Haşimoto tiroiditi tanısı alan çocuk hastaların tanı anındaki ve izlemdeki klinik, laboratuvar ve görüntüleme özelliklerinin retrospektif değerlendirilmesi
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Haşimoto tiroiditi (HT), çocuklarda iyot yeterli bölgelerde hipotiroidizm ve guatrın en sık nedenidir. Çalışmamızda, HT tanılı çocuk hastalarımızda tanı anındaki ve izlemdeki klinik, laboratuvar ve görüntüleme özelliklerini retrospektif olarak değerlendirmeyi amaçladık. Gereç ve Yöntem: Tanımlayıcı çalışmamızda, Ocak 2011-Ocak 2022 tarihleri arasında İnönü Üniversitesi Tıp Fakültesi Çocuk Endokrinoloji Polikliniğinde HT tanısıyla takip edilen 1-18 yaş aralığındaki 185 hastaya ait bilgiler retrospektif olarak incelendi. Daha sonra hastalar tiroid fonksiyonlarına göre alt gruplara ayrılarak birbiriyle karşılaştırıldı. İstatistiksel analizler için SPSS for Windows 23.0 programı kullanıldı. Bulgular: Hastaların %78,9'u kız cinsiyetteydi (K/E: 3,74), tanı yaşı ortalaması 11±4,1(1-18) yıldı. Olguların %68'i 10 yaş üzerindeydi, %55,7'si pubertaldi. Başvuru anında, hastaların %70,3'ünde (n=130) aktif şikâyet vardı, en sık boyunda şişlikti (%22,7). Hastaların %53,5'inde (n=99) başvuru anında eşlik eden en az bir hastalık [Down sendromu (%5,4), astım (%4,8,), T1DM (%3,2), Çölyak Hastalığı (%2,7), vitiligo (%1,6)] vardı. Hastaların %45,9'unun ailesinde tiroid hastalığı vardı. Boy SDS <-2 olan 16 (%8,6) vaka vardı, bunların çoğunda hipotiroidi vardı. Vücut ağırlığı ve VKİ indeksi SDS ortalamaları normal aralıktaydı. Fizik muayenede guatr %53,5 oranda vardı. Hastaların; %88,1'inde anti-tiroid peroksidaz (TPO), %41,1'inde anti-TG antikorları yüksek saptandı. Tanı anında hastaların %7'si (n=13) aşikâr hipotiroidi, %35,2'si (n=65) subklinik hipotiroidi, %45,4'ü (n=84) ötiroidi, %5,4'ü (n=10) subklinik hipertiroidi ve %7'si (n=13) aşikâr hipertiroidi tanıları aldı. Tiroid US'de hastaların %84,9'unda tiroid parankiminde patolojik bulgu (en sık heterojenite artışı, vaskülarite artışı, hipoekoik görünüm) saptandı. Tiroid US'de hastaların %42,2'sinin tiroid volümleri >+2SD, %1,6'sının ise <-2SD idi. Hastaların %8,1'inde tiroid nodülü saptandı, bir hastada Papiller Tiroid Karsinomu saptandı. Tiroid fonksiyonuna göre belirlenen alt gruplar arasında; cinsiyet dağılımı, antropometrik özellikler, muayenede guatr sıklığı ve otoantikor pozitiflik oranları açılarından fark saptanmadı. Hipertiroidi grubunda tanı yaşının diğer gruplardan daha büyük olduğu saptandı (p<0,05). Aşikâr hipotiroidide, subklinik hipertiroidide ve aşikâr hipertiroidide tiromegali saptanma oranı subklinik hipotiroidi grubuna göre anlamlı derecede yüksek bulundu (p:0,029). Aşikâr hipotiroidi ve ötiroid grup arasında fark saptanmadı. Ötiroid grupta tedavi verilmeden izlenen hastaların %92'sinin izlemde ötiroid kaldığı, subklinik hipotiroidi grubunda tedavi verilmeden izlenen hastaların %93'ünün ötiroidiye döndüğü görüldü. Hipertiroidi grubundaki hastaların %87'sinin izlemde ötiroidiye döndüğü görüldü. Sonuç: HT, çocuklarda kız cinsiyette ve adolesan dönemde daha sık görülmektedir. Hastalar başvuruda asemptomatik olabilirken en sık şikâyet boyunda şişliktir. Anti-TPO antikoru olguların çoğunda yüksektir. Olgular sıklıkla ötiroid veya hipotiroiddir. Guatr sık görülür. Guatr, tamamen tiroid fonksiyonları ile ilgili değildir. Hipertiroidide diğer gruplara göre tanı yaşı ve tiromegali sıklığı daha fazladır. Tedavi verilmeyen ötiroid ve subklinik hipotiroidili hastaların çoğu izlemde ötiroid seyretmektedir. Hipertiroidi sıklıkla izlemde ötiroidiye dönmektedir. HT tanılı çocukların muayene, tiroid fonksiyon testleri ve tiroid US ile düzenli izlemi önerilir. Anahtar Kelimeler: çocuk, guatr, Haşimoto tiroiditi, otoantikor, tiroid foksiyonları
