Hashitoxicosis in children: clinical features and natural history
Zeina M Nabhan1, Nerissa C Kreher, Erica A Eugster
1Department of Pediatric Endocrinology, James Whitcomb Riley Hospital for Children, Indiana University School Of Medicine, 702 Barnhill Drive, Indianapolis, IN 46202, USA.
Insights
Hashitoxicosis (Htx) is an uncommon cause of pediatric hyperthyroidism in autoimmune thyroiditis patients. Its clinical course varies, and diagnosis can be challenging due to overlap with Graves' disease.
Area of Science:
- Pediatric Endocrinology
- Autoimmune Diseases
- Thyroid Disorders
Background:
- Autoimmune thyroiditis is common in children.
- Hashitoxicosis (Htx), a form of hyperthyroidism, can occur in these patients.
- Understanding Htx in pediatric populations is crucial for accurate diagnosis and management.
Purpose of the Study:
- To determine the incidence and clinical characteristics of Hashitoxicosis (Htx) in pediatric patients with autoimmune thyroiditis.
- To investigate the natural history and potential predisposing factors for Htx development.
- To differentiate Htx from other causes of pediatric hyperthyroidism.
Main Methods:
- Retrospective review of medical records of children diagnosed with Hashimoto thyroiditis (1993-2002).
- Analysis of clinical course, thyroid hormone levels, antibody titers, and imaging for patients presenting with hyperthyroidism.
- Investigation of potential predisposing factors including sex, age, family history, and specific lab results.
Main Results:
- Eight out of 69 pediatric autoimmune thyroiditis patients were diagnosed with Htx.
- Hyperthyroidism duration ranged from 31 to 168 days.
- Three patients developed hypothyroidism, and five became euthyroid; elevated TSI and 123I uptake were noted in some cases.
Conclusions:
- Hashitoxicosis is an infrequent but significant cause of hyperthyroidism in children.
- The clinical presentation of Htx can mimic Graves' disease, complicating diagnosis.
- No specific predisposing factors for Htx development were identified in this pediatric cohort.
Objective:
To determine the incidence, natural history, and clinical characteristics of Hashitoxicosis (Htx) in pediatric patients with autoimmune thyroiditis.
Study Design:
Medical records of children diagnosed with Hashimoto thyroiditis between 1993 and 2002 were reviewed. The clinical course of patients presenting with hyperthyroidism was determined. Variables including sex, age, family history, thyroid hormone levels, anti-thyroid antibody titers, 123 I thyroid scan results, and presenting features were investigated as possible predisposing factors for the development of Htx.
Results:
Out of 69 patients with autoimmune thyroiditis, 8 were diagnosed with Htx. The duration of hyperthyroidism ranged from 31 to 168 days. Three patients became hypothyroid after an average of 46.3 +/- 13.2 days, and 5 patients became euthyroid after an average of 112.8 +/- 59.8 days. Additional findings included an elevated thyroid stimulating immunoglobulin (TSI) titer in 3 of the 8 patients with Htx, and increased uptake on 123 I scan in 2 patients.
Conclusion:
Htx is an uncommon yet important cause of hyperthyroidism in children that has a variable clinical course. The diagnosis may be complicated, as presenting features sometimes exhibit significant overlap with Graves' disease. No factors predisposing to the development of Htx were identified.
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