The Clinical Course of Hashimoto's Thyroiditis in Children and Adolescents: 6 Years Longitudinal Follow-up

Author(s):  
S. Jaruratanasirikul ◽  
K. Leethanaporn ◽  
P. Khuntigij ◽  
H. Sriplung
2008 ◽  
Vol 136 (5-6) ◽  
pp. 262-266 ◽  
Author(s):  
Slavica Markovic ◽  
Gordana Kostic ◽  
Zoran Igrutinovic ◽  
Biljana Vuletic

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.


Author(s):  
Selma Tunç ◽  
Behzat Özkan

Objective: Hashimoto’s thyroiditis is an organ-specific autoimmune disease and the most common cause of goiter and acquired hypothyroidism in children and adolescents in regions devoid of endemic iodine deficiency. In this study, it was aimed to examine the epidemiological, clinical and laboratory features of Hashimoto’s thyroiditis and autoimmune diseases accompanying Hashimoto’s thyroiditis in children and adolescents. Methods: We retrospectively examined thyrotropin, free thyroxin, thyroid autoantibodies (thyroid peroxidase and thyroglobulin antibodies), immunoglobulin A (IgA), anti-tissue transglutaminase antibodies (IgA-tTG), and thyroid ultrasonography findings of 108 cases aged 5-18 years with positive anti-thyroid antibodies. Results: The female/male ratio was 80/28 and 68% of the patients were adolescents. The most common admission complaint was goiter. At the time of diagnosis, the cases had euthyroidism (44.4%), subclinical hypothyroidism (35%), overt hypothyroidism (16.6%), and hyperthyroidism (3.7%). Goiter was detected in 58 (53.7%) cases by thyroid ultrasonography. During the follow-up, overt hypothyroidism developed in 6 patients who had subclinical hypothyroidism and subclinical hypothyroidism developed in 8 patients who had euthyroidism. All patients with hyperthyroidism became euthyroid. Levothyroxine treatment was administered to 47 (43.5%) patients. Celiac disease was detected in 2 and type 1 diabetes mellitus in 1 patient. Conclusions: The prevalence of Hashimoto’s thyroiditis increases with age both in childhood and adolescence, and thyroid functions tend to deteriorate over time. Therefore, close follow-up and appropriate treatment are important. Although the prevalence of celiac disease is higher in children and adolescents with Hashimoto’s thyroiditis compared to healthy children, the true prevalence of autoimmune diseases accompanying Hashimoto’s thyroiditis will be revealed in studies to be conducted in larger patient populations.


Author(s):  
İrem Ceren Erbaş ◽  
İbrahim Mert Erbaş ◽  
Olcay Evliyaoğlu

Abstract Objectives Hashimoto’s thyroiditis (HT) is the most common cause of goiter and acquired hypothyroidism in children and adolescents, especially in areas without endemic iodine deficiency. We aimed to evaluate the follow-up results of children and adolescents diagnosed with HT, including clinical, biochemical, and radiological findings and treatment approaches. Methods HT patients, who were diagnosed between 2012 and 2018 years in a single-center, were assessed retrospectively. Results Two hundred and twenty-four cases were included in the study, 75.9% of whom were girls (female/male ratio: 3.1) and 66.5% were pubertal. The median age of the cases at first admission was 12.5 (9.2–15) years. The median follow-up period of 196 patients, who continued their follow-up regularly, was 2.1 (0.7–4.8) years. When autoantibody levels were analyzed according to gender, mean anti-Tg levels were higher in girls (p=0.028), whereas anti-TPO levels were similar (p=0.372). A nodule was detected in the ultrasonographic follow-up of 29 (13%) patients. Papillary thyroid carcinoma was observed in 10.3% (n=3) of those with nodules. When the last ultrasonography findings of 188 patients with available radiological follow-up data were compared with their initial evaluation, the rate of heterogeneous parenchymal echogenicity increased significantly (p=0.008). The need for l-thyroxine dosage augmented over time. Conclusions Although HT is more common in adolescent girls, it can be encountered in both genders and at all ages in childhood. The incidence of malignancy was not higher in patients with nodules associated with HT than the reported incidences of malignancy in nodules not associated with HT.


Author(s):  
Jana-K. Dieks ◽  
David Backhoff ◽  
Heike E. Schneider ◽  
Matthias J. Müller ◽  
Ulrich Krause ◽  
...  

Abstract Atrial flutter (AFL) in children and adolescents beyond the neonatal period in the absence of any underlying myocardial disease (“lone AFL”) is rare and data is limited. Our study aims to present clinical and electrophysiological data of presumed “lone AFL” in pediatric patients and discuss the role of endomyocardial biopsy (EMB) and further follow-up. Since July 2005, eight consecutive patients at a median age of 12.7 (range 10.4–16.7) years presenting with presumed “lone AFL” after negative non-invasive diagnostic work-up had electrophysiological study (EPS) and induction of cavotricuspid isthmus (CTI) conduction block by radiofrequency (RF) current application. In 6/8 patients EMB could be taken. Induction of CTI conduction block was achieved in all patients. Histopathological examination of EMB from the right ventricular septum exhibited myocarditis or cardiomyopathy in 4/6 patients, respectively. During follow-up, 4/8 patients had recurrent arrhythmia (AFL n = 2, wide QRS complex tachycardia n = 1, monomorphic premature ventricular contractions n = 1) after the ablation procedure. 3/4 patients with recurrent arrhythmia had pathological EMB results. The remaining patient with recurrent arrhythmia had a negative EMB but was diagnosed with Brugada syndrome during further follow-up. Taking together results of EMB and further clinical course, only 3/8 patients finally turned out to have true “lone AFL”. Our study demonstrates that true “lone AFL” in children and adolescents is rare. EMB and clinical course revealed an underlying cardiac pathology in the majority of the individuals studied. EMB was very helpful in order to timely establish the diagnosis of myocarditis or cardiomyopathy.


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