Evaluation of Children with Goiter and Treatment Outcomes


Karalı Y., Sağlam H., Kamber K., Karalı Z., Sığırlı D., Tarım Ö. F.

The Journal of Current Pediatrics, vol.6, no.2, pp.10-18, 2008 (Scopus)

  • Publication Type: Article / Article
  • Volume: 6 Issue: 2
  • Publication Date: 2008
  • Journal Name: The Journal of Current Pediatrics
  • Journal Indexes: Scopus, CINAHL, EMBASE, TR DİZİN (ULAKBİM), Index Copernicus
  • Page Numbers: pp.10-18
  • Bursa Uludag University Affiliated: Yes

Abstract

Aim: Goiter is defined as the enlargement of thyroid gland independent of the etiology. It is common in childhood, especially in adolescence. The prevalence of goiter in children aged 6 to 12 years of age was found as 24.9 to 92% in different studies performed in different regions of Turkey. The most common cause in endemic regions is iodine deficiency and it is chronic lymphocytic thyroiditis in non-endemic areas. The aim of this study was to evaluate the demographic and diagnostic characteristics; and physical, laboratory and radiological findings of the children who were presented and followed-up with goiter, and the efficacy of the treatments applied was also assessed. Materials and Methods: A total of 116 children diagnosed as having goiter by physical and ultrasonographic examination in the outpatient clinic of Pediatric Endocrinology Division of Uludag University Faculty of Medicine, between January 2000 and December 2005. Data of the patient were collected retrospectively from the files/records of the patients. Goiter grades of the patients were determined according to that recommended by WHO. Thyroid volumes were calculated from the ultrasonographic measurement of thyroid dimensions. Patients with euthyroid or hypothyroid goiter had L-thyroxine therapy and those with hyperthyroidism had propiltiourasil and/or propranolol. Results: Of all children, 80 (69%) were girls and the remaining 36 were boys (31%). At the time of initial diagnosis, the mean ages of the girls and the boys were 10.1±2.9 years and 9.02± years, respectively. The mean followup period was 3.18±1.83 years. Most children (76.7%) had grade Ib (38.8%) or II (37.9%) goiter at the time of diagnosis. Of all children with goiter, 62 (53.4%) were euthyroid, 47 (40.5%) were hypothyroid and 7 (6.0%) were hyperthyroid. Seventy nine (68.1%) patients had history of thyroid disease in their families. There were additional endocrinological disturbances, epilepsy and other systemic diseases in 11 (9.5%), 11 (9.5%) and 7 (6.0%) patients, respectively. Eighty three (71.6%) patients had simple diffuse goiter, 18 had Hashimoto thyroiditis (4 of whom also having nodules), 11 (10.4%) had isolated nodüler/multinodüler goiter, 3 (2.6%) had Graves disease and 1 (0.9%) had papillary thyroid carcinoma. Mean thyroid volume by ultrasonography was significantly decreased from 12.68±3.57 (3.4 to 35.7) ml to 9.2±3.57 (3.19 to 22.1) ml with the treatment (p<0.05). Similarly goiter grades by physical examination were also significantly decreased, with only 36.2% of the patients having grade Ib (26.7%) or grade II (9.5%) goiter after the treatment (vs. a total of 76.7% at baseline) (p<0,01). Thyroid nodules were significantly regressed in 11 of 16 patients with nodüler goiter (p<0.01). Conclusion: Since TSH (Thyroid-stimulating hormone) elevation seems to be the main driving force in the pathogenesis of thyroid enlargement, thyroxine treatment is warranted to suppress the TSH in hypothyroid and euthyroid patients. The number of hyperthyroid patients in our study is not sufficient to draw conclusions, and the pathogenesis of goiter in hyperthyroidism does not involve TSH which is already suppressed by endogenous thyroid hormones. Nevertheless, control of hyperthyroidism with antithyroid medication and appropriate introduction of thyroxine seem to remedy the goiter as well. (Journal of Current Pediatrics 2008; 6: 10-8) Key words: Goiter, euthyroid, childhood, hypothyroidism, hyperthyroidism, L-thyroxine

