Zeren BARIŞ, Oya BALCI SEZEN, Figen ÖZÇAY

AKUT KARACİĞER YETMEZLİĞİ OLAN ÇOCUKLARDA TİROİD HORMONLARININ VE HASTALIĞIN SEYRİ İLE İLİŞKİSİNİN DEĞERLENDİRİLMESİ

Giriş: Çalışmamızda akut karaciğer yetmezliği ile başvuran çocuk hastalarda TSH, serbest T4 ve serbest T3 düzeylerinin hastalık seyrini belirlemedeki etkilerini inceledik. Gereç ve Yöntemler: Çalışmaya hastanemize 2000-2017 yılları arasında akut karaciğer yetmezliği ile başvuran 108 hasta içerisinden, başvuru sırasında tiroid hormonları bakılmış olan 39 hasta alındı. Bu hastaların geriye dönük olarak klinik ve laboratuvar bulguları değerlendirilerek, başvuru sırasındaki tiroid hormonları ile hastalığın seyri arasındaki ilişki incelendi. Bulgular: TSH düzeyleri hastaların 29/39’unda (%74,4) normalden düşük, serbest T3 düzeyleri 27/29 hastada (%93,1) normalden düşük saptanmıştır. Serbest T4 düzeyleri ise hastaların %69,4’sında (25/36 hasta) normal düzeylerde bulunmuştur. Hastalar, hastalığın seyrine göre, kendiliğinden düzelen hastalar (Grup 1) ile kaybedilen/nakil olan hastalar (Grup 2) olarak iki gruba ayrılmıştır. Grup 2’deki hastaların başvuru sırasında bakılan INR, total ve direk bilirubin düzeyleri ve PELD skorları grup 1’deki hastalara göre istatistiksel olarak anlamlı şekilde yüksek bulunmuştur (sırasıyla p=0,022, p<0,0001, p=0,003, p=0,004). TSH düzeylerinin ensefalopati evresi ve hemoglobin düzeyi arttıkça azaldığı (sırasıyla p=0,003, r=-0,464 ve p=0,046, r=-0,367), sT4 düzeylerinin ise serum albümin düzeyi arttıkça arttığı (p=0,005, r=0,459) saptanmıştır. Tartışma: Akut karaciğer yetmezliğinde, serum TSH ve sT3 düzeyleri baskılanmaktadır. Serum TSH düzeyleri ensefalopati evresi ve hemoglobin düzeyi arttıkça azalmakta, sT4 düzeyleri ise serum albümin düzeyi arttıkça artmaktadır.

Anahtar Kelimeler:

akut karaciğer hastalığı, tiroid hormonları

EVALUATION of THE RELATIONSHIP BETWEEN THYROID FUNCTIONS and DISEASE OUTCOME in CHILDREN WITH ACUTE LIVER FAILURE

Objective: We investigated if serum TSH, free T4 and free T3 could be prognostic factors in patients with acute liver failure.Materials and Methods: There were 39 out of 108 children with acute liver failure who applied to our hospital between 2000-2017 and whose thyroid function tests were measured at the time of arrival. We retrospectively collected the clinical and laboratory parameters of these 39 patients, and evaluated the relationship between thyroid hormones and prognosis of the patients.Results: TSH levels were low in 29/39 (74.4%) patients, while 27/29 (93.1%) patients had low fT3 levels. Free T4 levels were normal in 25/36 (69.4%) patients. Patients were divided into two groups according to disease course: group 1 (n=17) included patients with spontaneous resolution and group 2 (n=22) included patients who either died or underwent liver transplantation. Total and direct bilirubin levels, INR and PELD values were significantly higher in group 2 compared to the levels of group 1 (p=0.022, p<0.0001, p=0.003, p=0.004, respectively). Serum TSH levels were found to decrease with increasing levels of hemoglobin levels and with increasing stages of encephalopathy, and these correlations were statistically significant (p=0.003, r=-0.464 and p=0.046, r=-0.367, respectively). Serum free T4 levels were found to decrease significantly with decreasing levels of serum albumin levels (p=0.005, r=0.459). Conclusion: Serum TSH and free T3 levels are suppressed in pediatric patients with ALF. Serum TSH levels negatively correlates with increasing stages of encephalopathy, while fT4 levels decrease with decreasing levels of serum albümin.

Keywords:

acute liver failure, thyroid hormones,

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