Hashimoto Tiroiditli Pediatrik Hastalarda Hormon Replasman Tedavisinin Otoimmün Belirteçler ve Klinik Sonuçlar Üzerindeki Etkisi

Öz

Amaç: Hashimoto Tiroiditi (HT), (kronik otoimmün tiroidit) iyot yetersizliği görülmeyen bölgelerdeki hipotiroidizmin en sık görülen nedenidir. HT otoimmün saldırıya karşı tiroid bezinin immünolojik toleransının kaybolması olarak karşımıza çıkmaktadır. Çalışmamızda hashimoto hastalığı tanısı alan hastalar, tedavi verilen ve tedavisiz izlenen gruplar olarak ayrılmıştır. Tedavi verilen ve tedavisiz izlenen grupların otoantikor seyri, hastanın klinik ve laboratuvar bulgularıyla birlikte karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Kliniğimizde hashimoto tiroiditi tanısı alan hormon tedavisi alan ve tedavisiz izlenen hastaların klinik bulguları, laboratuvar verileri ve tiroid ultrasonografi (USG) bulguları karşılaştırıldı. Bulgular: 116’sı hormon replasman tedavisi alan, 133’ü tedavisiz izlenen toplam 249 hastanın ortalama yaşı 13.91±3.71 yıl, ortalama tanı yaşları ise 11.51±3.79 yıldı. On iki aylık izlem sonunda tedavisiz izlenen gruptaki hastaların serum sT4 ve antiTPO değerlerinde artış saptanırken (p=0.012 ve p=0.001), serum TSH, sT3 ve anti TG düzeylerinde anlamlı bir fark bulunmadı. Tedavi alanların serum TSH düzeylerinde anlamlı gerileme, serum sT4 düzeylerinde ise anlamlı bir artış olduğu görüldü (sırayla p=0.002 ve p<0.001). Ayrıca serum antiTPO ve antiTG düzeylerinde zamanla artış olmakla birlikte, serum sT3 düzeylerinde değişiklik saptanmadı. Klinik bulgularda gerileme, tedavi alan grupta anlamlı düzeyde daha fazlaydı (p=0.044). Sonuç: Hashimoto tiroiditinde, erken dönemde başlanan hormon replasman tedavisinin izlemdeki olumsuz klinik etkileri azaltabileceği, hastanın konforu ve klinik şikayetlerini yatıştırma açısından önemli olabileceği kanısına varılmıştır.

Anahtar Kelimeler

• Hashimoto Tiroiditi
• Çocuklar
• Hormon Replasman Tedavisi
• tiroid otoantikorları

Effects of Hormone Replacement Therapy on Autoimmune Markers and Clinical Outcomes in Pediatric Patients with Hashimoto's Thyroiditis

Öz

Objective: Hashimoto’s Thyroiditis (HT), a chronic autoimmune thyroiditis, is the predominant cause of hypothyroidism in regions without iodine deficiency. HT is characterized by the loss of immunological tolerance of the thyroid gland, leading to autoimmune attacks. This study aimed to compare the autoantibody profiles, along with clinical and laboratory findings, of patients diagnosed with Hashimoto’s disease who were either receiving treatment or followed without treatment. Material and Methods: Clinical manifestations, laboratory data, and thyroid ultrasonography (USG) findings of patients diagnosed with Hashimoto’s thyroiditis receiving hormone therapy and those followed without treatment were compared in our clinic. Results: Among a total of 249 patients, 116 received hormone replacement therapy, while 133 were followed without treatment. The mean age of all patients was 13.91±3.71 years, with a mean age at diagnosis of 11.51±3.79 years. After twelve months of follow-up, the untreated group showed an increase in serum fT4 and antiTPO levels (p=0.012 and p=0.001), with no significant difference found in serum TSH, fT3, and antiTG levels. Those receiving treatment exhibited a significant decrease in serum TSH levels and a significant increase in serum fT4 levels (p=0.002 and p<0.001, respectively). Although there was an increase in serum antiTPO and antiTG levels over time, no change was detected in serum fT3 levels. Clinical improvement was significantly greater in the treatment group (p=0.044). Conclusion: It has been concluded that early initiation of hormone replacement therapy in Hashimoto’s thyroiditis can mitigate negative clinical effects during follow-up, contributing to patient comfort and alleviating clinical complaints.

