Long-Term Follow-Up and Outcomes of Autoimmune Thyroiditis in Childhood

Abstract

Background: Autoimmune thyroiditis (AIT) is the most common cause of acquired hypothyroidism in children. The natural outcome of AIT in childhood has been reported previously however follow-up duration is generally short and results variable.Objectives: To characterize clinical and biochemical findings at presentation of AIT, evaluate long-term outcomes and assess which factors at presentation predict evolution over time.Study cohort: 201 children under 18 years of age at presentation (82% female) were enrolled. Subjects were divided into five subgroups according to thyroid stimulating hormone (TSH) level at referral.Results: Mean follow-up was 8.1 years (range 0-29 years). At presentation, 34% of patients had overt hypothyroidism, 32% subclinical hypothyroidism (SCH), 16% compensated hypothyroidism, 14% were euthyroid, and 3.7% had Hashitoxicosis. Children with overt hypothyroidism were younger (10.6 vs. 13.2 years) and had higher thyroid peroxidase antibody titers. At the time of the study, levothyroxine (LT 4 ) therapy was required in 26% of children who were euthyroid at presentation, 56% of SCH patients, 83-84% of those with TSH above 10 mIU/L, and 57% of those with Hashitoxicosis. Over the years, 16% of children presenting with overt hypothyroidism stopped therapy. Free T 4 at presentation was the only predictor of outcome over time.Conclusions: Our findings suggest that only 26% children who were euthyroid at presentation developed hypothyroidism, whereas over 50% of those with SCH went on to require treatment. Of those presenting with overt hypothyroidism, 16% recovered with time. The only predictive parameter for LT 4 therapy at the end of the study was free T 4 levels at presentation. Long-term follow-up is required to determine ongoing therapy needs and screen for additional autoimmune diseases.

Clinical Characteristics and Follow-Up of 19 Children With Hashimoto’s Thyroiditis Aged Below 3 Years: A Single-Center Retrospective Analysis

“…Further analysis of the data revealed that the male proportion was dominant in patients under 2 years old. The female-to-male ratio in 2-3-year-old patients was 5.5:1, which is similar to the previously published results (5,6,25). In-line with our findings, Foley et al (9) reported four patients with HT aged between 9 months and 2 years, of which three were boys and only one was a girl.…”

“…In a study of children and adolescents with HT, females were shown to have an increased incidence of HT with a female-tomale ratio of 4~5:1 (5,6,25). However, in this study, the female-to-male ratio was only 1.7:1, which was significantly lower than what has been previously reported (5,6,25).…”

“…The main reason for patients with HT to see a doctor is goiter (i.e., abnormal enlargement of the thyroid) (6). However, the clinical manifestations are very heterogenous, and abnormal thyroid function or elevated thyroid autoantibody levels are often recognized when addressing other clinical symptoms (6).…”

“…The main reason for patients with HT to see a doctor is goiter (i.e., abnormal enlargement of the thyroid) (6). However, the clinical manifestations are very heterogenous, and abnormal thyroid function or elevated thyroid autoantibody levels are often recognized when addressing other clinical symptoms (6). At the time of diagnosis, the patient's thyroid function may vary, mainly in cases of euthyroidism, hypothyroidism, and subclinical hypothyroidism (7), and occasionally in cases of subclinical hyperthyroidism (6,8).…”

Painful Hashimoto Thyroiditis in a 7-Year-Old Girl: Differential Diagnosis and Medical Treatment

“…In the case of hypothyroidism, levothyroxine can be effective for goiter shrinkage as well as for maintaining the euthyroid state. 11) The normalization of thyroid function has been found to occur in 16-50% of children with hypothyroidism resulting from HT. To treat the pain associated with HT in adults, oral prednisolone and NSAIDs, as well as levothyroxine, are recommended.…”