Objective: Hashimoto's thyroiditis (HT) is the most common cause of hypothyroidism and goiter in children in iodine-sufficient areas. In our study, we aimed to evaluate the clinical, laboratory, and imaging characteristics of pediatric patients diagnosed with HT at diagnosis and follow-up retrospectively. Material and Methods: In our descriptive study, 85 patients aged 1-18 years who were followed up with a diagnosis of HT at İnönü University Faculty of Medicine Pediatric Endocrinology Outpatient Clinic between January 2011 and January 2022 were retrospectively analyzed. Subsequently, patients were divided into subgroups according to their thyroid functions and compared with each other. SPSS for Windows 23.0 program was used for statistical analyses. Results: 78,9% of the patients were girls (Girls/Boys: 3,74), with a mean age at diagnosis of 11±4,1 (range: 1-18) years. 68% of the cases were over 10 years old, and 55,7% were in puberty. At the time of admission, 70,3% of the patients (n=130) had active complaints, with neck swelling being the most common complaint (22,7%). 53.5% of the patients (n=99) had at least one accompanying disease at admission [Down syndrome (5,4%), asthma (4,8%), type 1 diabetes mellitus (3,2%), celiac disease (2,7%), vitiligo (1,6%)]. 45,9% of the patients had a family history of thyroid disease. There were 16 (8,6%) cases with a height SDS <-2, most of whom had hypothyroidism. The mean SDS values for body weight and BMI were within the normal range. Goiter was present in 53,5% of the patients on physical examination. In the patients; anti-thyroid peroxidase (TPO) was detected as high in 88,1%, and anti-TG antibodies were detected as high in 41,1%. At diagnosis, 7% of the patients (n=13) had overt hypothyroidism, 35,2% (n=65) had subclinical hypothyroidism, 45,4% (n=84) were euthyroid, 5,4% (n=10) had subclinical hyperthyroidism, and 7% (n=13) had overt hyperthyroidism. Pathological findings in the thyroid parenchyma were detected in 84,9% of the patients on thyroid ultrasound (most commonly increased heterogeneity, increased vascularity, hypoechoic appearance). 42,2% of the patients had thyroid volumes >+2SD, and 1,6% had volumes <-2SD on thyroid ultrasound. Thyroid nodules were detected in 8,1% of the patients, and Papillary Thyroid Carcinoma was detected in one patient. Among the subgroups determined according to thyroid function; there was no difference in gender distribution, anthropometric characteristics, frequency of goiter on examination, and positivity rates of autoantibodies. It was found that the age at diagnosis was higher in the hyperthyroidism group compared to the other groups (p<0,05). The rate of detecting thyroid enlargement in overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism was significantly higher compared to the subclinical hypothyroidism group (p:0,029). There was no difference between overt hypothyroidism and euthyroid group. It was observed that 92% of the patients in the euthyroid group who were followed up without treatment remained euthyroid, and 93% of the patients in the subclinical hypothyroidism group who were followed up without treatment became euthyroid. It was observed that 87% of the patients in the hyperthyroidism group became euthyroid during follow-up. Conclusion: HT is more common in girls and during adolescence in children. Patients may be asymptomatic at admission, with neck swelling being the most common complaint. Anti-TPO antibody is high in most cases. Cases are often euthyroid or hypothyroid. Goiter is frequently seen. Goiter is not entirely related to thyroid functions. The age at diagnosis and the frequency of thyroid enlargement are higher in hyperthyroidism compared to other groups. Most untreated euthyroid and subclinical hypothyroid patients remain euthyroid during follow-up. Hyperthyroidism often returns to euthyroid during follow-up. Regular follow-up including physical examination, thyroid function tests, and thyroid ultrasound is recommended for children diagnosed with HT. Keywords: child, goiter, Hashimoto's thyroiditis, autoantibody, thyroid functions
