Ahmet ANIK, Ece BÖBER, Erdem ŞİMŞEK, Ayhan ABACI, Hale TUHAN, Özden ANAL, Sakine IŞIK

Hashimoto tiroiditi tanılı çocuk ve ergenlerde çölyak hastalığı

Amaç: Bu çalışmamızda, hashimoto tiroiditi tanısı ile izlenen çocuklardaki klinik ve laboratuvar bulguların değerlendirilmesi ve çölyak hastalığı sıklığının araştırılması amaçlanmıştır. Gereç ve Yöntemler: Kliniğimizde yaşları 6-17,9 arasında değişen, hashimoto tiroiditi tanısı ile izlenen 80 olgunun verileri geriye yönelik incelendi. Olguların yaş, cinsiyet, başvuru yakınması, ailede tiroid hastalığı öyküsü, klinik ve laboratuvar bulguları kaydedildi. Tirotropin, serbest tiroksin düzeyleri, tiroid otoantikorları (anti-tiroglobulin ve anti-peroksidaz), doku transglutaminaz immünglobülin A (dTG-IgA), serum IgA düzeyleri ve tiroid ultrasonografileri kaydedildi. Bulgular: Çalışmaya, 65'i (%81,2) kız, 15'i (%18,8) erkek olmak üzere 80 olgu alındı. Olguların 38'inin (%47,5) ailesinde tiroid hastalığı öyküsü vardı. En sık başvuru yakınması boyunda şişlik (%30) ve ağırlık artışıydı (%25). Tanı anında, olguların %53,8'inde (n=43) ötiroidizm, %28,7'sinde (n=23) subklinik hipotiroidizm, %17,5'inde (n=14) aşikâr hipotiroidizm saptandı. Fizik bakısında, 37 (%46,2) olguda guatr olduğu saptandı. Çalışmaya alınan olguların sadece birinde (%1,25) hashimoto tiroiditi tanısı aldıktan sonra klinik izleminde dTg-IgA pozitifliği belirlendi ve bu olgunun ince bağırsak biyopsisinde villus atrofisi, kript hiperplazisi ve intraepitelyal lenfosit sayısında artış saptandı ve çölyak hastalığı tanısı doğrulandı. Çıkarımlar: Çalışmamızda hashimoto tiroiditi tanılı olguların en sık başvuru yakınmasının guatr, güçsüzlük ve kilo artışı olduğu ve çölyak hastalığı sıklığının %1,25 (1/80) olduğu saptanmıştır. Bu çalışma, hashimoto tiroiditi tanısı ile izlenen hastalarda çölyak hastalığı sıklığının sağlıklı çocuk toplumuna göre daha yüksek olduğunu göstermiştir.

Celiac disease in children and adolescents with Hashimoto Thyroiditis

Aim: The aim of this study was to evaluate clinical and laboratory findings and determine the prevalence of celiac disease (CD) in children with Hashimoto thyroiditis (HT).Material and Methods: The data of a total of 80 patients with positive anti-thyroid antibodies who were aged between 6 and 17.9 years were retrospectively studied. Age, gender, complaints at the time of presentation, family history of thyroid disorders, clinical and laboratory findings were recorded. The levels of thyrotropin, free thyroxin, thyroid autoantibodies (thyroid peroxidase and thyroglobulin antibodies), immunoglobulin A (IgA), anti-tissue transglutaminase antibodies (IgAtTG), and thyroid ultrasonography findings were enrolled. Results: Eighty patients (65 females (81.2%) and 15 males (18,8%)) were included in the study. Family history of thyroid disease was present in 38 (47.5%) patients. The most common complaints at the time of presentation were goiter (%30) and weight gain (%25). Forty three (53.8%), 23 (28.7%), and 14 (17.5%) patients presented with euthyroidism, subclinical hypothyroidism and obvious hypothyroidism. Thirty seven (46.2%) patients had goiter. IgA-tTG was found to be positive after a diagnosis of HT was made in only one patient (1.25%) and the diagnosis of CD was confirmed when intestinal biopsy of this patient revealed villus atrophy, crypt hyperplasia and increase in the intraepithelial lymphocyte count. Conclusions: In our study, it was found that the most common complaints at presentation in patients with a diagnosis of hashimoto thyroiditis included goiter, weakness and weight gain and the prevalence of celiac diseases was found to be 1.25% (1/80). This study shows that the prevalence of CD in patients with a diagnosis of HT is higher compared to the prevalence in the healthy pediatric population.

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