Prepubertal ve Pubertal Hastalarda Hashimoto Tiroiditi’nin Dağılımı, Klinik Özellikleri ve Laboratuvar Bulguları

Year 2023, , 683 - 688, 31.12.2023

Aylin Kılınç Uğurlu , Abdurrahman Bitkay

https://doi.org/10.54005/geneltip.1253549

Abstract

Giriş: Hashimoto tiroiditi (HT) çocukluk çağında edinsel hipotiroidizmin en sık nedenidir. Otoimmün temelde gelişen bu hastalık sıklıkla ergenlik döneminde ortaya çıkmaktadır. Ancak son yıllarda prepubertal ve infant dönemde bu hastalık tanısı alan olgular bildirilmektedir. Bu durumun endokrin sistemi bozan ve otoimmüniteyi tetikleyen çevresel faktörlere erken dönemde maruz kalınmasından kaynaklandığı düşünülmektedir. Kliniğimizde prepubertal ve pubertal dönemde Hashimoto tiroiditi tanısı alan hastalarımızın dağılımını, klinik özelliklerini ve laboratuvar bulgularını değerlendirmeyi amaçladık.
Gereç ve Yöntem: Çalışmada Ağustos 2019-Mayıs 2022 tarihleri arasında Hashimoto Tiroiditi tanısı alan olgular prepubertal (Tanner evre 1) ve pubertal (Tanner evre 2-3-4-5) olarak iki gruba ayrıldı. İki grup klinik, laboratuvar ve ultrason bulguları açısından retrospektif olarak karşılaştırıldı.
Bulgular: HT tanısı konulan hastaların (n=134) ortalama yaşı 12.4±3.4 yıldı. Olguların %25’i (n= 33) prepubertal iken, %75’i (n=101) pubertaldi. Olguların kız/erkek oranı (K/E) 4,1/1, prepubertal dönemde K/E=2,3/1 ve pubertal dönemde K/E= 5,3/1 idi. Tanı anında yapılan tiroid fonksiyon testlerine göre, tüm olgularda en sık ötiroidizm saptandı. Prepubertal grupta, ötiroidizm ve subklinik hipotiroidizm oranları benzerdi ve en yüksek oranlara sahipti. Buna karşılık, pubertal grupta en sık ötiroidizm gözlendi. Prepubertal ve pubertal grupları karşılaştırdığımızda, prepubertal grupta subklinikhipotiroidi (%36.4), hipotiroidi (%21), pubertal gruba (%22.8 ve %10.9) göre daha sık saptandı. Bununla birlikte, subklinik hipertiroidizm ve hipertiroidizm pubertal grupta daha sık görüldü (p= 0.17).
Sonuç: Çalışmamızda, HT prepubertal evredeki erkek çocuklarda pubertal evredekilere göre daha yaygındır.Prepubertal dönemdeki hastalar hipotiroidi evresinde başvururken, pubertal grubun başvurularında hipertiroidi olması dikkat çekiciydi.

Keywords

Hashimoto Tiroiditi, prepubertal, pubertal, ötiroid faz, kız/erkek oranı

Distribution, Clinical Features and Laboratory Findings of Hashimoto’s Thyroiditis in Prepubertal and Pubertal Patients

Abstract

Aims:Hashimoto's thyroiditis (HT) is the most common cause of acquired hypothyroidism in childhood. This disease, which develops on an autoimmune basis, often appears in adolescence. However, in recent years, However, in recent years, cases diagnosed with this disease in prepubertal and infant period have been reported. This is considered to regarding early exposure to environmental factors that disrupt the endocrine system and trigger autoimmunity. We aimed to evaluate the distribution, clinical features, and laboratory findings of our patients diagnosed with Hashimoto's thyroiditis in our clinic in prepubertal and pubertal periods.
Material and Method:In the study, the cases diagnosed with Hashimoto's Thyroiditis in Ankara City Hospital Pediatric Endocrinology 5th outpatient clinic between August 2019 and May 2022 were divided into two groups prepubertal (Tanner stage 1) and pubertal (Tanner stage 2-3-4-5). The two groups were compared retrospectively in terms of clinical, laboratory, and ultrasound findings.
Results: The mean±SDS of 134 patients diagnosed with HT was 12.4±3.4 years. While 25% (n:33) of the cases were prepubertal, 75% (n:101) were pubertal. The cases' female/male ratio (F/M) was 4.1/1, F/M: 2.3/1 in the prepubertal period, and F/M: 5.3/1 in the pubertal period.
The euthyroid phase was detected most frequently in all cases at diagnosis. While the rate of euthyroid and subclinical hypothyroidism was the same in the prepubertal group, it was most detected in these two phases. In the pubertal group, it was mostly detected in the euthyroid phase. When we compared the prepubertal and pubertal groups, it was seen that subclinical hypothyroidism and hypothyroidism were most common in the prepubertal group. In contrast, subclinical hyperthyroidism and hyperthyroidism were more common in the pubertal group.
Conclusion:In our study, HT is more prevalent in boys at the prepubertal stage than in the pubertal stage.
While the patients in the prepubertal period applied in the hypothyroid phase, it was remarkable that the pubertal group had hyperthyroidism in their admissions.

Keywords

Hashimoto, prepubertal, pubertal, euthyroid phase, boys

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