Adıyaman ilinde guatrla başvuran çocuk hastalarda etiyolojik dağılım ile klinik ve laboratuvar özellikler
Öz
Amaç: Gelişmiş ülkelerde guatrın en sık sebebi otoimmün hastalıklar iken gelişmekte olan ülkelerde en yaygın neden iyot eksikliğidir. Guatr ile başvuran olguların klinik ve laboratuvar sonuçları ile etiyolojik ve demografik özelliklerini değerlendirmeyi amaçladık.
Gereç ve Yöntem: Çalışmaya Ekim 2016 ile Ocak 2019 tarihleri arasında guatr ile başvuran 5-17 yaş arasındaki 75 hasta dahil edildi.
Bulgular: Guatrlı çocukların % 90,7'si (68) kız, % 9,3'ü (7) erkek idi ve guatr oranı kızlarda 9,7 kat daha yüksek bulundu. Etiyoloji açısından 43 hastaya (% 57,3) iyot eksikliği, 25 hastaya (% 33,3) Hashimoto tiroiditi (HT), 5 hastaya Graves hastalığı (% 6,7) ve 2 hastaya (% 2,7) Tiroid hormon direnci (THD) tanısı konuldu. İyot eksikliği olan olgularda ortalama yaş 13,7 ± 2,1 yıl, HT grubunda 13,7 ± 2,7 yıl, Graves hastalarında 14,3 ± 1,4 yıl ve THD'li hastalarda 8,2 ± 2,3 yıl idi. İyot eksikliği olan hastalarda ortalama idrar iyot düzeyi en yüksek Adıyaman merkezde 45 ± 27,1 (12,10-84,13) μg/L olarak saptanırken, en düşük değer Gerger bölgesinde 16,8 ± 3,1 (14,27-20,25) μg/L idi.
Sonuç: İyot eksikliği Adıyaman ilindeki çocuklarda guatrın en sık sebebi olup bunu Graves hastalığı ve HT gibi otoimmün tiroid bezi hastalıkları izliyordu. Bu çalışma iyot eksikliğinin ilimiz genelinde yaygın bir sorun olarak devam ettiğini göstermektedir.
Anahtar Kelimeler
Kaynakça
- Rallison ML, Dobyns BM, Meikle AW, Bishop M, Lyon JL, Stevens W. Natural history of thyroid abnormalities: Prevalence, incidence, and regression of thyroid diseases in adolescents and young adults. Am J Med 1991; 91 (4): 363–70.
- Stroescu R, Bizerea T, Daniela C et al. Diagnostic approach to goiter in children. Jurnalul Pediatrului 2016; 19 (73-74): 67-70.
- WHO/UNICEF/ICCIDD: Assessment of iodine deficiency disorders and monitoring their elimination: A guide for programme managers. Third edition. Geneva: WHO; 2007: 36-7.
- Lamberg BA. Endemic goitre: iodine deficiency disorders. Ann Med 1991; 23 (4): 367-72.
- Delange F, Benoist B, Bürgi H. Determining median urinary iodine concentration that indicates adequate iodine intake at population level. Bulletin of the World Health Organization 2002; 80 (8): 633–6.
- Foley T, Malvaulx P, Blizzard R. Thyroid disease. In: Kappy MS, Blizzard RM, Migeon CJ (editors), The diagnosis and treatment of endocrine disorders in childhood and adolescence. 4th ed. Springfield, IL: Charles C Thomas 1994; 457–533.
- Mincer DL, Jialal I. Hashimoto Thyroiditis. [Updated 2019 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459262/
- Metso S, Jaatinen P, Salmi J. Graves' disease. N Engl J Med 2008; 359 (13): 1408–9.
- Weiss RE, Weinberg M, Refetoff S. Identical mutations in unrelated families with generalized resistance to thyroid hormone occur in cytosine-guanine-rich areas of the thyroid hormone receptor β gene. Analysis of 15 families. J Clin Invest 1993; 91 (6): 2408–15.
- WHO, UNICEF-ICCIDD. Indicators for assessing Iodine Deficiency Disorders and their control through salt iodization. WHO/NUT/94.6. Geneva: WHO, 1994: 1-55.
- Ogden CL, Flegal KM. Changes in terminology for childhood overweight and obesity. Natl Health Stat Reports 2010; 25 (25): 1-5.
