Hipertiroidi olgularının retrospektif olarak değerlendirilmesi
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Dosyalar
Tarih
2013
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Hipertiroidizm nispeten sık rastlanan bir hastalıktır. Genel olarak kadınları daha sık etkilediği bilinmektedir. Bu çalışmada; 2002 ile 2011 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Endokrinoloji polikliniğinde hipertiroidi tanısıyla takipli 243 hastayı kapsayan retrospektif bir inceleme planladık ve tanı ve tedavi süreci parametrelerini değerlendirdik. Yapılan bu incelemede; hastaların 174 tanesinin (% 72) kadın, 69 tanesinin ise (% 28) erkek; hastaların yaş ortalamasının 42,5 ±14,8 olduğunu tespit ettik. En sık etyolojik nedenlerin sırasıyla Graves, toksik nodül, toksik multinodüler guatr ve tiroidit olduğunu; en sık iki nedenden Graves'in daha çok genç yaştaki hastalarda toksik nodülün ise daha çok yaşlılarda gözüktüğünü belirledik. Hastaların sıklıkla çarpıntı, kilo kaybı, terleme, ellerde titreme ve sinirlilik şikayetleri ile başvurduğunu ve yapılan fizik muayenede guatr, egzoftalmi ve palpabl nodülün en sık bulgular olduğunu tespit ettik. Hipertiroidi tanılı hastaların % 27,7'sinde anemi; % 10'unda alanin aminotransferaz, % 15,9'unda aspartat aminotransferaz yüksekliği tespit ettik ve anemi ve hepatotoksisitenin hipertiroidiye bağlı olabilecek pek de nadir olmayan klinik durumlar olduğunu dolayısıyla hastaların bu açıdan mutlaka incelenmesi gerektiği kanaatine vardık. Graves Hastalığı tanısında önemli yer tutan egzoftalmusun Graves'li hastalarımızın % 16,9'unda; antitiroglobulinin % 36,6'sında; antitiroid peroksidazın % 56,2'sinde; tiroid stimülan hormon reseptör antikorunun ise % 50,9'unda saptandığını belirledik. Her ne kadar yüksek değerler elde edilmemiş olsa da yine de bakılan bu parametrelerin graves ayırıcı tanısında değerli olduğunu düşünmekteyiz. Hastalarımızın en yaygın olarak medikal tedavi aldıklarını; bu tedavi seçeneğinden propiltiyourasil kullananların % 6,3'ünde, metimazol kullananların % 2,5'inde yan etki geliştiğini ve ilaç değişimine gidildiğini tespit ettik. Cerrahi tedavi alanların % 77,6'sında, radyoaktif iyot tedavisi alanların ise % 71,4'ünde tedavi sonrası hipotiroidizm görüldüğünü belirledik. Cerrahi tedavi alanların patoloji sonuçlarını incelediğimizde % 88,5'inin benign, % 11,5'inin malign olarak rapor edildiğini saptadık. Nodül saptamada ultrasonografi ve sintigrafiyi karşılaştırdığımızda; ultrasonografinin sensitivitesi % 91,3, spesifitesi ise % 72 olarak; sintigrafinin sensitivitesi % 69,1, spesifitesi ise % 92,3 olarak bulunmuştur. Sonuçta nodül tespit etmede ultrasonografinin duyarlılığının sintigrafinin ise özgüllüğünün daha yüksek olduğu sonucuna vardık. Tüm incelemelerimiz sonucunda hipertiroididen şüphelenilen her hastada dikkatli anamnez, fizik muayene, laboratuar testleri ve görüntüleme yöntemleri ile tanı konup ayırıcı tanı yapılarak tedavi seçeneğinin belirlenmesinin ve hastaların düzenli takibi yapılarak oluşabilecek komplikasyonların önüne geçilmesinin önemli olduğu sonucuna vardık. Ayrıca bu düzenli takiple tedavi kalitesinde de artış olacağı düşüncesindeyiz.
