Subakut tiroidit tanılı hastaların demografik özellikleri ve laboratuvar verilerinin analizi: tek merkez deneyimi
Öz
Amaç: Tiroid bezinin inflamatuvar bir hastalığı
olan subakut tiroidit tirotoksikozların nadir bir nedenidir. Çalışmamızda endokrinoloji
polikliniğimize başvurup subakut tiroidit tanısı alan hastaları retrospektif
olarak inceleyip bu hastalarda tanı koymada yeni ipuçlarını araştırmayı amaçladık.
Gereç ve Yöntem: 2010–2014 yılları
arasında polikliniğimize başvurup subakut tiroidit tanısı alan 50 hasta ile
tiroid bezi ile ilgili herhangi bir patolojisi olmayan, kontrol amaçlı
polikliniğe başvuran 50 sağlıklı kişi olmak üzere toplam 100 kişi çalışmaya
dahil edildi. Hasta verileri
retrospektif olarak incelendi.
Bulgular: Subakut tiroiditli hastaların yaş
ortalaması 39.9±12.2 yıl olup %72’si (n:36) kadındı. Hastaların %42’si
sonbahar, %26’sı ilkbahar, %20’si yaz ve %12’si kış mevsiminde tanı almışlardı.
Sedimantasyon hızı ve CRP hasta grubunda anlamlı olarak yüksek bulundu
(sırasıyla; 53.7±14.22 mm/saat, 7.07±5.64 mg/dl, p<0.01). Lökosit sayısı,
nötrofil sayısı, nötrofil/lenfosit oranı ve T4/T3 oranı hasta grupta anlamlı
olarak yüksek bulunurken lenfosit sayısı arasında anlamlı fark saptanmadı.
Ortalama trombosit hacmi (MPV) kontrol grubuna kıyasla hasta grupta anlamlı
olarak düşük saptandı (p<0.01). Tiroid otoantikorları açısından yapılan
değerlendirmede anti tiroglobulin (Anti Tg) pozitifliği hasta grupta anlamlı
olarak yüksek bulundu (sırasıyla; %46.5 ve %12). Anti tiroid peroksidaz (Anti TPO)
pozitifliği açısından anlamlı fark bulunmadı.
Sonuç: Subakut tiroidit tanılı hastalarda Anti Tg
düzeylerinin yüksek olabileceği gözlenmiş olup, Anti Tg pozitif hastalarda
subakut tiroidit tanısı dışlanmamalıdır. Subakut tiroiditli hastalarda T4/T3
oranı ve nötrofil/lenfosit oranının artmış olduğunu, MPV düzeyinin ise düşük
olduğunu saptadık. Bu parametrelerin subakut tiroidit ile diğer
tirotoksikoz/hipertiroidi nedenleri arasında ayırıcı tanıda kullanılması için
başka çalışmalarla desteklenmesi gerekmektedir.
Anahtar Kelimeler
subakut tiroidit mevsimsel ilişki sedimantasyon anti tiroglobulin MPV.
Kaynakça
- Wondisford FE, Radovick S. Clinical Management of Thyroid Disease. 1st Edition. Philadelphia: Saunders; 2009: 191-202.
- Desailloud R, Hober D. Viruses and thyroiditis: an update. Virol J 2009; 6: 5.
- Papadakis MA, McPhee SJ. Current Medical Diagnosis & Treatment. 54th Edition. Publisher: McGraw-Hill Education / Medical; 2015: 1110.
- Pearce EN, Bogazzi F, Martino E et al. The prevalence of elevated serum Creactive protein levels in inflammatory and noninflammatory thyroid disease. Thyroid 2003; 13 (7): 643–8.
- İliçin G, Biberoğlu K, Süleymanlar G, Ünal S. İç hastalıkları. 3. Baskı. Ankara: Ayrıntı Basımevi; 2012: 1967–2023.
- Sato J, Uchida T, Komiya K, et al. Comparison of the therapeutic effects of prednisolone and nonsteroidal anti-inflammatory drugs in patients with subacute thyroiditis. Endocrine 2017; 55 (1): 209-14.
- Fatourechi V, Aniszewski JP, Fatourechi GZ, Atkinson EJ, Jacobsen SJ. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study. J Clin Endocrinol Metab 2003; 88 (5): 2100–5.
- Erdem N, Erdogan M, Ozbek M, et al. Demographic and clinical features of patients with subacute thyroiditis: results of 169 patients from a single university center in Turkey. J Endocrinol Invest 2007; 30 (7): 546–50.
