Hipotiroidizm Tanılı Hastalarda Levotiroksin Tedavisinin Oküler Vasküler Sistem Üzerine Etkilerinin İncelenmesi.

Year 2023, , 111 - 121, 06.09.2023

Çağatay Emir Önder , Ali Mert Koçer , Mesut Özdemir , Şerife Mehlika Kuşkonmaz , Merve Temmuz Ayduğan , Sevde Nur Fırat , Pınar Kösekahya

https://doi.org/10.18614/deutip.1224827

Abstract

Amaç: Sistemik vasküler değişikliklerin görülebildiği hipotiroidizm, tiroid hormonlarının yetersiz salgılanması ile karakterize endokrin sistem hastalığıdır. Bu çalışmada primer hipotiroidisi olan hastaların hipotiroid ve ötiroid dönemlerinde retina ve koroid vasküler değişikliklerinin kantitatif olarak optik koherens tomografi anjiografi (OKTA) ile incelenmesi amaçlandı.

Gereç ve Yöntemler: Aşikar veya tedavi gerektiren subklinik hipotiroidisi olan 20 hastanın 40 gözü çalışmaya dahil edildi. Hastalar hipotiroid ve levotiroksin tedavisi sonrası ötiroid dönemde OKTA ile değerlendirildi. OKTA cihazı ile foveal avasküler zon (FAZ) ve koryokapillaris akım (KA) değerleri ile yüzeyel kapiller pleksus (YKP), derin kapiller pleksus (DKP)ve radyal peripapiller kapiller pleksus (RPKP) vasküler dansite verileri elde edildi.

Bulgular: YKP, DKP ve RPKP vasküler dansite değerlerinde hipotiroid ve ötiroid dönemler arasında istatistiksel olarak anlamlı fark saptanmadı (tümü için p>0,05). 1,2 ve 3 mm tarama paternleri kullanılarak yapılan KA ölçümlerinde ise ötiroid dönemde hipotiroid döneme göre istatistiksel anlamlı artış görüldü (sırasıyla p=0,037; p=0,035; p=0,021). 1 ve 2 mm KA değerleri ötiroid dönemdeki sT4 düzeyleri ile pozitif korelasyon gösterirken (r=0,596; p< 0,001 ve r=0,402; p=0,012); 1 mm KA ölçümleri ile hasta yaşı ve ötiroid dönemdeki TSH düzeyleri arasında negatif korelasyon saptandı (r=-0,380; p= 0,016 ve r=-0,351; p=0,031).

Sonuç: Bu çalışmada ötiroid dönemde hipotiroid dönemle karşılaştırıldığında artmış KA hızı saptanmıştır. Bu değişikliklerin hipotroidide görülebilen sistemik vasküler değişiklikler ile ilişkili olabileceği ve hipotroidi tanılı hastalarda olası vasküler etkilerin saptanmasında OKTA ile oküler akımın değerlendirilmesinin önemli olduğu düşünülmektedir.

Keywords

Hipotiroidizm, Koroid pleksus, Optik koherens tomografi, Retina damarları.

Supporting Institution

-

Project Number

-

Thanks

-

Evaluation of the Effect of Levothyroxine Treatment on Ocular Vascular System in Patients with Hypothyroidism.

Abstract

Objective: Hypothyroidism, in which systemic vascular changes can be seen, is an endocrine system disease characterized by insufficient secretion of thyroid hormones. In this study, it was aimed to quantitatively investigate retinal and choroidal vascular changes in patients with primary hypothyroidism during the hypothyroid and euthyroid periods by optical coherence tomography angiography (OCTA).

Materials and Methods: Forty eyes of 20 patients with overt or subclinical hypothyroidism requiring treatment were included in the study. The patients were evaluated with OCTA in the euthyroid period after hypothyroid and levothyroxine treatment. Foveal avascular zone (FAZ) and choriocapillaris flow (CF) values, superficial capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillary plexus (RPCP) vascular density data were obtained with the OCTA device.

Results: There was no statistically significant difference between hypothyroid and euthyroid periods in the vascular density values of SCP, DCP and RPCP (p>0,05 for all). On the other hand, statistically significant increases were observed in the euthyroid period compared to the hypothyroid period in CF measurements made using 1,2 and 3 mm scanning patterns (p=0,037; p=0,035; p=0,021 respectively). While 1 and 2 mm CF values were positively correlated with fT4 levels in the euthyroid period (r=0,596; p<0,001 and r=0,402; p=0,012); a negative correlation was found between 1 mm CF measurements and patient age and TSH levels in the euthyroid period (r=-0,380; p=0,016 and r=-0,351; p=0,031).

Conclusion: In this study, increased CF rate was found in the euthyroid period compared to the hypothyroid period. It is thought that these changes may be related to the systemic vascular changes that can be seen in hypothyroidism, and the evaluation of ocular flow with OCTA is important in detecting possible vascular effects in patients with hypothyroidism.

Keywords

Hypothyroidism, Choroid plexus, Optical coherence tomography, Retinal vessels.

