Supklink Hipotiroidili obez Çocuklarda Miyokardiyal Fonksiyonlar

Amaç: Obez çocuklarda sıklıkla normal tiroid hormon seviyelerine izole tiroid stimulan hormon (TSH) yüksekliği eşlik eder. Bu durum izole hipertirotropinemi veya subklinik hipotiroidi (SKH) olarak adlandırılır ve çoğu zaman obezitenin bir sonucudur. Çalışmamızın amacı; çocukluk çağı obezitesinde SKHnin miyokard fonksiyonlarını etkileyip etkilemediğini değerlendirmektir. Materyal ve Metot: Çalışmaya obez olup TSH seviyeleri normal olan 70 olgu ve obez olup SKHsi olan 38 çocuk ve ergen alınmış olup her iki gruptaki olguların tümüne miyokard fonksiyonlarını değerlendirmek amacıyla Doppler ekokardiyografi uygulanmıştır. Bulgular: Global sistolik fonksiyon, ejeksiyon fraksiyonu (EF) ile değerlendirildi ve gruplar arasında karşılaştırıldı. Sağ ventrikül global sistolik fonksiyonu ve basıncı anlamlı olarak SKH grubunda azaldı. SKH grubunda, mitral anülüsün septal ve lateral bölümlerinden elde edilen pik sistolik esneme mesafesi diğer gruba göre anlamlı azalma gösterdi (12,9±1,39 mm ve 14,1±1,33 mm; p=0,002 ve p=0,004). Benzer şekilde SKH grubunda doku Doppler görüntüleme (DDG) ile pik sistolik hareketin azaldığı gösterildi (9,6±1,8 cm/s ve 11,5± 1,7 cm/sn; p=0,03). Ayrıca SKH grubunda sol ventrikülün hem sistolik hem diyastolik fonksiyonlarda önemli değişiklikler gözlendi. Sonuçlar: Bu sonuçlar, SKHli obez çocuklarda kardiyak fonksiyonların olası tutulumunu göstermektedir. Çocuklarda obezite ilişkili SKHnin kardiyovasküler sonuçlarına dikkat çekilmesi pediatrik endokrinologların bu tip hastalara klinik yaklaşımlarını etkileyebilir.

(Myocardial functions in subclinical hypothyroidic obese children)

Background: Isolated thyroid stimulant hormone (TSH) elevation often go with normal thyroid hormone levels in childhood obesity. This situation is called isolated hyperthyrotropinemi or subclinical hypothyroidism (SCH) and it is often a result of obesity. Aim of this study is to evaluate whether SCH affects myocardial function in childhood obesity. Material and Methods: 70 obese patients with normal TSH levels and 38 obese patients (childs and adults) with were was included in this study. Doppler echocardiography was performed in order to evaluate myocardial function to all cases in both groups. Results: Global systolic function was evaluated with, ejection fraction (EF) and compared between groups. Right ventricular global systolic function and pressure were significantly decreased in SCH group. Peak systolic stretching distance which obtained from septal and lateral parts of mitral annulus showed a significant decrease in SCH group compared to the other group (12,9±1,39 mm vs 14,1±1,33 mm; p=0.002 ve p= 0.004). Similarly, tissue Doppler imaging (TDI) and peak systolic movement were decreased in SCH group (9,6±1,8 cm/s vs 11,5±1,7 cm/sn; p=0.03). In addition, significant changes were observed in both systolic and diastolic functions in the left ventricle in SCH group. Conclusions: These results suggest the possible involvement of cardiac functions in obese children with SCH. Drawing attention to the cardiovascular results of obesity associated SCH in children may affect the clinical approach of pediatric endocrinologists to this type of patients.

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