Birinci basamakta tiroid disfonksiyonuna yaklaşım ve tarama

Fonksiyonel tiroid hastalıkları, birinci basamakta sıklıkla görülen endokrin hastalıklardır. Genellikle, hastaların ilk değerlendirmesini yapan ve biyokimyasal testlerini isteyen birinci basamak hekimidir. Birçok fizyolojik süreçte tiroid hormonları rol oynadığı için, tiroid disfonksiyonunda klinik bulgular ve belirtiler nonspesifiktir. Tanı için laboratuvar testleri (özellikle TSH) gereklidir. Primer hipotirodi tedavisinde levotiroksin (T4 hormonu) kullanılmaktadır ve hasta hangi ilaçla tedaviye başlamışsa onunla devam etmesi gerektiği savunulmaktadır. Türkiye’de tiroid fonksiyon anomalilerinin erken tanısı amacıyla, ailesinde tiroid hastalığı bulunanlarda ilk karşılaşmada olmak üzere 35 yaşın üzerindeki bireylere beş yılda bir TSH bakılması önerilse de semptomsuz hastalar ve gebe olmayanlar için tarama hala tartışmalıdır. Bu derlemede, tedavi ayrıntılı olarak anlatılmamış olup, özellikle birinci basamak hekimleri için, tiroid hastalıklarının tanısı ve taraması için yol gösterici olması hedeflenmiştir.

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