What Are the Common Characteristics of Pediatric Patients With Antibody Negative Primary Hypothyroidism?

Abstract Background: The most common cause of acquired primary hypothyroidism is autoimmune thyroiditis which is typically associated with positive anti-thyroid peroxidase and/or anti-thyroglobulin antibodies. However, some children present with primary hypothyroidism and negative antibodies. Whether there are differences between patients with acquired primary hypothyroidism who have positive vs negative anti-thyroid antibodies has not been systematically examined. Aim:To define the characteristics of patients with primary hypothyroidism and negative antibodies. Methods: A retrospective chart review of patients with hypothyroidism seen in the pediatric endocrine clinic at Riley Hospital for Children in Indianapolis, Indiana from August 2016 until December 2019 was performed. Variables examined included age at diagnosis, signs and symptoms at presentation, height, weight, BMI, TSH, FT4, T4, thyroid peroxidase and anti-thyroglobulin antibodies, family history of thyroid disease, physical exam at diagnosis, and associated diseases. Results: Of 173 patients aged 10.6 ± 3.9 years, 128 (74%) had positive antibodies and 44 (26%) had negative antibodies. Of those with positive antibodies, 80 % were female and 20% were male. Of those with negative antibodies, 53% were female and 47% were male. No differences were seen in the incidence of obesity or Down syndrome in patients with positive antibodies compared with those who had negative antibodies. A positive family history of thyroid disease was present in 45% of those with positive antibodies and in 22% of those with negative antibodies, P=0.006 Fifty-eight patients (45%) with positive antibodies reported excessive fatigue and 40 (31%) had a goiter. In contrast, 10 (22.7%) who had negative antibodies reported mild intermittent fatigue, P=0.006 and 7 (15.9 %) had a goiter, P=0.04 The average TSH in the antibody positive group was 129± 230 mcu/ml compared with 48 ± 131 mcu/ml in those with negative antibodies, p=0.04. A trend was also noted for a lower FT4 in those with positive antibodies (0.68±0.37 vs 0.85±0.27, p=0.050) No other differences in baseline characteristics were seen between patients with negative vs positive antibodies. Conclusion: Patients with positive anti-thyroid antibodies had more severe hypothyroidism and were more likely to report extreme fatigue than those with negative antibodies. It is unknown why some children with acquired primary hypothyroidism presumed due to autoimmune thyroid disease have negative antibodies. Long-term follow-up will be needed to determine whether the natural history of thyroid disease in children with primary hypothyroidism is associated with antibody status.

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Positive family history of thyroid disease as a risk factor for differentiated thyroid carcinoma

Polish Archives of Internal Medicine ◽

10.20452/pamw.1111 ◽

2011 ◽

Vol 121 (12) ◽

pp. 441-447 ◽

Cited By ~ 1

Author(s):

Elwira Przybylik-Mazurek ◽

Dorota Pach ◽

Sylwia Kuźniarz-Rymarz ◽

Marta Tracz-Bujnowicz ◽

Krystyna Szafraniec ◽

...

Keyword(s):

Risk Factor ◽

Family History ◽

Thyroid Carcinoma ◽

Thyroid Disease ◽

Positive Family History ◽

Differentiated Thyroid Carcinoma ◽

History Of

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Clinical, epidemiological and autoimmune associations in childhood vitiligo in Qatar

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20200594 ◽

2020 ◽

Vol 6 (2) ◽

pp. 151

Author(s):

Haya Al Mannai ◽

Mohamed Allam ◽

Hassan Riad

Keyword(s):

