The natural history of euthyroid Hashimoto's thyroiditis in children
ABSTRACT To study the natural history of Hashimoto's thyroiditis (HT) in children and identify factors predictive of thyroid dysfunction.
We evaluated 160 children (43 males and 117 females, mean age 9.10 +/- 3.6 years, with HT and normal (group 0; 105 patients) or slightly elevated (group 1; 55 patients) serum thyroid-stimulating hormone (TSH) concentrations. The patients were assessed at presentation and then followed for at least 5 years if they remained euthyroid or if their TSH did not rise twofold over the upper normal limit.
At baseline, age, sex, thyroid volume, free thyroxine, free triiodothyronine, thyroid peroxidase antibody (TPOab), and thyroglobulin antibody (TGab) serum concentrations were similar in the 2 groups. During follow-up, 68 patients of group 0 remained euthyroid, and 10 patients moved from group 0 to group 1. In 27 patients, TSH rose twofold above the upper normal limit (group 2), and 9 of these patients developed overt hypothyroidism. Sixteen patients of group 1 ended up in group 0, 16 remained in group 1, and 23 moved to group 2. A comparison of the data of the patients who maintained or improved their thyroid status with those of the patients whose thyroid function deteriorated revealed significantly increased TGab levels and thyroid volume at presentation in the latter group. However, none of these parameters alone or in combination were of any help in predicting the course of the disease in a single patient.
The presence of goiter and elevated TGab at presentation, together with progressive increase in both TPOab and TSH, may be predictive factors for the future development of hypothyroidism. At 5 years of follow-up, more than 50% of the patients remained or became euthyroid.
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Chapter: Hashimoto�s ThyroiditisA New Look at Hypothyroidism, 02/2012; , ISBN: 978-953-51-0020-1
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ABSTRACT: Malnutrition during lactation is associated with hypoprolactinemia and failure in milk production. Adult rats whose mothers were malnourished presented higher body weight and serum tri-iodothyronine (T(3)). Maternal hypoprolactinemia at the end of lactation caused higher body weight in adult life, suggesting an association between maternal prolactin (PRL) level and programming of the offspring's adult body weight. Here, we studied the consequences of the maternal PRL inhibition at the end of lactation by bromocriptine (BRO) injection, a dopaminergic agonist, upon serum TSH and thyroid hormones, thyroid iodide uptake, liver mitochondrial alpha-glycerophosphate dehydrogenase (mGPD), liver and pituitary de-iodinase activities (D1 and/or D2), and in vitro post-TRH TSH release in the adult offspring. Wistar lactating rats were divided into BRO - injected with 1 mg/twice a day, daily for the last 3 days of lactation, and C - control, saline-injected with the same frequency. At 180 days of age, the offspring were injected with (125)I i.p. and after 2 h, they were killed. Adult animals whose mothers were treated with BRO at the end of lactation presented lower serum TSH (-51%), T(3) (-23%), and thyroxine (-21%), lower thyroid (125)I uptake (-41%), liver mGPD (-55%), and pituitary D2 (-51%) activities, without changes in the in vitro post-TRH TSH release. We show that maternal PRL suppression at the end of lactation programs a hypometabolic state in adulthood, in part due to a thyroid hypofunction, caused by a central hypothyroidism, probably due to decreased TRH secretion. We suggest that PRL during lactation can regulate the hypothalamus-pituitary-thyroid axis and programs its function.Journal of Endocrinology 06/2008; 198(2):331-7. DOI:10.1677/JOE-07-0505 · 3.59 Impact Factor
Article: 3 Hashimoto's Thyroiditis