EN | TR
E-ISSN: 1307-5608
Clinical and Laboratory Characteristics of Children and Adolescents with Hashimoto Thyroiditis at Diagnosis and During Follow-up
PDF
Cite
Share
Request
Research Article
VOLUME: 72 ISSUE: 3
P: 314-319
December 2019

Clinical and Laboratory Characteristics of Children and Adolescents with Hashimoto Thyroiditis at Diagnosis and During Follow-up

J Ankara Univ Fac Med 2019;72(3):314-319
DOI: 10.4274/atfm.galenos.2019.18480
Özlem Kara
1. Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Çocuk Endokrinoloji Kliniği, Bursa, Türkiye
No information available.
No information available
Received Date: 28.05.2019
Accepted Date: 09.08.2019
Publish Date: 23.01.2020
PDF
Cite
Share
Request

ABSTRACT

Objectives:

The aim of this study was to evaluate the clinical and laboratory findings of children and adolescents with Hashimoto thyroiditis (HT) at diagnosis and during follow-up.

Materials and Methods:

Between January 2015 and January 2019, a total of 181 patients aged between 4 and 18 years who were followed in the pediatric endocrinology department were evaluated. All patients were evaluated at the time of diagnosis and during follow-up with the clinical, laboratory and radiological data.

Results:

Female patients constituted 85% of all patients. Mean age at diagnosis was 13.4±3.2 years and 77% of patients were pubertal. The follow-up period was 22.5±10.3 months (4-54 months). At the time of diagnosis 35% of patients were euthyroid, 29% had subclinical hypothyroidism, 22% had overt hypothyroidism, 4% had subclinical hyperthyroidism and 10% had overt hyperthyroidism. The common complaints of the patients were fatigue (44%), hair loss (25%), constipation (23%) and goitre (21%). In the ultrasonographic imaging of the patients, nodule was detected in 13% of the patients. The frequency of nodules was higher in patients with euthyroidism. Increased size of the thyroid gland was common in patients with hyperthyroidism. In follow-up, nodule development was observed in 6% of patients. All patients with subclinical hyperthyroidism became euthyroid during follow-up. Hypothyroidism developed in 13% of euthyroid patients during follow-up. The most common concomitant diseases were polycystic ovary syndrome and vitiligo.

Conclusion:

The admission of patients with HT is highly variable and clinical changes have continued during follow-up. Therefore these patients should be followed closely from the diagnosis and attention should be paid to other related diseases.

Keywords: Hashimoto Thyroiditis, Euthyroidism, Subclinical Hyperthyroidism, Thyroid Function, Long-term Prognosis

