Guatrlı çocukların değerlendirilmesi ve tedavi sonuçları
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Date
2008
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Uludağ Üniversitesi
Abstract
Amaç: Guatr etiyolojik nedene bakılmaksızın tiroid bezinin büyümesi olarak tanımlanır. Çocukluk yaş grubunda, özellikle ergenlerde yaygındır. Ülkemizde yapılan değişik çalışmalarda 6-12 yaş arası çocuklarda guatr prevalansı %24,9-92 arasında saptanmıştır. Endemik bölgelerde guatrın en sık nedeni iyot eksikliği iken endemik olmayan bölgelerde kronik lenfositik tiroidittir. Bu çalışmanın amacı guatr tanısı konan hastalarımızın demografik ve tanısal özellikleri, izlem süresince muayene, radyoloji, laboratuvar bulguları ve uygulanan tedavilerin etkinliğinin değerlendirilmesidir. Gereç ve Yöntem: Ocak 2000-Aralık 2005 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Çocuk Endokrinoloji Bilim Dalı polikliniğinden fizik muayene ve tiroid ultrasonografisi bulgularına göre 116 hasta guatr tanısı aldı. Hastaların verileri dosya kayıtlarından geriye dönük olarak incelendi. Guatr evresi Dünya Sağlık Örgütü (WHO) evrelemesine göre yapıldı. Tiroid hacimleri tiroid boyutlarının ultrasonografik ölçümü ile hesaplandı. Ötiroid ve hipotiroid hastalar L-tiroksin tedavisi, hipertiroid olgular propiltiourasil ve propranolol tedavileri aldı. Bulgular: Çocukların 80’i (%69) kız, 36’sı (%31) erkek idi. Tanı anında kızların ve erkeklerin yaş ortalaması sırasıyla 10,1±2,9 yıl, 9,02 ± 3,6 yıl idi. Ortalama takip süresi 3,18 ± 1,83 yıl idi. Tanı anında hastaların çoğu (%76,7), Evre Ib (%38,8) ve Evre II (%37,9) guatr evresindeydi. Tüm çocuklardan 62’si (%53,4) ötiroid, 47’si (%40,5) hipotiroid ve 7’si (%6,0) hipertiroid idi. Hastalardan 79’unda (%68,1) ailede tiroid hastalığı öyküsü mevcuttu. Ayrıca, 11 hastada (% 9,5) eşlik eden başka bir endokrinolojik hastalık mevcut iken 11’inde (% 9,5) epilepsi öyküsü ve 7’sinde (%6) ise başka bir sistemik hastalık mevcuttu. Basit difüz guatrlı 83 (%71,6) hasta mevcut iken, 18 Hashimoto tiroiditli (4’ünde nodül mevcut), 11 (%9,4) izole nodüler ya da multinodüler guatrlı, 1 (%0,9) papiller tiroid kanserli ve 3 (%2,6) Graves hastalığı olan olgu vardı. Ortalama tiroid hacmi tedaviyle 12,68±6,48 (3,4-35,7) ml’den anlamlı bir şekilde 9,2±3,57 (3,19-22,1) ml’ye azalmıştır (p<0,05). Başvuruda %76,7 olan evre Ib ya da evre II guatr oranıtedavi sonrası%36,2’ye (evre Ib %26,7, evre II %9,5) gerilemiş olup bu gerileme istatistiksel olarak anlamlıbulundu (p<0,05). Nodüler guatrıolan 16 hastanın 11’inde (%68,8) tedavi sonrasınodülleri kayboldu. Sonuç: TSH (Tiroid Stimulan Hormon) yükselmesi tiroid bezi büyümesindeki ana tetikleyici güç gibi göründüğünden hipotiroid veya ötiroid guatrıolan hastalarda tiroksin tedavisi uygulanmasıakla yatkın bir yaklaşımdır. Bu yaklaşımla elde ettiğimiz sonuçlar yüz güldürücüdür. Hipertiroidili hastalarımızın sayı- sıbir sonuca varmaya yetecek boyutta değildir ve hipertiroidili hastalarda guatrın patogenezi TSH yüksekliğini içermemektedir. Ancak antitiroid ilaçlarla hipertiroidinin kontrol altına alınmasıyla tiroid boyutu da küçülüyor gibi görünmektedir.
