Juvenile Autoimmune Thyroiditis

Abstract

Autoimmune thyroiditis is a frequent cause of goiter in children and studies point to the increasing prevalence of juvenile autoimmune thyroiditis (JAT) in children and adolescents. Clinically, JAT can manifest, depending on the presence or absence of goiter, as either a goitrous form or atrophic form. Both are characterized by the presence of thyroid antibodies in serum, with the goitrous form being more common in children. Recent evidence suggests that thyroid autoimmunity originates from an interaction of genetic, endogenous and environmental factors which end up activating thyroid-specific autoreactive T-cells in susceptible children. In addition to underlying genetic/HLA predisposition, factors including sex hormones, glucocorticoids, low birth weight, radiation and drugs may play a role in thyroid autoimmunity. Patients with JAT can present due to thyroid enlargement or symptoms arising due to hypothyroidism. Asymptomatic enlargement of the thyroid gland is a common presenting complaint, especially in older children and adolescents. Thyroid function can vary from euthyroidism to subclinical or overt forms of hypothyroidism and less commonly hyperthyroidism. Accordingly, patients can be symptomatic. There is considerable debate regarding the management of patients with euthyroidism or subclinical hypothyroidism. Available evidence indicates the presence of residual goiter in endemic form and a high prevalence of JAT in children. It is suggested that children should be screened for goiter as part of school health examinations, and goitrous children should be monitored for thyroid function.

Study of Antithyroid Peroxidase Antibodies in People with Normal Range Thyroid Stimulating Hormone

“…19,20 The pathogenesis of thyroid autoimmunity is believed to be multifactorial, with contributions from both humoral as well as cell-mediated immune systems. 4 Thyroid autoimmunity is being increasingly identified as the underlying cause of goitre in India, following the implementation of the salt iodization program in our country. 2 But, there is a paucity of literature on the pathogenesis of AITD among the Indian population.…”

“…3 The pathogenesis of thyroid autoimmunity is believed to be multifact-orial, with contributions from both humoral as well as cellmediated immune systems. 4 The role of iodine in triggering autoimmune thyroiditis has long been debated. Iodine supplementation in iodinedeficient areas increases the prevalence of lymphocytic infiltration of the thyroid 3-fold.…”

Hipotiroidismo primario por tiroiditis crónica autoinmune en una niña de dos años

“…La evolución es muy variable: los hipotiroideos suelen persistir en esa situación clínica, aunque algunos normalizan la función tiroidea sin tratamiento. Algunos eutiroideos pueden evolucionar hacia hipotiroidismo 3 .…”

“…La tiroiditis autoinmune (TA) es la causa más frecuente de hipotiroidismo y de enfermedad tiroidea en niños y adolescentes en un área con buen aporte de yodo [1][2][3] . En la edad pediátrica, ocurre sobre todo en la adolescencia y es rara en menores de tres años 2,[4][5][6][7] , en los que la principal etiología es la alteración congénita, definida por malformación tiroidea y dishormonogénesis 4 .…”

Hashimoto's Thyroiditis in Children and Adolescents

“…In a multicentre study Radetti et al investigated the outcome of euthyroid children with HT and showed that 64.8% of them remained euthyroid, 9.5% progressed to subclinical hypothyroidism and 25.7% to overt hypothyroidism after 5 years (78). Few studies have examined the spontaneous evolution of the disease (80,81). A recent Italian retrospective study described the outcome of 160 children affected with HT followed for up to 32.6 years in 20 pediatric endocrine clinics (78).…”