References

1
Rallison ML, Dobyns BM, Keating FR, et al. Occurrence and natural history of chronic lymphocytic thyroiditis in chidhood. J Pediatr. 1975;86:675-682.
2
Setian NS. Hypothroidisim in children: diagnosis and treatment. J Pediatr. 2007;83:209-216.
3
Matsuoka N, Unger P, Ben-Nun A, et al. Thyroglobulin-induced murine thyoiditis assessed by intrathyroidal T cell receptor sequencing. J Immunol. 1994;152:2562-2568.
4
Kotani T, Umeki K, Hirai K, et al. Experimental murine thyroiditis induced by porcine thyroid peroxidase and its transfer by the antigen-specific T cell line. Clin Exp Immunol. 1990;80:11-18.
5
Davies TF. Pathogenesis of Hashimoto’s thyroiditis (chronic autoimmune thyroiditis). www.uptodate.com 2019.
6
Huber G, Staub JJ, Meier C, et al. Prospective study of the spontaneous course of subclinical hypothyroidism:prognostic value of thyrotropin, thyroid reserve and thyroid antibodies. J Clin Endocrinol Metab. 2002;87:3221-3226.
7
World Health Organization. Indicators for assessing iodine deficiency disorders and their control programmes: report of a joint WHO/UNICEF/ICCIDD consultation; 1993. https://www.who.int/nutrition/publications/micronutrients/iodine_deficiency/WHO_NUT_93.1/en/
8
de Vries L, Bulvik S, Phillip M. Chronic autoimmune thyroiditis in children and adolescents: at presentation and during long-term follow-up. Arch Dis Child. 2009;94:33-37.
9
Lorini R, Gastaldi R, Traggiai C, et al. Hashimoto’s thyroiditis. Pediatr Endocrinol Rev. 2003;1 Suppl 2:205-11; discussion 211.
10
Markovic S, Kostic G, Igrutinovic Z, et al. Hashimoto’s thyroiditis in children and adolescents. Srp Arh Celok Lek. 2008;136:262-266.
11
Ozcelik T, Uz E, Akyerli CB, et al. Evidence from autoimmune thyroiditis of skewed Xchromosome inactivation in female predisposition to autoimmunity. Eur J Hum Genet. 2006;14:791-797.
12
Ansar Ahmed S, Young PR, Penhale WJ. The effect of female sex-steroids on the development of autoimmune throiditis in thymectomized and irradiated rats. Clin Exp Immunol. 1983;54:351-358.
13
Foley TP Jr, Abbassi V, Copeland KC, et al. Brief report: hypothyroidism caused by chronic autoimmune thyroiditis in very young infants. N Engl J Med. 1994;330:466-468.
14
Dündar B, Boyacı A, Sangün Ö, ve ark. Çocuk ve ergenlerde Hashimoto tiroiditi: klinik ve laboratuvar bulgularının değerlendirilmesi. Türk Ped Arş. 2011;46:318-322.
15
Fava A, Oliverio R, Giuliano S, et al. Clinical Evolution of Autoimmune Thyroiditis in Children and Adolescents. Thyroid. 2009;19:361-367.
16
Demirbilek H, Kandemir N, Gonc EN, at al. Hashimoto’s thyroiditis in children and adolescents: a retrospective study on clinical, epidemiological and laboratory properties of the disease. J Pediatr Endocrinol Metab. 2007;20:1199-1205.
17
Gopalakrishnan S, Chugh PK, Chhillar M, et al. Goitrous Autoimmune Thyroiditis in a Pediatric Population: A Longitudinal Study. Pediatrics. 2008;122:e670-674.
18
Sklar CA, Qazi R, David R. Juvenile autoimmune thyroiditis. Hormonal status at presentation and after long-term follow-up. Am J Dis Child. 1986;140:877-880.
19
Desai MP, Karandikar S. Autoimmune thyroid disease in childhood: a study of children and their families. Indian Pediatr. 1999;36:659-666.
20
Dayan CM, Daniels GH. Chronic autoimmune thyroiditis. N Engl J Med. 1996;335:99-107.
21
Zak T, Noczynska A, Wasikowa R, et al. Chronic autoimmune thyroid disease in children and adolescents in the years 1999 2004 in Lower Silesia, Poland. Hormones (Athens). 2005;4:45-48.
22
Skarpa V, Kappaousta E, Tertipi A, et al. Epidemiological characteristics of children with autoimmune thyroid disease. Hormones. 2011;10:207-214.
23
De Luca F, Santucci S, Corica D, et al. Hashimoto’s thyroiditis in childhood: presentation modes and evolution over time. Ital J Pediatr. 2013;39:8.
24
Radetti G, Gottardi E, Bona G, et al. Study group for thyroid diseases of the Italian society for pediatric endocrinology and diabetes (SIEDP/ISPED): the natural history of euthyroid Hashimoto’s thyroiditis in children. J Pediatr. 2006;149:827-832.
25
Wasniewska M, Salerno M, Cassio A, et al. Prospective evaluation of the natural course of idiopathic subclinical hypothyroidism in childhood and adolescence. Eur J Endocrinol. 2009; 160:417-421.
26
Wasniewska M, Corrias A, Aversa T, et al. Comparative evaluation of therapy with L-thyroxine versus no treatment in children with idiopathic and mild subclinical hypothyroidism. Horm Res Paediatr. 2012;77:376-381.
27
Takasu N, Komiya I, Asawa T, et al. Test for recovery from hypothyroidism during thyroxine. Lancet. 1990;336:1084-1086.
28
Radetti G. Clinical Aspects of Hashimoto’s Thyroiditis. Endocr Dev. 2014;26:158-70
29
Weetman AP. Graves’ disease. N Engl J Med. 2000;343:1236-1248.
30
Wasniewska M, Corrias A, Salerno M, et al. Outcomes of children with hashitoxicosis. Horm Res Paediatr. 2012;77:36-40.
31
Vlachopapadopoulou E, Thomas D, Karachaliou F, et al. Evolution of sonographic appearance of the thyroid gland in children with Hashimoto’sthyroiditis. J Pediatr Endocrinol Metab. 2009;22:339-344.
32
Aversa T, Lombardo F, Valenzise M, et al. Peculiarities of autoimmune thyroid diseases in children with Turner or Down syndrome: an overview. Ital J Pediatr. 2015;41:39.
33
Husebye ES, Anderson MS, Kämpe O. Autoimmune Polyendocrine Syndromes. N Engl J Med. 2018;378:1132-1141.
34
Arduc A, Dogan BA, Bilmez S, et al. High prevalence of Hashimoto’s thyroiditis in patients with polycystic ovary syndrome: does the imbalance between estradiol and progesterone play a role? Endocr Res. 2015;40:204-210.
35
Ganie MA, Marwaha RK, Aggarwal R, et al. High prevalence of polycystic ovary syndrome characteristics in girls with euthyroid chronic lymphocytic thyroiditis: a case–control study. Eur J Endocrinol. 2010;162:1117-1122.
2024 ©️ Galenos Publishing House