- Koloğlu S, Koloğlu B. Türkiye’de endemik guatr. Su ve gıda maddeleri ile vücuda giren günlük iyot miktarı. Ank Üni Tıp Fak Mecm 1966; 19: 572-85.
- Urgancıoğlu İ, Hatemi H, Uslu İ. Endemik guatr taramalarının değerlendirilmesi. Klinik Gelişim. 1987; 1: 36-8. 90 Ege Journal of Medicine / Ege Tıp Dergisi
- Erdoğan G, Erdoğan MF, Emral R et al. Iodine status and goiter prevalance in Turkey before mandatory iodization. J Endocrinol Invest 2002; 25 (3): 224-8.
- Erdoğan MF. The Iodine Status of Turkey: Where Were We? Where are We Now? Turkiye Klinikleri J Endocrin-Special Topics 2008; 1 (3): 8-13.
- Ozkan B, Olgun H, Ceviz N et al. Assessment of goiter prevalence, iodine status and thyroid functions in school-age children of rural Yusufeli district in eastern Turkey. Turk J Pediatr 2004; 46 (1): 16-21.
- Malboosbaf R, Hosseinpanah F, Mojarrad M, Jambarsang S, Azizi F. Relationship between goiter and gender: a systematic review and meta-analysis. Endocrine. 2013; 43 (3): 539-47.
- Workie SB, Abebe YG, Gelaye AA, Mekonen TC. Assessing the status of iodine deficiency disorder (IDD) and associated factors in Wolaita and Dawro Zones School Adolescents, southern Ethiopia. BMC Res Notes. 2017; 10 (1): 156.
- Ahmed M, Zama S, Nagarajarao V, Khan MA. Iodine deficiency in children: A comparative study in two districts of south-interior Karnataka, India. J Family Community Med. 2014; 21 (1): 48-52.
- Semiz S, Senol U, Bircan O et al. Thyroid hormone profile in children with goiter in an endemic goiter area. J Pediatr Endocrinol Metab 2001; 14 (2): 171-6.
- Benmiloud M, Chaouki ML, Gutekunst R et al. Oral iodized oil for correcting iodine deficiency: Optimal dosing and outcome indicator selection. J Clin Endocrinol Metab 1994; 79 (1): 20-4.
- Delange F, Benker G, Caron P et al. Thyroid volume and urinary iodine in European schoolchildren: standardization of values for assessment of iodine deficiency. Eur J Endocrinol 1997; 136 (2): 180-7.
- Shakya PR, Gelal B, Lal Das BK et al. Urinary iodine excretion and thyroid function status in school age children of hilly and plain regions of Eastern Nepal. BMC Res Notes 2015; 8: 374.
- Foley TP Jr, Abbassi V, Copeland KC, Draznin MB. Brief report: hypothyroidism caused by chronic autoimmune thyroiditis in very young infants. N Engl J Med 1994; 330 (7): 466-8.
- Dundar B, Boyacı A, Sarıgün Ö, Dündar N. Hashimoto thyroidits in children and adolescents: evaluation of clinical and laboratory findings. Turk Pediatri Ars 2011; 46: 318-22.
- Lorini R, Gastaldi R, Traggiai C, Perucchin PP. Hashimoto's thyroiditis. Pediatr Endocrinol Rev 2003; 1 (2): 205-11.
- Zak T, Noczyńska A, Wasikowa R, Zaleska-Dorobisz U, Golenko A. Chronic autoimmune thyroid disease in children and adolescents in the years 1999-2004 in Lower Silesia, Poland. Hormones (Athens) 2005; 4 (1): 45-8.
- Yeşilkaya E, Belen B, Bideci A et al. Kronik otoimmün tiroiditli çocuk ve ergenlerin klinik özellikleri. Gülhane Tıp Dergisi 2008; 50 (3): 147-50.
- Marković S, Kostić G, Igrutinović Z, Vuletić B. Hashimoto's thyroiditis in children and adolescents. Srp Arh Celok Lek 2008; 136 (5-6): 262–6.
- Jankauskiene J, Jarusaitiene D. The influence of juvenile Graves' ophthalmopathy on Graves' Disease course. J Ophthalmol 2017:1-5 doi: 10.1155/2017/4853905.
- Lafranchi SH, Snyder DB, Sesser DE et al. Follow-up of newborns with elevated screening T4 concentrations. J Pediatr 2003; 143 (3): 296-301.
