Çocukluk çağının gizli tehlikesi; subklinik hipotiroidi

Yıl 2017, Cilt: 9 Sayı: 1, 34 - 38, 02.03.2017

Ayşegül Alpcan , Ayça Törel Ergür Serkan Tursun

https://doi.org/10.21601/ortadogutipdergisi.293272

Öz

Tiroid hormonları; santral sinir sistemi gelişimi, büyüme, gelişme, vücut ısısı regülasyonu, lipit, karbonhidrat ve enerji metabolizması, iskelet sistemi üzerinde önemli role sahiptir. Diğer yönden çocukluk çağında santral sinir sistemi myelinizasyonunda görevli olduğu için önemi farklıdır. Subklinik hipotiroidi, serum tiroid stimulan hormon seviyesinin orta düzeyde artması ile birlikte serum tiroid hormon seviyelerinin normal referans laboratuvar aralığında olmasıdır. Çocuklarda %2 oranında görülmektedir. Etiyolojisinin büyük bir kısmını otoimmün tiroidit ve iyot eksikliği oluşturmaktadır. Asemptomatik olguların zamanında tanımlanması ve tedavisi önemlidir. Olgularda guatr, büyüme-gelişme geriliği veya duraksaması, ders başarısında azalma, negativizm, depresyon, obezite, demir eksikliği anemisi, dislipidemi, kemik yaşı geriliğinde levotiroksin tedavisi başlanması uygundur.

Anahtar Kelimeler

Çocukluk çağı, subklinik hipotiroidizm

Insidious danger in childhood era's: subclinical hypothyroidism

Öz

Thyroid hormones have an important role on the central nervous system, growth, development, body temperature regulation, metabolism of lipid, carbohydrate and energy, musculoskeletal system. The other hand, it has a different importance for its role in the myelinization of the central nervous system during the childhood period. Subclinical hypothyroidism (SH), is diagnosed when peripheral thyroid hormone levels are within normal reference laboratory range but serum thyroid-stimulating hormone levels are mildly elevated. Prevalance of subclinical hypothyroidism in chilhood is seen about %2. The majority of its etiology is due to the autoimmune thyroiditis and iodine deficiency. It is important to diagnose and treat the asymptomatic cases in a timely manner. Thyroxin treatment should be started if goiter, growth velocity is slowed down, decline in school success, negativism, depression, obesity, refractory iron deficiency anemia dyslipidemia, bone age retardation.

