Çocuklarda obezite ve tiroid fonksiyon testleri ilişkisi

Amaç: Obezite tüm dünyada giderek artan sağlık sorun- larından biridir. Yağ dokusunun birçok hormon, sitokin ve kimyasalların homeostaz ve regülasyonunda önemli rolü bulunmaktadır. Obezite tüm sistemleri etkilemekte- dir ve tiroid fonksiyonları da etkilenen sistemlerden biridir. Tiroid hormonlarının adaptif termogenez ve istira- hat enerji gereksinimi üzerinde belirleyici etkileri vardır. Bu nedenle obezite ile tiroid fonksiyonları arasında belirgin bir korelasyon beklenir. Biz de çocuklarda obe- zite ile tiroid fonksiyonları arasındaki ilişkiyi incelemeyi amaçladık. Materyal ve Metot: Çalışmaya yaşları 10-17 yıl arasında değişen 138 obez olgu (72 erkek, 66 kız) ve 63 kontrol (33 erkek, 30 kız) dahil edildi. Obez gruplar vücut kitle indeksi (VKø) z- skor değerlerine göre hafif-orta ve ağır obez olmak üzere iki gruba ayrıldı. Gruplar arasında ant- ropometrik ölçümler, metabolik parametreler, serbest T3 (sT3), serbest T4 (sT4), tiroid stimulan hormon (TSH) düzeyleri değerlendirildi. Bulgular: Kontrol, hafif-orta ve ağır obez gruplarında yaş (sırasıyla; 14,2±3.8; 14,1±2,6 ve 14,2±2,2 yıl) farklı değildi (p>0,05). Ancak, gruplar arasında VKİ(sırasıyla; 20,1±1.3; 33,9±9,3; 39,4±4,0 kg/m2) açısından anlamlı fark vardı (p

(Relationship between obesity and thyroid function tests in children)

ABSTRACT Background: Obesity is a major health problem, and prevalence of obesity is increasing worldwide. Various hormones, cytokines and chemokines secreted by adipose tissue exert important roles and regulation in homeostasis. Obesity affects all systems. Thyroid function is affected by obesity. Resting energy expenditure and adaptive thermogenesis are determined by thyroid hormone. We aimed to investigate the association between obesity and thyroid function in children. Material and Methods: Anthropomorphic values and thyroid hormone levels were measured in a group of 138 obese patients (72 male, 66 female). Obese groups according to BMI z-score of mild-to-moderate and severe obesity were divided into two groups. Between the groups with anthropometric measurements, metabolic parameters, free T3, free T4, thyroid stimulating hormone (TSH) levels were measured. Results: Control, mild-to-moderate and severe obese groups (14.2±3.8, 14.1±2.6 and 14.2±2.2 years respec- tively) did not differ regarding age (p>0.05). However, BMI (20.1±1.3, 33.9±9.3, 39.4±4.0 kg/m 2, respectively) had a statistically significant difference between the two groups (p<0.05). Serum TSH levels were higher in obese than in control group (P<0.05). There was a positive correlation between BMI and TSH. However, there was not significant correlation between obesity and FT4, FT3. Multivariate regression analysis was performed between TSH and other parameters. TSH was found to be significantly associated with BMI changes in this analysis (ǃ=0.042, p=0.012). Conclusions: Obesity is associated with TSH levels which may increase independently of the thyroid function.

