Tip 1 Diabetes mellitus tanılı olgularda tanı ve izlemde otoimmün tiroidit gelişiminin değerlendirilmesi
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Dosyalar
Tarih
2015
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Tip1 diyabetes mellitus insülin salgılanmasının eksikliğe bağlı olarak ortaya çıkan karbonhidrat, protein ve yağ metabolizmasında bozuklukla sonuçlanan, çocuk ve ergen yaş grubunda en sık görülen endokrin hastalıktır. Bu çalışmada Trakya Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı, Çocuk Endokrinoloji Bilim Dalı Polikliniği'de Ocak 2006 ile Eylül 2013 tarihleri arasında tip 1 diyabetes mellitus tanısı ile takip edilmiş olgularda tanı anında ve izlemde otoimmün tiroidit sıklığının saptanması, varsa otoimmün tiroidit için risk etmenlerinin belirlenmesi amaçlandı. Çalışmaya alınan 134 (63 erkek,71 kız) olgunun yaş ortalaması 11,3±4,6 desimal yıl, diyabet tanı yaşı ortalaması 8,1±3,9 desimal yıl ve diyabet süreleri 3,1±2,4 yıl idi. Olguların çoğu ilkbahar ve kış aylarında tanı almıştı ve en sık (%52,7) diyabetik ketoasidoz tablosu ile başvurmuştu. Olguların anne sütü ile beslenme ve D vitamini kullanma süreleri az, inek sütü ve unlu gıdalarla beslenmeye başlanması erkendi. Olguların tip 1 diyabetes mellitus tanısı aldıklarında ortalama glikolize hemoglobin düzeyi %12,3±2,7, C-peptid düzeyi 0,43±0,39 ng/ml, son 1 yıllık ortalama glikolize hemoglobin düzeyi ise %8,1±2,5 idi. Olguların %47,4'ünde glutamik asit dekarboksilaz antikoru, %1,7'sinde anti-insülin antikoru ve %0,9'unda adacık hücre antikoru pozitifti. Çalışmaya alınan 134 olgunun %14,2'sinde (19 olgu: 5erkek, 14 kız) otoimmün tiroidit saptandı. Bu olguların yaş ortalaması 13,9±3,6 desimal yıl, diyabet süreleri 4,2±2,9 yıl idi. Otoimmün tiroidit tanı anında olguların %68,4'ü 10-15 yaş aralığında ve %78,9'u pubertal dönemdeydi. Tüm otoimmün tiroiditli olgular tanı anında ötiroid olup, izlemde 6 olguda subklinik hipotiroidi gelişti. Otoimmün tiroiditli olgular otoimmün tiroidit gelişmeyen olgularla cinsiyet, yaş, puberte, antropometrik ölçümler, tip 1 diyabetes mellitus tanı anında klinik tablo ve laboratuvar özellikleri (glikolize hemoglobin, C-peptid, serbest tiroksin, tiroid stimülan hormon ve diyabet otoantikorları) açısından karşılaştırıldığında yaş ve puberte durumu dışında anlamlı farklılık bulunmadı. Otoimmün tiroiditi olan tip 1 diyabetes mellituslu olguların yaş ortalaması otoimmün tiroiditi olmayanlara göre daha büyük ve pubertal olan olgu sayısı daha fazlaydı. Otoimmün tiroiditli olgular tiroid antikor varlığına göre gruplandırılmasına karşın olgu sayısının yeterli olmaması nedeniyle antropometrik ölçümler ve laboratuvar bulguları açısından istatistiksel olarak değerlendirilemedi. Sonuç olarak tip 1 diyabetes mellituslu olgularda, özellikle ergenlik döneminde otoimmün tiroidit gelişme sıklığı fazladır. Otoimmün tiroiditli olgular tanı anında çoğunlukla ötiroid olmalarına karşın, izlemde tiroid disfonksiyonu gelişebileceği için yakın takip edilmeleri tedavide gecikme yaşanmaması açısından önemlidir. Bu nedenle tip 1 diyabetes mellitus olguları tiroid otoantikorları ve tiroid hormonları açısından yıllık olarak değerlendirilmelidir.
