Outcomes of Children with Hashitoxicosis

Abstract

Aim: To investigate hashitoxicosis outcome in 14 children with persistent absence of thyrotropin receptor autoantibodies who were followed for 1.3-8.8 years (mean 3.5 ± 2.5). Due to a more severe presentation, 4 patients required methimazole (subgroup A1), whilst in the remaining 10 cas es (subgroup A2) no treatment was given. Results: A definitive resolution of hyperthyroidism was recorded 8.3 ± 6.3 months after diagnosis, even though there was a wide variability between subjects (3-23 months). In subgroup A2, hyperthyroidism resolution occurred spontaneously and earlier with respect to subgroup A1 (4.8 ± 2.0 months after diagnosis vs. 17.0 ± 4.5, p = 0.00001). After hyperthyroidism resolution, no relapses were recorded in any patients. Hyperthyroidism duration positively correlated with thyroid peroxidase autoantibody (TPOAb) levels at presentation (r = 0.729, p = 0.002). Conclusions: In all the 14 hashitoxicosis children with persistently absent thyrotropin receptor autoantibodies, the hyperthyroid phase was widely variable and always followed by definitive resolution with no relapses and persistent euthyroidism or hypothyroidism. In the few patients with a more severe presentation, methimazole treatment was required, and definitive hyperthyroidism resolution was delayed. In this subgroup, TPOAb levels at diagnosis were higher than in the subgroup with less severe presentation and earlier hyperthyroidism resolution, suggesting a relationship between TPOAb levels and severity of the disease.

Management of hyperthyroidism in children

“…Clinical presentation of Hashitoxicosis may be similar to that generally observed in GD [67,68] and the only difference between these two conditions may be represented by the absence of TRABs in Hashitoxicosis.…”

“…This condition is believed to result from unregulated release of TH during inflammatory-mediated destruction of thyroid gland [67,68]. Hashitoxicosis is known to be the second commonest cause of hyperthyroidism in childhood, after GD [5].…”

“…In the children with Hashitoxicosis, in fact, the hyperthyroid phase usually lasts only few months and a spontaneous remission of clinical and biochemical manifestations is frequently observed [67,68], as against as in the children with GD. In a minority of cases, nevertheless, the evolution over time of hyperthyroid phase may be more prolonged and the normalization of biochemical picture may occur even after several months [68]. In these cases, therefore, a pharmacological treatment with MMI may be needed, at least for some months, whereas radical therapies are never necessary [68].…”

“…In a minority of cases, nevertheless, the evolution over time of hyperthyroid phase may be more prolonged and the normalization of biochemical picture may occur even after several months [68]. In these cases, therefore, a pharmacological treatment with MMI may be needed, at least for some months, whereas radical therapies are never necessary [68].…”

The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden

“…Graves disease was defined as CT with elevated TRAb levels or CT with a relapse during the 3-year follow-up period [3], since CT due to Hashimoto thyroiditis do not relapse [21]. …”