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Subklinik Hipotiroidisi Olan Obez Çocuk ve Adölesanlarda Lipid Metabolizması Anormallikleri

Yıl 2021, Cilt: 19 Sayı: 1, 100 - 105, 09.04.2021

Birgül Kırel İlhan Hazer Onur Kabukcu Murat Yağcı Zeynep Ertürk Gonca Kılıç Yıldırım

Öz

Giriş: Subklinik hipotiroidi (SH); serum serbest T4 (sT4) düzeylerinin normal sınırlarda ve tiroid stimülan hormon (TSH) düzeylerinin yaşa göre referans düzeylerinin üzerinde olduğu bir tablodur. Obez bireylerde vücut kitle indeksindeki artış ile birlikte serum TSH düzeylerinin arttığı; böylece obez bireylerde SH sıklığının yüksek olduğu bildirilmektedir. Hipotiroidi ve obezite sekonder dislipideminin ana sebeplerindendir. Bu çalışmada; fazla kilolu/obez çocuk ve adölesanlarda; SH sıklığı ve SH’nin lipid metabolizması anormallikleri ile ilişkisi araştırılmıştır.
Gereç ve Yöntem: Fazla kilolu/obez 291 çocuk ve adölesanın (169 kız, 122 erkek) klinik bulguları ve laboratuvar sonuçları geriye dönük olarak değerlendirildi. Lipid ve lipoprotein düzeyleri yaşa ve cinse göre referans değerleri ile karşılaştırılarak; düşük, normal ve yüksek olarak kaydedildi. Serum sT4 düzeyleri normal ve TSH düzeyleri: 4,5-10 mIU/ml olan ve sodyum L-throxin tedavisi almayan hastalar SH grubunu (n=53), normal serum T4 ve TSH düzeyleri olan hastalar kontrol grubunu oluşturdu (n=238). Bu iki grup lipid metabolizması anormallikleri açısından
karşılaştırıldı. 
Bulgular: Tüm çalışma grubunda SH sıklığı %18,2 idi. Yaşa göre referans değerleri ile karşılaştırıldığında; tüm çalışma grubunda, SH grubu ve SH olmayan
grupta; median total kolesterol ve LDL-K düzeyleri sınırda yüksek, median  TG düzeyleri yüksek, median HDL-K düzeyleri normal-yüksek ve median TG/ HDL>2 idi. SH grubunda SH olmayanlara göre; serum total kolesterol düzeyleri, hipertrigliseridemi sıklığı ve TG/HDL-K oranı >2 olan hastaların sıklığı daha yüksekti (p<0,05). Serum TSH düzeyleri; TG ile pozitif korele idi (r=0,13, p<0,05). 

Sonuç: Fazla kilolu/obez çocuk ve adölesanlarda yüksek SH sıklığı bulunmaktadır. Obez hastalarda dislipidemi olduğu; SH varlığında bu durumun daha belirginleştiği ve SH’nin atherojenik lipid profili gelişmesine katkıda bulunduğu anlaşılmıştır. Bu Bulgular obez hastaların kilo vermelerinin hem SH’nin hem de lipid metabolizması anormalliklerinin düzelmesi açısından da önemli olduğunu düşündürmüştü