Anahtar Kelimeler

• Hashimoto Thyroiditis
• Hormone Replacement Therapy
• Pediatrics
• Thyroid autoantibodies

Kaynakça

1. Aversa T, Corica D, Zirilli G, Pajno GB, Salzano G, De Luca F, et al. Phenotypic expression of autoimmunity in children with autoimmune thyroid disorders. Front Endocrinol 2019 10:476.
2. Cappa M, Bizzarri C, Crea F. Autoimmune thyroid diseases in children. J Thyroid Res 2010 2011:675703.
3. Morshed SA, Latif R, Davies TF. Delineating the autoimmune mechanisms in Graves’ disease. Immunol Res 2012;54:191– 203.
4. Aksoy DY, Kerimoglu U, Okur H, Canpinar H, Karaağaoğlu E, Yetgin S, et al. Effects of prophylactic thyroid hormone replacement in euthyroid Hashimoto’s thyroiditis. Endocr J 2005;52:337-43.
5. Padberg S, Heller K, Usadel KH, Schumm-Draeger PM. One-year prophylactic treatment of euthyroid Hashimoto’s thyroiditis patients with levothyroxine: is there a benefit? Thyroid 2001;11:249-55.
6. Dörr HG, Bettendorf M, Binder G, Karges B, Kneppo C, Schmidt H, et al. Levothyroxine Treatment of Euthyroid Children with Autoimmune Hashimoto Thyroiditis: Results of a Multicenter. Randomized. Controlled Trial Horm Res Paediatr 2015;84:266-74.
7. Yavuz K, Aylanc H. Retrospective evaluation of clinical and laboratory features of pediatric patients with Hashimoto’s thyroiditis. Troia Med J 2021;2: 85-9.
8. Kara Ö. Clinical and Laboratory Characteristics of Children and Adolescents with Hashimoto Thyroiditis at Diagnosis and During Follow-upAnkara Üniversitesi Tıp Fakültesi Mecmuası 2019;72:314-9.

9. Korkmaz Ö, Özen S, Gökşen D, Darcan Ş. Clinical Characteristics and Follow-up Findings of the Cases Pediatric Hashimoto’s Thyroiditis- a Single Centre Experience. Konuralp Tıp Dergisi 2019;11: 89-94.
10. Kust D, Matesa N. The impact of familial predisposition on the development of Hashimoto’s thyroiditis. Acta Clin Belg 2020;75:104-108.
11. Padberg S, Heller K, Usadel KH, Schumm-Draeger PM. One-year prophylactic treatment of euthyroid Hashimoto’s thyroiditis patients with levothyroxine: is there a benefit? Thyroid 2001;11:249-55.
12. Radetti G, Gottardi E, Bona G, Corrias A, Salardi S, Loche S. Study Group for Thyroid Diseases of the Italian Society for Pediatric Endocrinology and Diabetes (SIEDP/ISPED). The natural history of euthyroid Hashimoto’s thyroiditis in children. J Pediatr 2006;149:827-32.
13. Bülow Pedersen I, Laurberg P, Knudsen N, Jørgensen T, Perrild H. Ovesen L. Rasmussen LB. A population study of the association between thyroid autoantibodies in serum and abnormalities in thyroid function and structure. Clin Endocrinol (Oxf) 2005;62:713-20.
14. Mariotti S, Caturegli P, Piccolo P, Barbesino G, Pinchera A. Antithyroid peroxidase autoantibodies in thyroid diseases. J Clin Endocrinol Metab 1990;71:661-9.
15. Romaldini JH, Biancalana MM, Figueiredo DI, Sarah CS, Mathias PC. Effect of L-thyroxine administration on antithyroid antibody levels. lipid profile. and thyroid volume in patients with Hashimoto’s thyroiditis. Thyroid 1996;6:183–8.
16. Lee HS, Hwang JS. The natural course of Hashimoto’s thyroiditis in children and adolescents. J Pediatr Endocrinol Metab 2014;27:807-12.
17. Yeşilkaya E, Belen B, Bideci A, Çamurdan O, Boyraz M, Cinaz P. Clinical features of children and adolescents with chronic autoimmune thyroiditis. Gülhane Tıp Dergisi 2008; 50:147-50.
18. Aydın E. Otoimmün tiroid hastası adolesan kızların psikopatolojik incelemesi. Tıpta Uzmanlık Tezi. Sakarya Üniversitesi Tıp Fakültesi Hastanesi Çocuk Endokrinoloji Bilim Dalı 2018.