Subklinik hipotiroidisi olan obez çocuk ve adölesanlarda lipid metabolizması anormallikleri
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Date
2020-12-18
Authors
Kırel, Birgül
Hazer, İlhan
Kabukçu, Hilmi Onur
Yağcı, Murat
Ertürk, Zeynep
Yıldırım, Gonca Kılıç
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Giriş: Subklinik hipotiroidi (SH); serum serbest T4 (sT4) düzeylerinin normal sınırlarda ve tiroid stimülan hormon (TSH) düzeylerinin yaşa göre referans düzeylerinin üzerinde olduğu bir tablodur. Obez bireylerde vücut kitle indeksindeki artış ile birlikte serum TSH düzeylerinin arttığı; böylece obez bireylerde SH sıklığının yüksek olduğu bildirilmektedir. Hipotiroidi ve obezite sekonder dislipideminin ana sebeplerindendir. Bu çalışmada; fazla kilolu/obez çocuk ve adölesanlarda; SH sıklığı ve SH’nin lipid metabolizması anormallikleri ile ilişkisi araştırılmıştır. Gereç ve Yöntem: Fazla kilolu/obez 291 çocuk ve adölesanın (169 kız, 122 erkek) klinik bulguları ve laboratuvar sonuçları geriye dönük olarak değerlendirildi. Lipid ve lipoprotein düzeyleri yaşa ve cinse göre referans değerleri ile karşılaştırılarak; düşük, normal ve yüksek olarak kaydedildi. Serum sT4 düzeyleri normal ve TSH düzeyleri: 4,5-10 mIU/ml olan ve sodyum L-throxin tedavisi almayan hastalar SH grubunu (n=53), normal serum T4 ve TSH düzeyleri olan hastalar kontrol grubunu oluşturdu (n=238). Bu iki grup lipid metabolizması anormallikleri açısından karşılaştırıldı. Bulgular: Tüm çalışma grubunda SH sıklığı %18,2 idi. Yaşa göre referans değerleri ile karşılaştırıldığında; tüm çalışma grubunda, SH grubu ve SH olmayan grupta; median total kolesterol ve LDL-K düzeyleri sınırda yüksek, median TG düzeyleri yüksek, median HDL-K düzeyleri normal-yüksek ve median TG/ HDL>2 idi. SH grubunda SH olmayanlara göre; serum total kolesterol düzeyleri, hipertrigliseridemi sıklığı ve TG/HDL-K oranı >2 olan hastaların sıklığı daha yüksekti (p<0,05). Serum TSH düzeyleri; TG ile pozitif korele idi (r=0,13, p<0,05). Sonuç: Fazla kilolu/obez çocuk ve adölesanlarda yüksek SH sıklığı bulunmaktadır. Obez hastalarda dislipidemi olduğu; SH varlığında bu durumun daha belirginleştiği ve SH’nin atherojenik lipid profili gelişmesine katkıda bulunduğu anlaşılmıştır. Bu bulgular obez hastaların kilo vermelerinin hem SH’nin hem de lipid metabolizması anormalliklerinin düzelmesi açısından da önemli olduğunu düşündürmüştür.
Introduction: Subclinical hypothyroidism (SH); is a condition in which serum free T4 (fT4) levels are within normal limits and thyroid stimulating hormone (TSH) levels are above age-related levels. In obesity, serum TSH levels increase with the increase in body mass index; Thus, the frequency of SH is reported to be high in obese patients. Hypothyroidism and obesity are the main causes of secondary dyslipidemia. In this study; in overweight / obese children and adolescents; the frequency of SH and its relationship with lipid metabolism abnormalities were investigated. Materials and Methods: The clinical findings and laboratory results of 291 overweight / obese children and adolescents (169 girls, 122 boys) were evaluated retrospectively. Lipid and lipoprotein levels of the patients were compared according to the reference values according to age and gender and were recorded as low, normal and high. Patients with normal serum fT4 levels and TSH levels: 4.5-10 mIU / ml and not receiving sodium L-throxin treatment comprised the SH group (n = 53), and patients with normal serum T4 and TSH levels constituted the control group (n = 238). These two groups were compared in terms of lipid metabolism abnormalities. Results: The frequency of SH in the whole study group was 18.2%. When compared with reference values according to age; in the whole study group and as well as in both the groups with and without SH were found borderline high levels of median total cholesterol and LDL-C levels, high median TG levels and normal-high median HDL-C levels. Median TG/HDL-C levels were>2 in these three groups. In the SH group compared to the group without SH; serum total cholesterol levels, the frequency of hypertriglyceridemia and TG / HDL-C ratio> 2 were higher (p <0.05). Serum TSH levels were positively correlated with TG (r = 0,13, p <0,05). Conclusions: There is a high frequency of SH in obese children and adolescents. It was understood that obese patients had dyslipidemia and this situation became more pronounced in the presence of SH and SH contributed to the development of atherogenic lipid profile. These findings made us think that weight loss of obese patients can also improve both SH and lipid metabolism abnormalities.
Introduction: Subclinical hypothyroidism (SH); is a condition in which serum free T4 (fT4) levels are within normal limits and thyroid stimulating hormone (TSH) levels are above age-related levels. In obesity, serum TSH levels increase with the increase in body mass index; Thus, the frequency of SH is reported to be high in obese patients. Hypothyroidism and obesity are the main causes of secondary dyslipidemia. In this study; in overweight / obese children and adolescents; the frequency of SH and its relationship with lipid metabolism abnormalities were investigated. Materials and Methods: The clinical findings and laboratory results of 291 overweight / obese children and adolescents (169 girls, 122 boys) were evaluated retrospectively. Lipid and lipoprotein levels of the patients were compared according to the reference values according to age and gender and were recorded as low, normal and high. Patients with normal serum fT4 levels and TSH levels: 4.5-10 mIU / ml and not receiving sodium L-throxin treatment comprised the SH group (n = 53), and patients with normal serum T4 and TSH levels constituted the control group (n = 238). These two groups were compared in terms of lipid metabolism abnormalities. Results: The frequency of SH in the whole study group was 18.2%. When compared with reference values according to age; in the whole study group and as well as in both the groups with and without SH were found borderline high levels of median total cholesterol and LDL-C levels, high median TG levels and normal-high median HDL-C levels. Median TG/HDL-C levels were>2 in these three groups. In the SH group compared to the group without SH; serum total cholesterol levels, the frequency of hypertriglyceridemia and TG / HDL-C ratio> 2 were higher (p <0.05). Serum TSH levels were positively correlated with TG (r = 0,13, p <0,05). Conclusions: There is a high frequency of SH in obese children and adolescents. It was understood that obese patients had dyslipidemia and this situation became more pronounced in the presence of SH and SH contributed to the development of atherogenic lipid profile. These findings made us think that weight loss of obese patients can also improve both SH and lipid metabolism abnormalities.
Description
Keywords
Lipid, Subklinik hipotiroidi, Obez, Çocuk, Subclinical hypothyroidism, Obese, Children
Citation
Kırel, B. vd. (2021). ''Subklinik hipotiroidisi olan obez çocuk ve adölesanlarda lipid metabolizması anormallikleri''. Güncel Pediatri Dergisi, 19(1), 100-105.