Anahtar Kelimeler

subklinik hipotiroidi, obez, çocuk

Kaynakça

  • 1. Kaplowitz PB. Subclinical hypothyroidism in children: normal variation or sign of a failing thyroid gland? Int J Pediatr Endocrinol. 2010;2010:281453. doi:10.1155/2010/281453.
  • 2. Vigone MC, Capalbo D, Weber G, Salerno M. Mild hypothyroidism in childhood: who, when, and how should be treated? J Endocr Soc. 2018;2(9):1024-39. doi:10.1210/js.2017-00471.
  • 3. Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European Thyroid Association Guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3(2):76-94.
  • 4. Gallizzi R, Crisafulli C, Aversa T, et al. Subclinical hypothyroidism in children: is it always subclinical? Ital J Pediatr. 2018;44(1):25. doi:10.1186/s13052-018-0462-4.
  • 5. Kotwal A, Cortes T, Genere N, et al. Treatment of thyroid dysfunction and serum lipids: A systematic review and metaanalysis. J Clin Endocrinol Metab. 2020;105(12): dgaa672.
  • 6. Ergin Z, Savaş-Erdeve S, Kurnaz E, Çetinkaya S, Aycan Z. Follow-up in children with non-obese and non-autoimmune subclinical hypothyroidism. J Ped Endocrinol Metabol 2018;31:1133-8. doi.org/10.1515/jpem-2018-0095.
  • 7. Ergür AT, Taner Y, Ata E, Melek E, Bakar EE, Sancak. T. Neurocognitive functions in children and adolescents with subclinical hypothyroidism. J Clin Res Pediatr Endocrinol. 2012;4(1): 21-4. doi:10.4274/Jcrpe.497.
  • 8. Cerbone M, Capalbo D, Wasniewska M et al. Cardiovascular risk factors in children with long-standing untreated idiopathic subclinical hypothyroidism. J Clin Endocrinol Metab. 2014; 99:2697-703.
  • 9. Bona G, Prodam F, Monzani A. Subclinical hypothyroidism in children: natural history and when to treat. J Clin Res Pediatr Endocrinol 2013;5(1):23-8.
  • 10. Pearce EN. Update in lipid alterations in subclinical hypothyroidism. J Clin Endocrinol Metab. 2012; 97:326-33.
  • 11. Cappola AR, Ladenson PW. Hypothyroidism and atherosclerosis. J Clin Endocrinol Metab. 2003;88:2438-44.
  • 12. Alamdari S, Amouzegar A, Tohidi M, et al. Hypothyroidism and lipid levels in a community based study (TTS). Int J Endocrinol Metab. 2016;14(1): e22827.
  • 13. Toruner F, Altinova AE, Karakoc A, et al. Risk factors for cardiovascular disease in patients with subclinical hypothyroidism. Adv Ther. 2008;25(5):430-37. DOI:10.1007/ s12325-008-0053-7.
  • 14. Grandone A, Santoro N, Coppola F, Calabrò P, Perrone L, Del Giudice EM. Thyroid function derarangement and childhood obesity: an Italian experience. BMC Endocrinol Disord 2010;10:8.
  • 15. Canturk Z, Cetinarslan B, Tarkun I, Canturk NZ, Ozden M. Lipid profile and lipoprotein (a) as a risk factor for cardiovascular disease in women with subclinical hypothyroidism. Endocr Res. 2003;29(3):307-16.
  • 16. Ghergherehchi R, Hazhir N. Thyroid hormonal status among children with obesity. Ther Adv Endocrinol Metab. 2015;6(2):51- 5.
  • 17. Jin HY. Prevalence of subclinical hypothyroidism in obese children or adolescents and association between thyroid hormone and the components of metabolic syndrome. J Paediatr Child Health. 2018;54(9):975-80. doi: 10.1111/jpc.13926.
  • 18. Rumińska M, Witkowska-Sędek E, Majcher A, Brzewski M, Krawczyk M, Pyrżak B. Serum TSH level in obese children and its correlations with atherogenic lipid indicators and carotid intima media thickness. J Ultrason. 2018;18:296-301.
  • 19. Matusik P, Gawlik A, Januszek-Trzciakowska A, Malecka- Tendera E. Isolated subclinical hyperthyrotropinemia in obese children: Does levothyroxine (LT4) improve weight reduction during combined behavioral therapy? Int J Endocrinol. 2015;2015:792509. doi: 10.1155/2015/792509.
  • 20. Mika A, Sledzinski T. Alterations of specific lipid groups in serum of obese humans: a review. Obes Rev. 2017;18(2):247-72. doi:10.1111/obr.12475.
  • 21. Dursun A, Aykan. Dislipidemiler. Pediatri. Editör: Yurdakök M. Güneş Tıp Kitapevi Ltd. Şti. 2018. Sayfa: 271-86.
  • 22. Willian AN, Collin CJ. Disorders of lipoprotein metabolism and transport. Nelson Textbook of Pediatrics 20th Edition volume 1. Ed. Kliegman RM. Philadelphia: John F. Kennedy Blvd,2016:691-705.
  • 23. da Luz PL, Favarato D, Faria-Neto JR, Lemos P, Chagas AC. High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease. Clinics (Sao Paulo). 2008;63(4):427-32.

Evaluation of the Relationship Between Subclinical Hypothyroidism and Lipid Metabolism Abnormalities and Non- Alcoholic Fatty Liver Disease in Obese Children and Adolescents

Yıl 2021, Cilt: 19 Sayı: 1, 100 - 105, 09.04.2021

Birgül Kırel İlhan Hazer Onur Kabukcu Murat Yağcı Zeynep Ertürk Gonca Kılıç Yıldırım

