Tiroid Hastalıkları
Özet
Ötiroid hasta sendromu, yoğun bakım ünitelerinde yatan hastalarda sık görülen ve tiroid dışı hastalık nedeniyle gelişen anormal tiroid fonksiyonu olarak tanımlanan endokrin değişikliklerdir. Tiroid fırtınası (tirotoksikoz) sistemik dekompansasyon unsurlarının eşlik ettiği agresif hipertiroidizm varlığı, miksödem koması ise hipotermi, mental durum değişikliği ve çoklu organ sistem anormallikleri ile kendini gösteren şiddetli hipotiroidizm olarak tanımlanabilir. Tüm bu endokrin durumlar erken ve uygun tedavi edilmediğinde ölümcül sonuçlara neden olabilir. Tanı, yalnızca laboratuvar testleri ile değil, başvuru sırasındaki öykü ve fiziksel bulgulara dayanmaktadır. Bu hastalarda mortalitenin yüksek olduğu göz önüne alındığında, yoğun bakım ortamında agresif tedaviye mümkün olduğunca erken ve özenle başlanmalıdır.
Euthyroid patient syndrome is endocrine changes defined as abnormal thyroid function due to non-thyroid disease, which is common in patients hospitalised in intensive care units. Thyroid storm (thyrotoxicosis) can be defined as the presence of aggressive hyperthyroidism accompanied by elements of systemic decompensation, while myxedema coma can be defined as severe hypothyroidism manifested by hypothermia, altered mental status and multi-organ system abnormalities. All these endocrine conditions may lead to fatal outcomes if not treated early and appropriately. The diagnosis is based not only on laboratory tests but also on the history and physical findings at presentation. Considering the high mortality rate in these patients, aggressive treatment in the intensive care setting should be initiated as early as possible and with care.
Referanslar
Michaelsson LF, Medici BB, la Cour JL, Selmer C, Røder M, Perrild H, et al. Treating Hypothyroidism with Thyroxine/Triiodothyronine Combination Therapy in Denmark: Following Guidelines or Following Trends? Eur Thyroid J. 2015;4(3):174-80.
Elshimy G, Chippa V, Correa R. Myxedema. StatPearls [Internet]: StatPearls Publishing; 2022.
Shahid MA, Ashraf MA, Sharma S. Physiology, Thyroid Hormone. StatPearls. Treasure Island (FL): StatPearls Publishing, StatPearls Publishing LLC.; 2023.
Mughal BB, Fini JB, Demeneix BA. Thyroid-disrupting chemicals and brain development: an update. Endocr Connect. 2018;7(4):R160-r86.
Himler M, Hurcombe SD, Griffin A, Barsnick RJ, Rathgeber RA, MacGillivray KC, et al. Presumptive nonthyroidal illness syndrome in critically ill foals. Equine Vet J Suppl. 2012(41):43-7.
Sahana PK, Ghosh A, Mukhopadhyay P, Pandit K, Chowdhury BR, Chowdhury S. A study on endocrine changes in patients in intensive care unit. J Indian Med Assoc. 2008;106(6):362-4.
Haas NA, Camphausen CK, Kececioglu D. Clinical review: thyroid hormone replacement in children after cardiac surgery--is it worth a try? Crit Care. 2006;10(3):213.
Vasa FR, Molitch ME. Endocrine problems in the chronically critically ill patient. Clin Chest Med. 2001;22(1):193-208.
Plikat K, Langgartner J, Buettner R, Bollheimer LC, Woenckhaus U, Schölmerich J, et al. Frequency and outcome of patients with nonthyroidal illness syndrome in a medical intensive care unit. Metabolism. 2007;56(2):239-44.
Taş A, Köklü S, Beyazit Y, Kurt M, Sayilir A, Yeşil Y, et al. Thyroid hormone levels predict mortality in intensive care patients with cirrhosis. Am J Med Sci. 2012;344(3):175-9.
Akarsu E. Ötiroid Hasta Sendromu (ÖHS). Tiroid Hastalıkları Tanı ve Tedavi Kılavuzu, Türkiye Endokrinoloji ve Metabolizma Derneği2020. p. 22-8.
Warner MH, Beckett GJ. Mechanisms behind the non-thyroidal illness syndrome: an update. J Endocrinol. 2010;205(1):1-13.
Wartofsky L, Burman KD. Alterations in thyroid function in patients with systemic illness: the "euthyroid sick syndrome". Endocr Rev. 1982;3(2):164-217.
Van den Berghe G. Non-thyroidal illness in the ICU: a syndrome with different faces. Thyroid. 2014;24(10):1456-65.
Fliers E, Bianco AC, Langouche L, Boelen A. Thyroid function in critically ill patients. Lancet Diabetes Endocrinol. 2015;3(10):816-25.
Vincent JL, Singer M. Critical care: advances and future perspectives. Lancet. 2010;376(9749):1354-61.