Family History ◽

Autoimmune Diseases ◽

Age Of Onset ◽

Positive Family History ◽

Thyroid Peroxidase ◽

Base Line ◽

Adult Onset ◽

Prognostic Features ◽

History Of ◽

The Mean

Background: Childhood vitiligo although clinically similar to adult onset vitiligo but it has distinct clinical, epidemiological and prognostic features compared to adult onset vitiligo.Methods: This is a retrospective study that was carried out on 85 pediatric patients up to age of 18 years old with the diagnosis of vitiligo, where the clinical and epidemiological data including clinical type of vitiligo, family history of autoimmune diseases like thyroid disorders and diabetes mellitus and laboratory results including anti-thyroid peroxidase antibodies (anti-TPO antibodies), anti-parietal cell antibodies, antinuclear antibodies (ANA), Vitamin D and Vitamin B12 were retrieved from the files of these patients.Results: The mean age of the children affected by vitiligo was 10.4 years, the mean age of onset of vitiligo was 5.4 years, 54 (63.5%) percent were girls and 31 (36.5%) were boys. A positive family history of vitiligo was found in 44.7% of the participants, family history of DM was found in 64.7% of patients and family history of thyroid disease was found in 32.9% of the participants. The prevalence of thyroid autoimmunity was found to be in 22.4% of total participants.Conclusions: Childhood vitiligo has distinct clinical features, more common family history for autoimmune diseases and thyroid autoantibodies rather than overt clinical diseases, which raise the necessity to perform a routine initial immunological and thyroid screening in children with vitiligo and to repeat them at annual bases if there were abnormal values at base line or strong family history.

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Hyperthyroidism following primary hypothyroidism in association with polyendocrine autoimmunity

Acta Endocrinologica ◽

10.1530/acta.0.1080491 ◽

1985 ◽

Vol 108 (4) ◽

pp. 491-497 ◽

Cited By ~ 18

Author(s):

P. M. Bell ◽

D. G. Sinnamon ◽

P. P. A. Smyth ◽

H. A. Drexhage ◽

M. Haire ◽

...

Keyword(s):

Diabetes Mellitus ◽

Family History ◽

Autoimmune Disease ◽

Islet Cell ◽

Primary Hypothyroidism ◽

Strong Family History ◽

Thyroglobulin Antibodies ◽

Thyroid Stimulating Immunoglobulins ◽

History Of ◽

Islet Cell Autoantibodies

Abstract. A 37 year old male with a strong family history of autoimmune disease presented with typical symptoms of hyperthyroidism. He had exophthalmos but no goitre. Hyperthyroidism was confirmed by failure of 131I neck uptake to suppress after 7 days treatment with triiodothyronine. Six years previously a diagnosis of primary hypothyroidism has been made. At diagnosis of hyperthyroidism, thyroglobulin antibodies, thyroidal microsomal antibodies and thyroid stimulating immunoglobulins were detected. The absence of thyroid growth stimulating immunoglobulins and presence of immunoglobulins blockink TSH-induced growth may account for the absence of goitre throughout. HLA -B8, -B, -DR3 and -DR4 genotypes, low C4 complement cocentrations and islet cell autoantibodies were detected at the time of diagnosis and 1 year later diabetes mellitus developed.

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Central Centrifugal Cicatricial Alopecia: Retrospective Chart Review

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2010.09055 ◽

2010 ◽

Vol 14 (5) ◽

pp. 212-222 ◽

Cited By ~ 12

Author(s):

Sejal K. Shah ◽

Andrew F. Alexis

Keyword(s):

