenile autoimmune thyroiditis. Hormonal status at presentation and after long-term follow-up. Am J Dis Child 1986;140(9):877-80. PMid:3755566