- Refetoff S. Resistance to thyroid hormone with and without receptor gene mutations. Ann Endocrinol (Paris) 2003; 64 (1): 23-5.
The etiological distribution and clinical and laboratory characteristics of pediatric patients presenting with goiter in the province of Adıyaman
Öz
Aim: The most common cause of goiter in developed countries is autoimmune diseases, while the most common cause in developing countries is iodine deficiency. We aimed to evaluate the clinical and laboratory results and etiological and demographic characteristics of cases presenting with goiter.
Materials and Methods: Seventy-five patients aged between 5 and 17 years presenting with goiter between October 2016 and January 2019 were included in the study.
Results: 90.7% (68) of children with goiter were female and 9.3% (7) male, the rate of goiter being 9.7-fold higher among girls. In terms of etiology, 43 patients (57.3%) were diagnosed with iodine deficiency, 25 (33.3%) with Hashimoto’s thyroiditis (HT), five with Graves’ disease (6.7%), and two (2.7%) with thyroid hormone resistance (THR). Mean ages were 13.7±2.1 years in the iodine deficient cases, 13.7±2.7 in the HT group, 14.3±1.4 in the Graves’ disease patients, and 8.2±2.3 in the patients with THR. The highest mean urinary iodine level among iodine deficient patients was 45±27.1 (12.10-84.13) μg/L in Adıyaman center, while the lowest value was determined in Gerger district at 16.8±3.1 (14.27-20.25) μg/L, and 11 patients were diagnosed with mild iodine deficiency, 20 with moderate deficiency, and 12 with severe deficiency.
Conclusion: Iodine deficiency was the most common cause of goiter in children in the province of Adıyaman, followed by autoimmune thyroid gland diseases such as Graves’ disease and HT. This study shows that iodine deficiency remains still as a problem in our province.
Anahtar Kelimeler
Kaynakça
- Rallison ML, Dobyns BM, Meikle AW, Bishop M, Lyon JL, Stevens W. Natural history of thyroid abnormalities: Prevalence, incidence, and regression of thyroid diseases in adolescents and young adults. Am J Med 1991; 91 (4): 363–70.
- Stroescu R, Bizerea T, Daniela C et al. Diagnostic approach to goiter in children. Jurnalul Pediatrului 2016; 19 (73-74): 67-70.
- WHO/UNICEF/ICCIDD: Assessment of iodine deficiency disorders and monitoring their elimination: A guide for programme managers. Third edition. Geneva: WHO; 2007: 36-7.
- Lamberg BA. Endemic goitre: iodine deficiency disorders. Ann Med 1991; 23 (4): 367-72.
- Delange F, Benoist B, Bürgi H. Determining median urinary iodine concentration that indicates adequate iodine intake at population level. Bulletin of the World Health Organization 2002; 80 (8): 633–6.
- Foley T, Malvaulx P, Blizzard R. Thyroid disease. In: Kappy MS, Blizzard RM, Migeon CJ (editors), The diagnosis and treatment of endocrine disorders in childhood and adolescence. 4th ed. Springfield, IL: Charles C Thomas 1994; 457–533.
- Mincer DL, Jialal I. Hashimoto Thyroiditis. [Updated 2019 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459262/
- Metso S, Jaatinen P, Salmi J. Graves' disease. N Engl J Med 2008; 359 (13): 1408–9.
- Weiss RE, Weinberg M, Refetoff S. Identical mutations in unrelated families with generalized resistance to thyroid hormone occur in cytosine-guanine-rich areas of the thyroid hormone receptor β gene. Analysis of 15 families. J Clin Invest 1993; 91 (6): 2408–15.
- WHO, UNICEF-ICCIDD. Indicators for assessing Iodine Deficiency Disorders and their control through salt iodization. WHO/NUT/94.6. Geneva: WHO, 1994: 1-55.
- Ogden CL, Flegal KM. Changes in terminology for childhood overweight and obesity. Natl Health Stat Reports 2010; 25 (25): 1-5.
- Koloğlu S, Koloğlu B. Türkiye’de endemik guatr. Su ve gıda maddeleri ile vücuda giren günlük iyot miktarı. Ank Üni Tıp Fak Mecm 1966; 19: 572-85.