Abstract
Hyperthyroidism is not an uncommon disease frequent in women. In this retrospective study, we have collected data of 243 hyperthyroidism patients? diagnostic and therapeutic parameters, admitted to endocrinology outpatient clinics of Trakya University Medical Faculty in between 2002 and 2011. The mean patients age was 42.5 ±14.8 years whom 174 were women (72 %) and 69 were men (28 %). The most frequent diagnosis were Graves? Disease, toxic nodule, toxic multinodular goiter and thyroiditis; diagnosis of Graves were common in younger and toxic nodule were common in elder patients. Patients? most frequent symptoms were palpitation, weight loss, diaphoresis, tremor and nervousness. Goiter, exophthalmos and palpable nodules were most common findings in physical examination. Notable laboratory findings were anemia in 27.7 %, elevation of enzyme alanine aminotransferase in 10 % and aspartate aminotransferase in 15.9 % of patients. Liver enzyme elevations and hepatotoxicity were not infrequent and shouldn?t be ignored in hyperthyroidism patients. Subgroup analysis of Graves? disease patients? records revealed that expected common findings; exophthalmos was present in 16.9 %, anti-thyroglobulin antibody positivity was present in 36.6 %, anti-thyroperoxidase antibody positivity was present in 56.2 %, and thyrotropin receptor antibody positivity was present in 50.9 % of patients. On the other hand, our findings of these levels and percentages were not expectedly high and convenient with classical knowledge. Treatment option analysis showed that medical therapy had priority. Preceding therapeutic option were switched due to adverse reactions, observed in 6.3 % of patients prescribed in propylthyouracil and 2.5 % of patients prescribed in methimazole treatment. Inadvertent hypothyroidism was a common complication in patients both treated surgically 77.6 % and treated with radioactive iodine 71.4 %. Pathologic examinations of thyroid tissues which were extracted surgically revealed that 88.5 % were benign and 11.5 % were malign lesions. Comparison of thyroid ultrasonography and thyroid scintigraphy in respect of determination of thyroid nodules showed that; ultrasonography had sensitivity of 91.3 % and specificity of 72 %, in addition, scintigraphy had sensitivity of 69.1 % and specificity of 92.3 %. Concluded that; ultrasonography was more sensitive and otherwise scintigraphy was more specific in case of thyroid nodule determination. Results of this retrospective and descriptive study showed us that; a careful foremathed detailed medical history and physical examination, succeeded with definitive laboratory examinations and radio-diagnostic procedures, so after, evaluation of differential diagnosis leading to definitive diagnosis, than defining the utmost convenient therapeutic option and a close follow up for prevention of possible complications and adverse reactions related to therapy, should be un-overlooked main streams in approach to a patient with suspected hyperthyroidism, for liability of patients? treatment quality.
Abstract
Hyperthyroidism is not an uncommon disease frequent in women. In this retrospective study, we have collected data of 243 hyperthyroidism patients? diagnostic and therapeutic parameters, admitted to endocrinology outpatient clinics of Trakya University Medical Faculty in between 2002 and 2011. The mean patients age was 42.5 ±14.8 years whom 174 were women (72 %) and 69 were men (28 %). The most frequent diagnosis were Graves? Disease, toxic nodule, toxic multinodular goiter and thyroiditis; diagnosis of Graves were common in younger and toxic nodule were common in elder patients. Patients? most frequent symptoms were palpitation, weight loss, diaphoresis, tremor and nervousness. Goiter, exophthalmos and palpable nodules were most common findings in physical examination. Notable laboratory findings were anemia in 27.7 %, elevation of enzyme alanine aminotransferase in 10 % and aspartate aminotransferase in 15.9 % of patients. Liver enzyme elevations and hepatotoxicity were not infrequent and shouldn?t be ignored in hyperthyroidism patients. Subgroup analysis of Graves? disease patients? records revealed that expected common findings; exophthalmos was present in 16.9 %, anti-thyroglobulin antibody positivity was present in 36.6 %, anti-thyroperoxidase antibody positivity was present in 56.2 %, and thyrotropin receptor antibody positivity was present in 50.9 % of patients. On the other hand, our findings of these levels and percentages were not expectedly high and convenient with classical knowledge. Treatment option analysis showed that medical therapy had priority. Preceding therapeutic option were switched due to adverse reactions, observed in 6.3 % of patients prescribed in propylthyouracil and 2.5 % of patients prescribed in methimazole treatment. Inadvertent hypothyroidism was a common complication in patients both treated surgically 77.6 % and treated with radioactive iodine 71.4 %. Pathologic examinations of thyroid tissues which were extracted surgically revealed that 88.5 % were benign and 11.5 % were malign lesions. Comparison of thyroid ultrasonography and thyroid scintigraphy in respect of determination of thyroid nodules showed that; ultrasonography had sensitivity of 91.3 % and specificity of 72 %, in addition, scintigraphy had sensitivity of 69.1 % and specificity of 92.3 %. Concluded that; ultrasonography was more sensitive and otherwise scintigraphy was more specific in case of thyroid nodule determination. Results of this retrospective and descriptive study showed us that; a careful foremathed detailed medical history and physical examination, succeeded with definitive laboratory examinations and radio-diagnostic procedures, so after, evaluation of differential diagnosis leading to definitive diagnosis, than defining the utmost convenient therapeutic option and a close follow up for prevention of possible complications and adverse reactions related to therapy, should be un-overlooked main streams in approach to a patient with suspected hyperthyroidism, for liability of patients? treatment quality.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Tiroid Stimülan Hormon Reseptör Antikoru, Tiroid Nodülü, Hipertiroidi, Graves, Thyroid Nodule, Thyrotropin Receptor Antibody Disease, Hyperthyroidism, Graves
