Incidence and Dynamics of Thyroid Dysfunction and Thyroid Autoimmunity in Girls with Turner’s Syndrome: A Long-Term Follow-Up Study

Abstract

Objective: Clinical studies suggest that the thyroid autoantibodies and/or hypothyroidism are not present in Turner’s syndrome (TS) patients before the age of 8 years and are more frequent in patients with the X isochromosome. The aim of the study was to analyze the dynamics of thyroid dysfunction in girls with TS. Design: 86 TS patients with a median age of 10.6 years were followed for 4.6 ± 3.0 years. Outcomes: The prevalence of thyroid abnormalities increased from 25.5 to 50% during the follow-up. Finally, 31 (36%) patients had positive thyroid autoantibodies and 27 (31.4%) had subclinical hypothyroidism. Hashimoto’s thyroiditis was diagnosed in 15 patients. Median age of developing thyroid antibodies and subclinical hypothyroidism was 14.1 and 14.8 years, respectively. The youngest hypothyroid patient was 1.8 years old and the youngest girl with positive anti-thyroid antibodies was 5.5 years old. Autoantibodies appeared mainly after the age of 13. The risk of developing subclinical hypothyroidism was greatest between 12 and 14 years of age. The prevalence of thyroid abnormalities was not related to the karyotype. Conclusions: Thyroid autoimmunity and dysfunctions in TS may start early, their prevalence increases with age, independently of karyotype and without any clinical symptoms and signs.

Five-year prospective evaluation of thyroid function in girls with subclinical mild hypothyroidism of different etiology

“…This is not surprising considering that such a conversion is known to be detectable in the natural history of patients with HT (42,43,44,45,46) and has also been specifically described in children with either TS (29,30,31) or DS (38,47). Moreover, the shifting HT/GD has been, just recently, found to be more common in GD children with these chromosomal aberrations than in those without them (48).…”

“…In a limited number of cases, HT was associated with either Turner syndrome (TS) or Down syndrome (DS), i.e., two chromosomopathies that are known to be linked with an increased risk of autoimmune diseases (17,18,19,20,21,22,23,24,25) and especially thyroid diseases (26,27,28,29,30,31).…”

TRANSITION IN ENDOCRINOLOGY: Treatment of Turner's syndrome during transition

“…In the analysed studies, TS patients in transition time had a higher prevalence of autoimmune thyroid disorders (35,89,90). The health care for TS adolescents includes a yearly TSH; in patients with subclinical hypothyroidism, autoantibody assessment or ultrasound should be considered (89). Impaired glucose tolerance and diabetes are also more frequent in TS.…”

“…According to a Danish study, autoantibodies were present in 58% of all patients (range: 6-60 years), whereof 18% had autoantibodies targeting more than one organ (130). In the analysed studies, TS patients in transition time had a higher prevalence of autoimmune thyroid disorders (35,89,90). The health care for TS adolescents includes a yearly TSH; in patients with subclinical hypothyroidism, autoantibody assessment or ultrasound should be considered (89).…”

“…Review A Gawlik and E Malecka-Tendera autoantibodies was 14.1 years and they appeared mainly after the age of 13 (89). The incidence of positive autoantibodies grew with age.…”