Unfavorable Course of Subclinical Hypothyroidism in Children with Hashimoto’s Thyroiditis Compared to Those with Isolated Non-Autoimmune Hyperthyrotropinemia

Abstract

Subclinical hypothyroidism (SCH) is a common problem in pediatric population, and the natural history of SCH varies depending on its etiology. Whether Hashimoto’s thyroiditis (HT) negatively affects the natural course of SCH was investigated in pediatric patients without concomitant diseases. Predictors for levothyroxine medication were also evaluated. Medical records of 109 children with SCH (91 girls, 5−18 years) diagnosed between 2005 and 2014 were retrospectively reviewed. Patients were classified into HT (n = 37) and isolated non-autoimmune hyperthyrotropinemia (iso-NAHT, n = 72). During median 2 years of follow-up, only 10.1% of SCH patients eventually initiated levothyroxine, and HT patients showed a higher probability of requiring levothyroxine medication than iso-NAHT patients (21.6% vs. 4.2%). Underlying HT independently predicted deterioration of thyroid function, leading to levothyroxine medication (hazard ratios [HRs], 4.6 vs. iso-NAHT, P = 0.025). High titers of anti-thyroglobulin antibodies (TGAbs) predicted later medication in the HT group (HRs, 28.2 vs. normal TGAbs, P = 0.013). Most pediatric SCH showed benign and self-remitting courses. Underlying HT significantly increases the risk for levothyroxine medication, especially with high titers of TGAbs.

Diabetes duration and thyroid stimulating hormone levels in children with type 1 diabetes mellitus

“…20,21 Subclinical hypothyroidism is frequently observed in T1DM. 13,[21][22][23][24][25][26][27] We found no significant association between duration of diabetes and TSH levels in children with T1DM. Past studies have shown that the longer the duration of diabetes, the higher the prevalence of autoimmune thyroiditis.…”

Inflammation-Related Markers and Thyroid Function Measures in Pediatric Patients: Is the Grade of Obesity Relevant?

“…Subclinical hypothyroidism (SHT) (or isolated hyper-thyrotropinemia)—defined as a mild elevation of serum TSH concentration and a normal peripheral thyroid hormones concentration—has a prevalence of 1.7% in the pediatric population [ 43 ] and is more common in obese pediatric patients than in normal-weight patients (24.3% vs. 12.8%, p = 0.002) [ 44 ]. Thyroidal and non-thyroidal diseases may induce SHT, among which the most common are Hashimoto’s disease and isolated non-autoimmune hyper-thyrotropinemia, the latter being more prevalent in obese children [ 45 , 46 ]. In adults, NLR is more increased in patients with malignancy than in patients with benign thyroid nodules and is associated with a higher degree of thyroid function loss [ 47 , 48 ].…”

Subclinical hypothyroidism in children: updates for pediatricians

“…6) HT is characterized by the existence of thyroid autoantibodies (antithyroid peroxidase [TPO Ab] and antithyroglobulin [TG Ab]) with or without goiter. 7) Patients with HT may develop subclinical or overt hypothyroidism depending on the intensity of the immunological injury. 8) 2.…”