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

Yıl 2024, , 60 - 66, 10.01.2024

Başak Alan Tehçi , Fatih Gurbuz , Mehmet Boyraz

https://doi.org/10.12956/tchd.1391663

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

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

Etik Beyan

Etik kurul onayı bulunmaktadır. Belgelere yüklenmiştir. Çıkar çatışması bulunmamaktadır.

Kaynakça

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