Öz

Introduction: Subclinical hypothyroidism (SH); is a condition that serum free T4
(sT4) levels are normal and thyroid stimulating hormone (TSH) levels are above
the reference levels by age. It is reported that the increase in body mass index
(BMI) in overweight and obese children and adolescents leads to an increase in
serum TSH levels and the frequency of SH in these children. It is also suggested frequency of SH and the relationship between SH with lipid metabolism abnormalities and NAFLD were investigated in overweight
and obese children and adolescents.
Materials and Methods: Clinical, laboratory and imaging results of 291 overweight and obese children and adolescent patients
(169 girls, 122 boys) were analyzed retrospectively. Patients with normal serum sT4 levels and TSH levels between 4,5-10 mIU /
ml (SH group) (n=53) and patients with normal serum T4 and TSH levels (control group) (n=238), were compared in terms of liver
function tests, lipid parameters and presence of NAFLD.
Results: The frequency of SH was 18,2% (n=53), and the frequency of NAFLD was in 47,7% (n=139) in all study group. Serum
total cholesterol levels were higher in the SH group (p<0,05) and the frequency of NAFLD (n=23, 43,3%) was not different from
patients without SH (n=122, 48,7%) (p>0,05). Serum TSH levels correlated positively with triglyceride (r=0,1, p<0,05) and alanine
aminotransferase levels (r=0,135, p<0,05). The frequency (n=34) of patients with TG / HDL-K ratio>2 was higher than those
without SH (p<0,05).
Conclusions: The frequency of SH is high in obese children and adolescent patients. Atherogenic lipid metabolism disorders are
more common in patients with SH. The presence of SH in obese children and adolescents does not affect the frequency of NAFLD.

Kaynakça

  • 1. Kaplowitz PB. Subclinical hypothyroidism in children: normal variation or sign of a failing thyroid gland? Int J Pediatr Endocrinol. 2010;2010:281453. doi:10.1155/2010/281453.
  • 2. Vigone MC, Capalbo D, Weber G, Salerno M. Mild hypothyroidism in childhood: who, when, and how should be treated? J Endocr Soc. 2018;2(9):1024-39. doi:10.1210/js.2017-00471.
  • 3. Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European Thyroid Association Guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3(2):76-94.
  • 4. Gallizzi R, Crisafulli C, Aversa T, et al. Subclinical hypothyroidism in children: is it always subclinical? Ital J Pediatr. 2018;44(1):25. doi:10.1186/s13052-018-0462-4.
  • 5. Kotwal A, Cortes T, Genere N, et al. Treatment of thyroid dysfunction and serum lipids: A systematic review and metaanalysis. J Clin Endocrinol Metab. 2020;105(12): dgaa672.
  • 6. Ergin Z, Savaş-Erdeve S, Kurnaz E, Çetinkaya S, Aycan Z. Follow-up in children with non-obese and non-autoimmune subclinical hypothyroidism. J Ped Endocrinol Metabol 2018;31:1133-8. doi.org/10.1515/jpem-2018-0095.
  • 7. Ergür AT, Taner Y, Ata E, Melek E, Bakar EE, Sancak. T. Neurocognitive functions in children and adolescents with subclinical hypothyroidism. J Clin Res Pediatr Endocrinol. 2012;4(1): 21-4. doi:10.4274/Jcrpe.497.
  • 8. Cerbone M, Capalbo D, Wasniewska M et al. Cardiovascular risk factors in children with long-standing untreated idiopathic subclinical hypothyroidism. J Clin Endocrinol Metab. 2014; 99:2697-703.
  • 9. Bona G, Prodam F, Monzani A. Subclinical hypothyroidism in children: natural history and when to treat. J Clin Res Pediatr Endocrinol 2013;5(1):23-8.
  • 10. Pearce EN. Update in lipid alterations in subclinical hypothyroidism. J Clin Endocrinol Metab. 2012; 97:326-33.
  • 11. Cappola AR, Ladenson PW. Hypothyroidism and atherosclerosis. J Clin Endocrinol Metab. 2003;88:2438-44.
  • 12. Alamdari S, Amouzegar A, Tohidi M, et al. Hypothyroidism and lipid levels in a community based study (TTS). Int J Endocrinol Metab. 2016;14(1): e22827.
  • 13. Toruner F, Altinova AE, Karakoc A, et al. Risk factors for cardiovascular disease in patients with subclinical hypothyroidism. Adv Ther. 2008;25(5):430-37. DOI:10.1007/ s12325-008-0053-7.
  • 14. Grandone A, Santoro N, Coppola F, Calabrò P, Perrone L, Del Giudice EM. Thyroid function derarangement and childhood obesity: an Italian experience. BMC Endocrinol Disord 2010;10:8.
  • 15. Canturk Z, Cetinarslan B, Tarkun I, Canturk NZ, Ozden M. Lipid profile and lipoprotein (a) as a risk factor for cardiovascular disease in women with subclinical hypothyroidism. Endocr Res. 2003;29(3):307-16.
  • 16. Ghergherehchi R, Hazhir N. Thyroid hormonal status among children with obesity. Ther Adv Endocrinol Metab. 2015;6(2):51- 5.
  • 17. Jin HY. Prevalence of subclinical hypothyroidism in obese children or adolescents and association between thyroid hormone and the components of metabolic syndrome. J Paediatr Child Health. 2018;54(9):975-80. doi: 10.1111/jpc.13926.
  • 18. Rumińska M, Witkowska-Sędek E, Majcher A, Brzewski M, Krawczyk M, Pyrżak B. Serum TSH level in obese children and its correlations with atherogenic lipid indicators and carotid intima media thickness. J Ultrason. 2018;18:296-301.
  • 19. Matusik P, Gawlik A, Januszek-Trzciakowska A, Malecka- Tendera E. Isolated subclinical hyperthyrotropinemia in obese children: Does levothyroxine (LT4) improve weight reduction during combined behavioral therapy? Int J Endocrinol. 2015;2015:792509. doi: 10.1155/2015/792509.
  • 20. Mika A, Sledzinski T. Alterations of specific lipid groups in serum of obese humans: a review. Obes Rev. 2017;18(2):247-72. doi:10.1111/obr.12475.
  • 21. Dursun A, Aykan. Dislipidemiler. Pediatri. Editör: Yurdakök M. Güneş Tıp Kitapevi Ltd. Şti. 2018. Sayfa: 271-86.
  • 22. Willian AN, Collin CJ. Disorders of lipoprotein metabolism and transport. Nelson Textbook of Pediatrics 20th Edition volume 1. Ed. Kliegman RM. Philadelphia: John F. Kennedy Blvd,2016:691-705.
  • 23. da Luz PL, Favarato D, Faria-Neto JR, Lemos P, Chagas AC. High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease. Clinics (Sao Paulo). 2008;63(4):427-32.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular İç Hastalıkları
Bölüm Research Article
Yazarlar