Devereaux D, Tewelde SZ. Hyperthyroidism and thyrotoxicosis. Emerg Med Clin North Am. 2014;32(2):277-92.
Doubleday AR, Sippel RS. Hyperthyroidism. Gland Surg. 2020;9(1):124-35.
Pokhrel B, Aiman W, Bhusal K. Thyroid Storm. StatPearls. Treasure Island (FL): StatPearls Publishing, StatPearls Publishing LLC.; 2023.
Chiha M, Samarasinghe S, Kabaker AS. Thyroid storm: an updated review. J Intensive Care Med. 2015;30(3):131-40.
Ylli D, Klubo-Gwiezdzinska J, Wartofsky L. Thyroid emergencies. Pol Arch Intern Med. 2019;129(7-8):526-34.
Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011;17(3):456-520.
Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am. 1993;22(2):263-77.
Franklyn JA, Boelaert K. Thyrotoxicosis. Lancet. 2012;379(9821):1155-66.
Gül ND, T. Tiroid Krizi (Tiroid Fırtınası). Tiroid Hastalıkları Tanı ve Tedavi Kılavuzu, Türkiye Endokrinoloji ve Metabolizma Derneği BAYT Bilimsel Araştırmalar Basın Yayın; 2023. p. 297-301.
Badiu C. The Thyroid and Its Diseases-A Comprehensive Guide For The Clinician. Acta Endocrinologica (Bucharest). 2018;14(4):574.
Wall CR. Myxedema coma: diagnosis and treatment. Am Fam Physician. 2000;62(11):2485-90.
Kwaku MP, Burman KD. Myxedema coma. J Intensive Care Med. 2007;22(4):224-31.
Mathew V, Misgar RA, Ghosh S, Mukhopadhyay P, Roychowdhury P, Pandit K, et al. Myxedema coma: a new look into an old crisis. J Thyroid Res. 2011;2011:493462.
Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, et al. A diagnostic scoring system for myxedema coma. Endocr Pract. 2014;20(8):808-17.
Korkmaz FNG, A. Miksödem Koması Tanısı ve Tedavisi. Tiroid Hastalıkları Tanı ve Tedavi Kılavuzu, Türkiye Endokrinoloji ve Metabolizma Derneği: BAYT Bilimsel Araştırmalar Basın Yayın; 2023. p. 303-9.
Chamba NG, Sadiq AM, Kyala NJ, Mosha JE, Muhina IA, Said FH, et al. Initial treatment of myxedema coma using oral levothyroxine: a case report from Tanzania. Endocrinol Diabetes Metab Case Rep. 2022;2022.
Rajendran A, Bhavani N, Nair V, Pavithran PV, Menon VU, Kumar H. Oral Levothyroxine is an Effective Option for Myxedema Coma: A Single-Centre Experience. Eur Thyroid J. 2021;10(1):52-8.
Dutta P, Bhansali A, Masoodi SR, Bhadada S, Sharma N, Rajput R. Predictors of outcome in myxoedema coma: a study from a tertiary care centre. Crit Care. 2008;12(1):R1.
Kargili A, Turgut FH, Karakurt F, Kasapoglu B, Kanbay M, Akcay A. A forgotten but important risk factor for severe hyponatremia: myxedema coma. Clinics (Sao Paulo). 2010;65(4):447-8.
Referanslar
Michaelsson LF, Medici BB, la Cour JL, Selmer C, Røder M, Perrild H, et al. Treating Hypothyroidism with Thyroxine/Triiodothyronine Combination Therapy in Denmark: Following Guidelines or Following Trends? Eur Thyroid J. 2015;4(3):174-80.
Elshimy G, Chippa V, Correa R. Myxedema. StatPearls [Internet]: StatPearls Publishing; 2022.
Shahid MA, Ashraf MA, Sharma S. Physiology, Thyroid Hormone. StatPearls. Treasure Island (FL): StatPearls Publishing, StatPearls Publishing LLC.; 2023.
Mughal BB, Fini JB, Demeneix BA. Thyroid-disrupting chemicals and brain development: an update. Endocr Connect. 2018;7(4):R160-r86.
Himler M, Hurcombe SD, Griffin A, Barsnick RJ, Rathgeber RA, MacGillivray KC, et al. Presumptive nonthyroidal illness syndrome in critically ill foals. Equine Vet J Suppl. 2012(41):43-7.
Sahana PK, Ghosh A, Mukhopadhyay P, Pandit K, Chowdhury BR, Chowdhury S. A study on endocrine changes in patients in intensive care unit. J Indian Med Assoc. 2008;106(6):362-4.
Haas NA, Camphausen CK, Kececioglu D. Clinical review: thyroid hormone replacement in children after cardiac surgery--is it worth a try? Crit Care. 2006;10(3):213.