- Alfadda AA, Sallam RM, Elawad GE, AlDhukair H, Alyahya MM. Subacute Thyroiditis: Clinical Presentation and Long Term Outcome. Int J Endocrinol 2014; 2014: 794943.
- Cappelli C, Pirola I, Gandossi E, Formenti AM, Agosti B, Castellano M. Ultrasound findings of subacute thyroiditis: a single institution retrospective review. Acta Radiologica 2014; 55 (4): 429–33.
- Martino E, Buratti L et al. High prevalence of subacute thyroiditis during summer season Italy. J Endocrinol Invest 1987; 10 (3): 321-3.
- Uysal AR, Çorapçıoğlu D, Çetinarslan B, ve ark. Subakut tiroiditli 28 olgunun klinik laboratuvar değerlendirmesi. Ankara Tıp Mecmuası (The journal of the faculty of medicine) 1995; 48: 469–74.
- Schmoeller D, Picarelli MM, Munhoz TP, Poli de Figueiredo CE, Staub HL. Mean Platelet Volume and Immature Platelet Fraction in Autoimmune Disorders. Front Med (Lausanne) 2017; 4: 146.
- Kaushansky K. Historical review: megakaryopoiesis and thrombopoiesis. Blood 2008; 111 (3): 981-6
- Ford HC, Toomath RJ, Carter JM, Delahunt JW, Fagerstrom JN. Mean platelet volume is increased in hyperthyroidism. Am J Hematol 1988; 27 (3): 190–3.
- Lippi G, Danese E, Montagnana M, Nouvenne A, Meschi T, Borghi L. Mean platelet volume is significantly associated with serum levels of thyroid-stimulating hormone in a cohort of older euthyroid subjects. Endocrine Res 2015; 40 (4): 227–30.
- Ren X, Meng Z, Liu M, et al. No associations exist between mean platelet volume or platelet distribution width and thyroid function in Chinese. Medicine 2016; 95 (40): e4573.
- Mortoglou A, Candiloros H. The serum triiodothyronine to thyroxine (T3/T4) ratio in various thyroid disorders and after Levothyroxine replacement therapy. Hormones 2004; 3 (2): 120–6.
- Ross DS, Burch HB, Cooper DS, et al. American Thyroid Association Guidelines for Diagnosis and Manangement of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26 (10): 1343–421.
- Omori N, Omori K, Takano K. Association of the Ultrasonographic Findings of Subacute Thyroiditis with Thyroid Pain and Laboratory Findings. Endocr J 2008; 55 (3): 583–8.
- Qari FA, Maimani AA. Subacute thyroiditis in Western Saudi Arabia. Saudi Med J 2005; 26 (4): 630–3.
Demographic characteristics of patients with subacute thyroiditis and analysis of laboratory data: single center experience
Öz
Aim: In this study, we aimed to investigate retrospectively the patients
diagnosed with subacute thyroiditis who were admitted to our endocrinology
outpatient clinic and to search for new clues in diagnosis of these patients.
Materials and Methods: Fifty patients with subacute thyroiditis and 50
patients without any thyroid disease were included in the study. Patient data
were analyzed retrospectively.
Results: The mean age of the patients with subacute thyroiditis was 39.9±12.2
years and 72% (n:36) were female. Subacute thyroiditis was diagnosed in 42% of
the patients in autumn, 26% in spring, 20% in summer and 12% in winter.
Sedimentation rate and CRP were significantly higher in the patient group
(53.7±14.22 mm/h, 7.07±5.64 mg/dl, respectively, p<0.01). Leukocyte count,
neutrophil count, neutrophil/lymphocyte ratio and T4/T3 ratio were
significantly higher in the patient group. Mean platelet volume (MPV) were
significantly lower in the patient group compared to the control group
(p<0.01). In the evaluation of thyroid autoantibodies, anti-thyroglobulin
(Anti Tg) positivity was significantly higher in the patient group (46.5% and
12%, respectively). There was no significant difference in anti-thyroid
peroxidase (Anti TPO) positivity.
Conclusion: Anti Tg levels may be elevated in patients with subacute thyroiditis.
Subacute thyroiditis should not be excluded in anti Tg positive patients. We
found that T4/T3 ratio and neutrophil/lymphocyte ratio were increased and MPV
level was low in patients with subacute thyroiditis. In order to use these
parameters in the differential diagnosis between subacute thyroiditis and other
causes of thyrotoxicosis/hyperthyroidism, should be supported by further
studies.
Anahtar Kelimeler
subacute thyroiditis seasonal association sedimentation anti-thyroglobulin MPV.
Kaynakça
- Wondisford FE, Radovick S. Clinical Management of Thyroid Disease. 1st Edition. Philadelphia: Saunders; 2009: 191-202.