Family History ◽

Chart Review ◽

Seborrheic Dermatitis ◽

Positive Family History ◽

Retrospective Chart Review ◽

Control Group ◽

Adult Women ◽

History Of ◽

Hair Care ◽

Women Of African Descent

Background: Few studies have investigated central centrifugal cicatricial alopecia (CCCA). Thus, our understanding of CCCA is largely based on anecdotal evidence. Objective: The purpose of this study was to investigate clinical characteristics and hair care practices in CCCA patients. Methods: We conducted a single-center retrospective chart review of patients with a clinicopathologic diagnosis of CCCA. Results: Medical records of 69 patients were reviewed. Of these, 97% were female. The mean ages at onset and presentation were 38.2 and 42.4 years, respectively. All subjects for whom hair care data were available had used a traumatic practice at least once, the most common being chemical relaxer. Family history data were available for 27 subjects (39%). Of these, 56% had a positive family history of hair loss. Seborrheic dermatitis was the leading concurrent diagnosis. Limitations: Limitations include lack of a control group, retrospective design, and selection bias. Conclusions: Our results confirm that CCCA primarily affects adult women of African descent. The majority of patients presented several years after onset, suggesting that efforts to encourage earlier diagnosis are warranted. Although the role of hair care remains unclear, traumatic practices were reported in all patients in our study for whom hair care was documented.

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Development of Graves' Disease After SARS-CoV-2 mRNA Vaccination: A Case Report and Literature Review

Frontiers in Public Health ◽

10.3389/fpubh.2021.778964 ◽

2021 ◽

Vol 9 ◽

Author(s):

David Tak Wai Lui ◽

Ka Kui Lee ◽

Chi Ho Lee ◽

Alan Chun Hong Lee ◽

Ivan Fan Ngai Hung ◽

...

Keyword(s):

Thyroid Dysfunction ◽

Chinese Woman ◽

Thyroid Peroxidase ◽

Graves Disease ◽

Immunoglobulin Level ◽

Thyroglobulin Antibodies ◽

Old Chinese ◽

Autoimmune Thyroid ◽

Diffuse Goiter ◽

History Of

Background: Mounting evidence has revealed the interrelationship between thyroid and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to explain the thyroid dysfunction and autoimmune thyroid disorders observed after coronavirus disease 2019 (COVID-19). There are limited reports of thyroid dysfunction after SARS-CoV-2 vaccination.Methods: We report a case of a 40-year-old Chinese woman who developed Graves' disease after BNT162b2 mRNA vaccine. A search of PubMed and Embase databases from 1 September 2019 to 31 August 2021 was performed using the following keywords: “COVID,” “vaccine,” “thyroid,” “thyroiditis,” and “Graves.”Results: A 40-year-old Chinese woman who had 8-year history of hypothyroidism requiring thyroxine replacement. Her anti-thyroid peroxidase and anti-thyroglobulin antibodies were negative at diagnosis. She received her first and second doses of BNT162b2 mRNA vaccine on 6 April and 1 May 2021, respectively. She developed thyrotoxicosis and was diagnosed to have Graves' disease 5 weeks after the second dose of vaccine, with positive thyroid stimulating immunoglobulin level, diffuse goiter with hypervascularity on thyroid ultrasonography and diffusely increased thyroid uptake on technetium thyroid scan. Both anti-thyroid peroxidase and anti-thyroglobulin antibodies became positive. She was treated with carbimazole. Literature search revealed four cases of Graves' disease after SARS-CoV-2 vaccination, all after mRNA vaccines; and nine cases of subacute thyroiditis, after different types of SARS-CoV-2 vaccines.Conclusion: Our case represents the fifth in the literature of Graves' disease after SARS-CoV-2 vaccination, with an unusual presentation on a longstanding history of hypothyroidism. Clinicians should remain vigilant about potential thyroid dysfunction after SARS-CoV-2 vaccination in the current pandemic.

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Family History of Autoimmune Thyroid Disease

Clinical and experimental thyroidology ◽

10.14341/ket20139439-45 ◽

2013 ◽

Vol 9 (4) ◽

pp. 39 ◽

Cited By ~ 1

Author(s):

O D Rymar ◽

A K Pyankova ◽

V N Maksimov ◽

S V Mustafina

Keyword(s):

Family History ◽

Thyroid Disease ◽

Autoimmune Thyroid Disease ◽

Autoimmune Thyroid ◽

History Of

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Pediatric toxic polycystic thyroid

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2016-0443 ◽

2017 ◽

Vol 30 (7) ◽

Author(s):

Janeil M. Belle ◽

Nektarios Vasilottos ◽

Todd D. Nebesio ◽

Benjamin C. James

Keyword(s):