Vasa FR, Molitch ME. Endocrine problems in the chronically critically ill patient. Clin Chest Med. 2001;22(1):193-208.
Plikat K, Langgartner J, Buettner R, Bollheimer LC, Woenckhaus U, Schölmerich J, et al. Frequency and outcome of patients with nonthyroidal illness syndrome in a medical intensive care unit. Metabolism. 2007;56(2):239-44.
Taş A, Köklü S, Beyazit Y, Kurt M, Sayilir A, Yeşil Y, et al. Thyroid hormone levels predict mortality in intensive care patients with cirrhosis. Am J Med Sci. 2012;344(3):175-9.
Akarsu E. Ötiroid Hasta Sendromu (ÖHS). Tiroid Hastalıkları Tanı ve Tedavi Kılavuzu, Türkiye Endokrinoloji ve Metabolizma Derneği2020. p. 22-8.
Warner MH, Beckett GJ. Mechanisms behind the non-thyroidal illness syndrome: an update. J Endocrinol. 2010;205(1):1-13.
Wartofsky L, Burman KD. Alterations in thyroid function in patients with systemic illness: the "euthyroid sick syndrome". Endocr Rev. 1982;3(2):164-217.
Van den Berghe G. Non-thyroidal illness in the ICU: a syndrome with different faces. Thyroid. 2014;24(10):1456-65.
Fliers E, Bianco AC, Langouche L, Boelen A. Thyroid function in critically ill patients. Lancet Diabetes Endocrinol. 2015;3(10):816-25.
Vincent JL, Singer M. Critical care: advances and future perspectives. Lancet. 2010;376(9749):1354-61.
Devereaux D, Tewelde SZ. Hyperthyroidism and thyrotoxicosis. Emerg Med Clin North Am. 2014;32(2):277-92.
Doubleday AR, Sippel RS. Hyperthyroidism. Gland Surg. 2020;9(1):124-35.
Pokhrel B, Aiman W, Bhusal K. Thyroid Storm. StatPearls. Treasure Island (FL): StatPearls Publishing, StatPearls Publishing LLC.; 2023.
Chiha M, Samarasinghe S, Kabaker AS. Thyroid storm: an updated review. J Intensive Care Med. 2015;30(3):131-40.
Ylli D, Klubo-Gwiezdzinska J, Wartofsky L. Thyroid emergencies. Pol Arch Intern Med. 2019;129(7-8):526-34.
Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011;17(3):456-520.
Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am. 1993;22(2):263-77.
Franklyn JA, Boelaert K. Thyrotoxicosis. Lancet. 2012;379(9821):1155-66.
Gül ND, T. Tiroid Krizi (Tiroid Fırtınası). Tiroid Hastalıkları Tanı ve Tedavi Kılavuzu, Türkiye Endokrinoloji ve Metabolizma Derneği BAYT Bilimsel Araştırmalar Basın Yayın; 2023. p. 297-301.
Badiu C. The Thyroid and Its Diseases-A Comprehensive Guide For The Clinician. Acta Endocrinologica (Bucharest). 2018;14(4):574.
Wall CR. Myxedema coma: diagnosis and treatment. Am Fam Physician. 2000;62(11):2485-90.
Kwaku MP, Burman KD. Myxedema coma. J Intensive Care Med. 2007;22(4):224-31.
Mathew V, Misgar RA, Ghosh S, Mukhopadhyay P, Roychowdhury P, Pandit K, et al. Myxedema coma: a new look into an old crisis. J Thyroid Res. 2011;2011:493462.
Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, et al. A diagnostic scoring system for myxedema coma. Endocr Pract. 2014;20(8):808-17.
Korkmaz FNG, A. Miksödem Koması Tanısı ve Tedavisi. Tiroid Hastalıkları Tanı ve Tedavi Kılavuzu, Türkiye Endokrinoloji ve Metabolizma Derneği: BAYT Bilimsel Araştırmalar Basın Yayın; 2023. p. 303-9.
Chamba NG, Sadiq AM, Kyala NJ, Mosha JE, Muhina IA, Said FH, et al. Initial treatment of myxedema coma using oral levothyroxine: a case report from Tanzania. Endocrinol Diabetes Metab Case Rep. 2022;2022.
Rajendran A, Bhavani N, Nair V, Pavithran PV, Menon VU, Kumar H. Oral Levothyroxine is an Effective Option for Myxedema Coma: A Single-Centre Experience. Eur Thyroid J. 2021;10(1):52-8.
Dutta P, Bhansali A, Masoodi SR, Bhadada S, Sharma N, Rajput R. Predictors of outcome in myxoedema coma: a study from a tertiary care centre. Crit Care. 2008;12(1):R1.
Kargili A, Turgut FH, Karakurt F, Kasapoglu B, Kanbay M, Akcay A. A forgotten but important risk factor for severe hyponatremia: myxedema coma. Clinics (Sao Paulo). 2010;65(4):447-8.
