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The natural history of euthyroid Hashimoto's thyroiditis in children
Giorgio Radetti1, Elena Gottardi, Gianni Bona
1Department of Pediatrics, Regional Hospital, Bolzano, Italy. giorgio.radetti@asbz.it
Insights
Hashimoto's thyroiditis in children often resolves or stabilizes, with over 50% remaining euthyroid after 5 years. However, goiter and elevated antibodies at diagnosis may predict future hypothyroidism development.
Area of Science:
- Pediatric Endocrinology
- Autoimmune Diseases
- Thyroid Disorders
Background:
- Hashimoto's thyroiditis (HT) is an autoimmune condition affecting the thyroid gland.
- Understanding the natural history and predictive factors of HT in children is crucial for management.
Purpose of the Study:
- To investigate the long-term course of Hashimoto's thyroiditis in pediatric patients.
- To identify clinical and laboratory markers that predict thyroid dysfunction progression.
Main Methods:
- A cohort of 160 children with HT and varying thyroid-stimulating hormone (TSH) levels were followed for at least 5 years.
- Patients were monitored for changes in thyroid function, antibody levels, and goiter presence.
Main Results:
- Over 50% of patients remained euthyroid or improved during the 5-year follow-up.
- Elevated thyroglobulin antibody (TGab) levels and increased thyroid volume at presentation were associated with disease progression.
- No single factor reliably predicted individual patient outcomes.
Conclusions:
- Goiter and elevated TGab at diagnosis, along with rising TPOab and TSH, may indicate future hypothyroidism risk.
- A significant proportion of children with HT maintain or achieve euthyroid status over time.
Objective:
To study the natural history of Hashimoto's thyroiditis (HT) in children and identify factors predictive of thyroid dysfunction.
Study Design:
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.
Results:
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.
Conclusions:
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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