- Desailloud R, Hober D. Viruses and thyroiditis: an update. Virol J 2009; 6: 5.
- Papadakis MA, McPhee SJ. Current Medical Diagnosis & Treatment. 54th Edition. Publisher: McGraw-Hill Education / Medical; 2015: 1110.
- Pearce EN, Bogazzi F, Martino E et al. The prevalence of elevated serum Creactive protein levels in inflammatory and noninflammatory thyroid disease. Thyroid 2003; 13 (7): 643–8.
- İliçin G, Biberoğlu K, Süleymanlar G, Ünal S. İç hastalıkları. 3. Baskı. Ankara: Ayrıntı Basımevi; 2012: 1967–2023.
- Sato J, Uchida T, Komiya K, et al. Comparison of the therapeutic effects of prednisolone and nonsteroidal anti-inflammatory drugs in patients with subacute thyroiditis. Endocrine 2017; 55 (1): 209-14.
- Fatourechi V, Aniszewski JP, Fatourechi GZ, Atkinson EJ, Jacobsen SJ. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study. J Clin Endocrinol Metab 2003; 88 (5): 2100–5.
- Erdem N, Erdogan M, Ozbek M, et al. Demographic and clinical features of patients with subacute thyroiditis: results of 169 patients from a single university center in Turkey. J Endocrinol Invest 2007; 30 (7): 546–50.
- Alfadda AA, Sallam RM, Elawad GE, AlDhukair H, Alyahya MM. Subacute Thyroiditis: Clinical Presentation and Long Term Outcome. Int J Endocrinol 2014; 2014: 794943.
- Cappelli C, Pirola I, Gandossi E, Formenti AM, Agosti B, Castellano M. Ultrasound findings of subacute thyroiditis: a single institution retrospective review. Acta Radiologica 2014; 55 (4): 429–33.
- Martino E, Buratti L et al. High prevalence of subacute thyroiditis during summer season Italy. J Endocrinol Invest 1987; 10 (3): 321-3.
- Uysal AR, Çorapçıoğlu D, Çetinarslan B, ve ark. Subakut tiroiditli 28 olgunun klinik laboratuvar değerlendirmesi. Ankara Tıp Mecmuası (The journal of the faculty of medicine) 1995; 48: 469–74.
- Schmoeller D, Picarelli MM, Munhoz TP, Poli de Figueiredo CE, Staub HL. Mean Platelet Volume and Immature Platelet Fraction in Autoimmune Disorders. Front Med (Lausanne) 2017; 4: 146.
- Kaushansky K. Historical review: megakaryopoiesis and thrombopoiesis. Blood 2008; 111 (3): 981-6
- Ford HC, Toomath RJ, Carter JM, Delahunt JW, Fagerstrom JN. Mean platelet volume is increased in hyperthyroidism. Am J Hematol 1988; 27 (3): 190–3.
- Lippi G, Danese E, Montagnana M, Nouvenne A, Meschi T, Borghi L. Mean platelet volume is significantly associated with serum levels of thyroid-stimulating hormone in a cohort of older euthyroid subjects. Endocrine Res 2015; 40 (4): 227–30.
- Ren X, Meng Z, Liu M, et al. No associations exist between mean platelet volume or platelet distribution width and thyroid function in Chinese. Medicine 2016; 95 (40): e4573.
- Mortoglou A, Candiloros H. The serum triiodothyronine to thyroxine (T3/T4) ratio in various thyroid disorders and after Levothyroxine replacement therapy. Hormones 2004; 3 (2): 120–6.
- Ross DS, Burch HB, Cooper DS, et al. American Thyroid Association Guidelines for Diagnosis and Manangement of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26 (10): 1343–421.
- Omori N, Omori K, Takano K. Association of the Ultrasonographic Findings of Subacute Thyroiditis with Thyroid Pain and Laboratory Findings. Endocr J 2008; 55 (3): 583–8.
- Qari FA, Maimani AA. Subacute thyroiditis in Western Saudi Arabia. Saudi Med J 2005; 26 (4): 630–3.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Eylül 2019 |
| Gönderilme Tarihi | 29 Temmuz 2019 |
| Yayımlandığı Sayı | Yıl 2019 |
Cited By
Evaluation of the Prevalence and Laboratory Test Results of Overt Thyrotoxicosis Cases
Romanian Journal of Internal Medicine
https://doi.org/10.2478/rjim-2024-0007
Can the Prognosis be Predicted in Subacute Thyroiditis?
Batı Karadeniz Tıp Dergisi
https://doi.org/10.29058/mjwbs.1221562