Subklinik hipotiroidi hastalarında tiroid hormon replasmanı tedavisi öncesi ve sonrası solunum fonksiyon testlerinin değerlendirilmesi
.
Yazar: LOKMAN KORAL
Danışman: DOÇ. DR. BİLGİN ÖZMEN
Celal Bayar Üniversitesi / Tıp Fakültesi / İç Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2004
Konu: İç Hastalıkları = Internal diseases

Özet:
Solunum sistemi ve tiroid bezi arasmda 9ok yonlO baglant1lar vard1r. Anatomik
olarak tiroid bezi trakea ile 9ok yakm ili§kilidir, her iki organm fonksiyonlan hOcresel
oksidatif metabolizmaya dayanir, tiroid hormonlan akcigerlerin geli§iminde rol
allr (6-10).
Gerek hipotiroidi, gerekse hipertiroidi de solunum sisteminde baz1 degi§ikliklerin
oldugu bilinmektedir (6, 11-20). Hipertiroidi de oksijen toketimi, C02 Oretimi,
ventilasyon ve solunum say1s1 artarken, vital kapasite, CO difOzyon kapasitesi,
soiunum kasiannm guco azalmaktadir (6, 17-20). Hipotiroidi de dispne sik gorulen bir
yakmmad1r (3,4, 11, 12,22,23). Azalm1§ maksimal solunum kapasitesi ile difOzyon
kapasitesi ve karbondioksite azalm1§ solunum cevab1 gozlenebilir (24).
Subklinik hipotiroidi de solunum sistemindeki degi§iklikler tam olarak bilinmemektedir(
1,4, 12). <;all§mada ama9, subklinik hipotiroidi tanis1 konulan hastalarda tiroid
hormon replasman tedavisi oncesi ve sonras1 solunum sistemi Ozerine olan
degi§ikliklerin ara§tin lmas1d 1r.
$ubat 2003-Haziran 2004 tarihleri arasmda Celal Bayar Oniversitesi Tip FakOltesi
i9 hastal1klan Anabilim Dali Endokrinoloji ve Metabolizma Hastal1klan Bilim Dall
poliklinigine muracat eden ve subklinik hipotiroidi tanis1 ile 9all§maya alman toplam
38 ( 1 'i erkek, 37'si kadm) hastanm tiroid hormon replasman tedavisi oncesi solunum
fonksiyon testleri yap1ld1. Daha sonra her hastadan arter kan gazlan igin numune
almarak bron§ provakasyon (37 hasta) ve reversibilite (1 hasta) testleri yap1ld1.
Tedavi protokolu olarak subklinik hipotiroidili hastalara uygun dozda levotiron tb
(sabahlan ag olarak) ba§land1 ve ortalama 6-8 hafta sonra tiroid fonksiyon testlerine
bak1ld1. Otiroidi saglanan hastalann solunum fonksiyon testleri ve arter kan gazlan
analizleri tekrarland1.
Sonu9 olarak, tedavi sonrasmda tedavi oncesine gore solunum fonksiyon
testlerinde istatistiksel olarak anlamh fark bulunmad1 [FEV1 (p=0.36), FVC (p=0.084),
FEV1/FVC (p=0.53)] ( Tabla 15). Arter kan gazlan analizlerinde p02 (p=0.64) ve
pC02 (p=0.84) degerlerinde istatistiksel bir fark bulunmazken tedavi sonras1 02
satorasyonunda tedavi oncesine gore normal sm1rlar i9inde ancak istatistiksel olarak
anlamll bir art1§ saptand1 (p<0.011) (Tabla 13).

Abstract:
There is a multisided connections between the thyroid gland and the respiratory
system. Thyroid gland is closely localized to trachea by anatomic situation and either
thyroid gland or trachea functions by oxidative metabolism. Thyroid hormones
probably play an important role in the development of the lung(6-10).
Some of the changes occur with hypothyroid and hyperthyroid situations in the
respiratory system (6, 11-20). In hyperthyroid cases, oxygen consumption, C02
production, ventilation and respiration number increase where vital capacity, CO
diffusion capacity and respiratory muscle weakness decrease (6, 17-20). Dyspnea is
a frequent complaint within hypothyroid patients (3,4, 11, 12,22,23). Decreased
maximum respiration capacity, diffusion capacity and decreased respiration
response to carbondioxide can be observed (24)
Changes in the respiration system are not completely known in subclinic
hypothyroid cases (1,4, 12). Our objective in the study was to research the changes
within respiration system in the patients diagnosed as subclinic hypothyroid
situations before and after the thyroid hormone replacement therapy.
Respiration function tests of 38 patients (1 male, 37 female) were done before the
thyroid hormone replacement therapy who were diagnosed as subclinic hypothyroid
situations. These patients included our study and they were all referred to our
polyclinics of Endocrinology and Metabolism Diseases Department of internal
Medicine mainscience between February 2003 - June 2004 in Celal Bayar
University research and application hospital. Later, blood samples for artery blood
gases were taken from each participants. Then bronchial provacation (37 cases) and
reversibility (1 case) tests were applied. In our therapeutic procedure , all subclinic
hypothyroid patients of the study took appropiate doses of Levotiron® tabletes daily
(in morning fasting) for average 6-8 weeks. After this application, thyroid function
tests were observed. Respiratory function tests and artery blood gases analysis of
the patients were repeated who become euthyroid situations.
As a result, there was no statistical significance in respiration function tests after
the treatment in accordance with the pre-treatment situations [FEV1 (p=0.36), FVC
(p=0.084), FEV1/FVC (p=0.53)] (Table 15). There was no statistical significant
difference in the values of p02 (p=0.64) and pC02 (p=0.84) in artery blood gases
49
analysis. However, there was statistical significant increase in 0 2 saturation values
after the treatment in accordance with the pre-treatment situations (p<0.011 ); but this
increase was within normal limits (Table 13).