The natural history of euthyroid Hashimoto's thyroiditis in children

University of Bologna, Bolonia, Emilia-Romagna, Italy
Journal of Pediatrics (Impact Factor: 3.79). 01/2007; 149(6):827-32. DOI: 10.1016/j.jpeds.2006.08.045
Source: PubMed

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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    • "Presence of goiter, thryoglobulin antibody, TSH levels and progressive increase in anti-thyroid peroxidase (TPO) antibodies were predictive of progression to hypothyroidism in the whole group but not in individual patients.[19] In a prospective cohort of 92 Italian children followed for 2 years with other causes of SCH excluded and labeled “idiopathic,” 41.3% normalized their TSH and 12% increased their TSH to >10 mIU/L; however, none of these patients proceeded to overt hypothyroidism.[20] In the large Israeli cohort vide above, progression over 5 years depended on the level of TSH. "
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    ABSTRACT: The prevalence of SH in the pediatric population is < 2%, the caveat being the limited number of studies addressing SCH in the pediatric population. congenital deveolopental anamolies. Mutations in the several proteins are important causes of this condition. Despite the limited data available, SCH in children and adolescents appears to be a benign and remitting disease with a low risk of evolution to OH. It appears that thyroid hormones appear to be functioning well despite elevated TSH. Predictors of progression include, goiter, celiac disease, and positive anti TPO.
    12/2012; 16(Suppl 2):S156-8. DOI:10.4103/2230-8210.104028
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    • "We systematically searched PubMed, Cochrane, and EMBASE (1990 to 2012) and identified 8 articles analyzing the natural history of SH in the pediatric age group (8,9,10,11,12,13,14,15)-6 longitudinal trials (8,9,11,12,13,15) and 2 retrospective ones (10,14). Overall, data from a total of 3872 children were reported, even if most studies included a small number of subjects and only one retrospective study included a larger study population (14). "
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    ABSTRACT: Subclinical hypothyroidism (SH) is a quite common disorder in the pediatric age group. The aim of this paper is to present a review of the studies investigating the natural course of SH and the effects of replacement therapy with levothyroxine in childhood. We systematically searched PubMed, Cochrane, and EMBASE (1990 to 2012) and identified 14 articles suitable to be included. SH is a benign process that does not influence anthropometric parameters or puberty onset, and in most cases, it is a remitting disease, with a low risk of development of overt hypothyroidism, more frequently evolving toward euthyroidism or steadily remaining in a condition of isolated hyperthyrotropinemia. Studies analyzing the effects of replacement therapy in SH have reported an increased growth velocity in children with short stature or chronic diseases, discordant effects on thyroid volume reduction, and no effects on neurocognitive function. SH in children and adolescent is often a self-remitting process and its treatment should be considered only when thyroid stimulating hormone values are higher than 10 mIU/L, when clinical signs or symptoms of impaired thyroid function or goiter are detected, or when SH is associated with other chronic diseases. Conflict of interest:None declared.
    Journal of Clinical Research in Pediatric Endocrinology 11/2012; 4(4). DOI:10.4274/jcrpe.851
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    • "Fig. 2. Symptoms and signs of hypothyroidism based on specific pathophysiology Some patients are initially euthyroid and are at risk of developing hypothyroidism as the disease progresses. The concomitant presence of a goiter along with elevated thyroid antibody levels, at presentation, has been found to increase the risk of hypothyroidism (Radetti et al., 2006). Although, for a long time, it was believed that hypothyroidism secondary to Hashimoto's thyroiditis was irreversible, some recent studies have proved otherwise. "
    A New Look at Hypothyroidism, 02/2012; , ISBN: 978-953-51-0020-1
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