Mustafa ALTAY, Selman ÜNVERDİ, Mevlüt ÇERİ, Salih BAŞER, Mesudiye BULUT, Murat DURANAY

Yaşlı Kronik Diyaliz Hastalarında Tiroid Fonksiyon Test Anormallikleri

Amaç: Geriatrik diyaliz hastalarında tiroid hormonlarının nasıl etkilendiğine dair yeterli veri yoktur. Ayrıca bu hastalarda yaş ve hastalık süresinin tiroid fonksiyon testi anormallikleri açısından ek bir risk faktörü olup olmadığı bilinmemektedir. Bu yüzden bu çalışmada yaşlı kronik diyaliz hastalarının ve yaşlı sağlıklıların tiroid fonksiyon testlerini karşılaştırmayı amaçladık. Gereç ve Yöntemler: Kırk altı kronik diyaliz hastası (24 periton diyalizi (PD) ve 22 hemodiyaliz (HD)) ve 44 sağlıklı kontrol çalışmaya dahil edildi. Yapılan fizik muayene sonrasında hasta ve kontrol grubundan alınan açlık kan örneklerinden tiroid fonksiyon testleri çalışıldı. Diyaliz grubunda tüm hastalara tiroid stimüle edici hormon (TSH), serbest triiyodotironin (sT3) ve serbest tiroksin (sT4) çalışıldı, ancak kontrol grubunda 44 hastanın 14’ünde serbest hormon ölçümleri yapılamadı. Bulgular: Serum TSH ve sT4 düzeyleri iki grupta benzerdi, ancak sT3 düzeyleri diyaliz grubunda daha düşük bulundu (2.48 ± 0.57 ve 3.06 ± 0.90 p= 0.003). Kontrol grubunda düşük sT3 sendromu görülmezken, diyaliz hastalarının 7( % 15,2)’ sinde düşük sT3 sendromu saptandı (p=0,01). Tiroid fonksiyon test bozukluğu oranı diyaliz hastalarında daha fazla bulundu, sırayla 22 (% 47,8)’ye karşın 12 (%40) (p=0,05). Sonuçlar: Yaşlı diyaliz hastaları, sağlıklı kontrollere göre daha çok tiroid fonksiyon test anormalliklerine sahipti. Ayrıca bu hastalar, tıpkı genç ve orta yaşlı kronik diyaliz hastaları gibi, kontrol grubuna göre daha düşük sT3 düzeylerine sahipti. Bununla birlikte, bu sonuçların klinik süreçte ne anlama geldiği ve kliniğe nasıl bir yansımasının olduğu, özellikle yaşlı hastalarda henüz açık değildir. Bu konuda büyük, ileriye dönük, randomize ve kontrollü çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

diyaliz, yaşlı, serbest T3

Abnormality of thyroid function tests in geriatric population undergoing chronic dialysis

Objective: There is not enough data about how thyroid hormones were affected in geriatric dialysis patients and whether age and duration of disease could be considered as additional risk factors for the thyroid function test abnormalities. For this reason we aimed to compare thyroid function tests of elderly chronic dialysis patients and elderly healthy controls.Methods: Forty six chronic dialysis patients (24 peritoneal dialysis (PD) and 22 hemodialysis(HD)) and 44 healthy controls were taken into the study. After the physical examination, we collected patients’ and controls’ fasting blood samples and thereafter thyroid function tests were performed. In dialysis group thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (ft4) analysis of all patients were performed, but in control group free hormone levels were not studied at 14 of 44. Results: Serum TSH and fT4 levels were similar in two groups, however fT3 levels were found to be less in dialysis group ( 2.48 ± 0.57 and 3.06 ± 0.90 p= 0.003). Low fT3 syndrome was not detected in controls, but 7 (15,2%) patients have had low fT3 syndrome in dialysis patients (p=0,01). The rate of thyroid function test abnormalities were higher at dialysis patients as compared with controls, 22 (47,8%) and 12 (40 %), respectively (p=0,05).Conclusions: Elderly dialysis patients had higher thyroid function test abnormalities than controls. They had lower fT3 levels than controls such as young and middle age chronic dialysis patients. However, what does it mean for clinical process and how its clinical expression is not clearly known, especially in an elderly patients. Large, prospective, randomized and controlled trials are necessary for this topic.Key words: dialysis, elderly, free T3

Keywords:

dialysis; elderly; free T3,

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