Aim: Goiter is defined as the enlargement of thyroid gland independent of the etiology. It is common in childhood, especially in adolescence. The prevalence of goiter in children aged 6 to 12 years of age was found as 24.9 to 92% in different studies performed in different regions of Turkey. The most common cause in endemic regions is iodine deficiency and it is chronic lymphocytic thyroiditis in non-endemic areas. The aim of this study was to evaluate the demographic and diagnostic characteristics; and physical, laboratory and radiological findings of the children who were presented and followed-up with goiter, and the efficacy of the treatments applied was also assessed. Materials and Methods: A total of 116 children diagnosed as having goiter by physical and ultrasonographic examination in the outpatient clinic of Pediatric Endocrinology Division of Uludag University Faculty of Medicine, between January 2000 and December 2005. Data of the patient were collected retrospectively from the files/records of the patients. Goiter grades of the patients were determined according to that recommended by WHO. Thyroid volumes were calculated from the ultrasonographic measurement of thyroid dimensions. Patients with euthyroid or hypothyroid goiter had L-thyroxine therapy and those with hyperthyroidism had propiltiourasil and/or propranolol. Results: Of all children, 80 (69%) were girls and the remaining 36 were boys (31%). At the time of initial diagnosis, the mean ages of the girls and the boys were 10.1±2.9 years and 9.02± years, respectively. The mean followup period was 3.18±1.83 years. Most children (76.7%) had grade Ib (38.8%) or II (37.9%) goiter at the time of diagnosis. Of all children with goiter, 62 (53.4%) were euthyroid, 47 (40.5%) were hypothyroid and 7 (6.0%) were hyperthyroid. Seventy nine (68.1%) patients had history of thyroid disease in their families. There were additional endocrinological disturbances, epilepsy and other systemic diseases in 11 (9.5%), 11 (9.5%) and 7 (6.0%) patients, respectively. Eighty three (71.6%) patients had simple diffuse goiter, 18 had Hashimoto thyroiditis (4 of whom also having nodules), 11 (10.4%) had isolated nodüler/multinodüler goiter, 3 (2.6%) had Graves disease and 1 (0.9%) had papillary thyroid carcinoma. Mean thyroid volume by ultrasonography was significantly decreased from 12.68±3.57 (3.4 to 35.7) ml to 9.2±3.57 (3.19 to 22.1) ml with the treatment (p<0.05). Similarly goiter grades by physical examination were also significantly decreased, with only 36.2% of the patients having grade Ib (26.7%) or grade II (9.5%) goiter after the treatment (vs. a total of 76.7% at baseline) (p<0,01). Thyroid nodules were significantly regressed in 11 of 16 patients with nodüler goiter (p<0.01). Conclusion: Since TSH (Thyroid-stimulating hormone) elevation seems to be the main driving force in the pathogenesis of thyroid enlargement, thyroxine treatment is warranted to suppress the TSH in hypothyroid and euthyroid patients. The number of hyperthyroid patients in our study is not sufficient to draw conclusions, and the pathogenesis of goiter in hyperthyroidism does not involve TSH which is already suppressed by endogenous thyroid hormones. Nevertheless, control of hyperthyroidism with antithyroid medication and appropriate introduction of thyroxine seem to remedy the goiter as well.
Aim: Goiter is defined as the enlargement of thyroid gland independent of the etiology. It is common in childhood, especially in adolescence. The prevalence of goiter in children aged 6 to 12 years of age was found as 24.9 to 92% in different studies performed in different regions of Turkey. The most common cause in endemic regions is iodine deficiency and it is chronic lymphocytic thyroiditis in non-endemic areas. The aim of this study was to evaluate the demographic and diagnostic characteristics; and physical, laboratory and radiological findings of the children who were presented and followed-up with goiter, and the efficacy of the treatments applied was also assessed. Materials and Methods: A total of 116 children diagnosed as having goiter by physical and ultrasonographic examination in the outpatient clinic of Pediatric Endocrinology Division of Uludag University Faculty of Medicine, between January 2000 and December 2005. Data of the patient were collected retrospectively from the files/records of the patients. Goiter grades of the patients were determined according to that recommended by WHO. Thyroid volumes were calculated from the ultrasonographic measurement of thyroid dimensions. Patients with euthyroid or hypothyroid goiter had L-thyroxine therapy and those with hyperthyroidism had propiltiourasil and/or propranolol. Results: Of all children, 80 (69%) were girls and the remaining 36 were boys (31%). At the time of initial diagnosis, the mean ages of the girls and the boys were 10.1±2.9 years and 9.02± years, respectively. The mean followup period was 3.18±1.83 years. Most children (76.7%) had grade Ib (38.8%) or II (37.9%) goiter at the time of diagnosis. Of all children with goiter, 62 (53.4%) were euthyroid, 47 (40.5%) were hypothyroid and 7 (6.0%) were hyperthyroid. Seventy nine (68.1%) patients had history of thyroid disease in their families. There were additional endocrinological disturbances, epilepsy and other systemic diseases in 11 (9.5%), 11 (9.5%) and 7 (6.0%) patients, respectively. Eighty three (71.6%) patients had simple diffuse goiter, 18 had Hashimoto thyroiditis (4 of whom also having nodules), 11 (10.4%) had isolated nodüler/multinodüler goiter, 3 (2.6%) had Graves disease and 1 (0.9%) had papillary thyroid carcinoma. Mean thyroid volume by ultrasonography was significantly decreased from 12.68±3.57 (3.4 to 35.7) ml to 9.2±3.57 (3.19 to 22.1) ml with the treatment (p<0.05). Similarly goiter grades by physical examination were also significantly decreased, with only 36.2% of the patients having grade Ib (26.7%) or grade II (9.5%) goiter after the treatment (vs. a total of 76.7% at baseline) (p<0,01). Thyroid nodules were significantly regressed in 11 of 16 patients with nodüler goiter (p<0.01). Conclusion: Since TSH (Thyroid-stimulating hormone) elevation seems to be the main driving force in the pathogenesis of thyroid enlargement, thyroxine treatment is warranted to suppress the TSH in hypothyroid and euthyroid patients. The number of hyperthyroid patients in our study is not sufficient to draw conclusions, and the pathogenesis of goiter in hyperthyroidism does not involve TSH which is already suppressed by endogenous thyroid hormones. Nevertheless, control of hyperthyroidism with antithyroid medication and appropriate introduction of thyroxine seem to remedy the goiter as well.
Description
Keywords
Guatr, Ötiroid, Çocukluk çağı, Hipotiroidizm, Hipertiroidizm, L-tiroksin, Goiter, Euthyroid, Childhood, Hypothyroidism, Hyperthyroidism, L-thyroxine
Citation
Karalı, Y. vd. (2008). "Guatrlı çocukların değerlendirilmesi ve tedavi sonuçları". Güncel Pediatri, 6(1), 10-18.