Yasin ÖZTÜRK, Muammer BİLİCİ, Taner BAYRAKTAROĞLU

Hashimoto Tiroiditli Olgularda TEKHARF Puanlama Sistemine Göre Kardiyovasküler Hastalık Risk Durumu

Amaç: Bu çalışmada, Hashimoto tiroidit olgularında tiroid fonksiyonları ile kardiyovasküler hastalık (KVH) riski arasındaki ilişkinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Ağustos ve Ekim 2018 tarihleri arasında Bülent Ecevit Üniversitesi Tıp Fakültesi Hastanesi İç Hastalıkları kliniğince Hashimoto tiroidit tanısıyla levotiroksin tedavisi altında takip edilmiş olan 69 hasta retrospektif olarak kalp ve damar hastalığı etiyolojik risk faktörleri ve tiroid fonksiyon değerleri açısından incelendi. Tiroid cerrahisi ve malignite öyküsü olanlar çalışmaya dahil edilmedi. KVH risk durumu TEKHARF puanlama sistemine göre düşük, orta ve yüksek risk olarak belirlendi. Olgular serum tiroid bezini uyarıcı hormon (TSH) düzeylerine göre: TSH <2,5mIU/L ve üzeri olmak üzere iki grup olarak tanımlandı. TSH düzeyleri ile KVH risk durumu arasındaki ilişki analiz edildi.Bulgular: Çalışmaya katılanların %87’si kadındı ve olguların yaş ortalaması 42,71±14,15 yıl idi. TEKHARF puanlama cetveline göre katılımcıların %65,2’si düşük, %21,7’si orta, ve %13’ü ise yüksek risk grubunda yer aldı. Serum TSH düzeyleri ile KVH risk puanları arasında korelasyon saptanmadı (p=0,420; r=0,099). TSH <2,5mIU/L olanlarda serum trigliserid düzeyleri anlamlı derecede düşük bulundu. Bununla birlikte serum LDLve HDL-kolesterol düzeyleri ile anlamlı bir ilişki yoktu (sırasıyla; p=0,685 ve p=0,247).Sonuç: Hashimoto tiroidit olgularında tiroid fonksiyonları için tedavi hedef değerlerine ulaşılması, KVH riskinin azaltılmasına katkı sağlayabilir.

Anahtar Kelimeler:

Kardiovasküler hastalık riski, TEKHARF, Hashimoto tiroidi

Cardiovascular Disease Risk of Hashimoto Thyroiditis Patients According to the TEKHARF Points System

Aim: In this study, we aimed to assess the association between thyroid functions and cardiovascular disease (CVD) risk in patients with Hashimoto thyroiditis over TEKHARF points system. Material and Methods: From August to October 2018, 69 patients attending Bülent Ecevit University Faculty of Medicine Hospital Internal diseases clinic with Hashimoto thyroiditis diagnosis receiving levothyroxine treatment were retrospectively investigated in terms of cardiovascular disease etiologic risk factors and thyroid function values. Those with thyroid surgery and malignancy history were not included in the study. CVD risk status was determined as low, moderate and high according to the TEKHARF points system. According to serum thyroid gland stimulating hormone (TSH) levels, two groups were defined as those <2.5 mIU/L TSH and those above. The correlation between TSH levels and CVD risk status was analyzed.Results: Of those participating in the study 87% were female and the mean age of patients was 42.71±14.15 years. According to the TEKHARF points scale, 65.2% of participants were in the low risk group, 21.7% were in the moderate risk group and 13% were in the high risk group. There was no correlation identified between serum TSH levels and CVD risk points (p=0.420; r=0.099). The serum triglyceride levels of those with TSH <2.5 mIU/L were found to be significantly low. Additionally, there was no significant correlation between serum LDL and HDL cholesterol levels (p=0.685 and p=0.247, respectively).Conclusion: Achieving target TSH levels in Hashimoto thyroiditis patients may contribute to reducing the CVD risk.

Keywords:

Cardiovascular disease risk, TEKHARF, Hashimoto thyroiditis,

PDF

___

1. O’rourke K, Vander Zanden A, Shepard D, Leach-Kemon K. Cardiovascular disease worldwide, 1990-2013. JAMA. 2015;314(18):1905.
2. O’Donnell CJ, Elosua R. Cardiovascular risk factors. Insights from framingham heart study. Revista Espanola de Cardiologia (English Edition). 2008;61(3):299-310.
3. Wilson PW. Overview of established risk factors for cardiovascular disease. UpToDate, Waltham, MA. Accessed on: November; 2015.
4. Stamler J, Stamler R, Neaton JD, Wentworth D, Daviglus ML, Garside D, et al. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: Findings for 5 large cohorts of young adult and middle-aged men and women. JAMA. 1999;282(21):2012- 2018.
5. Patel SA, Winkel M, Ali MK, Narayan KV, Mehta NK. Cardiovascular mortality associated with 5 leading risk factors: National and state preventable fractions estimated from survey data. Ann Intern Med. 2015;163(4):245-253.
6. Feigin VL, Norrving B, Mensah GA. Primary prevention of cardiovascular disease through population-wide motivational strategies: Insights from using smartphones in stroke prevention. BMJ Global Health. 2017;2(2):e000306.
7. Dağıstan A, Gözüm S. Birinci basamak sağlık hizmetlerinde kardiyovasküler hastalık riskinin belirlenmesi ve yönetimi. TAF Preventive Medicine Bulletin. 2016;15(6).
8. Conroy R, Pyörälä K, Fitzgerald Ae, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovas- cular disease in Europe: the SCORE project. Eur Heart J. 2003;24(11):987-1003.
9. D’agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: The Framingham Heart Study. Circulation. 2008;117(6):743-753.
10. Onat A, Keleş İ, Çetinkaya A, Başar Ö, Yıldırım B, Erer B, et al. On yıllık TEKHARF çalışması verilerine göre Türk erişkinlerinde koroner kökenli ölüm ve olayların prevalansı yüksek. Türk Kardiyoloji Derneği Arşivi. 2001;29(1):8-19.
11. Chen WH, Chen YK, Lin CL, Yeh JH, Kao CH. Hashimoto’s thyroiditis, risk of coronary heart disease, and L-thyroxine treatment: A nationwide cohort study. J Clin Endocrinol Metab. 2015;100(1):109-114.
12. Ning Y, Cheng YJ, Liu LJ, Sara JD, Cao ZY, Zheng WP, et al. What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants. BMC Med. 2017;15(1):21.
13. McLeod DS. Autoimmune thyroid disease: A novel risk factor for atherosclerosis? Springer; 2013.
14. Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550-1562.
15. Taylor PN, Albrecht D, Scholz A, Gutierrez-Buey G, Lazarus JH, Dayan CM, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol. 2018;14(5):301- 316.
16. Taddei S, Caraccio N, Virdis A, Dardano A, Versari D, Ghiadoni L, et al. Low-grade systemic inflammation causes endothelial dysfunction in patients with Hashimoto’s thyroiditis. J Clin Endocrinol Metab. 2006;91(12):5076-5082.
17. Haentjens P, Van Meerhaeghe A, Poppe K, Velkeniers B. Subclinical thyroid dysfunction and mortality: An estimate of relative and absolute excess all-cause mortality based on time-to-event data from cohort studies. Eur J Endocrinol. 2008;159(3):329-341.
18. Singh S, Duggal J, Molnar J, Maldonado F, Barsano CP, Arora R. Impact of subclinical thyroid disorders on coronary heart disease, cardiovascular and all-cause mortality: A meta- analysis. Int J Cardiol. 2008;125(1):41-48.
19. Rizos C, Elisaf M, Liberopoulos E. Effects of thyroid dysfunction on lipid profile. Open Cardiovasc Med J. 2011;5:76-84.
20. Garg R, Aggarwal S, Kumar R, Sharma G. Association of atherosclerosis with dyslipidemia and co-morbid conditions: A descriptive study. J Nat Sci Biol Med. 2015;6(1):163-168.
21. Pearce EN. Hypothyroidism and dyslipidemia: Modern concepts and approaches. Curr Cardiol Rep. 2004;6:451-456.
22. Alves CB. Cardiovascular risk factors in patients with autoimmune thyroiditis. 2017.
23. Bouça BRP. Subclinical hypothyroidism as a cardiovascular risk factor in patients with autoimmune Thyroiditis. 2016.
24. Kuusı T, Taskınen MR, Nıkkılä EA. Lipoproteins, lipolytic enzymes, and hormonal status in hypothyroid women at different levels of substitution. J Clin Endocrinol Metab. 1988;66(1):51-56.
25. Tanis BC, Westendorp RG, Smelt AH. Effect of thyroid substitution on hypercholesterolaemia in patients with subclinical hypothyroidism: A reanalysis of intervention studies. Clin Endocrinol (Oxf). 1996;44(6):643-649.
26. Teixeira P, Reuters V, Ferreira M, Almeida C, Reis F, Melo B, et al. Treatment of subclinical hypothyroidism reduces atherogenic lipid levels in a placebo-controlled double-blind clinical trial. Horm Metab Res. 2008;40(1):50-55.