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Evolution of sonographic appearance of the thyroid gland in children with Hashimoto's thyroiditis
Elpis Vlachopapadopoulou1, Dimitrios Thomas, Feneli Karachaliou
1Department of Growth and Development, Children's Hospital P. & A. Kyriakou, Athens, Greece. elpis.vl@gmail.com
Insights
In children with Hashimoto
Area of Science:
- Pediatric Endocrinology
- Diagnostic Imaging
- Autoimmune Diseases
Background:
- Thyroid ultrasound is crucial for diagnosing and monitoring Hashimoto's thyroiditis (HT).
- Classical sonographic findings are not consistently present at diagnosis in pediatric HT cases.
Purpose of the Study:
- To determine the timeline for developing characteristic ultrasound findings in children with HT and normal initial sonograms.
- To identify factors influencing the progression of sonographic abnormalities in pediatric HT.
Main Methods:
- 105 children diagnosed with HT underwent regular physical examinations and thyroid function tests (TSH, fT4).
- Thyroid ultrasound was performed at diagnosis and biannually.
- Follow-up duration averaged 18 months, with some patients monitored for up to 61 months.
Main Results:
- 37% of children exhibited abnormal ultrasound findings at HT diagnosis.
- Within 7 months, 50% of children with initially normal ultrasounds developed abnormal patterns.
- Goiter, hypothyroidism, and dual positivity for anti-TPO and anti-Tg antibodies accelerated sonographic changes.
Conclusions:
- Characteristic ultrasound findings in pediatric Hashimoto's thyroiditis can take over 4 years to manifest.
- Early identification of risk factors like goiter and hypothyroidism aids in predicting sonographic progression.
- Regular ultrasound monitoring is essential for comprehensive HT management in children.
Background:
Although thyroid ultrasound is a valuable tool for the diagnosis and follow-up of patients with Hashimoto's thyroiditis (HT), classical sonographic findings are not always present.
Aim:
To calculate the time needed for children with HT and normal ultrasound at diagnosis to develop characteristic sonographic findings.
Patients And Methods:
105 children (23 male and 82 female) with HT (mean age 9.4 +/- 2.9 years) were studied. Physical examination and measurements of TSH and fT4 levels were performed at diagnosis, at 3-month intervals for the first year, and twice yearly thereafter. Thyroid ultrasound was performed at diagnosis and twice yearly thereafter. The median follow-up duration was 18 months (range: 6-61 months).
Results:
The time needed for 30%, 50%, and 70% of children to demonstrate an abnormal thyroid sonographic pattern was 4, 7, and 14 months, respectively. Important factors accelerating sonographic changes were goiter (p = 0.023), hypothyroidism (p = 0.0255), and seropositivity for both thyroid peroxidase (anti-TPO) and thyroglobulin (anti-Tg) autoantibodies (p = 0.0005).
Conclusion:
Sonographic findings of HT are present in 37% of children at diagnosis. Fifty percent of children with normal initial thyroid US will develop changes within 7 months; however, characteristic findings may not develop for over 4 years.
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