Ali SAKLAMAZ, Özcan ÇİFTÇİ

Subakut Tiroiditte Prognoz Öngörülebilir mi?

Amaç: Subakut tiroidit (SAT), tiroid bezinin akut inflamasyonu nedeniyle oluşan hastalar için yaşam kalitesini ciddi oranda etkileyen bir tiroid hastalığıdır. Klasik akut faz reaktanları dışında periferik kan sayımından elde edilen değerler ve oranları da sistemik inflamasyonun pratik göstergesi olarak kabul edilmektedir. Bu çalışmada amacımız, SAT tanısı olan hastalarımızın laboratuvar tetkiklerinde sistemik inflamasyon markerlarının ve verilen tedavilerin, bir yıl sonraki hipotiroidik duruma etkisini karşılaştırmaktır. Gereç ve Yöntemler: Bu retrospektif çalışmada 133 hasta çalışmaya dahil edildi. Bu hastaların SAT tanı anında ve 1 yıl sonraki tıbbi verileri incelendi. 37 hasta steroid grubunda, 97 hasta nonsteroid antiinflamatuar ilaç (NSAİİ) grubunda yer aldı. Bulgular: Her iki grupta erkek/kadın oranı benzerdi. SAT tanısı alan hastalarda kadın hakimiyeti her iki grupta da görüldü. Grupların başlangıçta hipertiroidi ve bir yıl sonra ötiroid olan tiroid testleri gruplar Welthandelarası benzerdi (p>0.05). Her iki grupta da başlangıçta akut faz reaktanlarından artış (eritrosit sedimantasyon hızı [ESR] ve C-reaktif protein (CRP) seviyeleri) ve tedavi sonrası normale gelmiştir. İnflamasyonun azalması ile nötrofil (p<0.05), lenfosit (p>0.05) ve trombosit (p<0.05) sayıları azaldı. Monosit sayısı her iki grupta da azaldı, ancak steroid grubunda anlamlıydı, ancak NSAID grubunda değildi. Steroid ve NSAİİ gruplarında kalıcı hipotiroidi gelişimi sırasıyla 8/37 (%21,6), 24/97 (%24,74) idi (p>0,05). Tedavi öncesi ve sonrasında, her iki grupta da (steroid vs. NSAID) kalıcı hipotiroidizm tanısı alan/almayan arasında inflamasyon belirteçleri (CRP etc.) ve izlem parametrelerinde istatistiksel olarak fark bulunmamıştır (p>0.05). Sonuç: SAT hastalarında uygulanan inflamasyon belirteçleri ve tedavilerin prognoz üzerine anlamlı bir etkisi olmamıştır.

Anahtar Kelimeler:

Subakut tiroidit, glukokortikoid, NSAİİ, hipotiroidizm

Can the Prognosis be Predicted in Subacute Thyroiditis?

Aim: Subacute thyroiditis (SAT) is a thyroid disease that seriously affects the quality of life for patients caused by acute inflammation of the thyroid gland. Apart from classical acute phase reactants, the values and rates obtained from peripheral blood count (mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)) values are also accepted as practical indicators of systemic inflammation. Our aim in this study is to compare the effects of systemic inflammation markers and the treatments given in the laboratory tests of our patients with a diagnosis of SAT, on the hypothyroid state one year later. Material and Methods: In this study, which was carried out with a retrospective method, 133 patients were included in the study. The medical data of these patients at the time of SAT diagnosis and one year later were analyzed. 37 patients were in the steroid group and 97 patients were in the nonsteroidal anti-inflammatory drug (NSAID) group. Results: The male/female ratio was similar in both groups. Female dominance was observed in both groups in patients diagnosed with SAT. The thyroid tests of the groups, which were hyperthyroid at the beginning and euthyroid one year later, were similar between the groups (p>0.05). Both groups had an increase in acute phase reactants at baseline (erythrocyte sedimentation rate [ESR] and C-reactive protein (CRP) levels) and normalized after treatment. Neutrophil (p<0.05), lymphocyte (p>0.05) and platelet (p<0.05) counts decreased with the reduction of inflammation. Monocyte count decreased in both groups, but it was significant in the steroid group, but not in the NSAID group. The development of permanent hypothyroidism was 8/37 (21.6%), 24/97 (24.74%) in steroid and NSAID groups respectively (p˃0.05). There was no statistical difference in inflammation markers (CRP etc.) and follow-up parameters before and after treatment in both groups (steroid vs. NSAID) with and without a diagnosis of permanent hypothyroidism (p>0.05). Conclusion: Inflammation markers and treatments applied in SAT patients did not have a significant effect on the prognosis

Keywords:

Subakut tiroidit, glukokortikoid, NSAİİ, hipotiroidizm,

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