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[Chronic autoimmune thyroiditis in the child]
D Marinovic1, J Léger, C Garel
1Service d'endocrinologie et diabétologie pédiatriques, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
Insights
Chronic autoimmune thyroiditis in children is unpredictable, with some recovering thyroid function. Lifelong monitoring is essential, particularly during pregnancy, to ensure optimal health outcomes.
Area of Science:
- Pediatric Endocrinology
- Autoimmune Diseases
- Thyroid Function
Context:
- Chronic autoimmune thyroiditis (also known as chronic lymphocytic thyroiditis) is a common endocrine disorder in children.
- Understanding its clinical course and long-term outcomes is crucial for effective management.
Purpose:
- To describe the clinical characteristics and long-term follow-up of pediatric patients diagnosed with chronic autoimmune thyroiditis.
- To investigate the variability in thyroid function over time and identify potential predictive factors.
Summary:
- A retrospective analysis of 60 children with chronic autoimmune thyroiditis revealed diverse presentations at diagnosis, with many exhibiting hypothyroidism.
- Thyroid ultrasonography showed characteristic abnormalities in all patients.
- During a mean follow-up of 4.4 years, 20% of cases showed altered thyroid function, including recovery in some initially hypothyroid patients.
- No predictive factors for disease course were identified.
- All treated children achieved normal final height.
Impact:
- The study highlights the variable and unpredictable natural course of chronic autoimmune thyroiditis in children.
- Recovery from hypothyroidism is possible, and the L-thyroxine withdrawal test may aid in its assessment.
- Lifelong thyroid surveillance is recommended, with particular attention to pregnant women to prevent adverse effects on the child.
Objective:
The aim of the study was to describe the clinical characteristics and long-term follow-up of a group of children with chronic autoimmune thyroiditis.
Patients And Methods:
Sixty children (age: 11.9 +/- 2.7 years) were studied in a retrospective analysis.
Results:
At diagnosis, 34 of the children were hypothyroid (compensated hypothyroidism, n = 15; true hypothyroidism, n = 19) and 26 euthyroid. Thyroid ultrasonography showed characteristic features of heterogenicity and/or hypoechogenicity in all patients. Other autoimmune diseases were found in ten subjects (17%) and 23% had a family history of thyroid disease. At the end of the follow-up, nine of 45 children (20% of the cases) followed up for at least one year (mean follow-up 4.4 +/- 3.7 years), demonstrated a change in thyroid function. Hypothyroidism was detected in two initially euthyroid patients. Among initially hypothyroid patients, seven (28%) recovered normal thyroid function, allowing L-thyroxine withdrawal for four weeks, after 1.5 to 8.4 years. No factor was found to be predictive of the course of the disease. All subjects treated with L-thyroxine for hypothyroidism reached normal final height.
Conclusion:
The natural course of chronic lymphocytic thyroiditis is variable and unpredictable. Recovery from hypothyroidism does occur and can be aided by the L-thyroxine withdrawal test. The disease requires lifelong thyroid surveillance, especially in women during pregnancy, in order to avoid a potential adverse effect on the future child.