YYB'ünde yatan hastalarda tiroid fonksiyon testlerinin retrospektif incelenmesi
Retrospective investigation of thyroid function tests in elderly diseases in neonatal intensive care unit
- Tez No: 468630
- Danışmanlar: DOÇ. DR. ESRA DENİZ PAPATYA ÇAKIR, DOÇ. DR. ÖZGÜL SALİHOĞLU
- Tez Türü: Tıpta Uzmanlık
- Konular: Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2017
- Dil: Türkçe
- Üniversite: Sağlık Bilimleri Üniversitesi
- Enstitü: İstanbul Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi
- Ana Bilim Dalı: Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 97
Özet
GİRİŞ Tiroid hormonları gebelik ve doğum sonrası beynin normal gelişimi için gereklidir. Serum tiroksin seviyeleri (T4) ve triiodotironin (T3) doğumdan sonra belirgin bir şekilde artmaktadır ve yenidoğanın somatik olgunlaşması ve gelişiminde çok önemli bir rol oynamaktadır. Hayatın erken dönemlerinde tiroid hormonlarında eksiklik, sadece büyüme ve gelişmeyi etkilemekle kalmaz aynı zamanda beyin hasarı nedeniyle geri dönüşümsüz zeka geriliği ile sonuçlanır. AMAÇ Yoğun bakım hastalarında, mevcut hastalıklara, stres ve ilaçlara bağlı endokrin bozukluklar tespit edilebilir. Özellikle prematüre (gebelik haftası
Özet (Çeviri)
INTRODUCTION Thyroid hormones are necessary for normal development of the brain after pregnancy and birth. Serum thyroxine levels (T4) and triiodothyronine (T3) increase prominently after birth and play a crucial role in the somatic maturation and development of the newborn. In early life, deficiency of thyroid hormones not only affects growth and development, but also results in irreversible mental retardation due to brain damage. OBJECTİVES In intensive care patients, endocrine disorders related to existing diseases, stress, drugs can be detected. Especially in premature infants, it is more likely to have impairment thyroid function tests due to immaturity of the thyroid axis, maternal and fetal drugs and prematurity-related morbidities. The aim of our study is to examine thyroid functions in premature infants, to compare patient and healthy preterms and full-term newborns in terms of thyroid functions. To emphasize the importance of identifying and scanning the frequency and etiology of the euthyroid sick syndrome. MATERIALS AND METHODS The files of the patients between 0-1 month monitored as inpatient between 2014-2015 in Bakırkoy Dr. Sadi Konuk Education and Research Hospital Pediatrics NICU are retrospectively evaluated. The data obtained in the study is analyzed in the SPSS 20.0 for Windows package program. Thyroid stimulating hormone (TSH), sT4 total and direct bilirubin lactic acid values are scanned from all the patients. Their values are scanned retrospectively. Inpatient snapp pe score is calculated to predict mortality. Respiratory support, hospitalization periods and respiration support periods are recorded on the day the values are taken. RESULTS 383 patients are included in our study. 60.2% of the patients (n=203) are male, 39.8% (134) are female and 59.3% (n= 200) are delivered by cesarean section. The average birth weight is 2708.4 gr. 86.3% of the patients are evaluated as AGA (Appropriate for gestational age) 7.9% as SGA (Small for Gestation Age), 5.8% as LGA (large for Gestation Age) and 43,6% (145) of all the patients are preterm and 56,8% are term (191) All of the patients considered to have euthyroid sick syndrome (NTIS) are AGA, 80% (12) of whom are preterm and 20% (3) are term. The rate of NTIS is 1.6% in term patients and 8.3% in preterms. NTIS is considered in 4.5% (15) of the patients studied and primary hypothyroidism is considered in 0.9% (3) of the patients studied. All patients with euthyroid sick syndrome are AGA. Thyroid function tests (TFT) of the 56.4% of the patients are taken in the first week, 44.2% on days 8-15, 16.6% on days 16-30 days and 8.3% are taken after 30 days. The ones whose TFT values are found to be abnormal are considered to be with euthyroid sick syndrome due to improvement in control values. Gestational week, birth weight, head circumference, height, 1st and 5th minute APGAR scores are lower in patients with euthyroid sick syndrome (NTIS) than those without euthyroid sick syndrome. In the NTIS patients, nasal CPAP duration and free oxygen period in the incubator are longer than non-NTIS patients. In patients with and without NTIS, the limit of phototherapy, the frequency of vasopressor use before the examination, the pre-examination transfusion frequency and the frequency of hypotension are similar. sT4 levels are lower in NTIS patients and TSH SGA is higher in infants after 30 days. ST4 and TSH levels in premature and term infants are significantly lower in premature infants during the first week. NTIS is more frequent in the low apgar group. There is no significant difference between sT4 and TSH levels in patients with and without congenital anomalies. There is no significant difference between sT4 and TSH levels in patients with and without bilirubin levels at the limit of phototherapy. There is no significant difference between sT4 and TSH in patients receiving and not receiving dopamine. In the group receiving mechanical ventilator support, sT4 levels are significantly lower in the first week. No significant difference is found in other measurement. While no significant difference is found between sT4 and TSH measurements in patients with and without sepsis, NTIS is more common in patients with sepsis. CONCLUSİON In summary, this study demonstrates the possibility of transient hypotyroxinemia in preterm infants with severe neonatal disease. The study also confirms the necessity of measuring thyroid hormones in the first days of life. There is a need for additional research to determine whether thyroxine levels are mediators or whether there is only a sign of clinical status. In the first weeks of life, the severity of the disease must account for the interpretation of the outcome of neonatal thyroid function tests. In addition, the significance of national neonatal scanning is evident because early measurement of thyroid hormones will result in better neurodevelopmental outcomes.
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