Anahtar Kelimeler

Childhood, subclinical hypothroidism

Kaynakça

• Bernal J, Guadano-Ferraz A, Morte B. Perspectives in the study of thyroid hormone action on brain development and function. Thyroid 2003;13:1005-1012
• Murphy NC, Diviney MM, Donnelly JC et all. The effect of maternal subclinical hypothyroidism on IQ in 7- to 8-year-old children: A case-control review. Aust N Z J Obstet Gynaecol. 2015;55:459-463
• D. S. Cooper and B. Biondi. Subclinical thyroid disease. The Lancet, 2002;379:1142-1154
• Aijaz NJ, Flaherty EM, Preston T. Neurocognitive function in children with compensated hypothyroidism: lack of short term effects on or off thyroxin. BMC Endocr Disord. 2006;6:2
• M. Cerbone, C. Bravaccio, D. Capalbo et al.. Linear growth and intellectual outcome in children with long-term idiopathic subclinical hypothyroidism. European Journal of Endocrinology 2011; 164:591–597
• Wasniewska M, Salerno M, A. Cassio et al.,Prospective evaluation of the natural course of idiopathic subclinical hypothyroidism in childhood and adolescence. European Journal of Endocrinology, 2009; 160:417–421
• M. W. Kuiper and E. J. van der Gaag. Subclinical hypothyroidismin children can normalize after changes in dietary intake. Food and Nutrition Sciences,2012;3:411–416
• A. Rapa, A. Monzani, S. Moia et al. Subclinical hypothyroidism in children and adolescents: a wide range of clinical, biochemical, and genetic factors involved. Journal of Clinical Endocrinology&Metabolism, 2009;94:2414–2420
• Beardsall K, Ogilvy-Stuart AL. Congenital hypothyroidism. Current Paediatrics 2004;14:422-429.
• Kaplowitz PB. Subclinical hypothyroidism in children: normal variation or sign of a failing thyroid gland? Int J Pediatr Endocrinol. Epub 2010 Jun 13
• Marwaha RK, Tandon N, Desai AK, Kanwar R, Aggarwal R, Sastry A, et al. Reference range of thyroid hormones in healthy school-age children: Country-wide data from India. Clin Biochem. 2010;43:51-56.
• Marwaha RK, Tandon N, Desai A, Kanwar R, Grewal K, Aggarwal R, et al. Reference range of thyroid hormones in normal Indian school-age children. Clin Endocrinol(Oxf). 2008;68:369-374.
• Wu T, Flowers JW, Tudiver F, Wilson JL, Punyasavatsut N. Subclinical thyroid disorders and cognitive performance among adolescents in the United States. BMC Pediatr. 2006: 19;6:12.
• Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witteman JC. Subclinical hypothyroidism is an indepen¬dent risk factor for atherosclerosis and myocardial infarc¬tion in elderly women: the Rotterdam Study. Ann Intern Med 2000;132:270-278.
• Gussekloo J, van Exel E, de Craen AJ, Meinders AE, Frol¬ich M, Westendorp RG. Thyroid status, disability and cog¬nitive function, and survival in old age. JAMA 2004;292:2591-2599.
• L. Lazar, R. B. D. Frumkin, E. Battat, Y. Lebenthal, M. Phillip, and J. Meyerovitch, Natural history of thyroid function tests over 5 years in a large pediatric cohort, Journal of Clinical Endocrinology and Metabolism,2009;94:1678–1682
• . Kim YA, Park YJ. Prevalence and risk factors of subclinical thyroid disease. Endocrinol Metab (Seoul). 2014;:20-29.
• . Azam HD, Hayat Z, Fida Z, Khan I. Subclinical hypothyroidism in patients with non specific symptoms. J Med Sci. 2010;18:191–193
• Chee YY, Wong KY, Low L. Review of primary hypothyroidism in very low birthweight infants in a perinatal centre in Hong Kong. J Paediatr Child Health. 2011:824-831
• Cho NH, Choi HS, Kim KW, Kim HL, Lee SY, Choi SH, Lim S, Park YJ, Park do J, Jang HC, Cho BY. Interaction between cigarette smoking and iodine intake and their im-pact on thyroid function. Clin Endocrinol 2010;73:264-70.
• Choi HS, Park YJ, Kim HK, Choi SH, Lim S, Park DJ, Jang HC, Cho NH, Cho BY. Prevalence of subclinical hy¬pothyroidism in two population based-cohort: Ansung and KLoSHA cohort in Korea. J Korean Thyroid Assoc 2010;3:32-40.
• Shriraam M, Sridhar M. Subclinical hypothyroidism in children. Indian Pediatr. 2014;51:889-895.
• Papi G, Uberti ED, Betterle C, Carani C, Pearce EN, Braverman LE, Roti E. Subclinical hypothyroidism. Curr Opin Endocrinol Diabetes Obes. 2007;14:197-208
• De Marco G, Agretti P, Montanelli, Dicosmo C, Bagattini B, De Servi M, et al. Identification and functional analysis of novel dual oxidase 2 (DUOX2) mutations in children with congenital or subclinical hypothyroidism. J Clin Endocrinol Metab. 2011;96:1335-1339.
• Grandone A, Perrone L, Cirillo G, Di Sessa A, Corona AM, Amato A, et al. Impact of phosphodiesterase 8B gene rs4704397 variation on thyroid homeostasis in childhood obesity. Eur J Endocrinol. 2012;166:255-260.
• Turkkahraman D, Alper OM, Aydin F, Yildiz A, Pehlivanoglu S, Luleci G, et al. Final diagnosis in children with subclinical hypothyroidism and mutation analysis of the thyroid peroxidise gene (TPO). J Pediatr Endocrinol Metab. 2009;22:845-851.
• Ergür A.T, Taner Y, Ata E, Melek E, Bakar E.E, Sancak T. Neurocognitive Functions in Children and Adolescents with Subclinical Hypothyroidism J Clin Res Pediatr Endocrinol. 2012; 4: 21–24
• Gawlik A, Such K, Dejner A, Zachurzok A, Antosz A, Malecka-Tendera E. Subclinical hypothyroidism in children and adolescents: is it clinically relevant? Int J Endocrinol. 2015 e pub.
• Papi G, Uberti ED, Betterle C: Subclinical hypothyroidism. Current Opinion in Endocrinology, Diabetes and Obesity. 2007;14: 197-208.
• Suzumura H, Nitta A, Tsuboi Y, Watabe Y, Kuribayashi R, Arisaka O. Thyroxine for transient hypothyroxinemia and cerebral palsy in extremely preterm infants. Pediatr Int. 2011;53:463-467
• Dilli D, Eras Z, Andiran N, Dilmen U, Sakrucu ED. Neurodevelopmental evaluation of very low birth weight infants with transient hypothyroxinemia at corrected age of 18-24 months. Indian Pediatr. 2012;49:711-715
• Moore DC. Natural course of ’subclinical’ hypothyroidism in childhood and adolescence. Archives of Pediatrics and Adolescent Medicine. 1996;150:293–297
• Radetti G, Gottardi E, Bona G, Corrias A, Salardi S, Loche S. The natural history of euthyroid Hashimoto’s thyroiditis in children. Journal of Pediatrics. 2006;149:827–832.
• Kaplowitz PB, Mehra R. Outcome of children with presumed hypothyroidism when selectively taken off thyroid hormone. In: Proceedings of the 91st Annual Meeting of the Endocrine Society; June 2009; Washington, DC, USA.