Project Number

-

References

• 1. Chaker L, Razvi S, Bensenor IM, Azizi F, Pearce EN, Peeters RP. Hypothyroidism. Nat Rev Dis Primers. 2022;8(1):30.
• 2. Garmendia Madariaga A, Santos Palacios S, Guillén-Grima F, Galofré JC. The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab. 2014;99(3):923-931.
• 3. Wang Y, Sun Y, Yang B, Wang Q, Kuang H. The management and metabolic characterization: hyperthyroidism and hypothyroidism. Neuropeptides. 2022;97: 102308.
• 4. Udovcic M, Pena RH, Patham B, Tabatabai L, Kansara A. Hypothyroidism and the Heart. Methodist Debakey Cardiovasc J. 2017;13(2):55-59.
• 5. Jabbar A, Pingitore A, Pearce SH, Zaman A, Iervasi G, Razvi S. Thyroid hormones and cardiovascular disease. Nat Rev Cardiol. 2017;14(1):39-55.
• 6. Rocholz R, Corvi F, Weichsel J, Schmidt S, Staurenghi G. OCT Angiography (OCTA) in Retinal Diagnostics. In: Bille JF, ed. High Resolution Imaging in Microscopy and Ophthalmology: New Frontiers in Biomedical Optics. Cham (CH): Springer; 2019:135-160.
• 7. Kocer AM, Kiziltoprak H, Fen T, Goker YS, Acar A. Evaluation of radial peripapillary capillary density in patients with newly diagnosed iron deficiency anemia. Int Ophthalmol. 2021;41(2):399-407.
• 8. Kashani AH, Chen CL, Gahm JK, Zheng F, Richter GM, Rosenfeld PJ, et al. Optical coherence tomography angiography: A comprehensive review of current methods and clinical applications. Prog Retin Eye Res. 2017;60:66-100.
• 9. Mihailovic N, Lahme L, Rosenberger F, Hirscheider M, Termühlen J, Heiduschka P, et al. Altered Retınal Perfusıon In Patıents With Inactıve Graves Ophthalmopathy Usıng Optıcal Coherence Tomography Angıography. Endocr Pract. 2020;26(3):312-317.
• 10. Wu Y, Tu Y, Bao L, Wu C, Zheng J, Wang J, et al. Reduced Retinal Microvascular Density Related to Activity Statusand Serum Antibodies in Patients with Graves' Ophthalmopathy. Curr Eye Res. 2020;45(5): 576-584.
• 11. Yıldız AM, Erdal GŞ, Tarakcioglu H, Yıldız AA, Yılmaz S. Evaluation of macular perfusion in patients with treatment-naive overt hypothyroidism using optical coherence tomography angiography. Journal of Surgery and Medicine. 2021; 5(9):838-842.
• 12. Khandelwal D, Tandon N. Overt and subclinical hypothyroisim. Who treat and how. Drugs 2012;72(1):17-33.
• 13. Kılınç Hekimsoy H, Şekeroğlu MA, Koçer AM, Önder ÇE, Kuşkonmaz ŞM. Is there a relationship between hypoparathyroidism and retinal microcirculation? Int Ophthalmol. 2020;40(8):2103-2110.
• 14. Kılınç Hekimsoy H, Şekeroğlu AM, Koçer AM, Hekimsoy V, Akdoğan A. Evaluation of the optic nerve head vessel density in patients with limited scleroderma. Ther Adv Ophthalmol. 2021;13:2515841421995387.
• 15. Lee WH, Park JH, Won Y, Lee MW, Shin YI, Jo YJ, et al. Retinal Microvascular Change in Hypertension as measured by Optical Coherence Tomography Angiography. Sci Rep. 2019;9(1):156.
• 16. Koçer AM, Şekeroğlu MA. Evaluation of the neuronal and microvascular components of the macula in patients with diabetic retinopathy. Doc Ophthalmol. 2021;143(2):193-205.
• 17. Tan KA, Gupta P, Agarwal A, Chhablani J, Cheng CY, Keane PA, et al. State of science: Choroidal thickness and systemic health. Surv Ophthalmol. 2016;61:566-581.
• 18. Yeung SC, You Y, Howe KL, Yan P. Choroidal thickness in patients with cardiovascular disease: A review. Surv Ophthalmol. 2020;65(4):473-486.
• 19. Ramrattan RS, van der Schaft TL, Mooy CM, de Bruijn WC, Mulder PG, de Jong PT. Morphometric analysis of Bruch's membrane, the choriocapillaris, and the choroid in aging. Invest Ophthalmol Vis Sci. 1994;35(6):2857-2864.
• 20. Zarbin MA. Current concepts in the pathogenesis of age-related macular degeneration. Arch Ophthalmol. 2004;122(4):598-614.
• 21. Borrelli E, Souied EH, Freund KB, Querques G, Miere A, Gal-Or O, et al. Reduced chorıocapıllarıs flow in eyes with type 3 neovascularızatıon and age-related macular degeneratıon. Retina. 2018;38(10):1968-1976.
• 22. Li H, Zheng M. Analysis of optic disc and macular vascular density in patients with non-proliferative diabetic retinopathy. Am J Transl Res. 2021;13(8):9160-9167.
• 23. Nickla DL, Wallman J. The multifunctional choroid. Prog Retin Eye Res. 2010;29(2):144-168.
• 24. Ng DS, Chan LK, Ng CM, Lai TYY. Visualising the choriocapillaris: Histology, imaging modalities and clinical research-A review. Clin Exp Ophthalmol. 2022;50(1):91-103.