- Urgancıoğlu İ, Hatemi H, Uslu İ. Endemik guatr taramalarının değerlendirilmesi. Klinik Gelişim. 1987; 1: 36-8. 90 Ege Journal of Medicine / Ege Tıp Dergisi
- Erdoğan G, Erdoğan MF, Emral R et al. Iodine status and goiter prevalance in Turkey before mandatory iodization. J Endocrinol Invest 2002; 25 (3): 224-8.
- Erdoğan MF. The Iodine Status of Turkey: Where Were We? Where are We Now? Turkiye Klinikleri J Endocrin-Special Topics 2008; 1 (3): 8-13.
- Ozkan B, Olgun H, Ceviz N et al. Assessment of goiter prevalence, iodine status and thyroid functions in school-age children of rural Yusufeli district in eastern Turkey. Turk J Pediatr 2004; 46 (1): 16-21.
- Malboosbaf R, Hosseinpanah F, Mojarrad M, Jambarsang S, Azizi F. Relationship between goiter and gender: a systematic review and meta-analysis. Endocrine. 2013; 43 (3): 539-47.
- Workie SB, Abebe YG, Gelaye AA, Mekonen TC. Assessing the status of iodine deficiency disorder (IDD) and associated factors in Wolaita and Dawro Zones School Adolescents, southern Ethiopia. BMC Res Notes. 2017; 10 (1): 156.
- Ahmed M, Zama S, Nagarajarao V, Khan MA. Iodine deficiency in children: A comparative study in two districts of south-interior Karnataka, India. J Family Community Med. 2014; 21 (1): 48-52.
- Semiz S, Senol U, Bircan O et al. Thyroid hormone profile in children with goiter in an endemic goiter area. J Pediatr Endocrinol Metab 2001; 14 (2): 171-6.
- Benmiloud M, Chaouki ML, Gutekunst R et al. Oral iodized oil for correcting iodine deficiency: Optimal dosing and outcome indicator selection. J Clin Endocrinol Metab 1994; 79 (1): 20-4.
- Delange F, Benker G, Caron P et al. Thyroid volume and urinary iodine in European schoolchildren: standardization of values for assessment of iodine deficiency. Eur J Endocrinol 1997; 136 (2): 180-7.
- Shakya PR, Gelal B, Lal Das BK et al. Urinary iodine excretion and thyroid function status in school age children of hilly and plain regions of Eastern Nepal. BMC Res Notes 2015; 8: 374.
- Foley TP Jr, Abbassi V, Copeland KC, Draznin MB. Brief report: hypothyroidism caused by chronic autoimmune thyroiditis in very young infants. N Engl J Med 1994; 330 (7): 466-8.
- Dundar B, Boyacı A, Sarıgün Ö, Dündar N. Hashimoto thyroidits in children and adolescents: evaluation of clinical and laboratory findings. Turk Pediatri Ars 2011; 46: 318-22.
- Lorini R, Gastaldi R, Traggiai C, Perucchin PP. Hashimoto's thyroiditis. Pediatr Endocrinol Rev 2003; 1 (2): 205-11.
- Zak T, Noczyńska A, Wasikowa R, Zaleska-Dorobisz U, Golenko A. Chronic autoimmune thyroid disease in children and adolescents in the years 1999-2004 in Lower Silesia, Poland. Hormones (Athens) 2005; 4 (1): 45-8.
- Yeşilkaya E, Belen B, Bideci A et al. Kronik otoimmün tiroiditli çocuk ve ergenlerin klinik özellikleri. Gülhane Tıp Dergisi 2008; 50 (3): 147-50.
- Marković S, Kostić G, Igrutinović Z, Vuletić B. Hashimoto's thyroiditis in children and adolescents. Srp Arh Celok Lek 2008; 136 (5-6): 262–6.
- Jankauskiene J, Jarusaitiene D. The influence of juvenile Graves' ophthalmopathy on Graves' Disease course. J Ophthalmol 2017:1-5 doi: 10.1155/2017/4853905.
- Lafranchi SH, Snyder DB, Sesser DE et al. Follow-up of newborns with elevated screening T4 concentrations. J Pediatr 2003; 143 (3): 296-301.
- Refetoff S. Resistance to thyroid hormone with and without receptor gene mutations. Ann Endocrinol (Paris) 2003; 64 (1): 23-5.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2020 |
| Gönderilme Tarihi | 7 Haziran 2019 |
| Yayımlandığı Sayı | Yıl 2020 |