| Abstract | CILJ ISTRAŽIVANJA: Pokazati učestalost i obilježja netiroidne bolesti štitnjače u djece i adolescenata s restriktivnim tipom anoreksije nervoze.
MATERIJALI I METODE: U ovo retrospektivno istraživanje bilo je uključeno 105 pacijentica u dobi od 11 do 20 godina, od kojih je 96 bilo hospitalizirano na Odjelu za gastroenterologiju Klinike za pedijatriju KBC-a ˶Sestre milosrdnice˝ u Zagrebu i 19 na Odjelu za gastroenterologiju Klinike za pedijatriju KBC-a Split pod dijagnozom AN u razdoblju od 1. siječnja 2013. do 31. prosinca 2017. Dijagnoza AN postavljena je na temelju kriterija DSM-V. Podaci su prikupljeni iz medicinske dokumentacije.
REZULTATI: U istraživanje je uključeno 105 pacijentica s novodijagnosticiranim restriktivnim tipom anoreksije u trajanju od 11,9 ± 10,4 mjeseci. Prosječna dob oboljevanja je bila 15,03 ± 1,7 godina, a prosječni ITM je bio 15,4 ± 1,8 kg/m2. Pouzdaniji pokazatelj devijacije tjelesne težine, s obzirom da uzima u obzir i dob, spol i visinu, jest Z -score koji iznosi -2;75 ± 1,74. Tjelesna masa ispitanica se kretala od 24 do 52 kilograma, prosječno 41,9
± 5,9 kg. Tjelesna masa prije nastupa AN bila je prosječno 54,7 ± 9,1 kg, što upućuje na prosječan gubitak 22,3 ± 9,5 % tjelesne mase s najvećim gubitkom od 43,8%. Pri prvoj hospitalizaciji dijagnosticirana je u 66 % pacijentica netiroidna bolest štitnjače (NBŠ) karakterizirana sniženim vrijednostima T3, a normalnim ili niskonormalnim vrijednsotima T4 i TSH. Razvoj NBŠ, odnosno snižene vrijednosti T3 pokazale su statistički značajnu negativnu povezanost s % gubitka TM, odnosno sa stupnjem pothranjenosti (rho = -0,370). Trajanje AN nije pokazalo nikakav utjecaj na poremećaj hormona štitnjače, već je utvrđena njihova rana pojava na samom početku bolesti, što se može iskoristiti kao biomarker AN. Najveći broj ispitanica imao je sekundarnu amenoreju 66,2 %, prosječnog trajanja 5,8 ± 6,1 mjeseci. Utjecaj netiroidne bolesti na ukupno trajanje amenoreje nije dokazan. Promjena u funkciji štitne žlijezde povezana je promjenom u lipidnom statusu oboljelih i to na način da snižene vrijednosti T4 dovode do porasta LDL, a smanjuju razinu triglicerida, dok povišene vrijednosti TSH dovode također do povišenih vrijednosti LDL-a.
ZAKLJUČAK: Restriktivni tip AN prati u više od 50 % slučajeva razvoj NBŠ koji se javlja vrlo rano na početku bolesti kao odgovor na gladovanje,a karakterizirana je niskim T3. Rana pojava NBŠ čini T3 vrijednim laboratorijskim parametrom u metaboličkom probiru, odnosno obradi djece kod sumnje na poremećaj u jedenju, a obzirom da negativno korelira s % gubitka TM daje uvid u ozbiljnost i težinu bolesti. |
| Abstract (english) | OBJECTIVES: The objective of the study was to demonstrate the incidence and the characteristics of non-thyroidal illness of thyroid in children and adolescents in the restrictive type of anorexia nervosa (AN).
MATERIAL AND METHODS: : The retrospective research study included 105 girls aged
11 to 20, out of which 96 diagnosed with AN were hospitalized in the Department of Gastroenterology of the “Sestre Milosrdnice” University Hospital in Zagreb and 19 in the Department of Gastroenterology of the University Hospital in Split, in the period between the 1st January 2013 and 31st December 2017. AN diagnosis was established on the basis of the Diagnostic and Statistical Manual V (DSM-V) criteria. The data were obtained from the medical records of the girls.
RESULTS: The study included 105 girls with newly diagnosed restrictive type of AN with a duration of 11,9 ± 10,4 months. The average age of the girls was 15.03 ± 1.7 and the average BMI was 15,4 ± 1,8 kg/m2. A more reliable indicator of the deviation of the body weight, related to the age, sex and height, is Z-score of -2.75 ± 1.74. The body mass of the girls was ranging from 24 to 52 kg which indicates an average reduction of 22.3 ± 9,5% of the body mass with the highest reduction of 43,8%. At the first hospitalization non thyroidal illness of the thyroid function (NIT), was characterized with the reduced levels of T3 and normal to low and the lower limits of normal levels of T4 and TSH. The development of NIT and the lowered levels of T3 indicated statistically significant negative relationship to the percent of the reduction of the body mass (BM) and the degree of undernutrition (rho = -0.370, p< 0,001). The duration of AN did not indicate any impact on the disorder of the thyroid hormones, whereas an early appearance was established at the beginning of the illness, which may be utilised as a biomarker of AN. Most of the girls, 66.2% of them, had the secondary amenorrhea, with an average duration of 5.8 ± 6.1 months. The impact of the non thyroidal illness on the total duration of amenorrhea was not proved. The changes of the thyroid function are associated with the changes of the lipid status of the girls in a way that the lowered levels of T4 lead to an increase in the levels of LDL, while lowering the levels of triglycerides, wheras the increased levels of TSH lead to an increase in the levels of LDL.
CONCLUSION: In more than 50% cases the restrictive type of AN is accompanied by the development of NIT, which appears in the early stages of the illness as a consequence of starvation, characterized by low levels of T3. The early occurrence of NIT makes T3 a valuable laboratory parameter in the metabolic screening and the treatment of the children suspected with the eating disorders and, since it is negatively correlated to the percent of the BM reduction, renders an insight in the seriousness and the gravity of the illness. |
