Phenotypic Expression of Autoimmunity in Children With Autoimmune Thyroid Disorders

Area of Science:

• Pediatric Endocrinology
• Immunology
• Genetics

Background:

• Autoimmune thyroid diseases (AITDs), including Hashimoto's thyroiditis (HT) and Graves' disease (GD), frequently co-occur with other non-thyroidal autoimmune diseases (NTADs).
• Understanding the patterns and pathophysiology of these co-occurring conditions in children is crucial for effective management.
• Pediatric autoimmune thyroid disease presentation and progression can be influenced by genetic and environmental factors.

Purpose of the Study:

• To review recent insights into the clustering of NTADs in pediatric patients with HT or GD.
• To explore the pathophysiology of AITDs and thyroid autoimmunity in children.
• To identify factors influencing the co-occurrence of autoimmune diseases in pediatric populations.

Main Methods:

• A systematic literature search was conducted for studies published in the last 15 years.
• Databases searched included MEDLINE, PubMed, Embase, CINAHL, and the Cochrane Library.
• Keywords focused on AITDs, NTADs, pediatric populations, specific autoimmune diseases, and genetic syndromes.

Main Results:

• Seventeen eligible manuscripts were identified from 128 initially retrieved.
• Clustering of NTADs in pediatric AITDs is influenced by patient age at presentation and association with Down syndrome (DS).
• Celiac disease and type 1 diabetes were more frequently associated with pediatric AITDs than in adults; sequential HT to GD shifts were more common in children with DS.

Conclusions:

• The co-occurrence of NTADs with pediatric AITDs is influenced by age and genetic factors like DS.
• Complex interactions between genetics, environment, and epigenetics likely drive the pathogenesis of these coexisting autoimmune conditions.
• Further research is needed to elucidate the precise mechanisms underlying autoimmune disease clustering in children.