Birgül Kırel

İlhan Hazer

Onur Kabukcu Bu kişi benim

Murat Yağcı Bu kişi benim

Zeynep Ertürk

Gonca Kılıç Yıldırım Bu kişi benim

Yayımlanma Tarihi 9 Nisan 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 19 Sayı: 1

Kaynak Göster

APA Kırel, B., Hazer, İ., Kabukcu, O., Yağcı, M., vd. (t.y.). Subklinik Hipotiroidisi Olan Obez Çocuk ve Adölesanlarda Lipid Metabolizması Anormallikleri. Güncel Pediatri, 19(1), 100-105.
AMA Kırel B, Hazer İ, Kabukcu O, Yağcı M, Ertürk Z, Kılıç Yıldırım G. Subklinik Hipotiroidisi Olan Obez Çocuk ve Adölesanlarda Lipid Metabolizması Anormallikleri. Güncel Pediatri. 19(1):100-105.
Chicago Kırel, Birgül, İlhan Hazer, Onur Kabukcu, Murat Yağcı, Zeynep Ertürk, ve Gonca Kılıç Yıldırım. “Subklinik Hipotiroidisi Olan Obez Çocuk Ve Adölesanlarda Lipid Metabolizması Anormallikleri”. Güncel Pediatri 19, sy. 1 t.y.: 100-105.
EndNote Kırel B, Hazer İ, Kabukcu O, Yağcı M, Ertürk Z, Kılıç Yıldırım G Subklinik Hipotiroidisi Olan Obez Çocuk ve Adölesanlarda Lipid Metabolizması Anormallikleri. Güncel Pediatri 19 1 100–105.
IEEE B. Kırel, İ. Hazer, O. Kabukcu, M. Yağcı, Z. Ertürk, ve G. Kılıç Yıldırım, “Subklinik Hipotiroidisi Olan Obez Çocuk ve Adölesanlarda Lipid Metabolizması Anormallikleri”, Güncel Pediatri, c. 19, sy. 1, ss. 100–105.
ISNAD Kırel, Birgül vd. “Subklinik Hipotiroidisi Olan Obez Çocuk Ve Adölesanlarda Lipid Metabolizması Anormallikleri”. Güncel Pediatri 19/1 (t.y.), 100-105.
JAMA Kırel B, Hazer İ, Kabukcu O, Yağcı M, Ertürk Z, Kılıç Yıldırım G. Subklinik Hipotiroidisi Olan Obez Çocuk ve Adölesanlarda Lipid Metabolizması Anormallikleri. Güncel Pediatri.;19:100–105.
MLA Kırel, Birgül vd. “Subklinik Hipotiroidisi Olan Obez Çocuk Ve Adölesanlarda Lipid Metabolizması Anormallikleri”. Güncel Pediatri, c. 19, sy. 1, ss. 100-5.
Vancouver Kırel B, Hazer İ, Kabukcu O, Yağcı M, Ertürk Z, Kılıç Yıldırım G. Subklinik Hipotiroidisi Olan Obez Çocuk ve Adölesanlarda Lipid Metabolizması Anormallikleri. Güncel Pediatri. 19(1):100-5.