Uğur ATMACA, Uğur ATES, Bilhan SIDA, Mehmet Aral ATALAY

HİPEREMEZİS GRAVİDARUM. GERÇEK HİPERTİROİDİZM Mİ, GEÇİCİ HİPERTİROİDİZM Mİ?

Amaç: Bu çalışmanın amacı, hiperemezis gravidarum HG etiyolojisinde tiroid hormonlarının etkilerini araştırmaktır. Gereçler ve Yöntem: Mayıs 2008 - Aralık 2011 tarihleri arasında gebeliklerinin birinci trimesterinde HG tanısıyla takip edilen ve yatarak tedavi başlanan 55 hasta ile herhangi bir yakınması olmayan 64 sağlıklı gebenin serumlarında tiroid stimüle edici hormon TSH düzeyleri 3. jenerasyon enzyme linked immunosorbent assay ELISA yöntemiyle, serbest T3 sT3 ve serbest T4 sT4 düzeyleri ELISA yöntemiyle ölçülmüştür. Bulgular: HG grubunda hastaneye yatış esnasında alı- nan ortalama serum TSH düzeyi kontrol grubuna göre daha düşük, ortalama sT4 düzeyi ise daha yüksek bulundu. Her iki değer de istatistiksel olarak anlamlı idi sırasıyla p=0.020, p=0.007 . Ancak, HG grubunda tedavi öncesi ortalama serum sT3 değeri ile kontrol grubu ortalama sT3 değeri arasında istatistiksel olarak anlamlı fark bulunmadı p=0.064 . HG grubunda, tedavi öncesi ve tedavi sonrası değerler karşılaştırıldığında, sade- ce serum sT4 düzeylerindeki değişim istatistiksel olarak anlamlı bulundu p=0.019 . Bununla beraber, HG grubunda tedavi sonrası ölçülen TSH, sT3 ve sT4 değerle- ri ile kontrol grubu arasında istatistiksel olarak farklılık saptanmadı. Sonuçlar: HG tanısı konulan hastalarda, tedavi öncesi saptanan biyokimyasal hipertiroidizmin konvansiyonel destekleyici tedaviye cevap verdiği, tedavi ile hastaların hormonal değerlerinde normale dönüş olduğu belirlendi. Tiroid baskılayıcı tedaviye ihtiyaç göstermemesi, gerçek hipertiroidizmden farklı olarak ST4 yüksekliğinin ön planda olması hiperemezis gravidarumda geçici hipertiroidizmin mevcut olduğunu göstermektedir.

Anahtar Kelimeler:

Gebelik, hiperemezis gravidarum, tiroid, hormon, serbest T3, serbest T4, TSH.

HYPEREMESIS GRAVIDARUM: IS IT ACTUAL HYPERTHYROIDISM OTHERWISE TRANSIENT HYPERTHYROIDISM?

Aim: To investigate the influence of thyroid hormones in etiology of hyperemesis gravidarum HG . Materials and Method: Serum thyroid stimulating hormone TSH levels were measured via third generation enzyme-linked immunosorbent assay ELISA method, whereas free T3 sT3 and Free T4 sT4 measurements were sorted with ELISA method in 55 patients with HG and 64 control individuals in their first trimester of pregnancy between May 2008 and December 2011. Results: Mean TSH level was found to decrease and mean sT4 level was found to elevate in pre-treatment serum samples of HG group when compared to the control group. Both differences were statistically significant p=0.020 and p=0.007, respectively . However, there was not a statistical difference in mean sT3 level between pre-treatment serum samples of HG and control groups p=0.064 . When pre and post-treatment values in HG group were compared, solely the difference in serum sT4 level was found statistically significant p=0.019 . Posttreatment measurements of TSH, sT3 and sT4 in HG group were not statistically different than the control group. Conclusion: Hyperthyroidism which is demonstrated biochemically before the pre-treatment responded to conventional supportive treatment in patients diagnosed as HG. With supportive treatment hormonal profile of the patients returned to normal values. As thyroid suppressive treatment was not needed, and sT4 elevation stood out in relief apart from actual hyperthyroidism, it is demonstrated that transient hyperthyroidism was the case in patients with HG rather than the actual hyperthyroidism.

Keywords:

Pregnancy, hyperemesis gravidarum, thyroid, hormone, free T3, free T4, TSH.,

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