PDF

___

1. Şıklar Z. Çocuk ve Adolesanlarda Obezite Komplikasyonları ve Metabolik Sendrom. Türkiye Çocuk Hast Derg 2012;1:7-14.
2. Parlak A, Çetinkaya ù. Çocuklarda obezitenin oluşumunu etkileyen faktörler. Fırat Sağlık Hizmetleri Dergisi 2007;2:5. 3. WHO: Obesity Preventing And Managing The Global Epidemic. Report of WHO Technical Report Series 894. Geneva, World Health Organization, 2000.
4. Cooper DS. Subclinical Hypothyroidism. N Eng J Med 2001;345:26- 65.
5. Reinehr T, De Sousa G, Andler W. Hyperthyrotropinemia in obese children is reversible afterweight loss and is not related to lipids. J Clin Endocrinol Metab 2006;91:3088-91.
6. Naslund E, Andersson M, Degerblad P, et al. Associations of leptin, insulin resistance and thyroid function with long-term weight loss in dieting obese men. J Intern Med 2000;248:299308.
7. Tagliaferri M, Berselli ME, Calo G, et al. Subclinical hypothyroidism in obese patients: relation to resting energy expenditure, serum leptin, body composition, and lipid profile. Obes Res 2001;9:196201.
8. Roti E, Mineli R, Salvi M. Thyroid hormone metabolism in obesity. Int J Obes Relat Metab Disord 2000;24:1135.
9. Rosenbaum M, Hirsch J, Murphy E, Leibel RL. Effects of changes in body weight on carbohydrate metabolism, catecholamine excretion, and thyroid function. Am J Clin Nutr 2000;71:14212.
10. Ritz P, Dumas JF, Salle A, Simard G, Malthiery Y, Rohmer V. Thyroid hormones and obesity. Ann Endocrinol 2002;63:1359.
11. Krotkiewski M. Thyroid hormones and treatment of obesity. Int J Obes Relat Metab Disord 2000;24:1169.
12. Lloyd RV, Jin L, Tsumanuma I, Vidal S, et al. Leptin and leptin receptor in anterior pituitary function. Pituitary 2001;4: 3347.
13. Kabalak T. Obezitenin diyetle tedavisi. østanbul, Nobel Tıp Kitabevleri 1995;107-37.
14. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ 2000;320:16.
15. Sen Y, Kandemir N, Alikasifoglu A, Gonc N, Ozon A. Prevalence and risk factors of metabolic syndrome in obese children and adolescents: the role of the severity of obesity. Eur J Pediatr 2008;167:1183-9.
16. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114:555-76.
17. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, YaziciHomeostasis model assessment is more reliable than the fasting glucose/ insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics 2005; 115:5003.
18. Antunes TT, Gagnon A, Chen B, Pacini F, Smith TJ, SoriskyInterleukin-6 release from human abdominal adipose cells is regulatedthyroid-stimulating hormone: effect of adipocyte differentiation and anatomic depot. Am J Physiol Endocrinol Metab 2006;290:11404.
19. Trayhurn P. Endocrine and signalling role of adipose tissue: new perspectives on fat. Acta Physiol Scand 2005;184:28593.
20. Chikunguwo S, Brethauer S, Nirujogi V, et al. Influence of obesity and surgical weight loss on thyroid hormone levels. Surgery for Obesity and Related Diseases 2007;3:631-5.
21. Rotondi M, Leporati P, La Manna A, et al. Raised serum TSH levels in patients with morbid obesity: is it enough to diagnose subclinical hypothyroidism? Eur J Endocrinol 2009;160:403-8.
22. Bhowmick SK, Dasari G, Levens KL, Rettig KR. The PrevalenceElevated Serum Thyroid Stimulating Hormone in Childhood/Adolescent Obesity and of Autoimmune Thyroid Diseases in a Subgroup. J Nat Med Ass 2007;99:773-6.
23. Mutlu RG, Özsu E, Çizmecioğlu FM. ùişman çocuklarda hafif TSH yüksekliği: Nasıl bir sorun? Türk Ped Arş 2011;46:33-6.
24. Wilms L, Larsen J, Pedersen PL, Kvetny J. Evidencemitochondrial dysfunction in obese adolescents. Acta Paediatr 2010;99: 906-11.
25. Caroline S. Relations of Thyroid Function to Body Weight. Arch Intern Med 2008;168:587-92.
26. Ross DS. Thyroid Function and the Metabolic Syndrome. J Clin Endocrinol Metab 2007;92:491-6.
27. Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, Looker HC. Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med 2010;362:485-93.
28. Karakurt F, Çarlıoğlu A, Köroğlu M, Uz B, Kasapoğlu B. Tiroid fonksiyonları obezite için bir risk faktörü müdür? Yeni Tıp Dergisi 2009;26: 27-30.
29. Krude H, Biebermann H, Schnabel D, et al. Obesity dueproopiomelanocortin deficiency: three new cases and treatment trials with thyroid hormone and ACTH. J Clin Endocrinol Metab 2003;88:4633-40.