Konjenital hipotiroidi tanısıyla takip edilen hastaların klinik ve laboratuvar özellikleri
Yükleniyor...
Tarih
2019
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Bursa Uludağ Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ: Konjenital hipotiroidi (KH) günümüzde hala çocuklarda
önlenebilir mental retardasyonun en sık sebeplerindendir. Bu çalışmada
kalıcı ve geçici konjenital hipotiroidili vakaların etyolojileri,
laboratuvar bulguları, tedavi dozları ve süreleri karşılaştırılmıştır.
GEREÇ ve YÖNTEM: Konjenital hipotiroidi tanısı ile en az 3 yıl
takip edilen 106 hasta (42 kız, 64 erkek) çalışmaya alındı. Hastaların
dosyaları retrospektrif olarak tarandı. Tanı anında, tedavinin birinci,
ikinci ve üçüncü yılında ve tedavi kesildikten 4-6 hafta sonra bakılan
TSH, FT4, FT3, boy SDS, kilo SDS ve tedavi dozları not edildi.
BULGULAR: Hastaların %41.5’inde kalıcı KH, %58.5’inde ise geçici
KH saptandı. Kalıcı hipotiroidilerin en sık sebebi tiroid disgenezileri
(%34) iken, geçici KH’li hastalarda en sık sebep dishormonogenezis
(%38,7) idi. En sık saptanan semptomlar uzamış sarılık ve kabızlıktı.
Hastaların büyük çoğunluğunu tarama testi sonucuyla polikliniğe
yönlendirilen (%27.4) ve tarama testi sonucunu beklemeden rutin
muayene amaçlı polikliniğimize başvuran (%27.4) hastalar
oluşturmaktaydı. Gruplar arasında tanı esnasındaki serum TSH, sT4 ve
sT3 seviyeleri açısından anlamlı fark yoktu (sırası ile p=0.955,
p=0.532, p=0.23). Geçici KH grubunda tiroglobulin düzeyi anlamlı
olarak yüksekti (p=0.026). Takiplerde kalıcı KH’li hastaların FT3
düzeyleri anlamlı ölçüde daha düşük idi. (sırasıyla p=0.003, p=0.017,
p=0.032).
SONUÇ: Çalışmamızda geçici KH oranının daha yüksek olduğu ve
geçiçi KH’lilerin büyük çoğunluğunun dishormonogenezise bağlı
olduğu görülmüştür. Tanı anındaki tiroid hormonu seviyelerinin kalıcı
ve geçici KH ayırımında belirleyici olmadığı gösterilmiştir. Ancak
takiplerde ihtiyaç duyulan ilaç dozunun ve TSH düzeyinin yüksek
olması ve FT3 seviyesinin düşük seyretmesi kalıcı KH’yi ayırt etmede
kullanılabileceği sonucuna varılmıştır.
INTRODUCTION: Congenital hypothyroidism (CH) is still the most common cause of mental retardation. ln this study, etiology, laboratory findings, treatment doses, durations of permanent and transient CH cases were compared. METHODS: 106 patients (42 female, 64 male) who had been treated for CH for at least 3 years were included. Patients’ files were retrospectively scanned. TSH, FT4, FT3, height, weight and treatment doses, findings at the first time of diagnosis, first, second, and third year of treatment and 4-6 weeks after the treatment was ended, were noted. RESULTS: Permanent CH was found in 41.5% of patients and transient CH was found in 58.5% of patients. The most common cause of permanent hypothyroidism was thyroid dysgenesis (34%). dyshormonogenesis (38.7%) was the most frequent cause in patients with transient CH. The most common symptoms were hyperbilirubunemia and constipation. 27 % of the patients were referred to the outcome screening program and 27% of the patients were visited for routine control. Serum TSH, FT4 and FT3 levels at diagnosis were not significantly different between the groups (p = 0.955, p = 0.532, p = 0.23). The level of thyroglobulin was significantly higher in the transient CH group (p =0,026). FT3 levels of patients with permanent CH were significantly lower during follow-up.( p= 0.003, p = 0.017, p = 0.032). CONCLUSION: In our study, it is found that the ratio of transient CH is higher and most of the transient cases were attributed to dyshormonogenesis. It is shown that the thyroid hormone levels at the time of diagnosis is not significantly different in the differential diagnosis of permanent and transient CH. However, it is concluded that the need for higher dose in the treatment during follow up and the higher TSH levels, and the lower fT3 levels can be used in diagnosis of permanent CH.
INTRODUCTION: Congenital hypothyroidism (CH) is still the most common cause of mental retardation. ln this study, etiology, laboratory findings, treatment doses, durations of permanent and transient CH cases were compared. METHODS: 106 patients (42 female, 64 male) who had been treated for CH for at least 3 years were included. Patients’ files were retrospectively scanned. TSH, FT4, FT3, height, weight and treatment doses, findings at the first time of diagnosis, first, second, and third year of treatment and 4-6 weeks after the treatment was ended, were noted. RESULTS: Permanent CH was found in 41.5% of patients and transient CH was found in 58.5% of patients. The most common cause of permanent hypothyroidism was thyroid dysgenesis (34%). dyshormonogenesis (38.7%) was the most frequent cause in patients with transient CH. The most common symptoms were hyperbilirubunemia and constipation. 27 % of the patients were referred to the outcome screening program and 27% of the patients were visited for routine control. Serum TSH, FT4 and FT3 levels at diagnosis were not significantly different between the groups (p = 0.955, p = 0.532, p = 0.23). The level of thyroglobulin was significantly higher in the transient CH group (p =0,026). FT3 levels of patients with permanent CH were significantly lower during follow-up.( p= 0.003, p = 0.017, p = 0.032). CONCLUSION: In our study, it is found that the ratio of transient CH is higher and most of the transient cases were attributed to dyshormonogenesis. It is shown that the thyroid hormone levels at the time of diagnosis is not significantly different in the differential diagnosis of permanent and transient CH. However, it is concluded that the need for higher dose in the treatment during follow up and the higher TSH levels, and the lower fT3 levels can be used in diagnosis of permanent CH.
Açıklama
Anahtar Kelimeler
Konjenital hipotiroidi, Geçici hipotiroidi, Kalıcı hipotiroidi, Congenital hypothyroidism, Transient congenital hypothyroidism, Permanent congenital hypothyroidism
Kaynak
Güncel Pediatri Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
17
Sayı
3
Künye
Yanmaz, S. Y., Ünal, E., Taş, F. F., Yıldırım, R. ve Haspolat, Y. K. (2019). Konjenital hipotiroidi tanısıyla takip edilen hastaların klinik ve laboratuvar özellikleri. Güncel Pediatri Dergisi, 17(3), 412-423.