Amaç: Guatr etiyolojik nedene bak›lmaks›z›n tiroid bezinin büyümesi olarak tan›mlan›r. Çocukluk yafl grubunda, özellikle ergenlerde yayg›nd›r. Ülkemizde yap›lan de¤iflik çal›flmalarda 6-12 yafl aras› çocuklarda guatr prevalans› %24,9-92 aras›nda saptanm›flt›r. Endemik bölgelerde guatr›n en s›k nedeni iyot eksikli¤i iken endemik olmayan bölgelerde kronik lenfositik tiroidittir. Bu çal›flman›n amac› guatr tan›s› konan hastalar›m›z›n demografik ve tan›sal özellikleri, izlem süresince muayene, radyoloji, laboratuvar bulgular› ve uygulanan tedavilerin etkinli¤inin de¤erlendirilmesidir. Gereç ve Yöntem: Ocak 2000-Aral›k 2005 tarihleri aras›nda Uluda¤ Üniversitesi T›p Fakültesi Çocuk Endokrinoloji Bilim Dal› poliklini¤inden fizik muayene ve tiroid ultrasonografisi bulgular›na göre 116 hasta guatr tan›s› ald›. Hastalar›n verileri dosya kay›tlar›ndan geriye dönük olarak incelendi. Guatr evresi Dünya Sa¤l›k Örgütü (WHO) evrelemesine göre yap›ld›. Tiroid hacimleri tiroid boyutlar›n›n ultrasonografik ölçümü ile hesapland›. Ötiroid ve hipotiroid hastalar L-tiroksin tedavisi, hipertiroid olgular propiltiourasil ve propranolol tedavileri ald›. Bulgular: Çocuklar›n 80’i (%69) k›z, 36’s› (%31) erkek idi. Tan› an›nda k›zlar›n ve erkeklerin yafl ortalamas› s›ras›yla 10,1±2,9 y›l, 9,02 ± 3,6 y›l idi. Ortalama takip süresi 3,18 ± 1,83 y›l idi. Tan› an›nda hastalar›n ço¤u (%76,7), Evre Ib (%38,8) ve Evre II (%37,9) guatr evresindeydi. Tüm çocuklardan 62’si (%53,4) ötiroid, 47’si (%40,5) hipotiroid ve 7’si (%6,0) hipertiroid idi. Hastalardan 79’unda (%68,1) ailede tiroid hastal›¤› öyküsü mevcuttu. Ayr›ca, 11 hastada (% 9,5) efllik eden baflka bir endokrinolojik hastal›k mevcut iken 11’inde (% 9,5) epilepsi öyküsü ve 7’sinde (%6) ise baflka bir sistemik hastal›k mevcuttu. Basit difüz guatrl› 83 (%71,6) hasta mevcut iken, 18 Hashimoto tiroiditli (4’ünde nodül mevcut), 11 (%9,4) izole nodüler ya da multinodüler guatrl›, 1 (%0,9) papiller tiroid kanserli ve 3 (%2,6) Graves hastal›¤› olan olgu vard›. Ortalama tiroid hacmi tedaviyle 12,68±6,48 (3,4-35,7) ml’den anlaml› bir flekilde 9,2±3,57 (3,19-22,1) ml’ye azalm›flt›r (p<0,05). Baflvuruda %76,7 olan evre Ib ya da evre II guatr oran› tedavi sonras› %36,2’ye (evre Ib %26,7, evre II %9,5) gerilemifl olup bu gerileme istatistiksel olarak anlaml› bulundu (p<0,05). Nodüler guatr› olan 16 hastan›n 11’inde (%68,8) tedavi sonras› nodülleri kayboldu. Sonuç: TSH (Tiroid Stimulan Hormon) yükselmesi tiroid bezi büyümesindeki ana tetikleyici güç gibi göründü¤ünden hipotiroid veya ötiroid guatr› olan hastalarda tiroksin tedavisi uygulanmas› akla yatk›n bir yaklafl›md›r. Bu yaklafl›mla elde etti¤imiz sonuçlar yüz güldürücüdür. Hipertiroidili hastalar›m›z›n say›- s› bir sonuca varmaya yetecek boyutta de¤ildir ve hipertiroidili hastalarda guatr›n patogenezi TSH yüksekli¤ini içermemektedir. Ancak antitiroid ilaçlarla hipertiroidinin kontrol alt›na al›nmas›yla tiroid boyutu da küçülüyor gibi görünmektedir. (Güncel Pediatri 2008; 6: 10-8) Anahtar kelim