Abstract
Type 1 diabetes mellitus,is a insulin secretion deficiency which resultin disorders ofcarbonhydrate,protein and fat metabolismand it's the most common endocrine disease in children and adolescents. In this study it was aimed to evaluate the frequency of autoimmune thyroiditis and find out the possible risk factors for autoimmune thyroiditis at diagnosis and at follow up of the patients with type 1 diabetes mellitus, who were admitted to Trakya University Medical Faculty PediatricDepartment, Pediatric Endocrinology Outpatient Clinic between January 2006 and September 2013. The mean age of 134 (63 M, 71 F) cases was 11,3±4,6 decimal years, mean diagnosis age of diabetes was 8,1±3,9 decimal years and mean diabetes duration was 3,1±2,4 years. Most of the cases were diagnosed at spring and winter months, and the most common administration reason was diabetic ketoacidosis (52,7%). Duration of breastfeeding and vitamin D supplementation of the cases were short whereas cow's milk and floury food intake were early. At the diagnosis of type 1 diabetesmellitus, meanglycosylated hemoglobinlevelwas %12,3±2,7 and mean C-peptide level was 0,43±0,39 ng/ml. Lastoneyear'smeanglycosylated hemoglobinvaluewasfoundto be %8,1±2,5. Glutamic acid decarboxylase antibody, anti-insulin antibody and islet cell antibody were positive in 47,4%, 1,7% and 0,9% of the cases, respectively. Autoimmunethyroiditiswasfound in 19(5 M, 14 F) outof 134 cases (%14,2). The mean age of these cases was 13,9±3,6 decimal years and the diabetes duration was 4,2±2,9 years. At the diagnosis of autoimmune thyroiditis 68,4% of cases were between ages 10-15 years and 78,9% were in puberty. All the cases were euthyroid at diagnosis but 6 of them developed subclinical hypothyroidism during follow up. When cases with autoimmune thyroiditis were compared with the ones without autoimmune thyroiditis for the parameters such as sex, age, puberty, anthropometric measures, clinical and laboratory findings (glycated hemoglobin, C-peptide, free thyroxine, thyroid stimulating hormone and diabetes autoantibodies) at the time of diagnosis of type 1 DM, no difference was found except for age and puberty. The mean age was higher and the number of cases in puberty was more in type 1 DM cases with autoimmune thyroiditis. Although cases with autoimmune thyroiditis were classified according to thyroid antibody presence, anthropometric measures and laboratory findings could not be compared statistically because of low number of study cases. In conclusion, autoimmune thyroiditis incidence is high in type 1 DM cases, especially at puberty. At the time of diagnosis, cases with autoimmune thyroiditis are mostly euthyroid but because thyroid dysfunction may be seen in the feature, close follow up is crucial for not to delay the treatment. Therefore, type 1 DM cases should be assessed for thyroid autoantibodies and thyroid hormones annually.
Abstract
Type 1 diabetes mellitus,is a insulin secretion deficiency which resultin disorders ofcarbonhydrate,protein and fat metabolismand it's the most common endocrine disease in children and adolescents. In this study it was aimed to evaluate the frequency of autoimmune thyroiditis and find out the possible risk factors for autoimmune thyroiditis at diagnosis and at follow up of the patients with type 1 diabetes mellitus, who were admitted to Trakya University Medical Faculty PediatricDepartment, Pediatric Endocrinology Outpatient Clinic between January 2006 and September 2013. The mean age of 134 (63 M, 71 F) cases was 11,3±4,6 decimal years, mean diagnosis age of diabetes was 8,1±3,9 decimal years and mean diabetes duration was 3,1±2,4 years. Most of the cases were diagnosed at spring and winter months, and the most common administration reason was diabetic ketoacidosis (52,7%). Duration of breastfeeding and vitamin D supplementation of the cases were short whereas cow's milk and floury food intake were early. At the diagnosis of type 1 diabetesmellitus, meanglycosylated hemoglobinlevelwas %12,3±2,7 and mean C-peptide level was 0,43±0,39 ng/ml. Lastoneyear'smeanglycosylated hemoglobinvaluewasfoundto be %8,1±2,5. Glutamic acid decarboxylase antibody, anti-insulin antibody and islet cell antibody were positive in 47,4%, 1,7% and 0,9% of the cases, respectively. Autoimmunethyroiditiswasfound in 19(5 M, 14 F) outof 134 cases (%14,2). The mean age of these cases was 13,9±3,6 decimal years and the diabetes duration was 4,2±2,9 years. At the diagnosis of autoimmune thyroiditis 68,4% of cases were between ages 10-15 years and 78,9% were in puberty. All the cases were euthyroid at diagnosis but 6 of them developed subclinical hypothyroidism during follow up. When cases with autoimmune thyroiditis were compared with the ones without autoimmune thyroiditis for the parameters such as sex, age, puberty, anthropometric measures, clinical and laboratory findings (glycated hemoglobin, C-peptide, free thyroxine, thyroid stimulating hormone and diabetes autoantibodies) at the time of diagnosis of type 1 DM, no difference was found except for age and puberty. The mean age was higher and the number of cases in puberty was more in type 1 DM cases with autoimmune thyroiditis. Although cases with autoimmune thyroiditis were classified according to thyroid antibody presence, anthropometric measures and laboratory findings could not be compared statistically because of low number of study cases. In conclusion, autoimmune thyroiditis incidence is high in type 1 DM cases, especially at puberty. At the time of diagnosis, cases with autoimmune thyroiditis are mostly euthyroid but because thyroid dysfunction may be seen in the feature, close follow up is crucial for not to delay the treatment. Therefore, type 1 DM cases should be assessed for thyroid autoantibodies and thyroid hormones annually.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Otoimmün Tiroidit, Çocuk, Tip 1 Diyabetes Mellitus, Tiroid Antikorları, Autoimmune Thyroiditis, Child, Type 1 Diabetes Mellitus, Thyroid Autoantibodies
