Erken başlangıçlı Graves olgusu

Ayça Altıncık, Pınar Gençpınar, Korcan Demir, Gönül Çatlı, Ayhan Abacı, Ece Böber
576 214

Öz


Graves hastalığı otoimmün bir hastalık olup hipertiroidi ile seyreder ve çocukluk çağında nadir görülür İki yaşında kız hasta bir yıldır gözlerinin dışarıya doğru çıkık olması nedeniyle başvurdu Fizik bakısında propitoz taşikardi ve toraks sol ön duvarında orta klavikular hatta 6x4 cm çapında geniş bir adet hiperpigmente lekesi vardı Olgunun tiroid işlev testlerinden ST4: 4 00 ng dL N: 0 8 1 9 ST3: 7 7 pg mL N: 1 57 4 71 TSH: 0 004 uIU mL N: 0 4 5 anti tiroglobülin: lt;20 IU mL N: 0 50 anti tiroidperoksidaz: 45 7 IU mL N: 0 50 saptandı Mc Cune Albright ve Graves hastalığı ayırıcı tanısı açısından yapılan ileri tetkiklerinde tirotropin almaç antikoru TRAb :57 IU L N:0 9 saptandı ve çekilen tüm vücut iskelet grafilerinde fibröz displaziye rastlanmadı Hastaya Graves tanısıyla propiltiyourasil tedavisi başlandı İzlemde propiltiyourasile bağlı olası hepatotoksisite riski nedeniyle metimazole geçildi Tirotropin almaç antikoru pozitifliği ve propitozu devam eden olguya oftalmopati açısından orbita manyetik rezonans incelemesi yapıldı ve oftalmopati lehine bulgu saptanmadı Olgu bu yaş grubunda Graves hastalığının ender görülmesi erişkinlere oranla göz bulgularının çocuklarda çok daha nadir olması ve Mc Cune Albright sendromu ile ayırıcı tanı yapılması nedeniyle sunuldu Türk Ped Arfl 2013; 48: 332 5

Anahtar kelimeler


Graves, oftalmopati, tirotoksikoz

Tam metin:

PDF


Referanslar


Dallas JS, Foley TP. Hyperthyroidism. In: Lifshitz F, (ed). Pediatric endocrinology. Fifth edition. Newyork: Marcel Dekker Inc, 2007: 415Wong GW, Cheng PS. Increasing incidence of childhood Graves’ disease in Hong Kong: a follow-up study. Clinical Endocrinol(Oxf) 2001: 54: 547-50.

Lavard L, Ranlİv I, Perrild H, Andersen O, Jacobsen BB. Incidence of juvenile thyrotoxicosis in Denmark, 1982-1988. A nationwide study. Eur J Endocrinology 1994; 130: 565-8.

Hamburger JI. Management of hyperthyroidism in children and adolescents. J Clin Endocrinol Metab 1985; 60: 1019-24.

Lazar L, Kalter-Leibovici O, Pertzelan A, Weintrob N, Josefsberg Z, Phillip M. Thyrotoxicosis in prepubertal children compared with pubertal and postpubertal patients. J Clin Endocrinol Metab 2000; 85: 3678-82.

Kaguelidou F, Carel JC, Léger J. Graves’ disease in childhood: advances in management with antithyroid drug therapy. Horm Res 2009; 71: 310-7.

Dattani M, Tziaferi V, Hindmarsh PC. Evaluation of disordered puberty. In: Brook C, Klayton P, Brown R, (eds). Brook clinical pediatric endocrinology textbook. 6th ed. Hong Kong: 2009; 227. Erken başlangıçlı Graves olgusu / A case of infantile onset Graves

Dumitrescu CE, Collins MT. McCune-Albright syndrome. Orphanet J Rare Dis 2008; 3:12.

Uretsky SH, Kennerdell JS, Gutai JP. Graves’ ophthalmopathy in childhood and adolescence. Arch Ophthalmol 1980; 98: 1963-4.

Grüters A. Ocular manifestations in children and adolescents with thyrotoxicosis. Exp Clin Endocrinol Diabetes 1999;107(Suppl 5): 172Goldstein SM, Katowitz WR, Moshang T, Katowitz JA. Pediatric thyroid-associated orbitopathy: the Children’s Hospital of Philadelphia experience and literature review. Thyroid 2008; 18: 997Chan W, Wong GW, Fan DS, Cheng AC, Lam DS, Ng JS. Ophthalmopathy in childhood Graves’ disease. Br J Ophthalmol 2002; 86: 740-2.

Krassas GE, Segni M, Wiersinga WM. Childhood Graves’ ophthalmopathy: results of a European questionnaire study. Eur J Endocrinol 2005; 153: 515-21.

Antoniazzi F, Zamboni G, Cerini R, Lauriola S, Dall’Agnola A, Tatò L. Graves’ ophthalmopathy evolution studied by MRI during childhood and adolescence. J Pediatr 2004; 144: 527-31.

Acuna OM, Athannassaki I, Paysse EA. Association between thyroid-stimulating immunoglobulin levels and ocular findings in pediatric patients with Graves disease. Trans Am Ophthalmol Soc 2007; 105: 146-51.

Rivkees SA. Pediatric Graves’ disease: controversies in management. Horm Res Paediatr 2010; 74: 305-11.

Panamonta O, Sumethkul V, Radinahmed P, Laopaiboon M, Kirdpon W. Propylthiouracil associated antineutrophil cytoplasmic antibodies (ANCA) in patients with childhood onset Graves’ disease. J Pediatr Endocrinol Metab 2008; 21: 539-43.

Read CH Jr, Tansey MJ, Menda Y. A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves’ patients ts. J Clin Endocrinol Metab 2004; 89: 4229-33.

Metso S, Jaatinen P, Huhtala H, Auvinen A, Oksala H, Salmi J. Increased cardiovascular and cancer mortality after radioiodine treatment for hyperthyroidism. J Clin Endocrinol Metab 2007; 92: 2190Kaguelidou F, Alberti C, Castanet M, et al. Predictors of autoimmune hyperthyroidism relapse in children after discontinuation of antithyroid drug treatment. J Clin Endocrinol Metab 2008; 93: 3817