Steroid Bağımlılığı Gelişen Subakut Tiroidit Olgusunda Kolşisin Kullanımı
Özet
Subakut tiroidit, ağrılı tiroiditler arasında en sık görülen form olup genellikle viral enfeksiyonlar sonrasında gelişen, kendini sınırlayan inflamatuvar bir tiroid hastalığıdır. Klinik olarak boyun ağrısı ve hassasiyet, sistemik inflamasyon bulguları, geçici tirotoksikoz ve ardından ötiroidi ile hipotiroidi evreleriyle karakterizedir. Tanı, öykü ve fizik muayene bulgularının yanı sıra tiroid fonksiyon testlerinde baskılanmış TSH ve hafif–orta derecede artmış serbest T4/T3 düzeyleri ile yüksek akut faz reaktanları ve düşük radyoaktif iyot tutulumu ile desteklenir. Ultrasonografide hipoekoik, heterojen ve psödonodüler görünümler, azalmış vaskülarite ile birlikte ayırıcı tanıda yardımcıdır. Tedavide ilk basamak nonsteroid antiinflamatuvar ilaçlar olup, yanıt alınamayan olgularda glukokortikoid tedavisi uygulanır. Bununla birlikte, bazı hastalarda nüksler ve steroid bağımlılığı klinik yönetimi güçleştirebilir. Son yıllarda antiinflamatuvar etkilerini nötrofil aktivasyonu ve sitokin yanıtının baskılanması üzerinden gösteren kolşisin, dirençli veya steroid bağımlılığı gelişen olgularda alternatif bir seçenek olarak gündeme gelmiştir. Bu bölümde, standart tedaviye yanıt vermeyen ve tekrarlayan relapslar nedeniyle uzun süreli glukokortikoid kullanımına bağımlı hale gelen bir subakut tiroidit olgusunun kolşisin eklenmesiyle başarılı bir şekilde yönetilmesi sunulmakta ve literatür ışığında bu yaklaşımın potansiyel yeri tartışılmaktadır.
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