Akromegali hastalarında somatostatin analogları ile tedavinin tiroid bezi üzerine etkisinin değerlendirilmesi
The evaluation of thyroid nodules in patients with acromegaly before and after somatostatin analog therapy
Yazar: FERİT KERİM KÜÇÜKLER
Danışman: PROF. SERDAR GÜLER
Sağlık Bakanlığı / Ankara Numune Eğitim ve Araştırma Hastanesi / Endokrinoloji Ana Bilim Dalı
Derece: Tıpta Yan Dal Uzmanlık, 2011
Konu: Endokrinoloji ve Metabolizma Hastalıkları = Endocrinology and Metabolic Diseases

Özet:
Çalışmamız da malignite oranlarımızı HLN grubunda %33,3, FN grubunda %23 ve malignite şüphesi grubunda %53,7 oranında saptadık. Hurthle hücreli lezyon grubunda malignite FN den daha fazla olmasına karşın bu fark istatistiksel olarak anlamlı değildi. Ancak malignite riskinin fazla olması nedeniyle HLN' li olguların FN'den daha ciddi ele alınması gerektiğini ve eş kategoride klasifiye edilmesinin uygun olabileceğini düşünmekteyiz. Her iki grup için de önerilen tedavi şekli lobektomi ya da klinik ve ultrasonografik özellikler göz önüne alındığında malignite riskine göre total tiroidektomi yapılmasıdır. Bu nedenle bu grup hastalarda preoperatif ultrasonografik değerlendirme önem kazanmaktadır. Şimdiye kadar literatürdeki çalışmalarda da preoperatif maligniteyi belirleyebilecek faktörler bularak cerrahi tedavinin şeklini belirlemeyi sağlamak amaçlanmıştır. Sonuçlarımızın ışığında HLN olgularına nodülün mikrokalsifikasyon içermesi ve nodül boyutunun ≥4 cm olması halinde total tiroidektomi yapılması gerektiğini düşünmekteyiz. Folliküler Neoplazi grubunda ise nodülün hipoekoik olması maligniteyi öngörebilmektedir, bu durum da da total tiroidektomi yapılmasını önermekteyiz. Ancak her iki grupta da maligniteyi öngörmek için daha kesin faktörler bulmak amacıyla daha geniş ve muhtemelen genetik çalışmalara ihtiyaç olduğunu düşünüyoruz.

Abstract:
Küçükler FK. The evaluation of thyroid nodules in patients with acromegaly before and after somatostatin analog therapy. Ankara Numune Training and Research Hospital, Departement of Endocrinology and Metabolism, Thesis of Specialist, Ankara, 2010. The primary treatment of acromegaly is surgery. However in patients those not cured with surgery, somatostatin analogs may be initiated. In our study, we aimed to investigate changes in thyroid nodules before and after somatostatin analog therapy. Data from 108 patients those followed at Ankara Numune Training and Research Hospital, Departement of Endocrinology and Metabolism, between Jan 2006 - Jan 2010, were screened retrospectively. 35 patients were included the study, those did not cured with surgery and thus somatostatin analog therapy was given and also met inclusion criteria.  Thyroid stimulating hormone (TSH), free triiodotironine (fT3), free thyroxin (fT4), anti thyroid peroxidase antibodies (anti TPO), anti thyroglobuline antibodies (anti Tg), thyroid volumes and thyroid nodules volume were compared before and at 12. month after somatostatin analog therapy initiated. Of the patients 21 were female (60 %) and 14 were male (40 %). The mean age was 40.2 ± 10.7 years (18-63). Seventeen of the patients (49 %) were on octreotide therapy while 18 (51 %) were on lanreotide therapy. Twenty of the patients (57.1 %) were controlled with medical therapy. However other 15 patient (42.9 %) had active disease. Thyroid doppler ultrasonography detected diffuse goitre in 7 patient, noduler goitre in 20 patient, thyroiditis in 3 patient and  normal thyroid in 5 patient. Thyroid doppler ultrasonography detected diffuse goitre in 7 patient, noduler goitre in 20 patient, thyroiditis in 3 patient and  normal thyroid in 5 patient. Thyroid doppler ultrasonography detected diffuse goitre in 7 patient, nodüler goitre in 20 patient, thyroiditis in 3 patient and  normal thyroid in 5 patient. Eight patient had soliter nodul while other 12 had multinodular goitre (MNG) among those patient with nodular goitre. There was a negative corelation between basale TSH level and thyroid volume, nodul volume and number of nodules. GH and IGF 1 levels decreased significantly after medical therapy. Before medical therapy 60 % of the patients had heterogen parancim ecogenity. However, it was 82.9 % after medical therapy. While thyroid volume decreased significantly after medical therapy, the volume of nodules did not changed. There was a negative correlation between age and change in thyroid volume. A positive correlation was found between change in thyroid volume after medical therapy and GH and IGF 1 levels. Thyroid volume was significantly higher in patients with active disease. However, nodul volume was not different between groups. Octreotide and lanreotide were both significantly lower GH and IGF 1 levels at 12. month of therapy, and both had same efficiency. Thyroid volume was decreased after one year treatment with both drugs and no difference was found between two group. In conclusion, somatostatin analog treatment decreased thyroid volume significantly but not nodul volume and number of nodules. This difference may be due to the expression of the somatostatin receptors mostly occure in thyroid bed not in thyroid nodule. No difference was found between octreotid and lanreotid in terms of change in thyroid volume and nodules.