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Epidemiological and clinical aspects of autoimmune thyroid diseases in children with Down's syndrome
Tommaso Aversa1, Giuseppe Crisafulli1, Giuseppina Zirilli1
1Department of Human Pathology in Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy.
Insights
Children with Down syndrome (DS) have a higher risk of autoimmune thyroid diseases (AITDs), including Hashimoto
Area of Science:
- Endocrinology and Immunology
- Pediatric Autoimmunity
Background:
- Children with Down syndrome (DS) exhibit an increased predisposition to autoimmune thyroid diseases (AITDs), specifically Hashimoto's thyroiditis (HT) and Graves' disease (GD).
- This heightened susceptibility exists independently of other known risk factors like female gender or family history of AITDs.
Discussion:
- In DS children, Hashimoto's thyroiditis often presents with a more severe biochemical profile that worsens over time.
- Conversely, Graves' disease in DS children does not typically show a more severe clinical or biochemical presentation compared to non-DS individuals.
- Alopecia areata and vitiligo are the extra-thyroidal autoimmune disorders that most frequently co-occur with AITDs in children with DS.
Key Insights:
- Down syndrome children with Hashimoto's thyroiditis may face a greater risk of progression to Graves' disease over time.
- The phenotypic expression of AITDs in DS children presents unique characteristics compared to the general pediatric population.
Outlook:
- Further research is needed to elucidate the specific mechanisms underlying AITD pathogenesis in Down syndrome.
- Understanding these peculiarities can inform tailored monitoring and management strategies for pediatric autoimmune thyroid conditions in DS.
Abstract:
Aim of this commentary is to report the main peculiarities that have been found to characterize the phenotypic expression of autoimmune thyroid diseases (AITDs) in children with Down's syndrome (DS). According to recent reports, DS children are, per se, more exposed to the risk of both Hashimoto's thyroiditis (HT) and Graves' disease (GD), irrespective of other concomitant risk factors, such as female gender and family antecedents for AITDs. In the context of extra-thyroidal autoimmune disorders, the ones that preferentially aggregate with AITDs in DS children are alopecia areata and vitiligo. Another peculiar aspect, in DS children, is that HT presents with a more severe biochemical picture, which furtherly deteriorates over time. By contrast, GD does not demonstrate a more severe clinical and biochemical picture with respect to that generally observed in patients without DS. Finally, DS children might be at higher risk of progressing from HT toward GD over time.