Objective: Hashimoto's thyroiditis (HT) is the most common cause of hypothyroidism and goiter in children in iodine-sufficient areas. In our study, we aimed to evaluate the clinical, laboratory, and imaging characteristics of pediatric patients diagnosed with HT at diagnosis and follow-up retrospectively. Material and Methods: In our descriptive study, 85 patients aged 1-18 years who were followed up with a diagnosis of HT at İnönü University Faculty of Medicine Pediatric Endocrinology Outpatient Clinic between January 2011 and January 2022 were retrospectively analyzed. Subsequently, patients were divided into subgroups according to their thyroid functions and compared with each other. SPSS for Windows 23.0 program was used for statistical analyses. Results: 78,9% of the patients were girls (Girls/Boys: 3,74), with a mean age at diagnosis of 11±4,1 (range: 1-18) years. 68% of the cases were over 10 years old, and 55,7% were in puberty. At the time of admission, 70,3% of the patients (n=130) had active complaints, with neck swelling being the most common complaint (22,7%). 53.5% of the patients (n=99) had at least one accompanying disease at admission [Down syndrome (5,4%), asthma (4,8%), type 1 diabetes mellitus (3,2%), celiac disease (2,7%), vitiligo (1,6%)]. 45,9% of the patients had a family history of thyroid disease. There were 16 (8,6%) cases with a height SDS <-2, most of whom had hypothyroidism. The mean SDS values for body weight and BMI were within the normal range. Goiter was present in 53,5% of the patients on physical examination. In the patients; anti-thyroid peroxidase (TPO) was detected as high in 88,1%, and anti-TG antibodies were detected as high in 41,1%. At diagnosis, 7% of the patients (n=13) had overt hypothyroidism, 35,2% (n=65) had subclinical hypothyroidism, 45,4% (n=84) were euthyroid, 5,4% (n=10) had subclinical hyperthyroidism, and 7% (n=13) had overt hyperthyroidism. Pathological findings in the thyroid parenchyma were detected in 84,9% of the patients on thyroid ultrasound (most commonly increased heterogeneity, increased vascularity, hypoechoic appearance). 42,2% of the patients had thyroid volumes >+2SD, and 1,6% had volumes <-2SD on thyroid ultrasound. Thyroid nodules were detected in 8,1% of the patients, and Papillary Thyroid Carcinoma was detected in one patient. Among the subgroups determined according to thyroid function; there was no difference in gender distribution, anthropometric characteristics, frequency of goiter on examination, and positivity rates of autoantibodies. It was found that the age at diagnosis was higher in the hyperthyroidism group compared to the other groups (p<0,05). The rate of detecting thyroid enlargement in overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism was significantly higher compared to the subclinical hypothyroidism group (p:0,029). There was no difference between overt hypothyroidism and euthyroid group. It was observed that 92% of the patients in the euthyroid group who were followed up without treatment remained euthyroid, and 93% of the patients in the subclinical hypothyroidism group who were followed up without treatment became euthyroid. It was observed that 87% of the patients in the hyperthyroidism group became euthyroid during follow-up. Conclusion: HT is more common in girls and during adolescence in children. Patients may be asymptomatic at admission, with neck swelling being the most common complaint. Anti-TPO antibody is high in most cases. Cases are often euthyroid or hypothyroid. Goiter is frequently seen. Goiter is not entirely related to thyroid functions. The age at diagnosis and the frequency of thyroid enlargement are higher in hyperthyroidism compared to other groups. Most untreated euthyroid and subclinical hypothyroid patients remain euthyroid during follow-up. Hyperthyroidism often returns to euthyroid during follow-up. Regular follow-up including physical examination, thyroid function tests, and thyroid ultrasound is recommended for children diagnosed with HT. Keywords: child, goiter, Hashimoto's thyroiditis, autoantibody, thyroid functions
Açıklama
Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