Thyroid Disease ◽

Pediatric Population ◽

Receptor Gene ◽

Hormone Replacement ◽

Gene Mutations ◽

Rare Condition ◽

Thyroid Stimulating Hormone ◽

Thyroid Peroxidase ◽

Autoimmune Thyroid ◽

History Of

AbstractBackground:Polycystic thyroid disease (PCTD) is a rare condition and has been described in adults in the setting of subclinical and clinical hypothyroidism. We present the first known case of a pediatric patient with diffuse macrocystic degeneration of the thyroid.Clinical presentation:A 6-year-old previously healthy patient was evaluated after presenting with a 16-month history of an enlarging polycystic thyroid and hyperthyroidism. Markers of autoimmune thyroid disease including thyroid stimulating immunoglobulin (TSI), thyroid stimulating hormone (TSH) receptor antibody, thyroid peroxidase antibody and thyroglobulin antibody were negative. No family history of benign or malignant thyroid or cystic disease was present. The patient underwent a total thyroidectomy without perioperative complication. She remains euthyroid with thyroid hormone replacement therapy.Summary:To our knowledge, this is the first report of PCTD in the pediatric population associated with hyperthyroidism without evidence of autoimmune disease. Somatic activating thyrotropin-receptor gene mutations are known to cause non-autoimmune hyperthyroidism in children, however it is unknown if similar mechanisms are responsible for pediatric PCTD.Conclusions:Polycystic thyroid degeneration can occur in children and may result in a hyperthyroid state.

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Hashimoto's thyroiditis in children and adolescents

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0806262m ◽

2008 ◽

Vol 136 (5-6) ◽

pp. 262-266 ◽

Cited By ~ 7

Author(s):

Slavica Markovic ◽

Gordana Kostic ◽

Zoran Igrutinovic ◽

Biljana Vuletic

Keyword(s):

Family History ◽

Children And Adolescents ◽

Thyroid Disease ◽

Hashimoto’S Thyroiditis ◽

Positive Family History ◽

Clinical Manifestations ◽

Hashimoto's Thyroiditis ◽

Long Term Outcome ◽

History Of

INTRODUCTION Hashimoto's thyroiditis (HT) is a common cause of goitre and hypothyroidism in children and adolescents. Spontaneous remission may occur in up to 50% patients, but the development of hypothyroidism is possible. OBJECTIVE We investigated the clinical manifestations, course and long-term outcome of HT. METHOD We reviewed charts of 43 children (36 females) with HT, mean age at presentation 12.3 years, and mean follow-up duration 4.6 years. RESULTS HT is five times more common in females. The common complaints leading to referral were goitre in 19 children (44.3%), diffuse in 17 children (89.5%). As to the prevalence of goitre, it accounted for significantly more referrals in females (14 girls, and 5 boys; 73.7% vs 26.3%, t-test; p<0.005). Goitre was either isolated in 15 (34.4%) or associated with other complaints in 4 children: anemia in 7 (16.2%), fatigue in 5 (11.8%), increased appetite in 4 (9.7%), weight gain in 3 (7.0%), growth retardation in 2 children (4.7%), at irregular menses in 3 pubertal girls. Hypothyroidism was present in 18 patients (41.1%), 7 (38.8%) on initial admission, and 11 (61.8%) had the mean follow-up duration of 4.6 years. There were 25 euthyroid HT patients (59.9%). The family history of the thyroid disease was positive in 16 children (37.1%) and 12 of them (71.4%) had hypothyroidism. There were 6 patients (13.9%) in whom the disease was associated with some other autoimmune disease. CONCLUSION HT is five times more common in females. The usual complaints leading to referral were diffuse goitre, which accounted for significantly more referrals in females. A positive family history of autoimmune thyroid disease is associated with a higher risk of hypothyroidism in children with HT. Hypothyroid patients may appear in higher percentage of children and adolescents than previously reported.

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