11-18 yaş arası sağlıklı çocuklarda Hashimoto tiroidit sıklığı

Abstract

Çocuk ve ergen yaş grubunda Hashimoto tiroiditinin görülme sıklığı % 0,3 ile % 9,6 arasında değişen oranlarda bildirilmektedir. Çocuk ve ergenlerdeki ötiroid guatrların % 55-65'inden Hashimoto tiroiditi sorumlu tutulmaktadır.Bu çalışma, 2008? 2009 yılı eğitim ve öğretim döneminde, Van ili merkez ilköğretim ve lise okullarında 11 ? 18 yaş grubunda, yaş ortalaması 14.57 ± 2.33 yıl olan, 500'ü kız, 500'ü erkek toplam 1000 öğrencide Hashimoto tiroiditi sıklığının saptanması amacıyla yapılan kesitsel bir çalışmadır. Bu amaçla Van iline ait üç ilköğretim ve üç lise okulu belirlendi. Bu okullarda öğrenciler rastgele örnekleme metoduyla seçildi.Serum tiroid peroksidaz antikoru ve/veya tiroglobulin antikor pozitif olan ve ultrasonografik olarak tiroid parankimi heterojen görünümde olan tespit edilen 36 (% 3,6) vaka otoimmün tiroidit olarak kabul edildi. Vakaların 32'si (% 88,8) kız, 4'ü (% 11,2) erkek olup kız / erkek oranı 8 idi. Vakaların yaş ortalaması 15.99 ± 2,1 yıl idi. Tiroid otoantikorlarından tiroid peroksidaz antikor pozitifliği % 88 olurken, tiroglobulin antikor pozitifliği % 61 bulundu. Otoimmün tiroiditli tüm vakalar ötiroidikti. Ultrasonografik olarak altı hastada (% 16,6) tek, dört hastada (% 11,1) multipl nodül saptandı.Otoimmün tiroiditli vakaların idrarla ortalama iyot atılımı 126.54 ± 65.54 ?g/l bulundu. Otoimmün tiroidit tanısı almayan çocukların ortalama iyot atılımı ise 93.03 ± 57.61 ?g/l idi. Aradaki fark istatistiksel olarak anlamlıydı (p <0.01).Palpasyon yöntemi ile guatr tespit edilen 175 vakanın 103'ü (% 58,8) kız, 72'si (% 41,2) erkekti. Yaş ortalaması 15.84 ± 2.37 yıl, idrarla ortalama iyot atılımı 95.92 ± 70.79 ?g/l, kız/erkek oranı 1.43 idi. Guatr tespit edilen çocukların 109'unda (% 62,2) iyot eksikliği saptandı. Guatr tespit edilen vakaların 31'ine (% 17,7) otoimmün tiroidit tanısı konuldu. Guatrlı vakaların tümü ötiroidikti. Ultrasonografi ile tiroid bezi parankimi değerlendirilen hastaların % 41,2'sinde tiroid parankimi heterojen yapıda olup, 11 vakada tek nodül, beş vakada multinodüler görünüm saptandı.Otoimmün tiroidit sıklığı, çalışmaya katılan tüm vakalarda % 3,6 iken, guatrlı vakalarda % 17,7 bulundu. Sonuç olarak özellikle ergenlik çağında rutin muayene sırasında tiroid muayenesinin ihmal edilmemesi ve guatrlı vakalarda tiroid hormonlarının yanı sıra tiroid antikorlarınada bakılması gerektiği kanaatine varıldı.

The frequency of Hashimoto thyroiditis in children and adolescent has been reported between 0.3% and 9.6 %. In these age groups, Hashimoto thyroiditis is responsible for 55-65 % of euthyroid goiter.The present study was a cross sectional study, which was performed between 2008 and 2009 school year in primary and high schools located in city center of Van and included 1000 school children [500 girls, 500 boys)] whose mean age was 14.57 ± 2.33 years with the range of 11 and 18 years and in which autoimmune thyroiditis (AT)?s frequency was tried to find. First three primaries and three high schools were selected in Van region and in these schools, subjects were selected via randomization sampling method.Of all subjects, 36 (3.6 %) children were diagnosed with AT after detection of anti-TPO and/or anti-Tg positivity and paranchymal heterogenity on thyroid gland ultrasonographic examination. Of all subjects with AT, 32 (88.8 %) was girl, 4 (11.2 %) was boy (girl/boy was 8/1) and the mean age of these subjects was found to be 15.99 ± 2.1 years. In children with AT, anti-TPO positivity and anti-Tg positivity were found to be 88 % and 61 %, respectively. All patients with AT were in euthyroid state. Thyroid gland ultrasonographic examinations were performed in all patients with AT and single nodule was determined in six (16.5 %) children with AT, multiple nodules were seen in four (11.1 %) children.In children with AT, the mean iodine excretion in urine was 126.54 ± 65.54?g/L. Additionally, it was found to be as 93.03 ± 57.61 ?g/l in children without AT. When we compared the mean iodine excretion in children with AT with that in children without AT, a statistically significant difference was found (p<0.01).All children included in the study, were examined about goiter via palpation method and goiter was determined with this method in 175 patients of whom 103 (58.8 %) was girl, 72 (41.2 %) was boy, girl/boy ratio was found to be 1.43. The mean age of patients with goiter was 15.84 ± 2.37 years and the mean iodine excretion in urine was 95.92 ± 70.79 ?g/L. Of patients with goiter, 109 (62.2 %) had iodine deficiency, 31 (17.7 %) had AT. All patients with goiter were in euthyroid state. Additionally, paranchymal heterogenity in ultrasonographic examination of gland was found in 41.2 % patients, single nodul was determined in 11 patients and multiple nodules in five patients.In present study, the frequency of AT was found to be 3.6% in all children and 17.7 % in children with goiter. In conclusion, we think that thyroid gland examination should be performed especially in adolescent children, and investigations of anti-TPO and anti-Tg should be done in children with goiter.